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A filler injection in the nose can be essential but is also dangerous, especially in the nasal cartilage region. To safely and accurately perform a filler injection, surgeons must have detailed knowledge of nasal anatomy.Associated the vessel branches and the characteristics of different nasal regions to provide suggestions for more suitable injection sites.Fifty specimens underwent computed tomography (CT) after contrast infusion. Qualified specimens were selected for 3D CT reconstruction. Dissection was performed to confirm the accuracy of the CT data.The branches of arteries with large diameters, the dorsal nasal artery (DNA) and the lateral nasal artery (LNA) were distributed within the superficial musculoaponeurotic system layer. The DNA was seen in only 58% of specimens. The artery crossed the midline over the upper lateral cartilage in 16% of specimens. The LNA was a constant branch that traversed the nasal tip. The LNA crossed the midline to the contralateral side in 18% of patients. We divided the nasal cartilage dorsum into two regions for easy handling: the supratip region (STR) and the nasal tip region (NTR). The branches distributed in the STR mostly originated from the DNA (81.6%, 40/49), while those in the NTR mostly originated from the LNA.The vasculature of the nasal cartilage region observed in this study is similar to that observed in previous studies. However, we found that the STR was an advantageous area for filler injection. At the same time, we provided suggestions for more suitable injection methods.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The forehead has high risks associated with filler injection considering its highly complex vascular system. This study aims to thoroughly describe the anatomical variations and relationships between the supratrochlear artery (STA) and supraorbital artery (SOA).We studied 56 cadaveric heads by computed tomography after contrast-agent injection.The deep branch of the STA originated in the deep superior orbital arcade and the ophthalmic artery (OA), whereas that of the SOA originated at 3 locations: the deep superior orbital arcade, deep superior orbital artery, and OA. The superficial branch of the STA also had 3 origins: the superficial superior orbital arcade, OA, and angular artery, whereas the superficial branch of the SOA had 2 origins: the superficial superior orbital arcade and OA. Based on the relationship between the STA and SOA, 2 main arterial distribution patterns were observed in both superficial and deep layer arteries: STA/SOA connected pattern and STA/SOA disconnected pattern, of which the latter pattern has 3 subtypes.The forehead arteries have complex origins. The relationship of the supratrochlear and supraorbital arteries could be categorized into 2 main patterns. The study elucidated the complexity of the forehead vasculature.

To investigate current Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) technologies applied in the treatment of dentofacial deformities secondary to condylar osteochondroma and introduce a modified method with additional pre-bent titanium miniplates to improve the accuracy of operation.Literature review about the application of CAD/CAM in the treatment of condylar osteochondroma and secondary dentofacial deformities was conducted. And 8 patients with condylar osteochondroma and secondary dentofacial deformities were treated by the CAD/CAM cutting and drilling surgical guides as well as pre-bent titanium miniplates. Pre- and post-operative 3D-cephalometric measurement were recorded and the difference between virtual simulation and postoperative modeling images was measured. Follow-up and radiographic examinations were performed.A total of 17 studies (including 216 patients) about the application of CAD/CAM in the treatment of dentofacial deformities secondary to condylar osteochondroma have been reported since 2010, including the 8 present patients. In our study, all patients were satisfied with the surgical outcome, without obvious relapse or evidence of temporomandibular joint disorder or other complications during follow-up; all patients avoided condylar reconstruction and sagittal split of ramus osteotomy on the ipsilateral mandible side. Comparison between simulated plans and actual postoperative outcomes showed surgical simulation plan was accurately transferred to the actual surgery.The application of CAD/CAM cutting and drilling guides as well as pre-bent titanium plates could achieve more accurate and favorable outcomes, improving the clinical planning and surgical execution for patients with condylar osteochondroma and secondary dentofacial deformities.

