Hyaluronic Acid Dermal Fillers for Treatment of Congenital and Acquired Lip Asymmetries and Deformities

Hyaluronic acid (HA) dermal fillers are widely used in aesthetic treatments for facial and lip modeling. Despite HA fillers has largely known to be use in procedures for augmentation the lip volume, their application to management lip abnormalities is not widespread. This study reviewed the use of HA fillers for reconstruction of congenital and acquired li p asymmetries and deformities, searching to expand knowledge about this treatment modality. To undertake this narrative review, the Medline-Pubmed, Web of Science, Scopus, Embase, Google Schoolar e Lillacs databases were searched. Several studies have reported positive results in the use of HA fillers for the treatment of lip deformities caused by different factors such as: Insatisfactory dermal fillers, permanent lip implants, excision of lip carcinoma, post-operative scars and electrical burns. HA fillers are also an alternative for the management of lip asymmetries and residual surgical scars in patients with cleft lip. Moreover, injection of HA fillers in individuals with facial paralysis and facioscapulohumeral muscular dystrophy can also improve lip incompetence. Additionally, HA fillers can be used as a complementary treatment in cases of severe malocclusion associated with skeletal changes, helping to maintain the seal and refine the lip appearance. Therefore, HA fillers can be used as alternative treatment for several types of congenital and acquired lip deformities and asymmetries. However, it is necessary to carry out randomized clinical trials with a greater number of patients and follow-up time, in order to investigate the benefits of the HA fillers for carriers patients of lip abnormalities.

Los rellenos dérmicos de ácido hialurónico (AH) son muy utilizados en tratamientos estéticos para el modelado facial y de labios. A pesar de que se sabe en gran medida que los rellenos de HA se utilizan en procedimientos para aumentar el volumen de los labios, su aplicación para el tratamiento de anomalías labiales no está muy extendida. Este estudio revisó el uso de rellenos de HA para la reconstrucción de asimetrías y deformidades labiales congénitas y adquiridas, buscando ampliar el conocimiento sobre esta modalidad de tratamiento. Para realizar esta revisión narrativa, se realizaron búsquedas en las bases de datos Medline-Pubmed, Web of Science, Scopus, Embase, Google Schoolar y Lillacs. Varios estudios han reportado resultados positivos en el uso de rellenos de HA para el tratamiento de deformidades labiales causadas por diferentes factores tales como: rellenos dérmicos insatisfactorios, implantes labiales permanentes, escisión de carcinoma labial, cicatrices postoperatorias y quemaduras eléctricas. Los rellenos de HA también son una alternativa para el manejo de asimetrías labiales y cicatrices quirúrgicas residuales en pacientes con labio hendido. Además, la inyección de rellenos de HA en personas con parálisis facial y distrofia muscular facioescapulohumeral también puede mejorar la incompetencia de los labios. Además, los rellenos de HA se pueden usar como un tratamiento complementario en casos de maloclusión severa asociada con cambios esqueléticos, lo que ayuda a mantener el sellado y refinar la apariencia de los labios. Por lo tanto, los rellenos de HA se pueden utilizar como tratamiento alternativo para varios tipos de deformidades y asimetrías labiales congénitas y adquiridas. Sin embargo, es necesario realizar ensayos clínicos aleatorizados con mayor número de pacientes y tiempo de seguimiento, para investigar los beneficios de los rellenos HA para pacientes portadores de anomalías labiales.

Asymmetry of Occupational Noise Induced Hearing Loss: An Electrophysiological Approach

Abstract Introduction The question as to whether occupational noise exposure causes symmetrical or asymmetrical hearing loss is still controversial and incompletely understood. Objective Two electrophysiological methods (cortical evoked response audiometry: CERA and auditory steady state responses: ASSR) were used to address this issue. Method 156 subjects with a well-documented history of noise exposure, a wide range of noise induced hearing loss (NIHL) and without middle ear pathology underwent both a CERA and an ASSR examination in the context of an exhaustive medicolegal expert assessment intended for possible compensation. Results Whatever the method (CERA or ASSR), the average electrophysiological hearing thresholds (1-2-3 kHz) are significantly worse in the left ear. The right - left differences in CERA and ASSR thresholds are strongly correlated with each other. No significant effect of frequency is found. No correlation is observed between right - left differences in hearing thresholds and either age or degree of hearing loss. Conclusion In NIHL, there is an actual average right - left difference of about 2.23 dB, i.e., 3.2%, the left ear being more impaired.

