Xiaolei Jin

Anterolateral thigh adipofascial flap for the restoration of facial contour deformities

From January 2000 to May 2008, 50 patients with facial contour deformities underwent soft tissue augmentation with 51 anterolateral thigh (ALT) adipofascial flaps. Fifty flaps survived with no complications; partial fat necrosis occurred in one flap. Mean follow‐up was 16 months. Flaps ranged from 10 × 6 cm to 20 × 12 cm. Perforators were found in 50 flaps, 43 musculocutaneous perforators (84.3%) and 7 septocutaneous perforators (13.7%), with a mean of 2.5 perforators per flap. In one flap (2.0%), no perforator was found. In this case, we used an anteromedial thigh adipofascial flap using the medial branch of the descending branch of lateral circumflex femoral artery as the vascular pedicle. Relatively symmetric facial contour was achieved in 20 cases. In 30 cases, adjunctive procedures including flap debulking, fat injection, and resuspension were necessary, and 23 patients achieved satisfactory outcomes. We conclude that the ALT adipofascial flap can be successfully elevated and transplanted for the correction of soft tissue facial defects. This flap can provide tissue to fill large defects, and posses the qualities of pliability, an excellent blood supply, ease of suspension and fixation, and minimal morbidity at the donor site.

Correction of inverted nipple: an alternative method using continuous elastic outside distraction.

Inverted nipple, which is defined as a nipple located on a plane lower than the areola, presents both functional and cosmetic problems. It is a source of repeated irritation and inflammation and interferes with nursing. In addition, its abnormal appearance may cause psychologic distress. With consideration of its underlying pathophysiologic components and severity, a number of techniques have been introduced for correction of this anomaly. Most of these techniques involve extensive skin incision around the nipple that may jeopardize the blood and nerve supply to the nipple or create much scar tissue that is esthetically objectionable. For correcting the inverted nipple, the authors introduce an alternative, simple method using continuous elastic outside distraction. Compared with other methods using outside distraction, the authors used an adjustable elastic instrument made of steel wire, spring, and plastic syringe; continuous distraction of the inverted nipples; and sustaining 3 to 6 months. From August 2002 to December 2003, 14 patients (26 nipples) were treated. 12 patients had bilateral inverted nipples. Patient age at operation ranged from 14 to 40 years (mean age, 24 years). All nipples were congenital, and they had no previous operation. Six nipples were grade I, 9 nipples were grade II, and 11 nipples were grade III according to the classification of inverted nipple by Han and Hong. The mean follow-up period was 7.3 months (range, 3-12 months). Follow-up examinations revealed no evidence of recurrence of inversion. There was no complication associated with surgery, such as infection, hematoma, permanent sensory disturbance, or nipple necrosis. All patients were satisfied with their results. The authors conclude that their procedure is reliable, a simple, safe, and effective method for correction inverted nipple. But a long-term follow-up is needed. This technique can be applied to any type of inverted nipple as a primary surgical procedure.

Epicanthoplasty with double eyelidplasty incorporating modified Z-plasty for Chinese patients

BACKGROUNDnBlepharoplasty, without correction of the epicanthal folds, weakens the aesthetic appearance of the results. Hence, a modified Z-plasty procedure with double eyelidplasty was carried out for different degrees of epicanthus.nnnMETHODSnFrom 2005 to 2010, the authors performed epicanthoplasties using the modified Z-plasty and double eyelidplasty for 322 Chinese patients. The conventional double eyelidplasty incisions were made with conterminous modified Z formation on the medial canthus as well as cutting off the malpositioned superficial head of preseptal musculus orbicularis oculi.nnnRESULTSnEpicanthoplasty, using this technique, showed good results in most cases. There were no recurrences of the epicanthal fold and the scars were inconspicuous.nnnCONCLUSIONnThe modified Z plasty is indicated for all types and degrees of medial epicanthi, except epicanthus inversus. The easy design and operation, and the excellent and reproducible results satisfy both the plastic surgeons and the Chinese patients.

Complications of absorbable fixation in maxillofacial surgery: a meta-analysis.

