Journal of Cranio-Maxillo-Facial Surgery

Editorial Board

2010-09-01

A three-dimensional study of facial mimicry in healthy young adults

Chiarella Sforza, Domenico Galante, Yuri F. Shirai, Virgilio F. Ferrario — 2009-11-26

Summary: To assess sex-related characteristics in facial movements, and to define a set of reference normal values, 20 healthy young adults (10 men, 10 women) performed six standardized facial movements (maximum smile; free smile; “surprise” with closed mouth; “surprise” with open mouth; right- and left-side eye closures). The three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded by an optoelectronic motion analyzer, their movements computed, and standardized for facial dimensions. Asymmetry indices were calculated. The mouth area had the largest movements. Sex-related differences were found only for the superciliare landmark (men had larger movements than women, p<0.001). Asymmetries in the eyes, mouth and nose were similar in both sexes (p>0.01), with a significant effect of movement (p<0.001): eye and mouth asymmetry was larger during the asymmetric eye closures than during the symmetric movements. The right-side asymmetric movements were somewhat larger than the left-side ones. The total facial movement did not differ between sexes; the “surprise with mouth open” movement had the largest landmark displacements (p<0.001). In conclusion, normal young adult men and women had similar standardized facial movements, except in the forehead. Some individual asymmetry was found in symmetric facial animations; some synkinesis was found even in normal adults.

Contouring the forehead and rhinoplasty in the feminization of the face in male-to-female transsexuals

Rupert Dempf, Alexander W. Eckert — 2009-12-28

Summary: Transsexualism is a gender identity disorder in which there is a strong and ongoing desire to live and be accepted as a member of the opposite sex. In male-to-female transsexuals with strong masculine facial features facial feminization surgery can be performed as part of gender reassignment. The male forehead has extensive supraorbital bossing, and above this there is often a flat area before the convex curvature of the upper forehead begins. In the female, the supraorbital bossing is considerably less, often nonexistent, and above this the flattening is usually less marked and more of a continuous mild curvature. The female nose is relatively smaller than the male nose. The glabellar and the nasolabial angle are less acute. The female nose is regarded as attractive if it shows a straight or mildly concave dorsum and an accented tip. We present a case of treatment of a 26-year-old male-to-female transsexual to demonstrate that contouring the forehead combined with a rhinoplasty can lead to significant feminization of the face. The procedures described seem to be safe and reliable.

Bone formation and degradation of a highly porous biphasic calcium phosphate ceramic in presence of BMP-7, VEGF and mesenchymal stem cells in an ectopic mouse model

2010-03-02

Summary: Introduction: Angiogenesis and mesenchymal stem cells (MSCs) promote osteogenesis. The aim of the present study was to evaluate whether bone morphogenetic protein (BMP-7) promoted osteoinduction could be enhanced by combining it with vascular endothelial growth factor (VEGF) or MSCs in highly porous biphasic calcium phosphate (BCP) ceramics.Materials and methods: BCP ceramic blocks were implanted in an ectopic site in 24 mice (BMP-7 vs. BMP-7/VEGF; BMP-7 vs. BMP-7/MSCs and BMP-7 vs. Control; each group n=8). Specimens were analysed 12 weeks after surgery by environmental scanning electron microscopy (ESEM) and Giemsa staining.Results: In all implanted scaffolds, newly formed bone was observed, even in the control site. No statistical differences in the amount of new bone were found in the presence of BMP-7 compared to BMP-7/VEGF (p=1.0) or BMP-7/MSCs (p=0.786). ESEM revealed a degradation of the scaffolds. A higher degradation was observed in areas where no bone-implant contact was present compared to areas where the ceramic was integrated in newly formed bone.Conclusions: Neither VEGF nor MSCs enhanced BMP-7 induced bone formation under the selected conditions. The present ceramic seemed to be osteoinductive and degradable, making this material suitable for bone tissue engineering.

