Lai Gui

Reduction malarplasty with a new L-shaped osteotomy through an intraoral approach: retrospective study of 418 cases.

Background: Oriental people usually have a wide midface and a prominent zygoma. Reduction malarplasty is one of the most frequently requested procedures for improvement of the facial contour in the Orient. Some methods involve coronal or preauricular incision for osteotomy, but this increases the likelihood of skin scars and injury to facial nerves, and increases the duration of surgery. Some methods involve an intraoral approach but cannot control the degree of reduction or the precision of interosseous fixation with the designed osteotomy lines. The authors designed an L-shaped osteotomy for malar prominence reduction through an intraoral approach to overcome these shortcomings. Methods: The authors reviewed 418 patients who underwent an L-shaped osteotomy for malar reduction performed in their department between 1997 and 2007. Follow-up was from 6 to 60 months (average, 12 months). The authors analyzed the rate of complications and evaluated the therapeutic efficacy of their method. Results: Four hundred two patients (96.2 percent) were satisfied. Only 16 patients (3.8 percent) with late complications were dissatisfied. Late postoperative complications focused mainly on asymmetry and cheek drooping. Conclusion: The new L-shaped osteotomy for correction of prominent zygoma is an ideal method, with the advantages of simpler manipulation, fewer complications, better outcome, shorter operative duration, no skin scars, and integrity of the structural characteristics of the zygoma.

Intraoral One-Stage Curved Osteotomy for the Prominent Mandibular Angle: A Clinical Study of 407 Cases

BackgroundMany Oriental people have a square face with a prominent mandibular angle. This article presents a good osteotomy method for the prominent mandibular angle (PMA).MethodsTwo modifications of the conventional procedures have been made. The first is a one-stage curved osteotomy for the mandibular angle. The second is nonresection of the masseter muscle. The surgical procedure has been performed using an intraoral approach with a direct field of vision.ResultsFrom October 1996 to December 2002, a total of 407 patients with PMA underwent surgery using this method with satisfactory results. The PMA osteotomy procedure was performed for only 248 patients. In addition, 29 patients received concurrent zygomatic reduction osteotomy, 38 patients underwent concurrent genioplasty, 41 patients had concurrent chin augmentation with excised PMA bone fragment, 2 patients received concurrent submental liposuction, and 39 patients underwent concurrent buccal fat pad resection.ConclusionThe described method is a very simple procedure with fewer complications for the surgical treatment of PMA.

Genioplasty and Chin Augmentation with Medpore Implants: A Report of 650 Cases

BackgroundGenioplasty is an old and useful technique. Chin augmentation with Medpore has become popular in recent years. The authors briefly examine their experience with the two techniques.MethodsFrom 2000 to date, 500 genioplasties and 150 chin augmentations with Medpore have been performed. The versatility and benefits of the two techniques are discussed.ResultsMost of the patients achieved satisfactory results with few complications. Genioplasty is recommended for severe developmental or complicated retrogenia and for deviated chin. Both techniques can be used for mild to modest retrogenia. Medpore is especially useful for patients who need a meticulous revision of the chin shape or contour.ConclusionsChin shape and contour are as important as the chin position. Although genioplasty has the widest range of indications, chin augmentation with Medpore has the advantage of minimal risk for some patients who need to change the chin shape or contour. Medpore is totally different from other alloplastic chin implants such as silicone.

Combined skeletal and soft tissue reconstruction for severe Parry-Romberg syndrome.