Skeletal muscle mass and function deteriorate with ageing. Adiponectin receptors (APNrs), mainly activated by adiponectin, participate in various physiological activities and have varying signalling pathways at different ages. This study aimed to explore whether discrepant performance exists in APNr activation regulating young and aged muscle satellite cells (MUSCs) and whether age-related muscle dysfunction could be alleviated upon APNr activation.The gastrocnemius muscle phenotype was observed in male mice aged 2 and 18 months. An APNr agonist (AdipoRon) was used in vitro and in vivo to investigate the changes in cell biological behaviours and whether muscle dysfunction could be retarded after APNr activation.Aged mice exhibited decreased muscle mass and increased fat infiltration. APNr activation inhibited C2C12 cells and young MUSCs (YMUSCs) proliferation but showed no obvious effect on aged MUSCs (AMUSCs). Moreover, APNr activation inhibited the migration of both YMUSCs and AMUSCs. Interestingly, APNr activation hampered the myogenic differentiation but advanced the adipogenic differentiation of YMUSCs, yet exact opposite results were presented in AMUSCs. It was demonstrated that Wnt and PI3K signalling pathways may mediate the phenotypic differences. Furthermore, in vivo experiments verified that APNr activation ameliorated age-related muscle atrophy and excessive fat infiltration.APNr activation exerted dual effects on the regulation of myogenesis and adipogenesis of YMUSCs and AMUSCs and rescued age-related skeletal muscle dysfunction.

Glabellar filler injection is linked to an increased risk of blindness. A thorough understanding of vascular changes in the glabellar area is critical for safety. The study's goal was to precisely determine the three-dimensional placements of the arteries in the glabellar area.In 117 cadavers, the vascular structures in the glabellar area were examined. There were four segments (S1/S1'-S4/S4') and five points (P1-P5) specified. The number of identified arteries found in each section and at each position was tallied. Additionally, the depth of the underlying identified artery under each site was measured.One to three named arteries per glabellar segment were found. Each segment had at least one named artery, and the number of named arteries detected between S1/S1' and S4/S4' decreased. The chance of encountering identified arteries at the 5 designated locations, P1-P5, was 7/117 (6.0%), 6/117 (5.1%), 7/117 (6.0%), 6/117 (5.1%), and 16/117 (13.7%), respectively. At P1-P5, the major artery trunk was 1.8 ± 0.3 mm, 1.6 ± 0.3 mm, 1.4 ± 0.2 mm, 1.3 ± 0.3 mm, and 1.1 ± 0.2 mm below the skin.The site of the glabellar arteries was clearly shown in this investigation; these arteries were met at a rate of 14% from P1 to P5. We demonstrated that a single entry site through the glabella via cannula could readily keep the needle deep enough for safe glabellar filler injection.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reduction malarplasty is one of the most common aesthetic procedures to improve a wide bizygomatic width and a prominent zygomatic body. Although there are various kinds of modifications, any method is imperfect, while some complications may occur. The purpose of this review was to compare kinds of complications of reduction malarplasty to provide certain suggestions for clinical application.A comprehensive computerized search of scientific literature was performed via the PubMed, Web of Science, and Library of Congress databases, involved in articles from January 1st, 1983 to February 28th, 2022. The outcomes were extracted and analyzed by 3 independent authors, including patient demographics, diagnoses, surgical techniques, postoperative outcomes, and complications.A total of 29 studies covering 6611 patients were included according to the inclusion and exclusion criteria. The L-shaped osteotomy may obtain a better effect when someone has both zygomatic body and arch protrusion. In the view of complications, our conclusion suggested that L-shaped osteotomy without bony resection reduced the zygomatic complex effectively with the lowest incidence of postoperative complications (0.02%). But the amount of bone resection is limited. If increasing bone resection is necessary, L-shaped osteotomy with long arm bony resection and L-shaped osteotomy with short arm bony resection are both preferable choices with lowest incidence of structural and functional complications, respectively.L-shaped osteotomy may obtain a better effect when a patient has both zygomatic body and arch protrusion. L-shaped osteotomy without bony resection reduced the zygomatic complex effectively with the lowest incidence of postoperative complications.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The malar augmentation injection has gained popularity in recent years, but the exact location of each injection site has not been clearly identified.To discover ideal injection sites by comprehensively considering the distributions of ligaments, muscles, and vessels.Eighteen cadaver heads were dissected to investigate the zygomatic ligamentous system and to measure the position of muscles. Sixty-six cadaver heads were subjected to computed tomographic scanning and three-dimensional vessel reconstruction. Radiological evaluation of the fillers was performed before and after experimental injection in one hemiface and dissected to confirm safe delivery. Five patients were enrolled in a prospective clinical study. 2D and 3D photographs were taken before and after the injections for comparison.Site 1 was defined along the zygomatic arch, except the first 1/4 length and the midline of the arch. Site 2 was on the body of the zygoma, superior to the level of the infraorbital foramen and medial to the jugale. Site 3 was defined in the anteromedial midface approximately 30 mm below the lateral canthus.Injections at these 3 sites can be performed within the range of the ligaments to achieve effective lifting effects and minimize potential complications.

