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ABSTRACT: To understand Asian noses, set goals for rhinoplasty, and find the best alternative columellar strut.
Six values were used to evaluate the morphology of the nose: tip projection, alar-tip-columellar base angle, alar-columellar base-philtrum angle, nasolabial angle, nasofacial angle, and tip angle. One hundred average Chinese people (50 males and 50 females) were compared with 36 preoperative Chinese patients (13 males and 23 females). We presented an application of high-density porous polyethylene (Medpor) implant as a columellar strut for use in lengthening. We performed 3 surgical techniques: a single-plate strut, a double-plate strut, and a butterfly-shaped strut. Open rhinoplasty (transcolumella incision) was performed on 21 patients; closed rhinoplasty (marginal incision) was performed on 15 patients.
Prominent changes in the 6 values were found in both male and female patients after rhinoplasty.
An analysis of the Asian nose will help surgeons achieve better results. High-density porous polyethylene columellar strut grafts provide adequate support for refined tip definition and the shaping of the columellar-lobular angle.
Archives of facial plastic surgery: official publication for the American Academy of Facial Plastic and Reconstructive Surgery, Inc. and the International Federation of Facial Plastic Surgery Societies 05/2012; 14(3):181-7. · 1.31 Impact Factor
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ABSTRACT: Ethnic characteristics of the Asian upper eyelid include the lack of a superior palpebral fold, excessive fat, laxity of pretarsal skin, and a medial epicanthal fold. We present the lazy S-curve epicanthoplasty for correction of the medial epicanthal fold.
The lazy S-curve incision was made as an entrance step. Then the connective and orbicularis oculi muscle dense fibers underlying the epicanthal folds were released and shifted. To reduce the tension of the new medial canthus, we anchored the canthus by suture fixation of both the subdermal and medial orbital periosteum. Rotation of the S-curve flap was settled as the last step.
From December 2005 to December 2009, the authors corrected the epicanthal folds on the eyelids of 156 Asian patients using the lazy S-curve epicanthoplasty. Results were satisfactory in most of the follow-up cases.
Lazy S-curve epicanthoplasty is a reliable and effective method to eliminate not only the epicanthal fold but also the undesirable orbicularis oculi muscle.
Aesthetic Plastic Surgery 08/2011; 36(2):254-60. · 1.41 Impact Factor
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ABSTRACT: The repair of fronto-orbital nasal bone defects may be a troublesome problem to plastic surgeons. This report aims to present the results of reconstruction of fronto-orbital nasal bone defects with the prefabrication of epoxied maleic acrylate/hydroxyapatite compound (EH compound) using 3-dimensional (3D) imaging data and computer-assisted manufacturing techniques, sometimes combined with autogenous bone to repair nasal defect. Helical computed tomography data were used to create a 3D model of the patient's skull. On the basis of these data, the individual shape of the implant was created by a computer-aided design/computer-aided manufacturing program. A rapid prototyping system was applied for production of the physical models. A total of 12 patients with traumatic fronto-orbital nasal defects were included in this study. The patients followed up for 1 to 24 months. The satisfactory results, such as excellent symmetry, stability, and normal fronto-orbital contours were obtained for all patients. The operating time was short without any complications. The depression of the region of fronto-orbital nasal bone defects always achieved an attractive or satisfactory prominence that was in balance and harmony with other facial features of all the patients. This method allows accurate fabrication of the implant. It improves the surgical techniques and reduces the risk of a second intervention, with improved aesthetic outcomes.
Annals of plastic surgery 05/2011; 67(5):493-7. · 1.29 Impact Factor
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ABSTRACT: To evaluate the dynamic morphologic changes in the masseter muscle after mandibular angle sagittal split osteotomy (MASO).