Parry-Romberg syndrome is an acquired facial deformity that manifests as progressive hemifacial atrophy that has unknown cause. Many surgical techniques to address it have been reported, such as fat transplantation and use of free flaps. Undoubtedly, the results of such techniques can be satisfactory for mild hemifacial atrophy after soft tissue restoration. But in severe cases, except for large-scale soft tissue atrophy, the osseous framework is involved, rendering their management difficult, and the results are often inadequate. On the basis of the severity of facial soft tissue atrophy and the extent of involvement of the osseous framework, we classified the deformities into 3 groups: (1) Mild: the facial atrophic area is confined to a small region and is located in the lateral face, the nasal ala and upper lip are normal, and there is no deviation of the oral commissure, and the occlusal plane is horizontal. (2) Moderate: there are large areas of soft tissue atrophy, and the nasal ala and upper lip are also affected; the oral commissure is deviated; the bony framework is nearly normal; and the occlusal plane is nearly horizontal or slightly deviated. (3) Severe: moderate form of soft tissue atrophy and serious bone framework atrophy, involving the zygoma, maxilla, and mandible; the chin and occlusal plane have deviated extensively to the affected side. In this article, we report our experience in successfully treating 23 patients with severe Parry-Romberg syndrome, according to our classification; mild and moderate cases were not included in this series. Microsurgical flap transplantation, lipoinjection, liposuction revision, dermis grafting, and cross-lip flap were used to correct soft tissue deformities, and bone augmentation using the MEDPOR implant, orthognathic surgery, bone grafting, and mandibular distraction were performed to reconstruct the bone framework.

Clinical outcome of cranioplasty with high-density porous polyethylene.

Background High-density porous polyethylene (Medpor) has long been used in cranioplasty and is still one of the best materials for calvarial reconstruction. Calvarial defects can be effectively reconstructed with fewer complications by using Medpor. This article reports our study on the use of Medpor in reconstructing calvarial defects. Methods Twenty-three patients who underwent cranioplasty from 1999 to 2011 were included in this study. In all patients, Medpor was used for calvarial defect reconstruction, and all were followed up for at least 6 months. Results Most patients were satisfied with the reconstructive outcome. Only 1 patient had an infection and 1 had transient extradural seroma. All complications occurred within 2 years, and no new complications were found during the long-term follow-up. Conclusions Using Medpor in cranioplasty is an effective method for reconstructing calvarial defects.

Restoration of facial symmetry in hemifacial microsomia with mandibular outer cortex bone grafting combined with distraction osteogenesis.

Background: Mandibular distraction is a well-established method of correcting facial asymmetry in hemifacial microsomia. However, asymmetry in lower facial width remains after distraction because of its inability to increase bone thickness. Therefore, the authors used mandibular outer cortex bone grafting to augment the lower face following distraction to restore facial symmetry. Methods: From January of 1997 to December of 2007, 21 patients with hemifacial microsomia underwent unilateral mandibular distraction followed by mandibular augmentation using mandibular outer cortex bone graft harvested from the normal side. Age at surgery ranged from 7 to 27 years. Facial symmetry was evaluated based on medical photography and radiography with a minimum 6-month follow-up. Results: Mandibular height and length were expanded successfully with distraction, resulting in improvements in chin position and oral commissure level. Lower facial width was increased on the affected side and reduced on the normal side after bone grafting. Thus, three-dimensional facial symmetry was significantly improved in all patients. Long-term follow-up showed no evidence of relapse. The majority of the patients were satisfied with the reconstructive outcome. Conclusion: Mandibular augmentation with bone grafts harvested from the contralateral outer cortex effectively addressed the asymmetry in lower facial width that was uncorrected by distraction alone, achieving three-dimensional restoration of facial symmetry in hemifacial microsomia.

The oblique mandibular chin-body osteotomy for the correction of broad chin.

