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In patients with mild to moderate Parry-Romberg syndrome (PRS), plastic surgeons have mainly focused on the restoration of soft tissue deficiencies. While, bone deficits are easily overlooked. This study developed a new method combines the autologous mandibular outer cortex (MOC) grafting with fat grafting in mild to moderate patients with PRS, and apply computer-assisted techniques to improve the surgical outcomes and accuracy.Seven patients with mild to moderate PRS were prospectively enrolled in the study. Preoperative and 7 days and 6 months postoperative computed tomography (CT) and photographs were performed. Computer-aided design was done based on preoperative CT data. Surgical templates for MOC harvesting and grafting were designed and printed out. The topographic map of fat grafting was generated. The accuracy of MOC bone grafting was evaluated by the MOC thickness relative error, the MOC thickness accuracy at the preop most severe bone atrophy point (preop MSBAP), and the MOC volume accuracy. The percentage volume maintenance of the fat grafting surgery was assessed.All 7 patients had ideal clinical outcomes with significant improvement in facial symmetry and no major complications happened. The average MOC thickness relative error is 2.85 ± 0.50%. The average MOC thickness accuracy at the preop MSBAP is 3.36 ± 1.13%. The average MOC volume accuracy is 3.41 ± 1.37%. The average percentage volume maintenance of fat grafting is 62.79 ± 5.73%.The combination of MOC grafting with fat grafting can be an excellent choice in reconstruction of mild to moderate patients with PRS. Applying computer-assisted techniques offers a reliable and accurate outcome.

PURPOSE Zygomatic osteotomy is a common method of zygomatic hypoplasia correction. Natural coral is considered to be a good bone substitute. Few studies on unilateral zygomatic hypoplasia correction by zygomatic osteotomy with natural coral have been reported. This study was performed to evaluate the clinical morphological results and surgical outcomes of unilateral zygomatic hypoplasia correction by L-shaped zygomatic osteotomy with natural coral. METHODS From 1996 to 2012, a total of 42 patients with hypoplastic zygomas treated by L-shaped zygomatic osteotomy with natural coral were included in this study. Based on facial analysis results and x-ray and CT measurements, the degradation of natural coral, new bone formation, and clinical outcomes were observed and recorded. RESULTS All surgical procedures achieved satisfactory results without complications. During the stabilization period of about 12 to 15 months, all natural coral blocks were completely degraded and replaced by new bone. Good mechanical strength and continuity of the new bone and good zygomatic asymmetry were achieved in each patient. No recurrence was observed during the follow-up period. CONCLUSION L-shaped zygomatic osteotomy with natural coral is an effective method of unilateral zygomatic hypoplasia correction.

UNLABELLED Many plastic surgeons use mandibular osteotomy (reduction gonioplasty) without masseter resection to correct a square face. However, there is not enough long-term observation of the masseter after reduction gonioplasty, although some researches have already confirmed that the volume of masseter muscle does decrease shortly after reduction gonioplasty. METHODS The Plastic Surgery Hospital database was retrospectively reviewed for patients who underwent reduction gonioplasty. Fifty-six patients with both preoperative and 4 years postoperative 3-dimensional computed tomography (3DCT) were included. The changes in the volume and morphology of the masseter muscle after reduction gonioplasty were assessed quantitatively. The 3DCT data were analyzed using Mimics 10.01 software. RESULTS All patients were satisfied with the outcome. No complications happened. There were significant differences between the preoperative and 4 years postoperative volume and morphology. CONCLUSION After reduction gonioplasty, the masseter muscle atrophied (reduced 20.98% ± 8.75%), especially the lower part of the masseter muscle in the long-term follow-up. Most patients with prominent mandibular angles should be treated with reduction gonioplasty without approaching the masseter muscle.

Zygomatic assymetry is common in the population, which often requires surgical correction for aesthetic concerns. Previously, surgeons performed the surgery often based on their personal experience and visual evaluation. The purpose of this study was to apply computer techniques in patients with mild zygomatic asymmetry treated with unilateral reduction malarplasty to improve surgical accuracy and reduce preoperative risks. The authors used computer techniques to plan osteotomies, to produce surgical template, and to evaluate the surgical outcome. Postoperative follow-up demonstrated that zygomatic asymmetry was corrected in all the patients without complications. The proposed methodology was considered to be helpful in improving the surgical accuracy and efficiency for treatment of zygomatic asymmetry, while greatly minimizing operative risk.

The purpose of this research was to simulate mandibular movement calculated from three-dimensional computed tomography (CT) data to determine the linear distractor position to correct mandibular deformities in a series of patients with hemifacial microsomia (HFM). Preoperative CT scans from 6 HFM patients were obtained and imported into a CT-based software program (Mimics) to produce three-dimensional images and data. After measurement of the mandibular deficiency in 3 dimensions (horizontal and vertical), the angle between the distraction device and the ramus was determined by a geometric calculation, and then the surgery was performed on the three-dimensional model constructed using the rapid prototyping technique. This planning method was finally used in the treatment of 6 HFM patients. The HFM was corrected, and a symmetrical facial contour obtained without any complications in these 6 patients. The results matched the expectation before surgery that the distractor elongation would range from 18 to 22 mm. The distraction tracing model fitted the actual postdistraction tracing to within 2 mm. The preoperative design and three-dimensional modeling technique are considered to be helpful in enhancing the predictability and improving the outcome of the treatment of distraction osteogenesis.

We aimed to plan an osteotomy line in orbital craniofacial fibrous dysplasia surgery using digital imaging techniques and to evaluate the treatment result. Five patients with unilateral craniofacial fibrous dysplasia were included in the study. After CT scanning, the skulls were reconstructed in 3 dimensions using analytic software. Surgical procedures were planned to mirror the orbit on the uninvolved side, and results were evaluated by comparison with the uninvolved orbit. There were no serious complications. All patients were satisfied with the results. There was minimal asymmetry between the levels of the repaired and the uninvolved orbital floors. The use of analytic software for surgical planning results in a satisfactory outcome with minimal risk. As this technology gains popularity, it offers the possibility of better results and safer surgery on orbital deformities in craniofacial fibrous dysplasia.

Screw fixation is used for accurate augmentation by porous polyethylene implant in traumatic enophthalmos correction to avoid complications such as migration and protrusion. We report an incident of titanium screw entered into the maxillary sinus during enophthalmos correction with porous polyethylene implant. Such incident could be avoided by standard manipulation. We here present the rare case and offer proposals for the screw fixation of porous polyethylene implant during traumatic enophthalmos correction.

Congenital skull defect is a rare malformation that is usually associated with congenital anomalies of the scalp and comparable lesions in the brain, spinal cord, limbs, and skeletal muscle. Most previously reported cases have described skull defects with aplasia cutis congenita and other congenital abnormalities. Very few patients with skull defects present with an intact scalp or neurofibroma. The authors report an adult patient with a rare congenital skull defect and local neurofibroma.