Computed tomographic (CT) examinations were performed on 130 patients treated with MASO before surgery and at 3, 6, 12, and 18 months after surgery. These CT images were stored and a 3-dimensional reconstruction was made for calculating the volume of masseter muscle using Mimics 10.01 software. The cross-sectional area of masseter muscle was evaluated preoperatively and postoperatively using 3-dimensional CT images observed from 3 selected slice levels, which paralleled the Frankfurt horizontal plane.
Following treatment, the reduction of the volume and cross-sectional area of masseter muscle were calculated. The volume of the masseter muscle was reduced by 28.18%, 39.58%, 33.37%, and 31.18% at 3, 6, 12, and 18 months postoperatively, respectively. The cross-sectional area of 3 slices were reduced, but the sectional area of the lower slice had the sharpest decline, with reductions of 79.27%, 84.39%, 84.02%, and 83.57% at 3, 6, 12, and 18 months postoperatively, respectively.
The results showed that the masseter muscle undergoes significant atrophy after mandibular osteotomy, and these changes could be considered as a guide for the design and simulation of MASO before surgery.
Archives of facial plastic surgery: official publication for the American Academy of Facial Plastic and Reconstructive Surgery, Inc. and the International Federation of Facial Plastic Surgery Societies 04/2011; 13(5):301-4. · 1.31 Impact Factor
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ABSTRACT: This study was conducted to investigate whether there is a consistent cutaneous branch by anatomic research of the supratrochlear artery. Ten fresh adult cadavers were selected. Anastomosis between the supratrochlear artery and supraorbital artery was observed. The mean distance from the supraorbital rim to the supratrochlear artery was 1.18 +/- 0.36 cm. A consistent cutaneous branch of the supratrochlear artery increased in a position 1.35 +/- 0.34 cm lateral to the midline that anastomosed abundantly with the cutaneous branch, the muscular branch of the opposite side, the ipsilateral muscular branch, and bilateral supraorbital arteries. An ultrathin forehead skin flap with the cutaneous branch as the blood vessel was designed and used for nasal reconstruction in 15 cases. Postoperatively, all flaps survived successfully with satisfactory surgical results. The advantages of the flap are its thin feature and preservation of the entirety of the frontalis muscle.
Annals of plastic surgery 08/2010; 65(2):183-7. · 1.29 Impact Factor
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ABSTRACT: To explore the application prospects of EH compound artificial bone material combined with computerized three-dimensional reconstruction in craniomaxillofacial surgery.
Computed tomographic scan, computer-aided design/computer-aided manufacturing three-dimensional reconstruction, and rapid prototyping were conducted on 39 patients during 2005 to 2008. An EH compound artificial bone material was made into the exact geometric shapes of the defect to be corrected and then implanted during surgical reconstruction.
The EH compound artificial bone implants were perfectly matched with the facial areas needed for repair. The reconstructed faces were symmetric on the whole, and postoperative results were satisfying.
The EH compound artificial bone material combined with computerized three-dimensional reconstruction offers a new method in craniomaxillofacial surgical practice. Aesthetic results after reconstruction surgery can therefore be effectively improved.
The Journal of craniofacial surgery 03/2010; 21(2):440-3. · 0.81 Impact Factor
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ABSTRACT: Making use of transcranial Doppler sonographic (TCD) technology to monitor the preoperative and postoperative changes in cerebral hemodynamics of sick children with craniostenosis and to evaluate the effects brought about by decompression surgery of craniostenosis by means of various changes in the parameters of cerebral blood flow.
Choosing bilateral middle cerebral arteries as target vessels by means of TCD and recording preoperative and postoperative cerebral blood flow velocities (peak systolic [Vs] and diastolic velocities [Vd]), pulsatility index (PI), blood pressure, and pulse rate.
