Colgajo de Mustardé como tratamiento de un carcinoma basocelular. A propósito de un caso

Introducción: El carcinoma basocelular es actualmente el cáncer de piel más frecuente, siendo su principal factor de riesgo la exposición a radiación ultravioleta. Su tratamiento es la resección quirúrgica, según riesgo de recurrencia. La reconstrucción facial posterior a la resección se enfrentará según la unidad estética de la cara, lo cual determinará la técnica quirúrgica a utilizar. Material y Método: El siguiente caso clínico aborda la resección de un carcinoma basocelular nodular morfeiforme ubicado en mejilla y ala nasal, y posterior reconstrucción mediante el uso de un Colgajo de Mustardé, con resultado exitoso. Resultados: Evolución favorable, con reseccion completa de la lesion tumoral y vitalidad del colgajo postoperatorio. Cursó con una leve desviación nasal que cedió con masaje de la cicatriz. Se puede plantear una plastía de retoque del ala nasal a futuro. Conclusión: Presentamos un caso clínico de un carcinoma basocelular facial con alto riesgo de recurrencia que fue tratado en forma segura y efectiva con un colgajo de Mustardé.

Introduction: Basal-cell carcinoma is currently the most frequent type of skin cancer, its main risk factor being exposure to ultraviolet radiation. Treatment consists of surgical resection, according to recurrence risk. Post-resection facial reconstruction should be faced according to the aesthetic unit of the face, which will determine the surgical technique. Material and Method: The following clinical case presents the resection of a morpheiform nodular basal-cell carcinoma located on the cheek and nasal wing, and subsequent reconstruction using a Mustarde flap, with successful results. Results: Favorable evolution with complete resection of the tumor lesion and postoperative vitality of the flap. The patient presented a slight nasal deviation that resolved with scar massage. A nasal wing plasty can be considered in the future. Conclusion: We present a facial basal-cell carcinoma clinical case that was safely and effectively treated with a Mustarde flap.

Reconstrucción de defecto de órbita con colgajo prelaminado de fascia temporal superficial / Orbit defect reconstruction with pre-laminated temporal superficial fascia flap

El colgajo de fascia temporal superficial es muy versátil para la reconstrucción de defectos tisulares localizados en los tercios superior y medio de la cara, en la región orbito-palpebral, en la cavidad oral, en la base del cráneo y a nivel mandibular. En nuestra experiencia, constituye una opción segura para reconstrucciones complejas de cavidades. En el presente artículo los autores exponen el caso de una paciente en quien se reconstruyó un defecto de órbita con un colgajo de fascia temporal superficial prelaminado

The superficial temporal fascia flap is versatile for the reconstruction of tissue defects located in the upper and middle thirds of the face, in the orbital-palpebral region, in the oral cavity, at the base of the skull and at the mandibular level. In our experience, it is a safe option for complex cavity reconstructions. In this article the authors present the case of a patient in whom an orbit defect was reconstructed with a pre-laminated superficial temporal fascia flap

Colgajos Locales en Reconstrucción Facial. Alternativas de Tratamiento

RESUMEN: Los defectos faciales de piel son frecuentemente secuelas producto de carcinomas basoceulares, carcinomas espinocelulares, melanomas, grandes tumores benignos o traumatismos de tejidos blandos. Las unidades y subunidades estéticas de la cara, la textura y color de la piel, junto a otros parámetros deben ser considerados durante la planificación de la reconstrucción mediante colgajos locales. El objetivo de este artículo de revisión bibliográfica fue describir y definir las técnicas más relevantes en los de colgajos locales aplicados en la reconstrucción facial y sus algoritmos actuales, en relación con la unidad o subunidad facial involucrada; sus consideraciones estéticas y cirugía complementaria. Las unidades y subunidades estéticas de la cara se dividen en regiones de la frente, párpados, mejillas, nariz, labios y mentón. Los colgajos de rotación, en isla, de avance y transposición son la base para la mayoría de los colgajos faciales; los más conocidos según la zona donante son: el colgajo frontal, colgajo de rotación y avance de mejilla; colgajo cérvico-facial, y colgajos nasolabiales, entre otros. La elección del colgajo depende de la zona y la unidad estética facial involucrada, siendo importante elegir y usar las líneas, los surcos y márgenes de estas unidades cuando sea posible con el fin de mejorar los resultados estéticos y reducir la posibilidad de secuelas. La cirugía complementaria y los procedimientos estéticos pueden lograr un buen camuflaje de algunas complicaciones estéticas o secuelas.