Multiple Osteomas of Mandible in a Patient with Gardner’s Syndrome - Report of a Case

Introduction: Osteomas are benign tumors of the bone usually seen in craniofacial bones which arise from either the cortex or medulla. They are usually asymptomatic with slow painless growth. Multiple osteomas are often associated with Gardners syndrome. Solitary osteomas are typically non syndromic. Case Presentation: The patient presented with remarkable facial asymmetry following the growth in the mandible. Multiple os- teomas were noted which invoked suspicion of a syndrome. On endoscopic evaluation the patient was found to have multiple intestinal polyps, pathgnomonic for Gardners syndrome. Management and prognosis: The lesion was surgically removed under local anaesthesia. as an excisional biopsy and the asymmetry was rectified. Histopathologic examination revealed it to be ivory osteoma with dense compact bone and less mar- row spaces. The jaw lesions would precede the development of colonic polyps and therefore may contribute to early diagnosis of Gardner’s syndrome. There is also a chance of malignant evolution associated with the polyps Conclusion: People with the condition have a higher risk of developing other family adenomatous polyp (FAP)related cancers including pancreatic cancer and liver cancer. The patient should be in close follow up

Effects of early unilateral mandibular first molar extraction on condylar and ramal asymmetry / Efectos de la extracción temprana del primer molar mandibular unilateral sobre la asimetría condilar y ramal

SUMMARY: Craniofacial symmetry is an important factor in creating a harmonious facial appearance. Genetic and external factors may cause the formation of mandibular asymmetry. The aim of this study was to evaluate vertical mandibular asymmetries in adolescents who had unilateral mandibular first permanent molar (FPM) teeth extracted at an early age. The study group consisted of 60 subjects (30 females, 30 males with a mean age of 16.18±1.04 years) who had their mandibular permanent first molar tooth extracted before the age of 12, and the control group consisted of 60 healthy subjects (30 females, 30 males with a mean age of 16.23±0.92 years). Condylar asymmetry index (CAI), ramal asymmetry index (RAI), and condylar-ramal asymmetry index (CRAI) were calculated using panoramic radiographs of the subjects. Independent samples t-test was used to evaluate the differences between groups. CAI, RAI, and CRAI values were similar between male and female subjects in both control and study groups, and no statistically significant difference was found (p>0.05). No statistically significant difference was observed between the group who had their mandibular first permanent molar teeth extracted at an early age and the control group (p>0.05). CAI values were relatively higher in both groups, but there was no significant difference between the CAI, RAI, and CRAI values between the groups.

La simetría craneofacial es un factor importante para crear una apariencia facial armoniosa. Factores genéticos y externos pueden causar la formación de asimetría mandibular. El objetivo de este estudio fue evaluar las asimetrías mandibulares verticales en adolescentes a quienes se les extrajo el primer molar permanente (FPM) mandibular unilateral a una edad temprana. El grupo de estudio consistió en 60 sujetos (30 mujeres, 30 hombres con una edad media de 16,18±1,04 años) a quienes se les extrajo el primer molar mandibular permanente antes de los 12 años, y el grupo control consistió en 60 sujetos sanos (30 mujeres, 30 hombres con una edad media de 16,23±0,92 años). El índice de asimetría condilar (CAI), el índice de asimetría ramal (RAI) y el índice de asimetría condilar-ramal (CRAI) se calcularon utilizando radiografías panorámicas de los sujetos. Se utilizó la prueba t de muestras independientes para evaluar las diferencias entre los grupos. Los valores de CAI, RAI y CRAI fueron similares entre los hombres y las mujeres tanto en el grupo control como en el de estudio, y no se encontraron diferencias estadísticamente significativas (p>0.05). No se observaron diferencias estadísticamente significativas entre el grupo al que se le extrajo el primer molar permanente mandibular a una edad temprana y el grupo control (p>0,05). Los valores de CAI fueron relativamente más altos en ambos grupos, pero no hubo diferencias significativas entre los valores de CAI, RAI y CRAI entre los grupos.

Influencia del pie como receptor en la postura corporal, la simetría facial y cráneo-mandibular / The influence of foot as a receptor on body posture and on facial, mandibular and cranial symmetries