Hippo pathway is a cellular regulatory pathway composed of core molecules such as MST1/2, LATS1/2, SAV1, MOB1A/B and downstream YAP/TAZ. Fully involved in regulating cell proliferation, differentiation, migration and apoptosis, the Hippo pathway is critical in regulating stem cells of oral origin, for instance, DPSCs and PDLSCs, enamel formation and periodontium regeneration. Here, we summarized the Hippo pathway involved in these progresses and concluded crosstalks of the Hippo pathway with BCL-2, ERK1/2, ROCK, TGF-β/BMP and Wnt/β-catenin pathways, hoping to provide foundation for further clinical therapy.

BACKGROUND When performing filler injection procedures to the nasojugal groove, there is the risk of iatrogenic damage to the detoured facial artery. OBJECTIVE To determine the 3-dimensional location of the detoured facial artery. MATERIALS AND METHODS The branches of the facial arteries from 118 cadaveric hemifaces were scanned using computed tomography and reconstructed using the Mimics software program. RESULTS Detoured facial arteries were found in 47 of the 118 hemifaces (39.8%). Two main arterial patterns were identified: in Type I (29 of 47 cases), there were both detoured and nasolabial trunks where the facial artery originated, whereas in Type II (18 of 47 cases), there was only a detoured trunk. The detoured trunk originated 32.0 ± 5.3 mm from the midsagittal line, 5.0 ± 2.8 mm from the occlusion plane, and 5.9 ± 3.5 mm below the skin layer; the inflection of the detoured trunk was located 30.0 ± 5.6 mm laterally, 26.2 ± 4.4 mm superiorly, and 5.7 ± 2.6 mm deep. The meeting point with the inferior orbital rim plane was located 17.1 ± 3.4 mm laterally, 43.4 ± 3.1 mm superiorly, and 2.8 ± 1.7 mm deep. CONCLUSION The 3-dimensional location of the detoured facial artery as reported here will help clinicians to avoid iatrogenic damage when they are performing filler injection procedures.

Background Temple filler injection is one of the most common minimally invasive cosmetic procedures involving the face; however, vascular complications are not uncommon. Objectives This study aimed to investigate the anatomy of the temporal vessels and provide a more accurate protocol for temple filler injection. Methods Computed tomography (CT) scans of 56 cadaveric heads injected with lead oxide were obtained. We then used Mimics software to construct 3-dimensional (3D) images of the temporal vessels described by a coordinate system based on the bilateral tragus and right lateral canthus. Results In the XOY plane, the superficial temporal artery (STA), middle temporal artery (MTA), zygomatico-orbital artery (ZOA), posterior branch of the deep temporal artery (PDTA), and lateral margin of the orbital rim divide the temple into 4 parts (A, B, C, and D). The probabilities of the STA, MTA, ZOA, and PDTA appearing in parts A, B, C, and D were 30.73%, 37.06%, 39.48%, and 77.18%, respectively. In 3D images, these vessels together compose an arterial network that is anastomosed with other vessels, such as the external carotid, facial, and ocular arteries. Conclusions 3D CT images can digitally elucidate the exact positions of temporal vessels in a coordinate system, improving the safety of temple filler injections in a clinical setting.