ABSTRACT: Skin face defects are frequently sequels of basal cell carcinomas, squamous cell carcinomas, melanomas, and large benign tumors or soft tissue trauma. Aesthetics units and subunits of the face, texture, color, and other parameters must be considered in the local flaps reconstructive planning. This review article aims to describe and define the most relevant techniques of facial local flaps in facial reconstruction and their current algorithms, regarding the unit or subunit, involve, their aesthetics considerations and complementary surgery. The aesthetics units and subunits of the face are divided into forehead, eyelids, cheek, nasal, lips, and chin. There are several well-known concepts and flaps used in these proceedings as rotation, island, advancement, and transposition flaps, and they are the basis for facial local flaps; The most relevant are: forehead flap, cheek advancement, and rotate flap; rhomboid, cervicofacial and bilobed flap, nasolabial flaps. The flap election depends on the zone and unit involve; it is important to choose the lines, sulcus, and borders of these units when is possible to enhance these aesthetics outcomes. These concerning improve the aesthetics outcomes and reduce the aesthetics sequels. Complementary surgery and aesthetics proceedings may accomplish a good camouflage of some aesthetics complications or sequels.

Variation In The Mode Of Origin And Level Of Formation Of Nerve To Medial And Lateral Head Of Gastrocnemius Muscle

Variations of nerve are not only of anatomic and embryological interest but also of clinical importance. Theiradequate knowledge certainly help in increasing surgical precision and decreasing morbidity. In present studyvariations in mode of origin and level of formation of nerve to medial and lateral head of gastrocnemius wasstudied. The material for the present study comprised of 60 lower extremities belonging to 30 adult humancadavers obtained from Department of Anatomy, PIMS, Jalandhar. Neurectomy of nerve to medial gastrocnemiusmuscle is used to reduce volume of the muscle. For facial reconstruction after total parotidectomy, the facialnerve is being reconstructed by using vascularized sural nerve with free lateral gastrocnemius muscle flap

Research Progress and Prospect of Facial Reconstruction in Forensic Science / 法医学杂志

Facial reconstruction is a way to recover facial morphology by restoring soft tissues based on unidentified skulls using the knowledge of anatomy, anthropology, aesthetics, and computer science. It is applied in forensic science, oral plastic surgery and archeology, and especially plays an important role in the identification of the origin of the unknown corpses in forensic science. Facial reconstruction is the supplementary means of identification when other approaches （such as DNA comparison, imaging matching, dental records comparison, etc.） cannot identify individual identity. Facial soft tissue thickness （FSTT） is the basis of facial reconstruction and with the development of imaging and computer science, the techniques for measuring FSTT are improving rapidly and many related researches have appeared. This paper summarizes the application of facial reconstruction in forensic science, the accuracy of different methods and the research progress of this field to provide reference to this field.

Histomorhological and clinical evaluation of maxillary alveolar ridge reconstruction after craniofacial trauma by applying combination of allogeneic and autogenous bone graft / 中华创伤杂志(英文版)

A variety of techniques and materials for the rehabilitation and reconstruction of traumatized maxillary ridges prior to dental implants placement have been described in literature. Autogenous bone grafting is considered ideal by many researchers and it still remains the most predictable and documented method. The aim of this report is to underline the effectiveness of using allogeneic bone graft for managing maxillofacial trauma. A case of a 30-year-old male with severely atrophic maxillary ridge as a consequence of complex craniofacial injury is presented here. Augmentation procedure in two stages was performed using allogeneic and autogenous bone grafts in different areas of the osseous defect. Four months after grafting, during the implants placement surgery, samples of both sectors were withdrawn and submitted to histological evaluation. On the examination of the specimens, treated by hematoxylin and eosin staining, the morphology of integrated allogeneic bone grafts was revealed to be similar to the autologous bone. Our clinical experience shows how the allogeneic bone graft presented normal bone tissue architecture and is highly vascularized, and it can be used for reconstruction of severe trauma of the maxilla.