Introducción: Un apoyo plantar incorrecto puede considerarse un factor etiológico de asimetrías faciales y cráneo-mandibulares pues modifica, de forma instantánea, la relación entre el maxilar y la mandíbula. Por tanto, resulta vital identificar la etiología de estas asimetrías para establecer diagnósticos y tratamientos certeros. Objetivo: Determinar la influencia del apoyo plantar en la postura corporal, la simetría facial y cráneo-mandibular en adolescentes. Métodos: Se realizó un estudio descriptivo y transversal de enero a septiembre de 2019 con 180 adolescentes que asistieron al servicio de Ortodoncia de la Clínica Docente de Especialidades «Victoria de Santa Clara», los cuales cumplían con criterios de selección de la investigación. Se analizaron variables faciales, posturales y cefalométricas. Se determinó: la simetría facial mediante el análisis de líneas faciales, el apoyo plantar al calcular el índice cavitario, la postura corporal, según la prueba de Di Rocca, y la simetría mandibular con el método modificado de Kurt y Uysal. Se siguieron las normas éticas y fueron aplicadas la prueba de Fisher, la de McNemar, y la técnica de conglomerado. Resultados: Predominaron los adolescentes con apoyo plantar asimétrico y los pies varo. Del total de casos con asimetría facial, 72,53 % presentó apoyo plantar asimétrico, y 39,44 % planos biilíaco y biclavicular desequilibrados y divergentes. La asimetría mandibular se observó en el 56,11%, la mayoría con apoyo plantar asimétrico. Conclusiones: Se pudo constatar la influencia del apoyo plantar en la postura corporal, la simetría facial y cráneo-mandibular, pues se observó un alto grado de relación entre las variables estudiadas.

Introduction: an incorrect plantar support can be considered an etiological factor of facial, mandibular and cranial asymmetries since it instantly modifies the relationship between the maxilla and mandible. Therefore, it is vital to identify the etiology of these asymmetries to establish accurate diagnoses and treatments. Objective: to determine the influence of plantar support on body posture and on facial, mandibular and cranial symmetries in adolescents. Methods: a descriptive and cross-sectional study was carried out from January to September 2019 with 180 adolescents who were seen in the Orthodontics service at "Victoria de Santa Clara" Specialty Teaching Dental Clinic, who met the research selection criteria. Facial, postural and cephalometric variables were analyzed. Facial symmetry was determined through the analysis of facial lines, plantar support by means of cavity index, body posture according to the Di Rocca test, and mandibular symmetry with the modified method of Kurt and Uysal. Ethical standards were followed and Fisher's and McNemar's tests as well as clustering technique were applied. Results: adolescents with asymmetric plantar support and varus feet predominated. The 72.53% had asymmetric plantar support from the total cases with facial asymmetry, and 39.44% had unbalanced and divergent biiliac and biclavicular planes. Mandibular asymmetry was observed in 56.11%, mostly with asymmetric plantar support. Conclusions: the influence of plantar support on body posture and on facial, mandibular and cranial symmetries was posible to verify since a high degree of relationship was observed among the variables studied.

Structural asymmetries in neonatal brain white matter: a diffusion tensor imaging study / 中华放射学杂志

Objective:To explore the asymmetry of neonatal brain white matter using fractional anisotropy (FA) parameter generated from diffusion tensor imaging (DTI).Methods:From January 2011 to June 2013, 88 neonates with normal cranial MRI performance, aged 1-14 (7.7±0.3) days and gestational age 31-42 (37.5±0.3) weeks, were retrospectively collected from the First Affiliated Hospital of Xi′an Jiaotong University. According to the gestational age at birth, the neonates were divided into preterm group (37 cases) and term group (51 cases). DTI was processed to generate FA parametric maps. Tract-based spatial statistics (TBSS) was used to analyze the asymmetry in neonatal white matter. Regions of interest were placed in bilaterally symmetrical white matter tracts. The white matter tracts included the bilateral anterior thalamic radiation, corticospinal tract-posterior limb of the inner capsule (CST-IC), corticospinal tract-corona radiata, cingulum hippocampus part (CGH), inferior frontal occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus (SLF), uncinate fasciculus, superior longitudinal fasciculus temporal part (SLF-temp). The FA value was measured and asymmetry index (AI) was calculated. The independent-sample t test or Mann-Whitney U test was used to compare the AI of each tract between the preterm and term groups. Partial correlation was used to analyze the effects of neonatal gestational age and birth anthropometric measures on the asymmetry of neonate at birth. Results:The results of TBSS showed that the left lateralized areas of brain white matter in the neonatal period were mainly located in the corticospinal tract, external capsule and genu of corpus callosum. The right lateralized areas of brain white matter in the neonatal period were mainly located in the optic radiation and splenium of corpus callosum. In both the preterm and term groups, the tracts related to motor (CST-IC) and language function (ILF, SLF, SLF-temp) were left asymmetry. The CGH of the preterm and the term neonates were right asymmetry, and AI was -0.086±0.114 and -0.140±0.108 respectively, with a statistically significant difference ( t=2.27, P=0.026), while the differences of AI in the remaining tracts were not statistically significant ( P>0.05). Only gestational age was correlated with the AI of ILF ( r=0.234, P=0.033), SLF ( r=0.259, P=0.018), SLF-temp ( r=0.252, P=0.022), CST-IC ( r=0.235, P=0.033). No significant correlation was found between birthweight, head circumference, body length and AI. Conclusions:The asymmetries of brain white matter already exist in neonates aged less than two weeks. The tracts associated with motor and language function are predominantly left asymmetry.