Objectives This study aims to establish a machine learn-based decision support system for the treatment of dental and maxillofacial malformations and verify its feasibility. Materials and Methods Between January 2015 to August 2020, 574 patients with spiral CT and have confirmed diagnosis of dento-maxillofacial deformities were used to train the diagnostic model based on five kind of machine learning algorithm. The diagnostic performance of the algorithm was compared with the ground truth and evaluated by accuracy, sensitivity, specifcity, and area under the ROC curve (AUC). The adaptive artificial bee colony (aABC) algorithm was used to calculate the orthognathic surgical plan based on cephalometrics in the normal population. The algorithm was used to automatically generate surgical plans for 50 patients and the plans were rated by three experienced maxillofacial surgeons. Results The binary relevance extreme gradient boosting model delivered the best overall performance. The final diagnosis success rates on six different kinds of maxillofacial deformities were all over 90%, except for maxillary overdevelopment (89.27%). Conclusions The machine learning algorithms show high accuracy and effectiveness in diagnosis and surgical plan design of dento-maxillofacial deformities. The AUC of all diagnostic types was greater than 0.88. The median score for surgical plan was 9. The scheme scores were further improved after human-computer interaction. Clinical Relevance The decision support system based on machine learning could be used for automatic diagnosis and surgical design for patients with dento-maxillofacial deformities, which will help improving diagnostic efciency and provide expertise to areas with lower medical levels.

Treatment of skeletal Class II patients with dual bite and idiopathic condylar resorption (ICR) is challenging for orthodontists because of the unstable position of the mandible as well as skeletal relapse attributed to improper seating of the mandibular condyles. This case report describes the successful treatment of an 18-year-old Mongolian man diagnosed with centric relation–maximum intercuspation discrepancy and ICR. After making a definitive diagnosis from verified centric relation using bilateral manipulation, orthodontic treatment was initiated followed by three-dimensional computer-aided design/computer-aided manufacturing prebent titanium plate–guided sagittal split ramus osteotomy and genioplasty. Postoperative 3D superimposition demonstrated that this surgical guide approach provided accurate repositioning of the condyles, which were well positioned in the fossae. Complete orthodontic and surgical treatment time was 24 months. The patient's facial appearance and occlusion improved significantly, and a stable result was obtained with a 1-year follow-up.

Background Strengthening weakened ligament tissues with injectable fillers to improve their supportive effect may achieve the aesthetic goal of face lifting. Objectives The aim of the study was to design an injectable technique for enhancing the true facial ligaments and dissect the ligaments to provide anatomical guidance for effective injection. Methods Six true facial ligaments were chosen as target anatomical sites for injection. Specimens were dissected, and 3-dimensional (3D) images were reconstructed to confirm the exact location of each injection site and to confirm that the proposed injection routes will not cause dangerous vascular damage. A total of 5 patients received the injections; 3D images were taken before and after the injections for comparison and clinical outcome assessments. Results The injection technique was designed to target 6 true facial ligaments, as follows. Site 1 targeted the temporal ligamentous adhesion region to lift the lateral ends of the eyebrows. Site 2 targeted the region of the lateral orbital thickening to lift the lateral canthus. Site 3 and site 4 targeted the zygomatic retaining ligaments and zygomatic cutaneous ligaments, respectively, to augment the soft tissues of the midface. Site 5 targeted the region of the maxillary ligament to lessen the nasolabial folds, and site 6 targeted the mandibular ligament to reduce the marionette line. Conclusions This site-specific injection technique targeting the true ligaments may lead to increased efficiency and accuracy of face rejuvenation and exert a lifting effect. Level of Evidence: 4

Background Injection-based techniques for "cheek augmentation" have gained popularity in recent years. The aim of this study was to perform a topographic analysis of the depth and distribution of the vessels in the zygomatic region to facilitate clinical procedures. Methods The external carotid arteries of seven cadaveric heads were infused with lead oxide contrast medium. The facial and superficial temporal arteries of another 12 cadaveric heads were injected sequentially with the same medium. Computed tomographic scanning was then performed, and three-dimensional computed tomographic scans were reconstructed using validated algorithms. Results The vessels on the zygomatic arch received a double blood supply from across the upper and lower borders of the arch, and the number of the vessels varied from one to four. Ninety percent of the vessels on the zygomatic arch were at a depth of 1 to 2.5 mm, and 75 percent were at a depth of 10 to 30 percent of the soft-tissue thickness. The vessels were concentrated on the midline of the zygomatic arch and the lateral margin of the frontal process. All samples showed a vessel travel along the lateral margin of the frontal process that eventually merged into the superior marginal arcades. Conclusions This study reported a topographic analysis of the depth and distribution of the vessels in the zygomatic region based on three-dimensional scanning. The results indicated that injection on the zygomatic arch should be performed deep to the bone, and the vascular zones anterior or posterior to the midline of the zygomatic arch were relatively safe injection areas.

