Aesthetic reconstruction of the scar contracture deformity in chin and neck with expanded flaps based on the "MRIS" principle / 中华烧伤杂志

Objective: The surgical reconstruction strategy for scar contracture deformity in chin and neck was explored, aiming to obtain better aesthetic outcome. Methods: A retrospective observational study was conducted. From December 2017 to April 2021, 34 patients with scar contracture deformity in chin and neck after burns were hospitalized in the Department of Plastic Surgery of the First Affiliated Hospital of Army Medical University (the Third Military Medical University), aged 12-54 years, including 13 males and 21 females, 4 cases with chin affected only, 7 cases with neck affected only, and 23 cases with both chin and neck affected. The scar areas were 48-252 cm2. All the patients were treated by operation with expanded flaps, following the "MRIS" principle of matching of the color and thickness of the repair flaps (match), reconstructing of the aesthetic features of subunits (reconstruction), design of incision according to the plastic principle (incision), and prevention of the surgical incision scar (scar). The rectangular or kidney shaped skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 80-400 mL was embedded in the first stage, which was routinely expanded to 3-5 times of the rated capacity of the expander. In the second stage, scar resection and expanded flap excision were performed to repair the secondary wound, and the flap donor site was sutured directly. The expansion ratio of the expander (with average value being calculated), the type of flaps used, the reconstruction of local aesthetic morphology, the appearance of postoperative incision, the survival of flap, and the situation of donor and recipient sites observed during follow-up were recorded. Results: Among the 34 patients, the average expansion ratio of the implanted expander was 3.82 times of the rated capacity of the expander. Three cases were repaired by the expanded local pedicled flap only, 19 cases by the expanded shoulder and/or chest perforator pedicled flap only, 10 cases by the expanded local pedicled flap combined with the expanded shoulder and/or chest perforator pedicled flap, and 2 cases by the expanded local pedicled flap combined with the expanded free flap of the second intercostal perforator of internal thoracic artery. After scar resection, the shapes of lower lip and chin-lip groove were reconstructed in 10 cases, chin process reconstruction and chin lengthening were performed in 16 cases, and the cervico-mental angle and mandibular margin contour were reconstructed in 28 cases. The surgical incision was concealed, most of which were located at the natural junction or turning point of the chin and neck subunits. The vertical incision of neck was Z-shaped or fishtail-shaped. All the expanded flaps in 34 patients survived after operation, of which 8 patients had minor necrosis at the edge or tip of the expanded flaps 1-3 days after operation and healed after dressing change. During the follow-up of 3-18 months, little difference in color and thickness between the expanded flap and the skin of chin and neck was observed, and the aesthetic shape of chin and neck was significantly improved, with mild scar hyperplasia of surgical incision. Conclusions: Reconstruction of scar contracture deformity in chin and neck by using expanded flaps based on the "MRIS" principle is beneficial to improve the quality of surgery and achieve better aesthetic outcome.

About chin (genioplasty) surgery / Sobre cirugía del mentón (genioplastía)

Facial harmony is the consequence of a proper balance between all facial structures. The identification and classification of morphologic characteristics that detract from facial harmony is most effectively accomplished by clinical examination. The maintenance of the ratios between the facial thirds, correct spatial bone position and soft tissues accommodation are all factors that directly contribute in a balanced facial profile. The chin, likewise, contributes significantly in facial balance, mainly in the profile view. Expressive changes on chin position are associated with the perception of strong or delicate characters. Thus, over the years, a series of studies has been constructed focusing on mandibular osteotomies techniques that enable changes in chin position: advances, setback, extrusion, intrusion, widening, narrowing and asymmetry. This study aims to address historical and technical aspects of genioplasty; associating patient's condition with the surgical techniques that can be applied for correction of chin deformities.