“Mandibular distraction osteogenesis for severe airway obstruction in Robin Sequence. Case report”

Ioannis Iatrou, Nadia Theologie-Lygidakis, Ourania Schoinohoriti — 2009-12-11

Summary: Mandibular distraction osteogenesis (MDO) has been increasingly gaining interest over the last decade as a treatment alternative for the challenging airway management in infants with the Robin Sequence (RS).This paper is a case report of a male child diagnosed with RS, suffering from life-threatening airway obstruction and feeding difficulties, treated with tracheostomy and gastrostomy since infancy. After evaluation of the patient by a multidisciplinary team of specialists, MDO performed as soon as possible, was considered the optimal treatment, not only to address the severe micrognathia but also to allow early tracheal decannulation.As the lack of space intraorally contraindicated the use of internal distractors, they were placed externally bilaterally. The patient was successfully decannulated 3 weeks postoperatively and the gastrostomy was removed 1 month postoperatively. The mandibular expansion exceeded 20mm bilaterally and the maxilla-mandible discrepancy was fully corrected. There were no complications related to device placement, activation or removal.Follow-up clinical and radiographic examinations of the patient 1 year after the removal of the distractors revealed improved mandibular projection and continued mandibular growth. No significant scarring occurred at the surgical site and the patient has normal respiratory and feeding function.

An alternative method to match planned and achieved positions of implants, after virtual planning using cone-beam CT data and surgical guide templates – A method reducing patient radiation exposure (part I)

Hans-Joachim Nickenig, Stephan Eitner — 2009-11-26

Summary: Objectives: The present study describes a new method of evaluating the precision of surgically placed dental implants compared after virtual planning of implant positions using cone-beam computed tomography (CT) data and surgical guide templates. This method reduces radiation exposure for patients participating in scientific studies.Materials and methods: Twenty-three implants in 10 patients with a unilateral free-end gap in the mandible (Kennedy Class II) were evaluated. After three-dimensional planning of implant position, the implant bed was prepared with a surgical guide template and transmucosal drilling. Preoperative cone-beam CT images were matched with postoperative images of the master cast with implant replicas. Deviations between planned and achieved positions were measured in position and axis.Results: On average, the match between planned and placed implant axis was within 4.2 degrees (range, 0.0–10.0). The mean difference in distance at the implant shoulder was 0.9mm (range, 0.0–4.5). The mean difference in distance at the implant apex was 0.6mm (range, 0.0–2.7) in the lateral/medial direction and 0.9mm (range, 0.0–3.4) in the anterior/posterior direction.Conclusions: This alternative matching method provides reliable postoperative evaluation of differences in position and axis of planned and placed implants while reducing patient radiation exposure.

How to revise and utilise the cephalogram for craniofacial dysostosis—Modification of the porion and the McNamara line

2009-11-30

Summary: McNamara line analysis is often utilised in orthognathic surgery and is particularly useful in that it can easily express the extent of maxillo-mandibular deformity quantitatively. However, in craniofacial dysostosis (CFD), the location of the porion (PR) is sometimes displaced inferiorly. The McNamara line depends on the Frankfurt horizontal plane (FH plane), and hence, its deviation is often extremely distorted in CFD.The objective of this study was to enable more correct reflection of deformities of CFD patients on lateral cephalogram analysis. The lateral cephalograms of 152 Asian individuals were involved. ∠basion(BA).orbitale(Or).PR, ∠BA. nasion(NA).PR, and the distance from BA to PR on the BA-NA plane were measured and each standard range was established. Using these ranges, modified PR (mPR) is supposed to lie within a fairly small area.Second, we utilised mPR in the practice of McNamara line analysis in CFD patients. In both cases in the present study, it was confirmed that modified McNamara line analysis can express the deformities more precisely than conventinal analysis, as far as the maxillo-mandibular relationship is concerned. However, particularly in Case 2, both the cranio-maxillary and cranio-mandibular relationships were not entirely consistent with the lateral profile appearance even on modified McNamara line analysis.

Development of a test for evaluation of taste perception after tongue reduction

2009-12-11

Summary: When performing a tongue reduction a frequently asked question is how operation will influence taste of the patient. Different kinds of taste tests are designed, most of these being non-specific ways to determine taste sensation in which high concentration of taste solutions are used to detect if a person is able to taste.To be able to judge the influence of tongue reduction on taste we wanted to develop a validated test that could be used in early childhood. No specific tasting areas were found. This test can be used to evaluate tongue reduction procedures.

The figure-of-eight radix nasi flap for medial canthal defects

Tamer Seyhan — 2010-01-15

Summary: Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been succesfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars.