Background The use of titanium during maxillofacial fixation is limited due to its palpability, mutagenic effects and interference with imaging, which lead to the requirement for subsequent removal. The use of a biologically absorbable fixation material will potentially eliminate these limitations. In this meta-analysis, we analyzed the complications of absorbable fixation in maxillofacial surgery. Methods We performed a systematic search of PubMed, Embase, Cochrane Central Register of Systematic Reviews and Cochrane Central Register of Controlled Trials for trials published through December 2012. Data extracted from literature were analyzed with Review manager 5.0.24. Results Relevant data was extracted from 20 studies (1673 participants) and revealed that patients in the absorbable group had significantly more complications than those in the titanium group (RRu200a=u200a1.20; 95% CI: 1.02–1.42; Pu200a=u200a0.03) in all enrolled maxillofacial surgeries. For bimaxillary operation subgroup, the absorbable fixation group did not have a significant increase in complications when compared with the titanium group (RRu200a=u200a1.89; 95% CI: 0.85–4.22; Pu200a=u200a0.12). There was no significant difference observed between the absorbable and titanium groups receiving a bilateral sagittal split ramus osteotomy (BSSRO) (RRu200a=u200a1.45; 95% CI: 0.84–2.48; Pu200a=u200a0.18) and Le Fort I osteotomy (RRu200a=u200a0.65; 95% CI: 0.34–1.23; Pu200a=u200a0.18). The combined results of the five trials revealed that the absorbable group had a significantly lower rate of complications compared to the titanium group (RRu200a=u200a0.71; 95% CI: 0.52–0.97; Pu200a=u200a0.03) in fracture fixation. Conclusion This meta-analysis shows that absorbable fixation systems used for fixation in maxillofacial surgery do not have adequate safety profiles. Subgroup indicated the safety of absorbable fixation systems was superior during fracture fixation. The absorbable fixation systems tend to have a similar favorable safety profile as titanium fixation during Le Fort I, bimaxillary operation and BSSRO.

Correction of hemifacial atrophy using free anterolateral thigh adipofascial flap.

Treatment of hemifacial atrophy presents a challenge for reconstructive surgeons. Previous studies have described numerous methods for the correction of facial asymmetry. We present our experience with treatment of hemifacial atrophy using a microsurgical anterolateral thigh adipofascial flap procedure and other adjunctive measures. This method is similar to that used for the free anterolateral thigh flap, but only the deep fascia of the anterolateral thigh and subcutaneous fatty tissue above the fascia were harvested. This flap procedure was used in 32 patients with moderate or severe hemifacial atrophy. In the first stage, the anterolateral thigh adipofascial flap procedure was used in all the patients, of whom eight accepted a porous polyethylene implant along with the anterolateral thigh adipofascial flap to reconstruct the skeleton. In the second stage, ancillary procedures including porous polyethylene implantation, liposuction debulking, fat injection and flap re-suspension were performed to refine the outcome in 28 patients. The anterolateral thigh adipofascial flap is advantageous in that it can provide a reliable vascular pedicle with relatively thin, pliable soft tissue and direct primary closure of the donor site.

Single stage surgery for contouring the prominent mandibular angle with a broad chin deformity: En-bloc Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG)

BACKGROUNDnVarious surgical options are reported to address the Asian squared face, characterized by a prominent mandibular angle (PMA) associated with an oversized chin deformity; but shortcomings lie in the requirement of multi-stage procedures with the risk of further revision surgery. We have developed a single-stage Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG) surgical technique to shorten the period of the surgical treatment and minimize the inherent surgical risks in the multi-staged procedures.nnnMETHODSnA retrospective study involving patients (n = 36) presented with prominent mandibular angle and an oversized chin who underwent the operation described from 2010 to 2012 with at least 12 months of follow-up. The surgical and aesthetic outcomes were evaluated through clinical assessment, photography, imaging analysis including preoperative and post-operative patient satisfaction rates.nnnRESULTSnAll the patients were satisfied with the improvement in their appearance following surgery; specifically the smoothness of the mandibular inferior border with no second mandibular angle. The width of the mandible was reduced with G-G distance reduced from 119.9 mm ± 3.9-109.7 mm ± 3.5 (p < 0.05). A significant preoperative and post-operative gonial angle (G-A) was found at the left (110.7° ± 9.6 vs 139.9° ± 11.5, p < 0.05) and right side of mandible (111.3° ± 10.7 vs 140.7° ± 11.8, p < 0.05). There was no iatrogenic inferior alveolar nerve or mental nerve injury and a stable aesthetic outcome beyond the first year.nnnCONCLUSIONnWe demonstrated favourable surgical and aesthetic outcomes with our single-stage en-bloc curved osteotomy surgical technique to reshape the prominent mandibular angle with a broad chin deformity with no increased in surgical risks but a high satisfaction rate and stable outcomes.