Among 11 cases of children with craniostenosis, postoperative Vs and Vd of 4 children aged 0 to 3 years old increased by 20.25 (14.75) and 15.75 (12.98) cm/s, respectively (P < 0.05); PI reduced by 0.09 (0.09) (P > 0.05); finger press marks could be found in 4 skull x-ray films, and ventricular dilatation was found in one of them. Postoperative Vs and Vd of 5 children aged 4 to 7 years old increased by 16.20 (15.39) and 15.00 (11.71) cm/s, respectively (P < 0.05); PI reduced by 0.14 (0.11) (P < 0.05); one of them experienced ventricular dilatation. In 2 children aged 11 years old, postoperative Vs, Vd, and PI increased by 2.50 (5.00) and 0.500 (3.79) cm/s and 0.09 (0.09), respectively (P > 0.05). An abnormality could be found in electroencephalograms of a child with Apert syndrome and 2 children with hydrocephalus.
Operation can improve obviously younger sick children's cerebral blood flow velocity and PI; for older children, the improvement of diastolic cerebral blood flow velocity was more obvious than that of systolic cerebral blood flow velocity, and PI reduced distinctly, which showed that decompression surgery had a perfect effect on craniostenosis. The TCD parameters of an 11-year-old sick child who has a smaller head circumference but without intracranial hypertension could not be improved obviously. Transcranial Doppler sonography can be regarded as a simple and convenient tool for the noninvasive evaluation on the effect of decompression surgery of craniostenosis.
The Journal of craniofacial surgery 03/2010; 21(2):432-5. · 0.81 Impact Factor
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ABSTRACT: To explore the concise surgical approach to treat complicated intracranio- and extracranio-orbital fibrous dysplasia.
A lateral approach started at the upper corner of the orbit was used in subtotal resection of fronto-orbital fibrous dysplasia, involving the frontal, orbital, sphenoid, and temporal bones. Subtotal lesion removal and optic nerve decompression were performed after unilateral frontotemporal craniotomy. Reshaping of the frontotemporal bone flap was then carried out for replacing to gain better shape of the fronto-orbital region. Radiological examinations and visual functional evaluations were conducted before and after the operation.
In our series of 21 cases, better fronto-orbital contour has been received, except 1 case of relapse in a teenager. The follow-up period ranged from 9 months to 3 years. Improvement in visual function was obtained in 19 cases of vision impairment.
Lateral approach that starts at the upper orbital rim and temporal fossa is a concise approach in correction of fronto-orbital fibrous dysplasia.
The Journal of craniofacial surgery 09/2009; 20 Suppl 2:1831-5. · 0.81 Impact Factor
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ABSTRACT: The zygomatic body and arch are usually prominent in Asians; therefore, malar reduction is one of the most popular procedures for aesthetic facial contouring. The purpose of this study was to establish a new option for reduction malarplasty and analyze the merits and demerits of conventional operative techniques, thus searched for more effective and reliable surgical procedures.
Records of 570 patients who underwent reduction malarplasty in our center from 1988 to 2008 were reviewed in this study. Several introduced malar reduction techniques were used until an alternative wedge-section osteotomy technique was performed by the senior author (X.M.) in 2002. This new technique consisted wedge-section osteotomy of the lower zygomatic body via intraoral approach and greenstick infracture of the posterior zygomatic arch through a tiny sideburn stab incision. In this way, the prominent malar complex could be reduced by being pressed inward and stabilized by only surgical suture in moderation. The surgical indications, major complications, and patient satisfaction of different techniques were compared.
In our experience, intraoral incision was better than coronal incision because of less iatrogenic scar formation and postoperative complications. Our wedge-section osteotomy was more effective and reliable as compared with other conventional methods.
Recently, intraoral and minor preauricular incision for malar reduction was more likely acceptable by surgeon as a typical procedure. Our new method was proven to be a safe, effective, and easily handled technique for malar complex reduction and thus was an optimal strategy for aesthetic facial shaping in Asians.