La armonía facial es la consecuencia del balance entre las estructuras facial. La identificación y clasificación de las características morfológicas que están acompañando la armonía facial son mas efectivas al realizar un estudio de análisis facial. La obtención de promedios entre los tercios, corrección especial de la posición del hueso y la acomodación de los tejidos blandos son factores directamente involucrados en el balance del perfil. El mentón, contribuye significativamente en este balance. Cambios expresivos en la posición del mentón son asociados con la percepción de características fuertes o delicadas. Durante los años, una serie de estudios han sido desarrollados enfocándose en las osteotomías mandibulares y técnicas capaces de alcanzar los cambios en la posición del mentón: avances, retrocesos, extrusiones, ensanchamientos, estrechamientos y asimetrías. Este estudio pretende orientar las condiciones históricas y técnicas respecto de la genioplastia; la asociación de las características del paciente con la técnica quirúrgica pueden ser aplicadas para la corrección de las deformidades.

Facial asymmetry: virtual planning to optimize treatment predictability and aesthetic results

Abstract Facial asymmetry is a condition that compromises function and social interactions and, consequently, the quality of life. Orthodontic-surgical treatment may be indicated to achieve a stable occlusion and significant improvement in facial aesthetics. The virtual planning of the maxillary, mandibular and chin movements can be done prior to surgery. These movements can be successfully performed with the use of prototyped guides obtained from virtual planning. The aim of this article is to show the state of the art of treatments of facial asymmetries, and emphasize how important is the multi-disciplinary approach to achieve predictable aesthetic and functionally stable results in a patient with facial asymmetry and chin protrusion.

Resumo A assimetria facial é uma condição capaz de comprometer a função oclusal e as interações sociais e, consequentemente, a qualidade de vida dos indivíduos. Nessas condições, para se obter oclusão estável e melhora significativa na estética facial, o tratamento ortodôntico-cirúrgico pode estar indicado. A simulação virtual da cirurgia permite planejar de forma adequada, e antecipada, os movimentos cirúrgicos a serem efetuados na maxila, mandíbula e mento. Esses movimentos são, então, realizados com sucesso graças ao uso de guias prototipados obtidos a partir do planejamento virtual. Assim, os objetivos do presente artigo consistem em relatar o estado da arte no planejamento virtual do tratamento de um paciente com assimetria facial e protrusão do mento, e enfatizar a importância da abordagem multidisciplinar para se atingir resultados estéticos previsíveis e funcionalmente estáveis.

Clinical evaluation for chin augmentation: literature review and algorithm proposal / Avaliação clínica para avanço de mento: revisão da literatura e proposta de um algoritmo

ABSTRACT INTRODUCTION: The esthetic balance of the face results from harmonic and symmetrical facial proportions. The literature describes several methods for lower-third facial analysis, but lacks a simple and practical method. OBJECTIVE: To review the methods of analysis of the ideal projections of the chin based on soft tissues, showing the advantages and disadvantages of each. METHODS: Literature review through the PubMed database. RESULTS: The following methods for chin analysis based on soft tissues were reviewed: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, cervicomentual angle, and mentocervical angle. CONCLUSION: An adequate analysis of the proportions of the face and facial disharmony is essential for the correct indication of the necessary procedures and good surgical outcome. The authors propose an algorithm to facilitate the indication for chin augmentation surgery.

Resumo Introdução: O equilíbrio estético da face resulta de proporções faciais harmônicas e simétricas. A literatura descreve vários métodos de análise do terço inferior da face, mas carece de um método simples e prático. Objetivo: Revisar os métodos de análise da projeção ideal do mento baseadas em tecidos moles, mostrando as vantagens e desvantagens de cada um. Método: Revisão da literatura através da base de dados Pubmed. Resultados: Os seguintes métodos para análise do mento baseada em partes moles são revisados: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, ângulo cervicomentual e ângulo mentocervical. Conclusão: A análise adequada das proporções da face e desarmonia facial faz-se essencial para a correta indicação dos procedimentos necessários e bom resultado cirúrgico. Propomos um algoritmo para facilitar indicação de avanço de mento.