Clinical characteristics of craniomaxillofacial fibrous dysplasia

BACKGROUNDnThe clinical characteristics of craniomaxillofacial fibrous dysplasia (FD) have not been clearly identified. The objective of this meta-analysis is to assess the predominance of the monostotic form of FD using an evidence-based review. Furthermore, we examined the laterality and sex dominance of FD in patients from international study populations.nnnMETHODSnWe performed a systematic search of PubMed, Embase, Cochrane Central Register of Systematic Reviews, Cochrane Central Register of Controlled Trials and EBSCO for trials published through August 2013. Data extracted from the literature were analysed with Review manager 5.0.24.nnnRESULTSnThe results of this study showed that unilateral FD occurred more frequently than bilateral FD (RR, 12.37; 95% CI, 2.92-61.24; P = 0.008, N = 263 patients). For unilateral FD, there was no significant difference between cases involving the left or right side of the face (RR, 0.98; 95% CI, 0.66-1.44; P = 0.91; N = 201 patients). There were no significant sex-dependent differences for monostotic and polyostotic forms of craniomaxillofacial FD.nnnCONCLUSIONnThere is a significantly higher percentage of the unilateral form than the bilateral form in the craniomaxillofacial FD studies analysed, and an almost equal distribution of left- and right-sided unilateral FD. These proportions were maintained among males and females and there were nearly equal frequencies of monostotic and polyostotic FD.

Hemimandibular hyperplasia: classification and treatment algorithm revisited.

AbstractHemimandibular hyperplasia (HH) is a developmental asymmetry characterized by three-dimensional enlargement of one half of the mandible. The hyperplastic side usually involves the condyle, condylar neck, ramus, and body, with the anomaly terminating abruptly at the symphysis. The malformation results in the clinical presentation of ipsilateral enlargement of the mandible and tilted occlusal plane, associated with a deviated chin to the contralateral side. Since the first case report of HH in the English literature in 1836, various terminology and classifications were used. In this study, the authors classified the patients into typical and atypical types of HH on the basis of clinical and radiologic observations in an effort to achieve a simplified and efficient surgical management on the basis of the severity of deformity. Accordingly, surgical treatments are designed respectively on the basis of the authors’ classification and treatment algorithm. In addition, in view of potential complications arising from condylectomy, none of the patients had undergone condylectomy as part of the surgical treatment. The authors present their experience on the basis of this proposed classification and treatment algorithm with functional and aesthetic outcomes as the end points of this study.

Surgical treatment of craniomaxillofacial fibrous dysplasia: functionally or aesthetically?

BackgroundFibrous dysplasia (FD) is a tumor-like growth that consists of replacement of the medullary bone with fibrous tissue, causing the expansion and weakening of the areas of bone involved. The most commonly affected bones are facial bones, causing a number of facial cosmetic and functional problems. MethodsFrom December 2008 to July 2012, 10 patients with craniomaxillofacial fibrous dysplasia were treated by conservative resection and local recontouring. The patients were followed up yearly, with an average of 3 years; the longest follow-up period was 5 years. ResultsAll the 10 patients received appropriate treatment and histopathological examinations were performed to confirm the diagnosis of FD. Four patients with zygoma involved had received partial zygoma osteoectomy and 2 patients received mandibular partial osteoectomy. Average time of follow-up was 3 years, with a range from 1 to 5 years, and all patients obtained satisfactory aesthetic and functional results. ConclusionIn most patients, a conservative surgery will achieve good functional and aesthetic results. For patients with mild symptoms, the aesthetic effect should be given priority while for the heavier patients the restoration of function and aesthetic effects should all be taken into account.

Female predominance and effect of sex on Parry-Romberg syndrome.

AbstractParry-Romberg syndrome (PRS) is a rare craniofacial disorder whose etiology has not been well understood. The objective of this study was to evaluate the sex difference and the scope of female predominance in PRS. The study used meta-analysis to examine 838 diverse patients from 26 articles. The result of the study showed a significantly higher risk in women in the PRS study populations; the pooled female ratio was 2.23 (95% confidence interval, 1.77–2.80; P < 0.00001; N = 838 patients). There was no significant difference in the association between laterality of PRS and sex, wherein female and male patients have almost the same distribution of left- and right-sided PRS.