Search

Background:. Facial proportions and contours influence perceptions of beauty and youthfulness. In particular, the shape and definition of the midface and lower face impact the overall appearance of the face. Methods:. This review provides anatomical evidence to support a holistic approach to facial analysis and rejuvenation that starts with assessment and treatment of the midface and lower face to create an aesthetically desirable facial balance. Results:. The cheek and chin can be considered “anchors” or starting points within full-face treatment because of the noticeable impact of their treatment on the definition and contour of the entire face. Age-related changes in the cheek and chin affect overall facial appearance and can produce unintended facial emotional attributes such as looking tired, angry, or sad. Patients seek facial aesthetic treatment typically for a global improvement such as revitalization or genderization of facial features. Best practices in aesthetics have evolved from treatment of individual areas to a holistic paradigm that uses multimodal therapy to improve overall facial emotional attributes. Hyaluronic acid fillers are useful for volume replacement and smoothing abrupt transitions that develop with age throughout the midface, chin, and jaw. A combination of hyaluronic acid filler for volume restoration and sodium deoxycholate and/or onabotulinumtoxinA for volume reduction where appropriate may optimize lower facial contour. Conclusions:. This review highlights the importance of facial angles and contours as well as the significance of panfacial assessments and treatment, focusing on the relationships within areas of the face, specifically the midface and lower face, to optimize results.

In recent years, robots have been increasingly used in various fields of medicine, including surgery, dentistry, and ophthalmology. One of the newest and most promising applications of robotic technology in medicine is in the field of facial aesthetics, particularly in the injection of facial fillers and neuromodulators. While facial injections have traditionally been performed manually by trained physicians and nurses, the introduction of robots has the potential to revolutionize the field, offering a range of potential benefits, including increased precision, accuracy, and consistency of results. However, the significant disadvantages of robots are high cost, lack of flexibility and personal touch, limited experience, and risk of injury due to malfunction.

The surgical extraction of the impacted third molar is frequently associated with several complications. The purpose of this study is to assess how two different surgical protocols affect post-operative complications during the extraction of the lower impacted third molars. In order to compare and evaluate two different techniques (triangular flap vs. envelope flap), and the relative post-extraction complications, two groups of 150 patients each underwent to surgical impacted third molar extraction and 60 days of follow-up. The complication rate in the two groups was 14.00% in group A and 17.33% in group B. There was a strong association between smoking (OR: 2.8) and the use of oral contraceptives (OR: 1.75) with complications. The age- and sex-related incidence of complications in hard tissue healing has great variability in the literature; the analysis performed on our data did not show a statistically significant association between them. Even though related to a higher incidence of transient changes in sensitivity, it was found that the envelope flap saw a lower percentage of complications. There is still no clarity on which is the best protocol for the extraction of the lower impacted third molar, and the choice often depends on the surgeon’s experience.

Abstract BackgroundNonsurgical nasal reshaping (nSNR) with hyaluronic acid (HA) filler is a well-established procedure performed to ameliorate nasal appearance and is considered a valid alternative to surgical rhinoplasty in selected patients. ObjectivesThe aim of our study is to evaluate the decision-making process and management of patients undergoing rhinoplasty, with previous HA filler injection, and evaluate if consensus could be achieved to recommend guidelines. MethodsBetween April and May 2021, an online survey was sent to 402 Italian surgeons of different specialties. The survey collected information regarding the types of treatment of patients who have previously undergone nSNR, who should undergo surgical rhinoplasty. For those surgeons using hyaluronidase, an additional information was collected. ResultsIn a range of time of 2 months (April and May 2021), a total of 72 surgeons replied and completed the survey: out of the 402 questionnaires sent, the response rate was approximately 18%. The majority of respondents (61.5%) replied to inject hyaluronidase (HYAL) in patients who had to undergo a rhinoplasty but reported previous nSNR. Of the surgeons who use HYAL, 70% performed rhinoplasty after a waiting time of 3 to 4 weeks. ConclusionsEither direct surgical approach or hyaluronidase injection first seems to be a viable options. The use of HYAL before surgery is the choice with the broadest consensus in our survey. However, a larger case-control study with long follow-ups is necessary to understand if in patient seeking surgical rhinoplasty who already received nSNR, the injection of hyaluronidase before surgery is mandatory, recommended, or not.