Considerações atuais sobre a remoção de enxerto do mento / Current considerations on the chin bone harvesting

A utilização de enxerto ósseo do mento com o objetivo de readequar regiões alveolares atróficas é reportada na literatura como um procedimento viável e previsível, com elevados índices de sucesso. No entanto, trabalhos relacionados a essa modalidade de enxerto, abordando os cuidados necessários e principalmente as alterações que essa remoção causa na região doadora, são escassos. O objetivo deste trabalho foi relatar um caso clínico, procurando abordar e discutir as alterações que a remoção de enxerto do mento pode causar no contorno do tecido mole da região, na sensibilidade do tecido mole e pulpar, além de abordar o potencial de neoformação óssea e a percepção dos pacientes frente a essas alterações... (AU)

The use of the chin bone graft in order to readjust atrophic alveolar regions is reported in the literature as a viable and predictable procedure with high success rates. However, works related to this type of graft covering the necessary care and especially the changes that the removal because the donor region are scarce. Therefore, the objective was case report seeking to address and discuss the changes that the removal of the graft in treatment can cause soft tissue contour of the region, the sensitivity of the soft tissue and pulp, and to discuss the potential for new bone formation and perception of patients treated with these changes... (AU)

Effects of chin advancement surgery in hyoid bone and tongue positions and in the dimension of the oropharynx

INTRODUÇÃO: a cirurgia de avanço de mento isolado tem sido cada vez mais indicada para a correção de deficiência anterior da mandíbula, harmonizando o perfil e gerando alterações funcionais. OBJETIVO: essa pesquisa teve a finalidade de avaliar os efeitos da cirurgia de avanço de mento no tamanho da orofaringe e nas posições do osso hioide e da língua. MÉTODOS: a amostra constou de 22 radiografias cefalométricas de perfil de 11 indivíduos que se submeteram à cirurgia de mentoplastia de avanço isolada. Dessas radiografias, 11 retratavam o período imediatamente pré-cirúrgico (T0) e 11 o pós-cirúrgico de, pelo menos, quatro meses (T1). As radiografias foram digitalizadas e transferidas para o programa Radiocef Studio 2.0, por meio do qual foram feitas as medições entre os pontos demarcados. RESULTADOS: verificaram-se diferenças estatisticamente significativas entre T0 e T1 quanto à posição do osso hioide e da língua no sentido horizontal e ao tamanho da orofaringe. O osso hioide se apresentou posicionado mais anterior em T1 (p = 0,01), assim como a língua, aumentando o tamanho da orofaringe (p = 0,01). CONCLUSÃO: houve aumento do espaço aéreo da orofaringe com o posicionamento mais anterior da base da língua, bem como a reposição do osso hioide anteriormente.

INTRODUCTION: Advancement genioplasty has been increasingly indicated for the correction of anterior mandibular deficiency as it balances the patient's profile and generates functional changes. OBJECTIVE: Thus, the aim of this study was to assess the effects of advancement genioplasty in the oropharyngeal size and in the position of the hyoid bone and tongue. METHODS: The sample comprised 22 lateral cephalometric radiographs of 11 individuals who had undergone advancement genioplasty alone. Eleven of these radiographs depicted the immediate preoperative period (T0) and the other 11 the postoperative period after at least four months (T1). The radiographs were scanned and exported to the Radiocef Studio 2.0® software (Radio Memory Ltda., Belo Horizonte, MG, Brazil). The landmarks were then identified and automatically measured by the program. RESULTS: The results showed statistically significant differences between the horizontal position of the hyoid bone and tongue and in the oropharyngeal size. The hyoid bone and tongue were repositioned anteriorly after surgery (p = 0.01), thereby increasing the dimension of the oropharyngeal airspace (p = 0.01). CONCLUSIONS: The oropharyngeal dimension increased as the tongue base and hyoid bone were repositioned more anteriorly.

Avaliação de déficit neurossensorial em pacientes com síndromes craniofaciais submetidos a avanço horizontal do mento / Evaluation of neurosensory disturbance in patients with craniofacial syndrome subjected to horizontal chin advancement

