Evolución del concepto de deformidad facial / Evolution of the concept of facial deformity

RESUMEN Introducción: La cara es el soporte anatómico para el funcionamiento de los sentidos y piedra angular para la integración social. El paradigma biologicista se mantiene como base para la conceptualización teórica de las deformidades faciales, mientras el enfoque biopsicosocial de la salud, no se evidencia con fuerza para las deformidades faciales, se efectuó una revisión narrativa de la literatura, en las bases de datos: SciELO, PubMed, Redalyc e Infomed y con el buscador Google académico. Objetivo: Valorar los conceptos que se exponen en la literatura científica y proponer el más integrativo. Desarrollo: Se abordan fortalezas y limitaciones de 12 conceptos expuestos de acuerdo al enfoque de cada autor, dentro un contexto científico actualizado, además se valora cómo evoluciona el concepto desde el enfoque biologicista hasta el sociomédico, desde las primeras definiciones que no hacían referencia al impacto psicosocial de las deformidades o no eran inclusivas con toda la región facial, hasta las definiciones más integrativas a criterio de los autores y avalados por estudios de otros investigadores. Conclusiones: El concepto de deformidad facial ha evolucionado desde un paradigma biologicista a otro sociomédico. La extensión a toda la región facial, así como la percepción de los pacientes de sí mismos y de cómo la sociedad los asume e integra, debe ser parte del problema teórico a conceptualizar. Los autores proponen el concepto expuesto por Blanco y otros, por considerarlo el más integrativo; lo recomiendan para estudios de validación de contenido y su uso posterior en la práctica clínica.

ABSTRACT Introduction: The face is the anatomical support for the functioning of the senses and the cornerstone for social integration. The biological paradigm is maintained as the basis for the theoretical conceptualization of facial deformities, while the biopsychosocial approach to health is not strongly evidenced for facial deformities, a narrative review of the literature was carried out in the databases: SciELO , PubMed, Redalyc and Infomed and with the academic Google search engine. Objective: Assess the concepts that are exposed in the scientific literature and propose the most integrative. Development: Strengths and limitations of 12 exposed concepts are addressed according to the approach of each author, within an updated scientific context, as well as how the concept evolves from the biological to the sociomedical approach, from the first definitions that did not refer to the impact. psychosocial of the deformities or were not inclusive with the entire facial region, up to the most integrative definitions at the discretion of the authors and supported by studies by other researchers. Conclusions: The concept of facial deformity has evolved from a biological paradigm to a sociomedical one. The extension to the entire facial region, as well as the patients' perception of themselves and how society assumes and integrates them, must be part of the theoretical problem to be conceptualized. The authors propose the concept exposed by Blanco and others, considering it the most integrative; recommend it for content validation studies and subsequent use in clinical practice.

Caracterización de pacientes con deformidades faciales / Characterization of patients with facial deformities

Introducción: Las deformidades faciales se expresan como alteraciones métricas perceptibles en la proporción o simetría facial, en desacuerdo con los cánones de belleza y aceptación social históricamente concretos, con repercusión en la psicología del paciente y su entorno. Objetivos: Caracterizar a los pacientes con deformidades faciales de acuerdo al sexo, edad, etiología y localización, así como determinar la relación entre ellas. Método: Las variables estudiadas fueron recogidas durante el examen físico de los pacientes (46), previo consentimiento, vaciadas en una base de datos para su procesamiento, mediante medidas de frecuencias. Para las comparaciones se realizó la prueba exacta de Fisher. Resultados: Predominó el sexo masculino (54,3 por ciento), la etiología traumática con el grupo de edad de 40 - 49 años (19,6 por ciento), el 26,1 por ciento de los pacientes presentaron deformidades de más de una región y no se obtuvieron relaciones estadísticamente significativas en ningunas de las relaciones exploradas. Conclusiones: En los pacientes estudiados prevaleció el sexo masculino, de entre 40 y 49 años, la etiología traumática y localización en una sola región anatómica (AU)