Background:. Prominent ears are a common congenital deformity of the head and neck. Correcting concha hypertrophy is an important step in otoplasty. Despite the risk of postoperative deformity due to the sharp edges created by excision, removing a section of cartilage is sometimes the only method to obtain a satisfying and long-lasting result. Multiple conchal excision techniques have been reported in the literature, with significant differences in approach, outcome evaluation, and complication classification. The objective was to review cartilage excision-based otoplasty procedures to offer plastic surgeons’ insights into current data on outcomes and complications of conchal excision techniques. Methods:. We conducted a literature search through the MEDLINE, EMBASE, Scopus, and Cochrane databases. Prospective and retrospective studies on otoplasty, including revision surgeries and conchal excision techniques involving concha cartilage resection, were included. Articles with no outcomes data, review articles, case reports, expert opinion or comment, and nonclinical studies were excluded. Results:. There were a total of four manuscripts that fulfilled our criteria. Three out of four authors preferred posterior access that separates the skin excision from the cartilage excision. Following resection, cartilage edges can be approximated by placing cartilage sutures, or they can be allowed to collapse spontaneously. Although only two authors employed a systematic classification for complications, all the articles reviewed indicated a low complication rate and excellent postoperative cosmetic outcomes. Conclusion:. Although the techniques and principles stated in the literature varied to some extent, the outcomes of all studies reviewed were comparable.

Abstract Introduction Idiopatic trigeminal neuralgia purely paroxysmal (ITNp) distributed in the supraorbital and suprathrochlear dermatomes (SSd), refractory to conventional treatments have been linked to the hyperactivity of the corrugator supercilii muscle (CSM). In these patients, the inactivation of the CSM via botulinum toxin type A (BTA) injections has been proven to be safe and effective in reducing migraine burden. The main limitation of BTA is the need of repetitive injections and relative high costs. Based on the study of the motor innervation of the CSM, we describe here an alternative approach to improve these type of migraines, based on a minimally invasive denervation of the CSM. Materials and methods Motor innervation and feasibility of selective CSM denervation was first studied on fresh frozen cadavers. Once the technique was safely established, 15 patients were enrolled. To be considered eligible, patients had to meet the following criteria: positive response to BTA treatment, migraine disability assessment score > 24, > 15 migraine days/month, no occipital/temporal trigger points and plausible reasons to discontinue BTA treatment. Pre- and post- operative migraine headache index (MHI) were compared, and complications were classified following the Clavien-Dindo classification (CDC). Results Fifteen patients (9 females and 6 males) underwent the described surgical procedure. The mean age was 41 ± 10 years. Migraine headache episodes decreased from 24 ± 4 day/month to 2 ± 2 (p

Abstract Objectives The aim of this narrative review was to collect all findings from literature about oral signs and symptoms of COVID‐19, in order to draw a picture of oral involvement of this challenging viral infection, to help oral professionals in a better triage and early diagnosis. Material and methods The search for international literature was made including articles written in English and reporting about oral manifestations in patients with a diagnosis of COVID‐19. The publication time was limited to 2019 and 2020, up to May 20, 2020. A narrative review was performed. Results Twenty‐three articles were included in this review. Three different oral manifestations were found: taste alteration, oral blister and ulcers, and oral lesions associated with Kawasaki‐like diseases (erythema, bleeding of lips, “strawberry tongue”). The higher expression of Angiotensin‐converting enzyme 2 in the oral cavity and in endothelial cells might be responsible for oral manifestation and the major report of signs and symptoms in the occidental countries. Conclusions Detecting oral signs and symptoms of COVID‐19 could be useful to perform a better preliminary triage in dental setting, and in recognizing possible early manifestations of the disease. However, considering the outbreak of COVID‐19 and the consequent difficulty of undergoing oral examinations, the oral manifestations might be misdiagnosed; then, we would encourage oral professionals to perform other studies about this topic.