Association of peripheral axial length, retinal curvature with refraction in school-aged children / 中华实验眼科杂志

Objective:To investigate the association of peripheral axial lengths and retinal curvatures with refractive status.Methods:A cross-sectional study was conducted out.Two hundred and eighty-seven eyes of 287 consecutive children aged 6-15 years old who recieved eye examinations at Beijing Tongren Hospital from July to October 2021 were enrolled, including 154 males and 133 females.Uncorrected and best corrected visual acuity were tested with a standard logarithmic visual acuity chart.Spherical equivalent (SE) was measured via an auto refractometer after cycloplegia with tropicamide.The hyperopic, emmetropic and myopic groups were defined with a SE >+ 0.5 D, SE >-0.5 D to ≤+ 0.5 D and SE≤-0.5 D, respectively.Central and 30° peripheral eye lengths (nasal, temporal, superior, inferior) were obtained using the Lenstar LS900.Retinal coordinates were derived from partial coherence interferometry modeling and converted to retinal curvatures.According to the median horizontal peripheral eye length differences (absolute difference between nasal and temporal), participants were assigned to H1 group (absolute difference <0.35 mm) or H2 group (absolute difference ≥0.35 mm). According to the median vertical peripheral eye length differences (absolute difference between superior and inferior), participants were assigned to V1 group (absolute difference <0.32 mm) or V2 group (absolute difference ≥0.32 mm). Four groups of V1H1, V1H2, V2H1 and V2H2 were constructed according to the grouping methods in both directions above.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2021-162). Written informed consent was obtained from guardians of each subject prior to any medical examination.Results:The central axial length was 23.53(22.93, 24.10)mm.Peripheral eye lengths of temporal, nasal, superior and inferior were 22.75(22.11, 23.22)mm, 22.99(22.32, 23.45)mm, 23.24(22.58, 23.75)mm and 23.12(22.52, 23.56)mm, respectively.Temporal eye length was shorter than nasal, showing a statistically significant difference ( Z=-3.58, P<0.01). Compared with H2 group, H1 group had shorter central, nasal, superior and inferior eye lengths, showing statistically significant differences (all at P<0.05). Compared with V2 group, V1 group had shorter central, nasal and superior eye lengths, showing statistically significant differences (all at P<0.05). SE of H1 group was + 0.06 (-1.06, + 0.75) D, which was significantly greater than -0.32 (-1.64, + 0.56) D of H2 group ( Z=-2.10, P=0.04). SE of V1 group was + 0.13 (-0.81, + 0.80) D, which was significantly greater than -0.56 (-1.83, + 0.48) D of H2 group ( Z=-3.39, P<0.01). The myopia ratio of V1 group was 33.5% (58/173), which was significantly lower than 50.5% (53/105) of V2 group ( χ2=7.83, P<0.01). There was a significant overall difference in SE among VIH1, V1H2, V2H1 and V2H2 groups ( H=24.79, P<0.01). SE was greater in V1H1 group than V1H2, V2H1 and V2H2 groups (all at P<0.01). There was a significant difference in both horizontal and vertical retinal curvatures among different refractive groups ( H=22.34, 19.30; both at P<0.01). The retical curvature in both directions of hyperopic and emmetropic groups were significantly larger than those of myopic group (both at P<0.01). Conclusions:Peripheral eye lengths are asymmetric in school-aged children.Higher asymmetry is associated with myopic shifts.Myopic children have a steeper retina than the hyperopic and emmetropic children.

CBCT analysis of condylar and occlusal plane features in skeletal Class Ⅲ malocclusion patients with mandibular asymmetry / 口腔医学

