Lin Yin

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.

The influence of gender and laterality on the incidence of hemifacial microsomia.

ObjectiveThe objective of this study was to identify the presence of gender and laterality bias in patients with hemifacial microsomia. MethodsWe performed a systematic search of PubMed, EMBASE, Cochrane Central Register of Systematic Reviews, and Cochrane Central Register of Controlled Trials to identify trials published up to January 2014. Data extracted from the literature were analyzed using Review Manager 5.0.24. ResultsRelevant data were extracted from24 articles (1121 participants), and the finding revealed no significant difference in incidence according to gender with the male-to-female ratio being 1.09:1 (relative risk, 1.13; 95% confidence interval, 0.94–1.36; P < 0.00001; n = 908) There was no obvious difference in the laterality subgroup either, with the ratio of between the right and left sides of the head being 1.12 (relative risk, 1.08; 95% confidence interval, 0.94–1.24; P = 0.006; n = 977). ConclusionsThis meta-analysis reveals no difference in the incidence of hemifacial microsomia between male and female patients; in addition, there is no obvious difference in distribution between the left and right sides of the head.

Surgical guide assistant mandibular distraction osteogenesis and sagittal split osteotomy in the treatment of hemifacial microsomia.

BackgroundHemifacial microsomia is the second most common congenital craniofacial malformation after cleft lip/palate with a wide variety of pathologic expression in jaws, skeletal components, ears, and soft tissues. Among the deformities, mandibular hypoplasia is the most common and is the main component that affects facial asymmetry. Mandibular distraction osteogenesis is the mainstay treatment; however, the vector of device and osteotomy lines need to be well designed. We utilized the sagittal split osteotomy for mandibular distraction with rapid prototyping surgical guide plate, making a successful outcome. MethodsHemifacial microsomia with unilateral Pruzansky II mandibular hypoplasia were selected in this study. Three-dimensional CT reconstructive data was put into Proplan CFM for preoperative designing and then manufacturing the surgical guide plate. The mandibular osteotomy and implantation of the internal distractor were performed through an intraoral approach aided with the prefabricated guide plate. Distraction began 7 days postoperation with a frequency of 1 mm/d and the distractor was kept in place 6 to 10 months after the first operation, then the distractor was removed. ResultsFrom July 2012 to March 2014, 6 cases of Pruzansky II hemifacial microsomia aged from 7 to 11 years were treated with the technique mentioned above. The range of distraction extends from 20 to 30 mm. The facial asymmetry deformities were improved obviously and without any complication. ConclusionsMandibular distraction osteogenesis by sagittal split osteotomy through rapid prototyping surgical guide plate provides certain advantages in the treatment of hemifacial microsomia.

Mandibular distraction combined with orthognathic techniques for the correction of severe adult mandibular hypoplasia.

Background Mandibular hypoplasia may result from congenital deformities or trauma or infection during the early stage of facial skeleton development. Deficiencies in the growth of the mandible can not only cause various degrees of facial deformity but also affect breathing and occlusal function. Here, we report our experiences with mandibular distraction combined with orthognathic surgical techniques for the treatment of severe adult mandibular hypoplasia. Methods Cephalometric analysis was conducted in all patients for quantitative evaluation. A computer-assisted surgical simulation was prepared before distraction. According to the simulation data, an operative osteotomy guide plate was designed and three-dimensionally printed with photosensitive resin. With the help of the guide plate, the osteotomy line was precisely placed. An internal distractor was then placed through an extraoral incision created under general anesthesia. Distraction began after 7 days of latency at the rate of 1 mm/d. After a 6- to 8-month consolidation period, the distractor was removed. At the same time, genioplasty and/or subapical osteotomy was performed to correct the patient’s crossbite and improve the facial contour for bilateral mandibular hypoplasia. For unilateral mandibular hypoplasia, a Le Fort I osteotomy was performed to correct the open bite on the affected side, whereas a mandibular outer cortex excision was performed on the unaffected side to improve lower facial symmetry. Results The mandible symmetry and chin protrusion were efficiently improved in all 36 patients (mean age, 20.3 y). No facial nerve palsy was reported, nor were there complaints about postoperative facial scarring. The postoperative infection rate was 2.8%. The distance of lengthening was 26.2 (2.8) mm. The increased ramus length on the affected side was 18.9 (9.3) mm. At the end of the consolidation period (T2), the affected mandibular ramus length increased by 46.3% (23.6%) in unilateral distraction osteogenesis; however, it decreased by 18.6% (12.4%) after device removal (T3). For bilateral distraction osteogenesis, condylion-gonion increased by 34.0% (50.0%) in T2 but had no significant change in T3. Conclusion Complicated mandibular hypoplasia can be well corrected with mandibular distraction combined with orthognathic surgery.