Background:. Aesthetic improvement of the lips with hyaluronic acid fillers is a popular procedure. A comprehensive, modular, and highly individualizable method has been developed: the Lip Omnicomprehensive Volume Enhancement (LOVE) approach. The present study assessed the safety and effectiveness of LOVE across different patient age groups. Methods:. This was a prospective, single-center study of women aged 20–70 years seeking nonsurgical lip enhancement or asymmetry correction. Three equally sized groups were formed based on patient age: 20–34, 35–45, and 46 years or older. Individualized treatment plans were developed taking into account patient preferences expressed in a pre-injection questionnaire. Treatment used one or more of the three modules of LOVE: lip shape [vermilion border, Vycross (VYC)-17.5]; volume (vermilion body, VYC-17.5); and hydration (submucosal area, VYC-12). Follow-up lasted 6 months. Results:. Sixty patients were enrolled (mean age: 41.3 ± 13.3 years; n = 20 per age group), all of whom were White. Most were treated with all three LOVE modules. Mean filler quantities increased with age: 20–34 years, 1.1 ± 0.1 mL; 35–45 years, 1.5 ± 0.1 mL; 46 years or older, 1.6 mL ± 0.2 mL. Mean patient satisfaction at 4 weeks [on a seven-point scale from 0 (extremely dissatisfied) to 6 (extremely satisfied)] was 4.8–4.9 in each age group. Apart from minor and transient edema/bruising, there was only one complication: a case of lumps that resolved with home massage. Conclusion:. The LOVE approach is safe and effective across a range of ages, with high levels of patient satisfaction.

Background: Nowadays, digital dentistry is a fundamental skill that dentists need to acquire at this time. The digital workflow has gained acceptance and is widely used in most disciplines of dentistry. For this reason, it might be advisable to include this content in the undergraduate curriculum. The aim of this work was to create a course in digital aesthetic dentistry and evaluate its effectiveness. Methods: Dental students at the University of Verona (from third to sixth year) participated in a 2-h course on photography, digital aesthetic analysis, and digitally planned rehabilitations. Students were randomly divided into two groups, the first group attending the course with video tutorials and the second group attending the traditional class with slides. The students’ ability to perform digital aesthetic analysis and rehabilitation was tested. In addition, a questionnaire was completed to determine student satisfaction with the course and method of delivery. Statistical analysis was performed. Results: The course was highly appreciated, especially by the students who received the video tutorials. Good results were obtained in the performance of digital analysis and rehabilitation, which were better in the first group. Conclusions: Digital aesthetic dentistry was a success in terms of newly acquired skills. From this point of view, the proposal of a course on this subject in the undergraduate curriculum deserves a close evaluation. The video tutorial method seems to be a good way to teach operative digital procedures.

Orthodontic tooth movement (OTM) is based on intermitted or continuous forces applied to teeth, changing the mechanical loading of the system and arousing a cellular response that leads to bone adaptation. The traditional orthodontic movement causes a remodeling of the alveolar bone and changes in the periodontal structures that lead to tooth movement. The use of a piezoelectric instrument in orthodontic surgery has already shown great advantages. The purpose of this study is to rank the behavior of inflammatory mediators in accelerating orthodontic tooth movement. Ten patients with malocclusion underwent orthodontic surgical treatment, which included a first stage of surgically guided orthodontic movement (monocortical tooth dislocation and ligament distraction, MTDLD) to accelerate orthodontic movements. In all cases, corticotomy was performed by Piezosurgery. Bone and dental biopsy was executed to evaluate changes in the cytokines IL-1beta, TNF-alpha and IL-2 in different time intervals (1, 2, 7, 14 and 28 days). The molecular mediators are IL-1 beta, TNF-alpha and IL-2. Immediately after the surgical procedure there was a mild expression of the three molecular markers, while the assertion of IL-1 beta and TNF-alpha reached the maximum value after 24 h and 48 h, indicating a strong activation of the treated tissues. The Piezosurgery® surgical technique induces an evident stress in short times, within 24–48 h from the treatment, but it decreases significantly during the follow-up.