Estimation of External Features of Eyes for the Adult Male of Han Nationality in Northeast China Based on the Characteristics of Skull / 法医学杂志

Objective To explore the correlation between the imaging parameters of skull and the external features of eyes.Methods Positive images of the head face and the frontal and lateral X-ray films were obtained from 101 cases of adult males of the Han nationality aged from 20 to 40 years old in Northeast China.The face width (x1),upper face width (x2),biorbital width (x3),all facial height (x4),upper facial height (x5),maximum breadth of skull (x6),minimum breadth of frontal bone (x7),orbital width Ⅱ (x8),anterior interorbital breadth (xg),maximum height of skull (x10),minimum width of nasal bone (x11) and orbital height (x12) were measured and the data were statistically analysed.Results Through the linear regression analysis,the regression equations of the presumed inboard canthi (y1) and outboard canthi distances (y2) were established,respectively,which were y1=0.025 x2+0.291 x3-0.011 x7+0.041 x10-0.525(R=0.613,SEE=0.222 cm) and y2=1.703-0.08x2+0.573 x3-0.142x4+0.421 x5+0.096x7-0.256x8+0.149x9+0.071x10(R=0.745,SEE=0.341 cm).The back-substitution check showed that the accuracy rate of two equations at ±1SEE were 75.2％ and 80.2％,respectively.Conclusion The established regression equations of external features of eyes have high estimation accuracy,which can be used to the practical work of facial reconstruction.

Three-dimensional and topographic relationships between the orbital margins with reference to assessment of eyeball protrusion / 대한해부학회지

This study investigated the topographic relationships among the eyeball and four orbital margins with the aim of identifying the correlation between orbital geometry and eyeball protrusion in Koreans. Three-dimensional (3D) volume rendering of the face was performed using serial computed-tomography images of 141 Koreans, and several landmarks on the bony orbit and the cornea were directly marked on the 3D volumes. The anterior-posterior distances from the apex of the cornea to each orbital margin and between the orbital margins were measured in both eyes. The distances from the apex of the cornea to the superior, medial, inferior, and lateral orbital margins were 5.8, 5.8, 12.0, and 17.9 mm, respectively. Differences between sides were observed in all of the orbital margins, and the distances from the apex of the cornea to the superior and inferior orbital margins were significantly greater in females than in males. The anterior-posterior distance between the superior and inferior orbital margins did not differ significantly between males (6.3 mm) and females (6.2 mm). The data obtained in this study will be useful when developing practical guidelines applicable to forensic facial reconstruction and orbitofacial surgeries.

Facial Transplantation Surgery Introduction

Severely disfiguring facial injuries can have a devastating impact on the patient's quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie "Face/Off" have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea.

Abordagem multidisciplinar do trauma facial grave / Combined approach of severe facial trauma soft tissue

As lesões faciais são comuns nos serviços de emergências médicas, representando cerca de 7% a 10% dos atendimentos. As agressões são as principais causas de fraturas faciais, enquanto que a maior proporção de lesões dos tecidos moles é causada por quedas e acidentes. Embora raramente fatais, o tratamento destas lesões pode ser complexo e determinar impacto significativo sobre a função e estética facial do paciente traumatizado. Este artigo apresenta um caso de lesão facial grave, enfatizando aspectos importantes no manejo do traumatismo facial de partes moles e revisa a literatura relacionada ao tema (AU)

Facial lesions are common in emergency medical services, representing about 7-10 % of cases. Attacks are the main causes of facial fractures, while a higher proportion of soft tissue injuries are caused by falls and accidents. Although rarely fatal, treatment of these injuries can be complex and have a significant impact on facial function and aesthetics of the trauma patient. This article describes a case of severe facial injury, emphasizing important aspects in the management of facial trauma of soft tissues, and reviews the literature related to the topic (AU)

Aproximação fisionômica pericial através de função de base radial hermitiana / Forensic facial approximation through hermitian radial basis functions