Parry-Romberg syndrome with rare maxillofacial deformities: a report on two cases.

Parry-Romberg syndrome, also known as progressive hemifacial atrophy, is a rare developmental disorder characterized by progressing unilateral facial atrophy slowly, which may affect the skin, fat, muscle and bone. It can also be associated with different systemic manifestations and deformities. In this article, we present the two cases with Parry-Romberg syndrome. Of them, one has additional and rare facial deformity with rare facial cleft and the other has a special tongue feature.

3D-CT evaluation of mandibular morphology after mandibular outer cortex osteotomy in young miniature pigs: The role of the periosteum

AIM The purpose of this study was to evaluate the role of periosteum on the healing and growth of mandible after mandibular outer cortex osteotomy using three-dimensional computed tomography. METHODS Eighteen 3-month-old miniature pigs were randomized into three groups. The mandibular outer cortex osteotomy was performed on both sides in group I, and on the left side in group II. In groups I and II, the local periosteum on the left side was resected. In group III, no operation was performed. The evaluation of mandibular morphology of all the animals was performed based on multiple spiral CT data before and after surgery. RESULTS The bone defects healed well when the periosteum was preserved, whereas they healed poorly with residual bone defects when the periosteum was resected after surgery. When the periosteum was resected, the decrease in the mean thickness of the mandibular body was more than that of the contralateral side after surgery. In group I, about 66.7% of the animals exhibited mandible deviation at 24 weeks after surgery. The median point of mentum was inclined toward the side that the periosteum was preserved. In groups II and III, no mandible deviation was observed. CONCLUSION The periosteum plays an important role in bone growth and fracture healing. Mandibular outer cortex osteotomy inhibited the mandibular development and resulted in postoperative mandibular deviation in young miniature pigs. The simultaneous periosteum resection may offset the phenomenon of mandibular deviation to a certain extent.

Accident entry of titanium screw into the sphenoid sinus during paranasal augmentation with porous polyethylene implant.

We report a rare case of accident entry of titanium screw into the sphenoid sinus during paranasal augmentation with porous polyethylene implant. The screw was finally retrieved from the sphenoid sinus by a nasal endoscope. We emphasize that, on this surgery region, the simple fixation skill must be performed delicately. Otherwise, an adverse event may still happen.

Surgical correction of a median cleft of the mandible.

We report a rare case of a boy with median clefts of the lower lip and mandible. In addition, there was a fibrous band extending from the symphysis of the mandible to the suprasternal notch. We repaired the mandibular cleft using autologous iliac bone grafts. The separated mandibular bones were reconnected by rigid fixation with titanium miniplates. Z-plasty with cervical skin was also performed. The fibrous band extending from the mandibular symphysis to the suprasternal notch was dissected. The suprasternal notch end of the band was cut off, and a fibrous soft-tissue pedicled superior flap was formed. The flap was turned over and transferred to the mental region subcutaneously to correct the microgenia. The appearance of this child was greatly improved by this procedure.

A Rare Eyeball Luxation After Cranioplasty and a Four-Year Follow-Up

A rare patient of reducible eyeball luxation after cranioplasty in a child Crouzon syndrome was reported. To remedy the patients chronic intracranial hypertension and brachycephaly, orbitofrontal advancement and cranial vault remodeling were carried out. About 25 days of postoperation, an acute eyeball luxation was observed, with the presence of a subcutaneous accumulation of liquid in the bilateral temporal regions. The dislocated eyeballs were brought back by applying gentle manual pressure. The patient received a conservative treatment without a tarsorrhaphy. The dislocation recurrence never occurred again. In a 4-year follow-up, it was shown that the childs vision was normal and proptosis was improved by series craniofacial reconstructions.

Temporal bone resorption: an uncommon complication after mandibular distraction.

Temporal bone absorption is a very infrequent complication following a intraoral mandibular distraction. We present a case of severe temporal bone absorption with skull base bone destruction in a child who experienced the mandibular distraction operation. In her follow-up of the 6th month, it was observed that the implanted distraction device drilled to the temporal bone and stretch into the middle cranial fossa. We recommend to optimize the positioning of the osteotomy and the design of the distraction to avoid the otential risk of adjacent skull destruction.