The bilobed flap in skin cancer of the face: Our experience on 285 cases

2009-11-26

Summary: Background: This article describes how many of the defects caused by oncological surgery can be closed with an easily estended flap.Patient and Method: The Zitelli bilobed flap was used to treat 285 consecutive patients with basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs); 167 men (58.60%) and 118 women (41.40%) between 45 and 98 years of age. Histologically, 247 BCCs (86.6%) and 38 SCCs (13.4%) were documented. Regarding the site, 148 (51.9%) involved the nose, 51 (17.9%) the cheeks, 36 (12.6%) the preauricular region, 27 (9.5%) the perilabial region and chin and 23 (8.1%) the periorbital region. To measure long-term satisfaction patients responded to a telephone survey consisting of a single global question.Results: The size of the defect following tumour removal was between 1 and 4cm. Carcinomas up to 1cm were treated using a one step procedure with a cryostat test of the surgical margins; all others cases were treated using two step procedure after excision and histological in sano resection. Completely acceptable aesthetic and functional deficits were obtained in 275 (96.4%) patients over a 6–72-month follow-up. Ten (3.6%) patients suffered postoperative complications. Two cases of local infection; one case of completely flap necrosis and seven cases of partial revision due to flap necrosis occurred. The level of satisfaction with the surgical long-term result reported by the patients was high.Conclusion: In our experience the bilobed Zitelli flap for covering defects in the area of the face showed very few complications and good aesthetic results.

Total mandibular reconstruction after resection of rare “honeycomb-like” ameloblastic carcinoma – A case report

2009-11-30

Summary: Purpose: This case report describes a rare and aggressive ameloblastic carcinoma that infiltrated the mandible in a “honeycomb” pattern.Methods: A total mandibulectomy with bilateral modified neck dissection was followed by primary reconstruction with a single free vascularised fibula flap.Results: The postoperative course was uneventful. The one year follow-up revealed no signs of recurrent tumour or metastases. Nine months later distant metastases occurred in the lung.Conclusion: Ameloblastic carcinoma is a highly malignant lesion, which requires aggressive therapy. Prognosis is poor. Further reporting of ameloblastic carcinoma is encouraged.

Simultaneous management of the enophthalmos and sinus pathology in silent sinus syndrome: A report of three cases

Enrico Sesenna, Gabriele Oretti, Marilena Laura Anghinoni, Andrea Ferri — 2010-01-22

Summary: Silent sinus syndrome is a rare disorder affecting the maxillary sinus unilaterally, characterized by ipsilateral enophthalmos and hypoglobus. The treatment is surgical: the endoscopic approach represents the gold standard for the restoration of normal sinus aeration, but there is no consensus in the management of the enophthalmos. Most authors suggest a two stage procedure consisting of endoscopic sinus surgery initially and a delayed secondary operation for the restoration of the orbital floor. We present our experience with three cases treated with a single-stage procedure, focusing on the advantages of this one-step approach.

Bilateral carcinoma of the temporal bone: Case report and literature review

Theodore Vamvakidis, John Sengas, John Xenellis — 2009-12-25

Summary: Introduction: Squamous cell carcinoma of the temporal bone is a rare entity. Only a few cases have been reported in the literature and even fewer describe bilateral tumours. Because its clinical presentation resembles chronic otitis media or otitis externa, diagnosis could be delayed.Case Report: A case is presented of bilateral squamous cell carcinoma of the temporal bone in a 66 year old woman. The patient underwent a left subtotal petrosectomy followed by a right subtotal petrosectomy a month later.Conclusions: Early diagnosis is directly related to patient prognosis. However, prognosis remains poor and the surgical treatment is a challenge for the experienced skull base surgeon.

EACMFS Prizes and Awards

2010-09-01

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

Announcements

2010-09-01

Dear Colleagues, As the Education and Training Officer of the European Association for Cranio-Maxillofacial Surgery, I would like to draw your attention to the forthcoming educational activities. Courses included in the Rolling Programme of the Association are linked to the EBOMS examination curriculum and cover all aspects related to our specialty and are open to all colleagues working in our field. Trainees are especially invited to attend these Courses. A refund of Euro 150 is available for each EACMFS Trainee Member attending a Course of this Programme.