Robotic surgical system has been gradually applied in thyroid neoplasms as a novel treatment for years, with presenting some superiorities as well as limitations. To compare the effectiveness and safety of robotic surgery with open surgery for the patients with thyroid neoplasms, this review was conducted METHODS: We performed electronic search in CENTRAL, MEDLINE, EMBASE, CNKI, CBM, Opengray, and Sciencepaper Online databases and manual search in specific online databases and according to the reference list of relevant papers to get all the studies that compared the effectiveness and safety of robotic surgery with that of open surgery for patients with thyroid neoplasms. Last update was conducted in March 2020. Randomized-controlled trials, case-control studies, cohort studies, and cross-sectional surveys were all included.In this review, 59 studies were included: two RCTs, 15 NRSs, 40 cohort studies, and two cross-sectional studies. Robotic surgery was found to be associated with longer operative duration, less retrieved lymph nodes, higher postoperative thyroglobulin before radioactive iodine ablation, similar complication incidence but less blood loss, better functional recovery, and higher cosmetic satisfaction compared to open surgery.Robotic surgery is a safe and feasible approach with remarkable superiority in reducing intraoperative damage and improving patients' quality of life compared to open surgery for thyroid neoplasms. Meanwhile, this procedure is also associated with long operative duration, insufficient removal of neck lymph nodes, which need to be given careful consideration.

Background: Adequate peri-implant bone mass and bone quality are essential factors to ensure the initial stability of the implant and success of implant operation. In clinical settings, the lack of bone mass often restricts the implant operation. In this study, we fabricated a smart porous scaffold with a shape memory function and investigated whether it could promote peri-implant osteogenesis under the periosteum. Methods: A porous shape memory polymer (SMP) scaffold was fabricated and its shape memory function, mechanical properties, and degradation rate were tested in vitro. Moreover, the scaffold was implanted in the mandible of rabbits to evaluate its efficacy to promote peri-implant osteogenesis in the periosteum and enhance the initial stability of the implant. Histological, micro-CT, and biomechanical analyses were carried out for further verification. Results: The SMP scaffold has a good shape memory function and biocompatibility in vitro. In vivo experiments demonstrated that the SMP scaffold could recover to its original shape after implantation to create a small gap in the periosteum. After 12 weeks, the scaffold was gradually replaced by a newly formed bone, and the stability of the implant increased when it implanted with the scaffold. Conclusion: The present study indicates that the SMP scaffolds have a good shape memory function and could enhance peri-implant bone formation under the periosteum. The SMP scaffold provides a clinical potential candidate for bone tissue engineering under the periosteum.

The aim of this study is to evaluate the osteogenesis around titanium implant and in bone defect or fracture in jaw bones and long bones in ovariectomized (OVX) animal models. The literature on the osteogenesis around titanium implant and in bone defect or fracture in jaw bones and long bones was reviewed with charts. Fourty-eight rats were randomly divided into OVX group with ovariectomy and SHAM (sham-surgery) group with sham surgery. Titanium implants were inserted in the right mandibles and tibiae; bone defects were created in the left mandibles and tibiae. Two-week postoperatively, mandibles and tibiae of 8 rats were harvested and examined by hematoxylin and eosin staining and histological analysis; 4-week postoperatively, all mandibles and tibiae were harvested and examined by Micro-CT and histological analysis. A total of 52 articles were included in this literature review. Tibial osteogenesis around titanium implant and in bone defect in OVX group were significantly decreased compared with SHAM group. However, osteogenesis differences in the mandible both around titanium implant and in bone defect between groups were not statistically significant. OVX-induced osteoporosis suppresses osteogenesis around titanium implant and in the bone defect or fracture in long bones significantly while has less effect on that in the jaw bones.

