A Modified Frontal Cephalometric Analysis for Aesthetic Facial Bone and Maxillofacial Surgery

The frontal cephalometric analysis has not gained its importance in maxillofacial surgery compared to the lateral cephalometric analysis. In general, the frontal cephalometric analysis is practicable in providing an accurate measurement of the horizontal position and the width of maxilla, zygoma, and mandible. It also provides an assessment in the horizontal and vertical asymmetry of the face. With this knowledge, it is reasonable to regard the frontal cephalometric analysis as a valuable tool in making accurate diagnosis, planning of operation and evaluation of the results for sophisticated maxillofacial surgery. In addition, a recent development of computer software provides an extra benefit in diagnosing and performing surgery which has been frequently used in the dental field, in contrast to its limited application in the plastic surgery. The authors measured the frontal cephalometry of 115 patients who had maxillofacial surgery in our hospital from January 2000 to October 2002. The total 124 operative procedures for the patients are as follows: 58 was angle contouring; 22 zygomatic reduction; 16 genioplasty; 11 sagital split ramus osteotomy; 4 anterior segmental osteotomy; 10 distraction osteogenesis, and 6 was two-jaw surgery. The detailed procedure of the measurement is as follows: Digital scanning of cephalometric films; Presentation of the digital images on computer software (Vceph(R), CyberMed Inc. Korea); Registration of 43 anatomic landmarks such as zygomatic arch, gonion, antegonion, jugular process, and the automatic analysis with a custom-modified computer software with 27 items including midline analysis, facial width and height analysis, ratio analysis, symmetry analysis, and mandibular analysis. The analyzed data can be depicted as in the figure and chart. With above the mentioned automatic analysis, we found it to be effective, time-saving and accurate in the diagnosis of the facial asymmetry and estimation of the ratio of the facial bone. In this study, the authors have devised the frontal cephalometric analysis for the plastic and reconstructive maxillofacial surgery and its automatically analyzed measurements by using the computer software. This modified frontal cephalometric analysis has proved to be useful and efficient for diagnosis, operation planning and evaluation of the result in maxillofacial surgery.

The Correction of Deep Facial Wrinkles using Preserved Particulate Fascia Lata

Preserved particulate fascia lata, derived from screened human cadavers, has recently become available. This injectable form of the material can be injected when soft tissue augmentation is desired. Historically, preserved fascia grafts have proven efficacy and an excellent safety record over the past 70 years. Deep facial wrinkles, especially grabellar frown and nasolabial fold remain a difficult problem to be corrected. Clinical subjects(N=35; 29 women, 6 men, age range 29 - 48 years) requiring soft tissue augmentation to correct deep facial wrinkles were injected with a total of 53 syringes of freeze-dried, irradiated, human cadaver fascia lata. After an subdermal pocket was created at each depressed site, two different preparations -2.0 mm, 0.5 mm particle sizes-were hydrated in 2 - 3 cc normal saline and injected with needles ranging in size from 16 to 20 gauge. The patients were followed for 9 months (1-17 months) after implantation without incidence of infection, allergic reaction, or acute rejection. After the treatment day, patients experienced no further discomfort. No dermal inflammation was evident and the local ecchymosis associated with infections was minor. Soft tissue augmentation was evident 6 months after grafting or longer in most cases. Ultimately, a predictable improvement in skin contour occurred in the majority of the facial wrinkles.Preserved particulate fascia lata grafting is a simple, safe, controlled technique for correction of facial wrinkles. This patient series indicates that injectable preparations of preserved fascia lata have the high biocompatibility as experienced with whole-tissue implants.