Introduction: Facial deformities are expressed as perceptible metric alterations in facial proportion or symmetry, at odds with historically specific canons of beauty and social acceptance, with repercussions on the psychology of the patient and his or her environment. Objectives: To characterize patients with facial deformities according to sex, age, etiology and location, as well as to determine the relationship between them. Method: The variables studied were collected during the physical examination of the patients (46) with their consent, and were entered into an SPSS Statistics 22 database where statistical processing was carried out with frequency measures. To compare the Fisher's exact test was used. Results: Male sex predominated (54,3 percent ), traumatic etiology with the age group of 40-49 years (19,6 percent), 26,1 percent of the patients presented deformities of more than one region and no statistically significant relationships were obtained in any of the explored relationships. Conclusions: Among the patients studied prevailed male sex, age between 40 and 49 years old, traumatic etiology and located in one anatomical region(AU)

Reconstruction of large facial defects via excision of skin cancer by using mandibular flap / 中华整形外科杂志

Objective@#To explore the effect of the mandibular flap application on one-stage repairing facial large defects after resection of skin tumors.@*Methods@#Thirteen patients with malignant facial skin tumors were treated from June 2016 to June 2018 in Taizhou First Hospital department of Plastic Surgery. The lesion included zygomatic in 3 cases (including 2 cases of non-adjacent defects in zygomatic area), buccal area area in 2 cases, parotid masseter in 6 cases and compound area in 2 cases. Pathological findings included 8 cases of squamous cell carcinoma, 4 cases of basal cell carcinoma and 1 case of fibrosarcoma. Using Mohs method resect the skin tumor (Rapid pathology intraoperatively to ensure lesion was all removed ). According to the diameter and location of the defect, the mandibular Flap was used to repair the large scale defects in a one-stage operation.@*Results@#All mandibular Flap survived. During a follow-up period from 6 to 24 months, all patients obtained excellent functional and aesthetic result, and none had local recurrence.@*Conclusions@#The flexible application of mandibular Flap can basically solve the problem of repairing a large area of facial skin and soft tissue defect in zygomatic, buccal and parotid masseter of the face, which is one of the ideal methods to repair the tissue defects after resection of facial malignant tumor for the middle and old age.

Application of horn shaped flap pedicled with the angular artery perforator for midface reconstruction / 中华整形外科杂志

Objective@#To evaluate the effect of the horn shaped flap pedicled with the angular artery perforator for midface reconstruction.@*Methods@#From March 2014 to April 2017, twenty patients underwent operations for the reconstruction of midface defect, defect due to trauma, tumors, moles, scar and other soft tissue defects after resection. Various horn shaped flap pedicled with the angular artery perforator, perforator flap was rotated and pushed to repair the defect area.The maximum width of the perforator flap was equal to the width of the defect, and the length is about 2.5 to 3.0 times the length of the defect.@*Results@#All flaps survived.After 1 month to 1 year follow up on 20 cases, the flap is significantly improved in color、shape and function.The patients were satisfied with the final aesthetic and functional results.@*Conclusions@#The flap has flexibility and simply with reliable blood supply.The donor sites could be closed directly without skin graft.it is a simple and fast method for the reconstruction of midface defect.

A Case Report of Simplified Cosmetical Correction of Post-Exenterated State

Orbital exenteration has been used as a corrective method to treat lifetreatening neoplasm, life-threatening infection, and pain or deformity. After orbital exenteration, patients have been left with a severely disfiguring facial defect. Nowadays postoperative adjustment is usually better than before, with improved surgical and prosthesis manufacturing techniques. Actually Korean ophthalmologists do not have chances of adequate ocular prosthesis support compared to the other foreign countries. Authors experienced satisfying cosmetic result using a photography glasses frame for the pos-exenterated patient who had a squamous cell carcinoma of the orbit. We report this first case in Korea with review of the literatures.