A aproximação fisionômica é o método que busca, a partir do crânio, simular a fotografia de um indivíduo quando em vida. Deve ser empregada como último recurso, na busca de desaparecidos, quando não houver possibilidade de aplicação de um método válido de identificação. O objetivo deste estudo foi obter a aproximação fisionômica, a partir de um crânio seco e de tomografia computadorizada multislice de indivíduos vivos, através da função de base radial hermitiana (FBRH). Constituiu-se também em avaliar o resultado da mesma quanto ao reconhecimento. Na primeira etapa do estudo, foi utilizada a imagem escaneada de um crânio seco, de origem desconhecida, com o intuito de avaliar se a quantidade de pontos obtidos seria suficiente para aplicação da FBRH e consequente reconstrução da superfície facial. Na segunda fase, foram utilizadas três tomografias de indivíduos vivos, para análise da semelhança alcançada entre a face escaneada e as aproximações faciais. Nesta etapa, foi aplicada uma associação de diferentes metodologias já publicadas, para reconstrução de uma mesma região da face, a partir de um mesmo crânio. Na última etapa, foram simuladas situações de reconhecimento com familiares e amigos dos indivíduos doadores das tomografias. Observou-se que a metodologia de FBRH pode ser empregada em aproximação fisionômica. Houve reconhecimento positivo nos três sujeitos estudados, sendo que, em dois deles, os resultados foram ainda mais significativos. Desta forma, conclui-se que a metodologia é rápida, objetiva e proporciona o reconhecimento. Esta permite a criação de múltiplas versões de aproximações fisionômicas a partir do mesmo crânio, o que amplia as possibilidades de reconhecimento. Observou-se ainda que a técnica não exige habilidade artística do profissional...

Facial approximation works by building the visual face up from the skull. This method should be performed as last resort, to carry out for missing persons, when there is no other primary identification method avaliable. The purpose of this study was to introduce a new computerized method with hermite radial basis function (HRBF) for facial approximation using dry skull and computed tomography (CT). The same was also evaluated as a result of the recognition. Firstly, a scan of a dry unidentified skull image was used in order to assess if the amount of points would be sufficient for HRBF methodology and subsequent reconstruction of the facial surface. In second, three CT scans of living individuals were used to evaluate the similarity achieved between the real face scanned and facial approximations. An association of different facial structures reconstruction techniques already published for the same region of the face was applied for the same skull. Moreover, some situations from developed facial approximations were simulated, as recognition by a relative or parent, on a face pool-test. Results from the study showed that the purposed methodology can be used for facial approximation. At the three cases a correct approximation identification as one of a few possible matches to the missing person happened. In two of them, the results were consistently better at identifying the correct approximation. In conclusion, the proposed methodology is fast, objective and reaches visual identification. It is possible to perform multiple versions of the same skull, changing the selected data into the system, which maximizes the chances of establishing recognition of the target face. It was also observed that the technique does not need artistic interpretation...

Aproximação fisionômica pericial através de função de base radial hermitiana / Forensic facial approximation through hermitian radial basis functions

A aproximação fisionômica é o método que busca, a partir do crânio, simular a fotografia de um indivíduo quando em vida. Deve ser empregada como último recurso, na busca de desaparecidos, quando não houver possibilidade de aplicação de um método válido de identificação. O objetivo deste estudo foi obter a aproximação fisionômica, a partir de um crânio seco e de tomografia computadorizada multislice de indivíduos vivos, através da função de base radial hermitiana (FBRH). Constituiu-se também em avaliar o resultado da mesma quanto ao reconhecimento. Na primeira etapa do estudo, foi utilizada a imagem escaneada de um crânio seco, de origem desconhecida, com o intuito de avaliar se a quantidade de pontos obtidos seria suficiente para aplicação da FBRH e consequente reconstrução da superfície facial. Na segunda fase, foram utilizadas três tomografias de indivíduos vivos, para análise da semelhança alcançada entre a face escaneada e as aproximações faciais. Nesta etapa, foi aplicada uma associação de diferentes metodologias já publicadas, para reconstrução de uma mesma região da face, a partir de um mesmo crânio. Na última etapa, foram simuladas situações de reconhecimento com familiares e amigos dos indivíduos doadores das tomografias. Observou-se que a metodologia de FBRH pode ser empregada em aproximação fisionômica. Houve reconhecimento positivo nos três sujeitos estudados, sendo que, em dois deles, os resultados foram ainda mais significativos. Desta forma, conclui-se que a metodologia é rápida, objetiva e proporciona o reconhecimento. Esta permite a criação de múltiplas versões de aproximações fisionômicas a partir do mesmo crânio, o que amplia as possibilidades de reconhecimento. Observou-se ainda que a técnica não exige habilidade artística do profissional.