Orthognathic surgery is a branch of maxillo-facial surgery increasingly in demand, which deals with the correction of skeletal deformities. The aim of the present study is to identify the most common post-operative complications following orthognathic bimaxillary surgery performed by means of Piezosurgery®. Furthermore, through an examination of the available scientific literature, we wanted to establish whether the frequency of postoperative complications were consistent with those already reported. A retrospective study on 58 patients who underwent orthognathic surgery with a bilateral sagittal osteotomy (BSSO) of the mandibular bone branch, maxillary surgery with Le Fort I mono-segmented or multi-segmented approach, and genioplasty technique using Piezosurgery®. The complications taken into consideration were disorders of the temporomandibular joint (TMJ), paraesthesia and hypoesthesia, asymmetries, nose enlargement, nasal septum deviation, nasal obstruction, dental discolorations, pulpal necrosis, occlusion and masticatory efficiency, gingival recession, periodontal problems, dysgeusia, nausea and vomiting, weeping alterations, hearing problems, delayed healing, superinfection, removal of synthesis means, reoperation, cicatricial outcome, and bilateral pneumothorax. It has been highlighted that a number and type of postoperative complications matched those reported by the most recent literature reviews. Temporomandibular disorders and paraesthesia were the most common ones. The only complication rate that differed from the literature was nerve damage, which was significantly lower. Post-surgical complications depend on the used surgical techniques, clinical work, and treatment methods. The use of piezoelectric devices in orthognathic surgery operations provides an innovative, safe, and effective technique compared to traditional methods.

Published studies regarding Bichat fat pad focused, quite exclusively, on the implant of this adipose depot for different facial portions reconstruction. The regenerative components of Bichat fat pad were poorly investigated. The present study aimed to describe by an ultrastructural approach the Bichat fat pad, providing novel data at the ultrastructural and cellular level. This data sets improve the knowledge about the usefulness of the Bichat fat pad in regenerative and reconstructive surgery. Bichat fat pads were harvested form eight patients subjected to maxillofacial, dental and aesthetic surgeries. Biopsies were used for the isolation of mesenchymal cell compartment and for ultrastructural analysis. Respectively, Bichat fat pads were either digested and placed in culture for the characterization of mesenchymal stem cells (MSCs) or, were fixed in glutaraldehyde 2% and processed for transmission or scanning electron microscopy. Collected data showed very interesting features regarding the cellular composition of the Bichat fat pad and, in particular, experiments aimed to characterized the MSCs showed the presence of a sub-population of MSCs characterized by the expression of specific markers that allow to classify them as multilineage differentiating stress enduring cells. This data set allows to collect novel information about regenerative potential of Bichat fat pad that could explain the success of its employment in reconstructive and regenerative medicine.

Although the Le Fort I osteotomy is a safe surgical technique, many complications have been reported. We present a case of an extended cervico-facial haematoma due to delayed bleeding from the terminal branches of the maxillary artery after orthognatic surgery. A 23-year-old man was referred to our observation for the surgical correction of a class III asymmetric malocclusion. The patient underwent a Le Fort I osteotomy, with impaction of the maxilla, associated with an Epker mandibular bilateral sagittal split osteotomy, with maxillary advancement and rigid internal fixation of the mandible with four miniplates and another four for the upper maxilla as well. The first post-surgery day, the patient developed a gradual dispnea together with neck swelling. By second postoperative day, the patient′s general condition improved with a progressive normalization of laboratory tests values. The Computerised Axial Tomography (CAT) scan confirmed a decrease in the parapharyngeal thickening. Total recovery was achieved within two months, the final clinical check showed a healthy appearance with good occlusion. An increased knowledge of the basic biology of the Le Fort I osteotomy, the development of instruments specially designed for the Le Fort I procedure and the use of hypotensive anaesthesia could reduce the morbidity and duration of this procedure.

Among complications in orthognathic surgery, the insurgence of pneumothorax is very rare. Pneumothorax is the presence of air or gas in the pleural cavity and it is rare complications in the postoperative oral and maxillofacial surgery patient. The clinical results are dependent on the degree of collapse of the lung on the affected side. Pneumothorax can impair oxygenation and/or ventilation. If the pneumothorax is significant, it can cause a shift of the mediastinum and compromise haemodynamic stability. While 10% of pneumothoraces are asymptomatic, patients often complain of acute chest pain and difficulty breathing. There is a reduction in vital capacity, tachycardia, tachypnoea and a decrease in partial pressure of oxygen with an inability to maintain oxygen saturations. We observed this unusual surgical consequence in a 28-year-old female with negative clinical history and instrumental evaluation after Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). No further consequences, no neurological sequelae, no infections and no other osteotomies sequelae were seen. Sudden post-surgical dispnea associated to sub-cutaneous emphysema of the neck and of the thorax must be adequately observed with the aim of monitoring further severe sequelae. The anaesthetic management of the emergency difficult airway in any post-surgical orthognatic treatment can be extremely difficult requiring a multi-disciplinary approach.

No Abstract