The Journal of craniofacial surgery 09/2009; 20 Suppl 2:1856-61. · 0.81 Impact Factor
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ABSTRACT: Le Fort III osteotomy with midface distraction osteogenesis (Le Fort III DO) can improve the midface form and change the upper airway space. Some surgeons believe that midface advancement can improve respiratory outcome dramatically, but others think it does not predictably result in the cure of obstructive sleep apnea (OSA). In this study, we evaluated the structural and functional changes of the upper airway before and after Le Fort III DO; we hope these studies can improve future protocols for midface advancement. A retrospective study of 11 patients with severe midface retrusion who underwent Le Fort III osteotomy with midface external distractor system was undertaken. These patients had an average of 5.4 months of follow-up. Three-dimensional volumetric assessment of the upper airway was used before and after surgery. We also evaluated the two-dimensional cross-sectional area of the upper airway to show the changes in different airway levels. Two patients with preoperative evidence of OSA were evaluated both preoperatively and postoperatively by overnight polysomnography. The midface was distracted for an average of 20.27 +/- 8.04 mm. Comparison between preoperative and postoperative three-dimensional computed tomographic data showed an average 64.30% increase in upper airway volume, an improvement of 9.13 +/- 6.94 mL (P < 0.05). The two-dimensional measurement also showed that the cross-sectional area at the posterior nasal spine and uvula airway level increased (P < 0.05), but the cross-sectional area at the epiglottis level and the separation of airway and esophagus level did not increase (P > 0.05). Two patients with preoperative evidence of OSA had both preoperative and postoperative sleeping studies that showed improvement. Le Fort III DO can significantly improve the upper airway space in the cases of syndromic craniosynostosis. The upper airway space above the uvula level was significantly enlarged after Le Fort III DO according to two-dimensional and three-dimensional image measurements, and according to the polysomnography, the OSA was alleviated. Le Fort III DO is a promising procedure in the treatment of severe midface retrusion with OSA in young patients.
The Journal of craniofacial surgery 09/2009; 20 Suppl 2:1876-81. · 0.81 Impact Factor
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Xianxian Yang, Xiongzheng Mu,
Qing Gu,
Zheyuan Yu,
Meixiu Ding,
Zhilin Guo,
Dejun Cao,
Dong Yu,
Min Wei,
Tisheng Chang,
Shengzhi Feng
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ABSTRACT: To summarize and analyze the diagnosis, treatment protocol, and therapeutic effect of orbital hypertelorism in the past 30 years in our center.
This retrospective study reviews the records of 128 patients from 1978 to 2008. Both radiologic measurements, such as the interorbital distance and the outer orbital distance, and anthropometric measurements, such as the width of the inner canthi (W-IC), the width of the palpebral fissure, the width of the face, and the nasofrontal angle, were conducted before and after the operation to evaluate both osseous and soft tissue alteration. An analysis of the etiology, surgical method, and complication has been undertaken.
The main cause of orbital hypertelorism in our center was craniofacial cleft. Significant improvement in cranio-orbital appearance was noted, and 91.4% of the patients were satisfied with the surgical correction. Follow-up examinations showed a statistically significant difference between preoperative and postoperative measurements: interorbital distance; outer orbital distance; facial ratios W-IC/width of the palpebral fissure and W-IC/width of the face (P < 0.01); and nasofrontal angle (P < 0.05). Temporary complications and side effects remained low, with cerebrospinal fluid leakage occurred as the major complication (6.3%).
There are several important protocols regarding the management of orbital hypertelorism that will provide patients with great benefit in achieving more aesthetic facial appearance.
The Journal of craniofacial surgery 05/2009; 20(3):718-23. · 0.81 Impact Factor
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ABSTRACT: The aim of the study was to find a proper method that may evaluate the severity of facial asymmetry quickly and accessibly in clinics.
The three-dimensional image data of facial asymmetry patients were collected with three-dimensional laser surface scanning, and the desired therapy outcomes were simulated in computers by flip-registration procedure. The discrepancy between desired results and initial images was calculated automatically, and a colored hypsography was printed. A questionnaire was given to both the patient and the craniofacial surgeon to examine the symmetry, accessibility, achievability, and helpfulness of these outcomes.