INTRODUÇÃO: Embora os distúrbios neurossensoriais após genioplastias tenham sido avaliados em diferentes estudos, não existe uma padronização de como testar e classificar tais alterações. Por essa razão, a incidência de distúrbios neurossensoriais varia de 0 a 100%, dependendo da definição da lesão dos nervos, da sensibilidade do método diagnóstico e do período de seguimento. Portanto, o propósito deste estudo foi avaliar objetivamente o déficit neurossensorial permanente em pacientes submetidos a avanço horizontal do mento. MÉTODO: Foi realizado estudo retrospectivo de todos os pacientes submetidos a avanço horizontal do mento no Hospital SOBRAPAR, no período de 2009 a 2010. A avaliação neurossensorial objetiva do lábio inferior e do mento foi realizada com dois testes neurológicos (teste dos limiares de pressão de Semmes-Weinstein e teste de sensibilidade térmica). O déficit neurossensorial permanente foi definido como testes clínicos anormais com no mínimo 12 meses de pós-operatório. RESULTADOS: Foram avaliados 13 pacientes, sendo 8 deles portadores de síndromes craniofaciais. Houve predomínio de pacientes com os testes de sensibilidade tátil à pressão e térmica (quente e frio) normal (P < 0,05). A análise dos pacientes sindrômicos revelou que a maioria teve o teste de sensibilidade tátil à pressão normal (P < 0,003), não existindo diferenças no teste de sensibilidade térmica (P = 0,317). Não foram identificadas diferenças entre as regiões anatômicas com testes de sensibilidade anormais (P > 0,05). CONCLUSÕES: A maioria dos pacientes apresenta sensibilidade tátil (pressão e temperatura) do lábio inferior e mento preservada 12 meses após terem sido submetidos a avanço horizontal do mento.

BACKGROUND: Although neurosensory disturbances after genioplasty have been evaluated in different studies, standardization for testing and grading of neurosensory injuries is lacking. For this reason, the incidence of neurosensory disturbance varies from 0% to 100%, depending on the definition of nerve damage, the sensitivity of the diagnostic test method, and the follow-up period. Therefore, the aim of this study was to perform an objective evaluation of the permanent neurosensory disturbances in patients who underwent horizontal chin advancement. METHODS:A retrospective study of all patients who underwent horizontal chin advancement at the Hospital SOBRAPAR between 2009 and 2010 was conducted. The objective neurosensory assessment of the lower lip and chin was performed using 2 neurological tests, namely the Semmes-Weinstein pressure and thermal sensitivity tests. Permanent neurosensory disturbance was defined as abnormal clinical test results obtained at least 12 months after surgery. RESULTS: Thirteen patients (8 with craniofacial syndrome) were evaluated. The prevalence of the patients who showed normal results for sensitivity to pressure/touch and thermal sensitivity (warm and cold; P < 0.05) was significantly high. The analysis of the data of the patients with craniofacial syndrome revealed that most of the patients had normal pressure sensitivity test results (P < 0.003). Results from the thermal sensitivity tests showed no significant difference between these patients (P = 0.317). No significant differences were observed between the anatomical regions with abnormal sensitivity test results (P > 0.05). CONCLUSIONS: Tactile sensitivities of the lower lip and chin to pressure and temperature were preserved in most of the patients 12 months after horizontal chin advancement.

Estudio radiográfico prospectivo de la reparación ósea en sínfisis mandibular posterior a la remoción ósea de mentón / Radiographic prospective study of osseous repair in mandibular symphysis after chin bone remove

El retiro de hueso de sínfisis mandibular ha sido utilizado ampliamente para diferentes procedimientos reconstructivos maxilofaciales. El objetivo de esta investigación fue establecer la existencia de la reparación ósea en el defecto creado en sínfisis debido al retiro de hueso. Treinta pacientes (22 mujeres, 8 hombres) de entre 21 y 65 años fueron operados para retirar hueso de mentón que fue posteriormente aplicado en reconstrucción ósea alveolar; las cirugías fueron realizadas por dos cirujanos maxilofaciales y los pacientes fueron evaluados con telerradiografías en la etapa preoperatoria, postoperatoria inmediata (PIn) y postoperatoria tardía (PTar), donde se realizaron medidas horizontales y verticales del defecto óseo; los valores fueron estudiados con la prueba t de Student con valor de p<0,05. Luego del retiro óseo se observó un defecto vertical promedio de 12,80+/-1,99 y horizontal de 8,33+/-1,77; luego de un año, se obtuvo una disminución de 32,8 por ciento en el sentido vertical y 50,3 por ciento horizontal, presentando significancia estadística en relación al PIn. Se concluye que existe reparación ósea del defecto originado en sínfisis siendo próximo al 30 por ciento-50 por ciento en la evaluación de un año posterior a la cirugía.