Background The forehead is a challenging area for filler injection because of the risk of serious complications. Anatomy-based filler injection techniques help to avoid severe vascular complications. Materials and methods Sixty-six cadaver heads were infused with adequate lead oxide contrast through the external carotid arteries, internal carotid arteries, facial artery, and superficial temporal artery. Three-dimensional computed tomography scans were reconstructed using validated algorithms. We measured the length and arc length of "beautiful" foreheads evaluated by 3 skilled surgeons. Results The frontal branch of the superficial temporal artery (FBSTA) was classified based on the main trunk as follows: Type I FBSTA (89.72%) took a sudden turn (89.56° ± 11.76°) once passing through the temporal crest, whereas Type II FBSTA (10.28%) barely turned (52.26° ± 6.81°) at the temporal crest. A total of 319 arteries passed through the midline in 48 cadaver heads. There were more superficial arteries (292 of 319) than deep arteries (27 of 319). The difference in the length and arc length of the forehead was 19.66 ± 4.35 mm. Conclusion This study introduces an effective technique for forehead filler injection that minimizes the risk of filler injection and improves patient satisfaction.

Computer-aided surgery has been widely used in treatment of hemifacial microsomia and matured in recent decades. These techniques include the computer-aided design, virtual surgical planning, modeling surgery, rapid prototyping techniques, intraoperative navigation and so on. The purpose of this article is to summarize the current application of computer-aided design/computer-aided manufacturing technology in the treatment for hemifacial microsomia during the last 5 years, as well as the views and discussions on some topics, and finally introduce a method of our team. Our effort is that using the holes predrilled in cutting guides, the pre-bent titanium plates are easily placed. Avoiding potential bone autorotation caused by unfitness between conventional titanium plates and bone surface, which keeps the bone fixation precisely in line with the preoperative virtual plan and reduce the movement of bone segments due to the undesirable stress of the plates.

MicroRNAs (miRNAs) are considered as promising cancer biomarkers. The aim of the present study is to investigate the prognostic significance of miR-200c in patients with oral squamous cell carcinoma (OSCC). Quantitative real-time PCR (qRT-PCR) was used to determine the expression levels of miR-200c in 204 pairs of OSCC and adjacent noncancerous. Correlations between miR-200c expression levels and clinicopathological characteristics were investigated. Survival analysis was performed using the Kaplan–Meier method and log-rank test. Multivariate analysis of the prognostic factors was performed with a Cox proportional hazards regression model. The expression of miR-200c was significantly down-regulated in OSCC tissues compared with adjacent non-tumor tissues (p

Anatomical knowledge of the zygomatic cutaneous ligament is crucial for rejuvenation of the anteromedial midface. However, there is a lack of satisfactory descriptions of the anatomy of the zygomatic cutaneous ligament, and the exact range and location are still controversial. The present study attempts to clarify the anatomy of the zygomatic cutaneous ligament to provide vital information for clinical operations.Facial dissection was performed on 36 cadaver hemifaces. The location of the zygomatic cutaneous ligament was investigated and recorded relative to the Frankfort horizontal line and several vertical reference lines. The relative relationship of the zygomatic cutaneous ligament with surrounding anatomical structures was also investigated.The zygomatic cutaneous ligament is a septum-like osteocutaneous ligament originating from the periosteum of the maxilla and zygoma. The overall range of the zygomatic cutaneous ligament starts at the origin of the levator labii superioris and then extends laterally, following the curvature of the inferior bone margin. After merging with the ligamentous part at the origin of zygomaticus minor and zygomaticus major muscle (11.65 mm inferior to the horizontal line), it continues as the zygomatic retaining ligament on the zygomatic arch. The vertical distances between the zygomatic cutaneous ligament and horizontal line along the L1, L2, L3, L4, and L5 reference lines are 9.1, 19.5, 22.1, 21.7, and 18.7 mm, respectively.The anatomical data obtained in the present study regarding the location of the zygomatic cutaneous ligament might be valuable for understanding the appearance of the midcheek fold and be helpful for surgical procedures to rejuvenate the anteromedial midface.