The three-dimensional image data offered by laser surface scanning were accurate and convenient. The desired results were reliable and acceptable to the patients. The colored hypsography was clear and accessible and achieved high appreciations from the surgeons.
Three-dimensional laser surface scanning together with flip registration procedure can evaluate the severity of facial asymmetry quickly, quantitatively, and effectively with an achievable outcome. It is welcomed by the craniofacial surgeons and has a great potential in clinic application.
The Journal of craniofacial surgery 02/2009; 20(1):157-60. · 0.81 Impact Factor
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Plastic and reconstructive surgery 12/2008; 122(5):1589-90; author reply 1590-1. · 2.74 Impact Factor
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ABSTRACT: Acquired orbital deformity is a common disease in the practice of craniofacial surgery. Defective orbital volume and abnormality of eyeball position are the most important characteristics of pathologic changes. This study includes 87 cases of acquired orbital deformity, which received surgery for volume aberration from 2002 to present. Among them, 73 cases received orbital volume expansion surgery and 14 cases received reduction surgery. Coronal scalp, lower eyelid, or intraoral gingival-buccal incisions were carried out for the approach. In some patients, the original scar around the orbit was chosen for the incision. Operation aims were reduction of orbit and reconstruction of the orbital wall integrity. Operative methods were osteotomy for reduction and implantation of autologous bone or artificial materials. Orbital volume and eyeball position were restored to normal in all patients after the operation, and no serious complications occurred. Treatment of acquired orbital deformity should make restoration of orbital volume as the most important target of therapy. Autologous bone should be the material of first choice, and the selection and amount of implanted material should be decided by the specialty and experience of the physician.
The Journal of craniofacial surgery 07/2008; 19(4):1092-7. · 0.81 Impact Factor
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ABSTRACT: The surgical treatment of craniofacial malformation is a sophisticated task which needs careful and detailed preoperative planning. However, based on the patient's 2-D CT and X-ray images, the surgeons always feel hard to produce a convincible and satisfying surgical scheme. In this article, a craniofacial surgery simulation system based upon 3-D reconstruction and volume calculation of two eye sockets is presented. By using this system, the surgeon can virtually repose bone fragment according to the D-value between the volumes of two eye sockets. The D-value serves as a guideline to direct the bone reposing. The simulated key steps of real surgical procedure are presented, which demonstrate the efficiency of the system. The contrast images between postoperative and preoperative surgery are also given.
Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi 05/2005; 22(2):293-6.
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ABSTRACT: For dealing with the problems in orbital and periorbital deformities.
In orbital deformities such as hypertelorism, orbital dystopia, radiated orbit, and secondary deformities of traumatic orbit, the authors used lamella osteotomies of either orbital rim and wall or complex osteotomies in both adjacent orbital rims and walls with bicoronal incision and galea aponeurotica dissection. In most of the cases, the fragments of complex osteotomies were repositioned with rigid fixation.
Best results with nearly normal orbital volumes, better contour of orbit and midface, and improved eyelids and vision were achieved in 44 cases. There were 5 cases of supraorbital osteotomy (intracranial routine), 8 cases of medial orbital osteotomy, 3 cases of inferior orbital osteotomy, and 28 cases of both lateral and inferior orbital osteotomy in the series. No complications occurred. Clinical measurement was achieved in both pre- and postoperative osteotomies. According to comparative recordings, such as cephalometric measurement of the interorbital distance, exophthalmic measurement with Hertel exophthalmometer, the angle between orbital horizontal level and bilateral tragus linkage, and the linear distance between lateral canthus and tragus, the gap difference between pre- and postoperative data were achieved. The orbital and midface appearance has improved significantly.
Lamella and complex osteotomies of orbital rim and wall were proved to be save and effective for correction of most deformities of the orbital and periorbital region.
Journal of Craniofacial Surgery 02/2005; 16(1):144-9. · 0.82 Impact Factor