Bone harvest of mandibular symphysis has been used in maxillofacial reconstruction procedures. The aim of this research was to establish the presence of bone repair into osseous defect caused by removal of bone. Thirty patient s, 2 female and 8 male, ranging between 21 and 65 years of age underwent surgery for chin bone harvest and alveolar reconstruction. The surgery was performed by two maxillofacial surgeons and the patients were evaluated with lateral radiography in the pre-operatory stage, in early post-operatory and in late post-operatory stages. Horizontal and vertical measures of bone defect were realized; the dates were analyzed by Student t test with a value of p<0.05. After bone harvest, a vertical defect of 12.80 +/-1.99 was observed and a horizontal defect of 8.33 +/- 1.77 was observed. After one year the defect decreased to 32.8 percent in vertical evaluation, and 50.3 percent in the horizontal evaluation with a statistical significance (p<0.05) in relation to the early post-operatory stage. Therefore, we conclude that in bone repair of mandibular symphysis defect is close to 30 ­ 50 percent in a one-year follow-up.

Evaluation of stability in advancement genioplasty: an 18-month follow-up

The main aim of advancement genioplasty is soft tissue and hard tissue stability which is important in improvement of the patients' aesthetics. The evaluation of the soft and hard tissue stability in advancement genioplsty was the aim of this study. The subjects in this study were 15 patients who presented with retrognathia. All of the 15 patients underwent advancement genioplasty alone to correct retrognathia. The soft and hard tissue pogonion in pre-operation, immediately post-operation, and 18 months after operation in tow groups of 9 patients with genial advancement equal or greater than 7 mm [means 7.16 mm] were assessed. After operation, no patient had infection or dehiscence and bone instability. In group 1 with advancement less than 7mm, hard tissue pogonion relapse was 0.60 +/- 0.66mm and soft tissue pogonion relapse was 1.55 +/- 0.46mm. I group 2 with advancement equal or more than 7mm, hard tissue pogonion relapse of 1.6 +/- 0.46mm and soft tissue pogonion relapse of 1.8 +/- 0.68mm were observed. Advancement genioplasty is a predictable operation specially when using rigid fixation. In this study, the result of operation in an 18 month period was stable

Uso de la intubación submentoniana en cirugía buco-maxilofacial / Use of submental intubation in oral and maxillofacial surgery

Diferentes métodos de intubación endotraqueal están disponibles para manutención de las vías aéreas durante el tratamiento quirúrgico de pacientes portadores de fracturas maxilofaciales severas. Cuando los métodos de intubación nasotraqueal y orotraqueal estén contraindicados, la intubación endotraqueal por vía submentoniana es una alternativa útil para esos pacientes severamente traumatizados en los cuales el bloqueo maxilo-mandibular intra-operatorio es necesario. Esta técnica permite el establecimiento de una vía aérea segura y posibilita la realización de fijación intermaxilar durante la cirugía, que es esencial para conseguir un óptimo resultado en la reducción y fijación de las fracturas en los huesos faciales, evitando de esa forma la realización de una traqueotomía y las complicaciones inherentes a ese procedimiento. El presente trabajo tiene como objetivo describir la técnica de intubación submentoniana, sus indicaciones así como relatar un caso clínico

Diferentes métodos de intubação endotraqueal estão disponíveis para manutenção das vias aéreas durante o tratamento cirúrgico de pacientes portadores de fraturas maxilofaciais severas. Quando os métodos de intubação nasotraqueal e orotraqueal estiverem contra-indicados, a intubação endotraqueal pela via submentoniana é uma alternativa útil para esses pacientes severamente traumatizados de face nos quais o bloqueio maxilomandibular intraoperatório é necessário. Essa técnica permite o estabelecimento de uma via aérea segura e possibilita a realização da fixação intermaxilar durante a cirurgia, que é essencial para se conseguir um ótimo resultado na redução e fixação das fraturas nos ossos da face, evitando dessa maneira a realização de uma traqueostomia e as complicações inerentes a esse procedimento. O presente trabalho tem o objetivo descrever a técnica de intubação submentoniana, suas indicações, assim como relatar um caso clinico