Facial approximation works by building the visual face up from the skull. This method should be performed as last resort, to carry out for missing persons, when there is no other primary identification method avaliable. The purpose of this study was to introduce a new computerized method with hermite radial basis function (HRBF) for facial approximation using dry skull and computed tomography (CT). The same was also evaluated as a result of the recognition. Firstly, a scan of a dry unidentified skull image was used in order to assess if the amount of points would be sufficient for HRBF methodology and subsequent reconstruction of the facial surface. In second, three CT scans of living individuals were used to evaluate the similarity achieved between the real face scanned and facial approximations. An association of different facial structures reconstruction techniques already published for the same region of the face was applied for the same skull. Moreover, some situations from developed facial approximations were simulated, as recognition by a relative or parent, on a face pool-test. Results from the study showed that the purposed methodology can be used for facial approximation. At the three cases a correct approximation identification as one of a few possible matches to the missing person happened. In two of them, the results were consistently better at identifying the correct approximation. In conclusion, the proposed methodology is fast, objective and reaches visual identification. It is possible to perform multiple versions of the same skull, changing the selected data into the system, which maximizes the chances of establishing recognition of the target face. It was also observed that the technique does not need artistic interpretation.

Análisis de los grosores tisulares a nivel de nasion y glabela según sexo y biotipo, en pacientes entre 20 y 27 años de edad / Nasion and glabela thickness tissue according to sex and biotypein patients between 20 and 27 years of age

La población chilena se caracteriza por ser una población muy heterogenea, debido a la gran mezcla exístente entre las distintas etnias y razas a lo largo del tiempo. Esto supone una gran diversidad de formas, tamaños y grosores de estructuras anatómicas, dentro de las cuales ubicamos a los grosores faciales. Si bien existen bases de datos de los grosores tisulares faciales en la población chilena, éstas han sido realizadas a través de técnicas como la ultrasonografía y punción, sin existir estudios realizados en Chile utilizando técnicas radiológicas para medir, como es la telerradiografía de perfil. Los objetivos fueron: 1. Medir los grosores tisulares a nivel de GB y NA, 2. Evaluar correlación de grosores según distribución por sexo y biotipo, 3. Comparar grosores entre distintos grupos, 4. Creación de una base de datos de referencia de la población chilena sobre el espesor del tejido blando a nivel de GB y Nay 5. Comparar los resultados obtenidos con otros estudios de grosores realizados en la población chilena. Se escogió al azar a 99 alumnos de odontología entre 20 a 27 años que necesitaban tratamiento de ortodoncia, a los cuales se les solicita una telerradiografía de perfil, en donde se mide los grosores de tejidos blandos a nivel de glabela y nasion, se clasifican a los pacientes según sexo y biotipo utilizando el análisis de Roth-Jaraback. Al analizar los resultados según sexo se observó siempre un grosor mayor en hombre que en mujer, con diferencia significativa a nivel de glabela y nasion. Al evaluar los resultados según biotipo no se observa diferencias siginificativas entre un biotipo y otro. Los hombres presentan un mayor grosor de tejido blando a nivel de glabela y nasion, con diferencia significativa en ambos. Se propone una nueva clasificación según biotipo, pero no se encuentra resultados concluyentes.

Chilean population is characterized for being heterogeneous, due to a large variety and mix of different ethnicities and races. This includes diversity in shapes, sizes and thickness of anatomic structures, part of which is facial thickness. Even though there are databases of facial tissue thickness for Chilean population, these have been carried out through techniques such as ultrasonography and puncture, without taking into consideration radiologic techniques, such as profile teleradiography. The aims of the study were: 1. Measure tissue thickness at GB and NA level, 2. Evaluate correlation in thickness according to distribution per sex and biotype. 3. Compare thickness among the groups. 4. Create a database of soft tissue thickness at GB and NA level in Chilean population, 5. Compare results with other studies regarding tissue thickness in Chilean population. Ninety-nine dentistry students between 20 and 27 years of age, candidates for orthodontic treatment, were randomly chosen. Lateral teleradiography was requested from all individuals, soft tissue thickness was measured at GB and NA level, classifying patients according to Roth-Jaraback analysis. When analysing the results according to sex, larger thickness was observed in men each time, with a significant difference at GB and NA levels. When evaluating biotype differences no significant difference was observed. Men showed thicker soft tissue at NA and GB level than women, with a significant difference between both. A new classification is proposed according to biotype, but no concluding data is found.