Background:The position and contour of the chin are important components in facial harmony and balance. In the aesthetic facial contouring of the lower face, the mandibular angle, body, and chin should be considered as 1 aesthetic unit. Any developmental broad chin or residual square chin after mandibular angle osteotomy can often make the lower face appear unattractive. For the correction of broad chin, the technique of horizontal-T genioplasty has been introduced; however, manipulation of this technique is sometimes complicated during repositioning and fixation because there is multiple osteotomy lines and if the muscular attachment is widely detached with an unskilled hand, after the muscular attachment is stripped off when the central segment is removed, there is the risk of bone necrosis and resorption. Therefore, a more simple and effective method for narrowing genioplasty needs to be further studied. Methods:From July 2005 to September 2008, we used the technique of oblique mandibular chin-body osteotomy for the narrowing of the broad chin. Osteotomy of the everted mandibular chin-bodys inferior border and reshaping of the lateral cortex with a bur reduces the width of the chin and the mandibular body, and the lateral outline of the mandibular inferior border becomes natural and smooth. Results:Twenty-five patients underwent the operation either separately or combined with other procedures such as a mandibular angle osteotomy or advancement genioplasty. All of the patients were satisfied with the improvement of their facial appearance at both the 3 months and 2 years follow-up. Conclusion:The oblique mandibular chin-body osteotomy is a simple method that can be used for the narrowing of broad chins caused by both developmental deformity and postmandibular angle osteotomy. It can effectively reduce the width of the mandibular body and mental region and make the lower face look attractive from both the anterior and lateral perspectives. It can be used independently or as a supplementary operation to osteotomy of prominent mandibular angles and horizontal advancement genioplasty.

Staged reconstruction for adult complete Treacher Collins syndrome.

Treacher Collins syndrome is a congenital craniofacial malformation affecting the structures derived from the first and second brachial arches. For the complete form, the deformities can be severe; both the orbital-zygomatic region and mandible as well as the soft tissues should be reconstructed. To explore the surgical management of this kind of deformities, we proposed our protocol for the staged reconstruction: (1) upper-facial reconstruction with specially designed outer calvarial table, (2) mandibular lengthening by distraction osteogenesis technique and orthognathic surgery to correct the birdlike facial appearance and anterior open bite after distraction, and (3) lipofilling for the correction of residual depressive deformities. Two adult patients have undergone this protocol, and the results were satisfactory. Even though many authors advised using pedicled bone flap for the reconstruction of the orbit and zygomatic complex in young patient because free bone graft has the tendency of bone resorption and multiple onlay bone graft may need to be added in later stage, for adult patient, however, the reconstructed bone framework using outer cranial table can well maintain the bony facial contour of the orbital zygomatic region. The residual depressive deformities in the temporal and cheek regions can be treated with lipofilling. Compared with the technique of mandibular advancement osteotomy, bilateral mandibular lengthening by gradual distraction is relatively safe and can effectively elongate the mandible and the surrounding soft tissues. After the distraction, the open bite can be closed with subapical osteotomy, and the chin projection can be further added by advancement genioplasty.

Three-dimensional preoperative design of distraction osteogenesis for hemifacial microsomia.

AbstractThe 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.

Application of computer techniques in repair of oblique facial clefts with outer-table calvarial bone grafts.

ObjectiveThis study focused on the application of computer-aided and rapid prototyping techniques in the repair of oblique facial clefts with outer-table calvarial bone. MethodsFive patients with oblique facial clefts underwent repair with outer-table calvarial bone. A mirror technique and rapid prototyping techniques were applied to design and prefabricate the individualized template for the preoperative repair of orbital inferior wall and maxillary anterior wall defects. Using computer software, the ideal region from which to take outer-table calvarial bone was located according to the size and surface curvature of the individualized template. During the operation, outer-table calvarial bone was fixed according to the shape of the individualized template, and bone onlay grafting was carried out after appropriate trimming. Surgical accuracy was evaluated by comparing the preoperative and postoperative 3-dimensional reconstructed images. ResultsWith computer-aided and rapid prototyping techniques, all 5 patients had an ideal clinical outcome with few complications. The 3-dimensional preoperative design images and postoperative images fit well. Six-month to 8-year postoperative follow-up demonstrated that 4 patients had good aesthetic facial appearances and 1 had developed recurrence of lower eyelid shortage. ConclusionsComputer-aided and rapid prototyping techniques can offer surgeons the ability to accurately design individualized templates for craniofacial deformity and perform a simulated operation for greatly improved surgical accuracy. These techniques are useful treatment modalities in the surgical management of oblique facial clefts.