Different endotracheal intubation methods are available for airway maintenance during surgical treatment of patients who have severe maxillofacial fracture. When the nasotracheal as well as the orotracheal intubation methods are not indicated, the endotracheal intubation through the submental route is a useful alternative for such patients who have had a severe trauma in their face in which the maxilomandibular intraoperatory is required. Such technique allows the accomplishment of the intermaxilary fixation during the surgery, which is essential in order to get an excellent  result concerning the reduction and fixation of face bone fractures, avoiding this way, the tracheotomy and its complications. The aim of the present research is to report the case of a patient who was victim of a car accident and who presented nasal pyramid fracture, which contraindicated the nasotracheal intubation, besides other fractures in the midface.  The orotracheal intubation would not be viable due to the necessity of reestablishing occlusion of the patient using intermaxilary fixation during the transoperatory. This way the submental intubation technique was indicated for the surgical treatment of this case. In this article we are going to describe and discuss the clinical use of such procedure

Mentoplastia: do planejamento à técnica cirúrgica / Genioplasty: from treatment planning to surgical technique

Por meio das mentoplastias, algumas deformidades isoladas do terço inferior da face podem ser corrigidas, modificando-se a forma e o tamanho da sínfise mandibular, melhorando o suporte dos tecidos moles e o perfil do paciente. Neste artigo serão descritos importantes aspectos do planejamento e tratamento cirúrgico das deformidades da região mentoniana e o relato de um caso clínico de osteotomia horizontal deslizante para a reposição anterior do mento em uma paciente com padrão facial tipo II.

Reemplazo condilar total como tratamiento de la anquilosis temporomandibular: reporte de dos casos bilaterales / Total condylar replacement as the treatment for temporomandibular ankylosis: report of two bilateral cases

La anquilosis temporomandibular es la fusión ósea, fibrosa o cartilaginosa de las superficies que conforman la articulación: cavidad glenoidea del temporal-cóndilo mandibular. La anquilosis puede presentarse en período de crecimiento o después de completado éste, afectando la función mandibular y, en ocasiones, la estética facial. Los daños que puede presentar esta patología no son sólo funcionales o estéticos, sino también psicológicos. La etiología es en un alto porcentaje traumatismos que dañan el área articular. El tratamiento está dirigido a eliminar la fusión ósea y crear una nueva articulación que contribuya a la movilidad y evitar la reanquilosis mediante la colocación de prótesis metálicas de titanio que sustituyan al cóndilo mandibular. En este artículo se reportan dos casos de anquilosis temporomandibular bilateral en pacientes adultos tratados con condilectomía y colocación de prótesis metálicas de ATM bilaterales, tratados en el Hospital de Especialidades N§71 de Torreón, Coah, IMSS, con buenos resultados, tanto estéticos como funcionales, siendo pocos los casos reportados en México. Se revisa además la literatura referente a la anquilosis temporomandibular y al uso de prótesis metálicas condilares

Surgical correction of chin deformities: indications and technique

The prominent position of the chin between the head and neck makes of it an essential component of the equilibrium and aesthetic of the face. It has a rather conscious impact on the subject personality and affects his relation with his peers. The horizontal osteotomy in genioplasty is a simple, reliable and rapid technique allowing an accurate three-dimensional repositioning of the chin including advancement, posterior, and transverse displacement, and chin height reduction. Indications of this procedure are variable. It is performed as an isolated cosmetic genioplasty, or as a part of a profiloplasty surgery or surgery for correction of a maxillomandibular dysmorphosis. The authors describe their technique and discuss its benefits and disadvantages with emphasis on patient selection and knowledge of technical details

Abordajes quirúrgicos intraorales / Intraoral surgical approaches

El artículo que se presenta tiene como objetivo, dar una visión general de las diversas maneras de acceder intraoralmente, tanto a patologías orales superficiales y profundas, como al esqueleto facial y a los senos maxilares. Se reseñan brevemente, abordajes en cirugía dentoalveolar, cirugía preprotésica, cirugía de seno maxilar, trauma facial, cirugía ortognática y patología tumoral benigna. Se presentan casos clínicos para ilustrar diferentes procedimientos