Evaluation of facial asymmetry using soft-tissue thickness for forensic purposes / Evaluación de la asimetría facial mediante el grosor de tejidos blandos para propósitos forenses

Facial reconstruction for forensic sculpture aims to reproduce the face of an individual for identification. This technique is based on the knowledge of the facial soft-tissue thickness, which differs in terms of sexual dimorphism. However, in terms of asymmetry, the real significance of the soft-tissue thickness on both sides of the face is not considered to make an approximation of the morphofacial characteristics of an individual. This study analyzed the facial tissue thickness of 32 adult Spanish corpses of both sexes in six bilateral cephalometric landmarks through the needle puncture technique, comparing the measurements of right and left sides. No significant differences were found when comparing the soft-tissue thickness on the right and left sides in the total sample (p <0.05), or when comparing the values in men and women (p<0.05). The facial morphology is created by internal and external forces exerted on the soft tissue and influenced by their evolutionary development in vivo, where asymmetry parameters have a genetic and muscular determination, which in normal individuals do not represent a significant difference in the process of reconstruction of forensic sculpture, and can reliably standardize the entire information of facial thickness to the right or left side of the face.

La reconstrucción facial por escultura forense tiene por finalidad reproducir el rostro de un individuo para su identificación. Esta técnica se sustenta en el conocimiento del grosor del tejido blando facial; el cual presenta diferencias en términos de dimorfismo sexual. Sin embargo, en términos de asimetría, no se ha considerado la real significancia del espesor de tejido blando a ambos lados del rostro al realizar una aproximación de las características morfofaciales de un individuo. En este estudio se analizaron los grosores tisulares faciales de 32 cadáveres españoles adultos de ambos sexos en 6 puntos cefalométricos paramedianos bilateralmente mediante el método de punción por agujas, comparando las mediciones del lado derecho e izquierdo. No se encontraron diferencias significativas al comparar el espesor del tejido facial en el lado derecho e izquierdo en el total de la muestra (p<0,05), así como al comparar los valores en hombres y mujeres (p<0,05). La morfología facial es creada in vivo por fuerzas internas y externas ejercidas sobre el tejido blando e influenciada por su desarrollo evolutivo, donde parámetros de asimetría tienen una determinación genética y muscular, que en individuos normales no representan una diferencia significativa para el proceso de reconstrucción por escultura forense, pudiendo homologar de manera confiable la totalidad de la información del grosor facial del lado derecho o izquierdo del rostro.

Preoperative Evaluation of the Facial Artery Using Facial Angio Computed Tomography

PURPOSE: Previous studies of the facial artery have shown significant anatomical variability in this region. The vascular anatomy of the region is considered unreliable in predicting the ideal pedicle. Preoperative imaging has been suggested as a means of improving preoperative awareness, with Doppler ultrasound as useful tools. Multi-detector row angiographic computed tomography (angio CT) is a significant improvement, providing non- invasive operator-independent details of the vascular anatomy. This tool was used to perform an in vivo anatomical study of the facial artery, demonstrating the usefulness of facial angio CT in planning the facial reconstruction. METHODS: Eleven consecutive patients underwent facial angio CT of the facial vasculature with the anatomical details of the facial artery assessed. RESULTS: Facial angio CT could demonstrate the size and course of the facial vasculature, particularly the facial artery. CONCLUSION: The vascular anatomy of the facial artery is highly variable, and thus there is a role for preoperative imaging. Facial angio CT can demonstrate cases where there is an aberrant or non-preferred anatomy, or select the method of a facial reconstruction.

Facial tissue thickness in Chilean cadavers with medico-legal / Grosores tisulares faciales en cadáveres de individuos chilenos con fines médicos-legales

The reconstruction of facial features is a key process in human identification with anthropological methods, and represents the ultimate aim of forensic facial reconstruction. This study aimed to record the values of facial tissue thickness of the Chilean population to have a reference table with forensic purposes. We used 40 Chileans cadavers of both sexes, with dates of death between 3 and 48 hours (mean 13.05 hours, SD 10.49) kept in cold storage at -4 º C, aged between 23 and 76 years (mean 45.95 years, SD 11.23), with a BMI average 25.38 (SD 2.27) in men and 26.41 (SD 3.09) in females. We analyzed the facial tissue thicknesses in 20 cephalometric points, eight median and six bilateral paramedian, using the needle puncture--method. We evaluated the presence of sexual dimorphism. The men have a greater thickness at the midpoints, unlike women, where thickness was greater in the paramedian points. However, the differences were significant only in the nasion point. Several studies have reported differences in tissue thickness between men and women, that would justify their systematic determination to develop protocols for facial reconstruction for forensic sculpture. In our study there were no differences, suggesting that different methods of preservation, postmortem time and BMI have influence on gender differences and should be considered in generating population data.

