Evaluation of the Effects of Mandibular Angle Sagittal Ostectomy and Botulinum Toxin Type A Treatment using Facial Golden Mask

PURPOSE: A lower facial contouring surgery has become a commonly performed procedure in Asia. Currently, mandibular angle sagittal ostectomy and botulinum toxin type A treatment are main procedures for aesthetic correction of a broad lower face. There are a few data to show the differences in the mandibular contouring changes between mandibular angle splitting ostectomy and botulinum toxin type A treatment. Facial golden mask is easy to apply, inexpensive, and relatively objective in evaluating facial contour analysis. This study was designed specifically to compare the changes in lower face width after two different forms of lower facial contouring procedure using facial golden mask. METHODS: Seventeen patients, with the ages ranged from 18 to 55 years(mean, 28.6 years), 15 women and 2 men, consented to the study and receive a contouring procedure of lower face. The patients were classified into 2 groups. In group A, the sample consisted of 10 patients with a prominent squared mandibular angle and mandibular angle splitting ostectomy was performed. In group B, the sample consisted of 7 patients with masseteric hypertrophy and botulinum toxin type A treatment was performed. Photographs of the face were taken to record the facial change at preoperative and postoperative. The postoperative photographs were taken to considered maximal effect in 2 years after the surgery in group A, and 4.8 months after the treatment in group B. The authors applied the facial golden mask to preoperative and postoperative photographs and horizontal ratio, which compares facial width with golden mask width, were calculated. We made an analysis of the result of horizontal ratio using SPSS. RESULTS: Overall average horizontal ratio of pre- and postoperative photos of group A were 1.24 and 1.11, whereas overall average horizontal ratio of pre- and postoperative photos of group B were 1.19 and 1.12. The horizontal ratio decreased 10.24% in group A and 5.93% in group B. There was a statistically significant changes in before and after treatment, but there was no significant change in comparing the group A and group B. CONCLUSION: The results from this study suggest that mandibular angle sagittal ostectomy and botulinum toxin type A treatment showed relatively satisfactory clinical effects on lower facial contouring treatment. There were no statistical significant differences within two lower facial contouring treatment. Facial golden mask is easy to apply, inexpensive, and relatively objective, so we think that facial golden mask is a good method for evaluation of lower facial contouring treatment.

The Usefulness of Intermolar Traction Wiring for Restoration of Maxillary & Mandibular Dental Arch in Facial Bone Fracture

PURPOSE: Palatal fracture and mandible fracture result in instability of dental arch. Because they divide the maxillary and mandibular alveolus sagittally and / or transversely and comminute the dentition, they permit rotation of dental alveolar segments and significantly increase the potential for fracture malalignment, complicating fracture treatment. Previous treatment of palatal fracture consisted of palatal splint application and rigid palatal vault stabilization. This procedure result in patient's oral discomfort and removal of palate and screw. Mandible fracture often results in malocclusion due to widening of posterior aspect of dental arch. So we introduce simpler method using intermolar traction wiring, which can protect the widening of dental arch and rotation of dental alveolar segment. METHODS: Arch bar and intermolar traction wiring with wire 1-0, or 2-0 was applied. After exposure of fracture line, neutroclusion was maintained with intermaxillary fixation. And then open reduction & internal fixation on maxillary fracture line, commonly maxillary buttress, alveolar ridge, pyriform aperture except palatal vault or mandibular fracture line. After 1 week, intermolar traction wiring was removed. We checked occlusion and postoperative radiologic finding. RESULTS: From June 2007 to October 2007, 10 patient, who have maxillary fracture with palatal fracture and mandible fracture, underwent open reduction & internal fixation with intermolar traction wiring. All have satisfactory occlusion and there were no complication, like gingiva disease, mouth opening impairment and nonunion. CONCLUSION: The intermolar traction wiring accompany open reduction and internal fixation can be an alternative method for restoration of dental arch in facial bone fracture.

Use of Submuscular-Subcutaneous Pocket in Immediate Prosthetic Breast Reconstruction for the Realization of Natural Ptotic Breast

One-stage breast reconstruction with implant is the most popular method for the breast reconstruction. Since most of the implant is inserted into submuscular pocket, displacement of implant and loss of ptosis are inevitable, because of narrow space of submuscular pocket. Therefore, submuscular-subcutaneous pocket has been introduced to reproduce natural ptotic breast and we have experienced complication of "bottom-out" of implant. To prevent this complication, supportive surgical brassiere was applied. After subcutaneous mastectomy, the undermining of the pocket was submuscular in its upper part and subcutaneous in the lower part of the breast. The muscle was released inferiorly from the origin, and the detached pectoralis muscle was sutured to the subcutaneous tissue of skin flap. Supportive surgical brassiere postoperatively maintained for 3 months. From June of 2006 through May of 2007, 30 subcutaneous mastectomies combined with breast reconstruction were performed in 29 patients. The reconstructed breasts appeared satisfactorily ptotic. Nevertheless, there were short term complications such as infection (2 cases) and wound dehiscence (1 case). Capsular contracture occurred in 6 patients. We suggest the submuscular-subcutaneous pocket technique combined with postoperative supportive surgical brassiere as a simple and reliable method of breast reconstruction for realization of natural ptotic breast.