Reconstrucción de maxilar superior con injerto autólogo de mentón y micromalla de titanio: reporte de dos casos / Autogenous mandibular bone graft with titanium micromesh for reconstruction of the maxillary alveolar ridge: a report of two cases

Existen ciertas condiciones que pueden alterar la anatomía del reborde alveolar de los maxilares, tales como osteorradionecrosis, tumores, enfermedad periodontal y secuelas de trauma o de labio y paladar hendido, comprometiendo el patrón oclusal, la fonética y el aspecto estético y funcinal de los pacientes. En procedimientos convencionales de reconstrucción, usualmente son utilizados injertos óseos autólogos de cresta ilíaca, arcos costales, calota y tibia. Debido a la morbilidad asociada con la toma de injertos de estos lugares, se han estudiado diferentes zonas alternas de donación. El presente artículo describe una técnica de reconstrucción del reborde alveolar del maxilar superior mediante la combinación de injerto óseo autólogo de mentón más micromalla de titanio en dos casos de diferente etiología

Aumento de rebordes edéntulos con autoinjertos óseos de sínfisis mentoniana. Estudio piloto / Edentulous ridges augmentation with mandibular symphysis autogenous bone grafts. A pilot study

En esta investigación se presentan los resultados obtenidos al aumentar rebordes edéntulos con autoinjertos óseos de sínfisis mentoniana, realizados en 13 pacientes, 8 mujeres y 5 hombres, con una edad promedio de 40 años (rango 16 - 58 años). Este aumento en amplitud del reborde se llevó a cabo con el fin de colocar implante endoóseos en maxilar con defectos en espesor debidos a extracciones, enfermedad periodontal, trauma, infección endodóntica y otras patologías. En todos los pacientes, excepto en uno, se obtuvo una amplitud final de 5 o más milímetros de espesor del reborde. La amplitud final promedio fue 5.72 mm. para colocar implantes estándar (3.75 mm. de diámetro). La calidad del hueso obtenida fue tipo I (5/13) y tipo II (7/13), en ningún caso se obtuvo calidad tipo III y IV. La resorción del injerto utilizado fue de 45 por ciento en promedio y no se presentaron complicaciones postoperatorias mayores, tanto en el sitio donante como en el receptor. El éxito total del procedimiento fue de 92.31 por ciento y el fracaso 7.69 por ciento, representado en un caso de los trece, que tuvo perforación del colgajo, contaminación del injerto y resorción total de él. Este sistema de aumento de reborde es eficaz, predecible y más económico al compararlo eventualmente con los procedimientos de regeneración ósea guiada y los injertos óseos tomados de otros sitios del mismo individuo

Osteotomia estetica do mento: analise critica de sua indicacao / Esthetic osteotomy of the chin: critical analysis of its indication

Os autores apresentam uma casuistica de 34 pacientes com microgenia submetidos a osteotomias de avanco do mento para melhora do perfil facial. Analisam as principais indicacoes deste metodo cirurgico para a correcao estetica do mento, ressaltando suas vantagens em relacao aos outros metodos descritos na literatura.

Contouring of the lower face

Abnormalities of the lower face can be related to any or a combination of several anatomical structures. These include excessive skin, excess subcutaneous fat, platysma bands, subplatysmal excess fat, ptosis of submaxillary glands, malpositioned hyoid bone, micro or retrogenia and retrognathia. It is crucial to evaluate each of these anatomical elements individually and decide what, exactly, would most benefit the patient. It is not common for one abnormality to mask another. For example, significant excess fat might cover ptotic submaxillary glands, making the recognition of this problem difficult if not impossible. With careful examination, however, most imperfections can be detected and analyzed appropriately. The subjects of correction of excessive skin, platysmal band, sub - and supraplatysmal fat and ptotic submaxillary gland will be discussed by other authors. This writing will primarily address chin abnormalities and the role of the hyoid bone in dysmorphic necks.