La reconstrucción de la fisonomía facial es una de las claves del proceso de identificación humana con métodos antropológicos y representa el fin último de la reconstrucción con plastía forense. El presente estudio busca registrar los valores de los grosores tisulares faciales de la población chilena para tener una tabla de referencia en el uso con fines médico legales. Se utilizaron 40 cadáveres de individuos chilenos de ambos sexos, con una data de muerte de entre 3 y 48 horas (media 13,05 horas, D.S. 10,49) conservados en cámaras frías a -4º C, con edades entre 23 y 76 años (media 45,95 años, D.S 11,23), IMC promedio hombres 25,38 (DS 2,27) y mujeres 26,41 (DS 3,09). Se analizaron los grosores tisulares faciales en 20 puntos cefalométricos, 8 medianos y 6 paramedianos bilaterales, utilizando el método de punción por agujas. Se evaluó la presencia de dimorfismo sexual. Los hombres presentan un mayor espesor en los puntos medianos, a diferencia de las mujeres en las que grosor fue mayor en los puntos paramedianos. Sin embargo las diferencias sólo fueron significativas en el punto Nasion. Diversos estudios han reportado diferencias en los grosores tisulares entre hombres y mujeres, que justificarían su determinación sistemática al desarrollar protocolos de reconstrucción por plastía forense. En nuestro estudio no se encontraron estas diferencias, lo que sugiere que distintos métodos de conservación, tiempo transcurrido postmortem e índice de masa corporal tiene influencia en las diferencias entre sexos por lo que deben ser consideradas al generar datos poblacionales.

Analysis of Color Difference in Facial Reconstruction Used Various Flaps

PURPOSE: Good color match is a key element in facial reconstruction for good aesthetic result. To correct the wide facial soft tissue defect were usually used the tissue expanded cheek flap, deltopectoral flap or radial forearm free flap. This study is aimed to analyse the color difference after flap surgery by using chromameter. METHODS: From August 1995 to December 2006, 30 patients who underwent flap operations were chosen randomly and evaluated color differences between flap site and adjacent skin. Reconstructive procedures included tissue expanded cheek flap(n=10), deltopectoral flap(n= 10), and radial forearm free flap(n=10). The measured sites were flap center within a radius of 1cm and four points of adjacent skin along the flap margin. The colors were quantified in a three dimensional coordinate system composed of L* (brightness), a*(redness), b*(yellowness). RESULTS: There were no significant color differences between the pedicled flaps(tissue expanded cheek flap and deltopectoral flap) and adjacent skin area. On the other hand, color values of the radial forearm free flap were statistically different from those of adjacent skin area. Total color difference(delta E) of tissue expanded cheek flap and deltopectoral flap were 7.45+/-5.78 versus 9.41+/-7.09, and that of radial forearm free flap was 11.74+/-3.85. It suggests that pedicled flaps have a potential of better color match than radial forearm free flap. CONCLUSION: Thus, better esthetic results and satisfaction is more likely to be expected in pedicled flaps as long as it could be applied comparing radial forearm free flap.

Comparisons in soft-tissue thicknesses on the human face in fresh and embalmed corpses using needle puncture method / Comparación en el grosor del tejido blando de la cara, con el método de punción con aguja, en cadáveres frescos y conservados

The aim of the present study is to analyze the differences in the soft facial tissue thicknesses measured in corpses without fixing, with recent death, and in embalmed corpses. 30 male human corpses were used; they were divided into two groups according to the presence or absence of a conservation method. Fifteen bodies, without any method of conservation, with an average age of 38.6 years (SD 8.37) and Fifteen preserved bodies by means of the intravascular injection technique of fixing conservative solution on the basis of formaldehyde, with an average age of 38.4 years (SD 7.67). In each one of them the thickness was measured in eight medium and six bilateral paramedium landmarks, using the needle-punction method. The descriptive statistical ones were calculated and the t test was applied with 95 percent of significance. All the landmarks, except for right exocanthion and left and right gonion, presented bigger thickness in the cadavers embalsamed. You differ significant they were in the Trichion, glabella, nasion, pogonion, right superciliare, right supraorbital, right infraorbital, right gonion, left superciliare, left supraorbital, right infraorbital landmarks.

El propósito de este estudio fue analizar las diferencias en el grosor tisular facial entre cadáveres frescos y conservados. Se utilizaron 30 cadáveres de sexo masculino, 15 de los cuales presentaron una data de muerte media de (SD) y los otros 15 fueron cadáveres conservados mediante inyección intravascular de solución fijadora conservadora en base a formol. En cada uno de ellos fueron medidos los grosores en 8 puntos medianos y 6 puntos paramedianos bilaterales, utilizando el método de punción con aguja. Se calcularon los estadísticos descriptivos y luego se aplicó el t test con un 95 por ciento de significancia. Todos los puntos, con excepción de Exocanthion derecho y Gonion derecho e izquierdo, presentaron grosores mayores en los cadáveres conservados. Diferencias significativas se encontraron en los puntos Trichion, Glabela, Nasion, Pogonion, Superciliar derecho, Supraorbitario derecho, Infraorbitario derecho, Gonion derecho, Superciliar izquierdo, Supraorbitario izquierdo, Infraorbitario derecho.

Color Analysis of Forehead Flap and Full Thickness Skin Graft in Facial Reconstruction

PURPOSE: For facial reconstruction, skin color match is crucial to achieve great aesthetic result. Forehead flap and full thickness skin graft have been used for many years to reconstruct facial defect. Their results are aesthetically valuable with remarkable resemblance and harmony of the skin color between donor and recipient sites. The purpose of this study is to evaluate and compare the aesthetic outcome of the two methods as the analysis of skin color match. METHODS: From January 1995 to December 2005, ten forehead flaps and ten full thickness skin grafts were performed. The reconstructed areas of forehead flaps were five noses and five eyelids. Recipient sites of full thickness skin grafts were seven eyelids, two noses and one forehead. In order to obtain the objective validity, the skin color of flap(or graft) and the recipient sites were measured by chromameter. The skin colors were quantified according to a three-dimensional coordinate system used in chromameter, L*(brightness), a*(redness), and b*(yellowness). RESULTS: There was no significant color difference between forehead flap site and adjacent skin in all color values. On the other hand, the L* and b* values of graft sites were significantly lower than those of the adjacent skins. The a* values of graft sites were higher than those of the adjacent skins. CONCLUSION: This study reveals that skin color match of forehead flap is greater than that of full thickness skin graft. As forehead flap has adequate volume and great color match, it can be useful to reconstruct deep facial defect such as nasal defect. On the other hand, full thickness skin graft can be used for superficial defect like partial eyelid defect.

Effectiveness of Vascular Network Including Angular Artery in Inner Canthal Region for Mid-facial Reconstruction

Angular artery as a terminal branch of facial artery ends at inner canthal region and anastomoses with adjacent arteries to form the vascular network in this region. Flaps using this network have been widely used to reconstruct the mid-facial defects. This study was designed to investigate the anatomical basis of theses arteries, especially angular artery which is known to have variable courses, and to demonstrate safety and effectiveness of flaps using this network. The authors reviewed several textbooks of anatomy and reported literatures through MEDLINE search about anatomy of angular artery and its anastomosis. To document clinical application, the authors also analyzed clinical experiences of 19 patients for recent 6 years who were undergone the reconstructive flap surgeries for mid-facial defects using forehead, dorsal nasal and retroangular flaps based on anastomosed vascular network in inner canthal region. As a result of review, the authors could not get an exact conclusion, although there were numerous opinions about anatomical variations of facial and angular artery. However, robust network composed of anastomotic arteries in inner canthal region seems to give high viability to flaps due to rich blood supply regardless of variation. Clinical experiences also showed excellent flap viability without any complication and satisfactory results functionally and cosmetically. In conclusion, flaps using vascular network in inner canthal region should be suggested as safe and effective methods for mid-facial reconstruction.