Objective@#To analyze the condylar and inclination of the occlusal plane features in skeletal Class Ⅲ malocclusion patients with mandibular asymmetry by using cone beam computed tomography(CBCT).@* Methods@#Forty eligible patients with Angle Class Ⅲ malocclusion were enrolled. All individuals were classified based on the distance from Me point to median sagittal plane. The left and right angles between OP and FH plane, the position and morphology of the condyle were measured in both groups.Then the data collected were statistically analyzed. @* Results@#Compared to the opposite side, there was a statistically significant difference(P<0.05) in angle between OP and FH plane, the anterior joint space, superior joint space, lateral joint space and condylar mediolateral diameter, with a higher proportion of joint posteriority in deviated side. Mandibular deviations were positively correlated with both the anterior joint space of the deviated side and the angle between OP and FH plane of the opposite side(P<0.01). There was no statistical difference between the left and right side of angles between OP and FH plane, the position and morphology of the condyle in skeletal Class Ⅲ patients without mandibular deviation(P>0.05); the joint was predominantly in anterior and middle position. @*Conclusion@#There is asymmetry on the left and right sides of the inclination ofocclusal plane, the position and morphology of the condyle of skeletal Class Ⅲ malocclusion patients with mandibular asymmetry. Compared with the opposite side, the deviated side has smaller angle between OP and FH plane and smaller condylar mediolateral diameter, and the condyle shows generally more posterior, inferior and inward movement in glenoid fossa. The inclination of the occlusal plane and the position of condyle are significantly and positively correlated with the distance from Me point to median sagittal plane.

Research progress on three-dimensional evaluation methods for facial asymmetry / 口腔疾病防治

@#Facial symmetry evaluation has always been a hot topic of concern for doctors who engage in the study of facial beauty disciplines such as orthodontics, dentistry, and plastic surgery. Although scholars at home and abroad have carried out much research on the evaluation of facial symmetry with a variety of emerging technologies and methods, there is still a lack of unified standards for the evaluation of facial asymmetry due to the complexity of the content and methods and individual subjectivity. Facial asymmetry involves changes in the length, width and height of the face. It is a complex dental and maxillofacial malformation whose early identification and accurate evaluation are particularly important. Clinically, in addition to the necessary dental and maxillofacial examinations, it is also necessary to evaluate facial asymmetry with the help of corresponding auxiliary methods. This paper gives a summary of the commonly used three-dimensional evaluation methods. The evaluation methods of facial asymmetry can be divided into 5 categories: qualitative analysis, quantitative analysis, dynamic analysis, mathematical analysis, and artificial intelligence analysis. After the analysis and summarization of the characteristics, advantages and limitations of each method in clinical applications, it is found that although these methods vary in accuracy, evaluation scope, diagnosis nature and calculation method, etc., the three-dimensional evaluation methods are more objective, more accurate and more convenient and will become the mainstream evaluation method for facial asymmetry with further development of three-dimensional measurement technologies.

Enxertos compostos de gordura para correção de distrofia facial em caso de esclerodermia localizada / Composite fat grafts for correcting facial dystrophy in a case of localized scleroderma

A esclerodermia localizada (morfeia linear) é uma doença rara que causa distrofia e assimetria faciais em mulheres jovens. É relatado o caso de uma paciente de 20 anos que foi tratada com enxertos compostos de gordura. Após a coleta do lipoaspirado de gordura subcutânea profunda, a microgordura e a nanogordura não filtrada foram processadas separadamente para formar enxertos compostos de gordura. Estes foram meticulosamente transplantados em camadas, para reconstruir o subcutaneo da face da paciente. Após um ano, observou-se boa pega de gordura com correção bem-sucedida da assimetria e restabelecimento do equilíbrio facial.

Localized scleroderma (linear morphea) is a rare disease that causes facial dystrophy and asymmetry in young women. We report the case of a 20-year-old female patient who was treated with novel composite fat grafts. After extracting lipoaspirate from deep subcutaneous fat, the microfat and the unfiltered nanofat were processed separately, and amalgamated, obtaining composite fat grafts. These were meticulously transplanted layer by layer to rebuild the subcutaneous tissue of the patient's face. After one year, a good volume of fat retention was observed with successful correction of asymmetry and restoration of facial balance.

Does head tilt influence facial appearance more than head turn?

Purpose: To evaluate the frequency of facial asymmetry parameters in patients with head tilt versus those with head turn. Methods: This cross-sectional comparative study was performed on 155 cases, including 58 patients with congenital pure head turn due to Duane retraction syndrome (DRS), 33 patients with congenital pure head tilt due to upshoot in adduction or DRS, and 64 orthotropic subjects as the control group. The facial appearance was evaluated by computerized analysis of digital photographs of patients' faces. Relative facial size (the ratio of the distance between the external canthus and the corner of the lips of both face sides) and facial angle (the angular difference between a line that connects two external canthi and another line that connects the two corners of the lips) measured as quantitative facial parameters. Qualitative parameters were evaluated by the presence of one-sided face, cheek, and nostril compression; and columella deviation. Results: The facial asymmetry frequency in patients with head tilt, head turn, and orthotropic subjects was observed in 32 (97%), 50 (86.2%), and 22 (34.3%), respectively (P < 0.001). In patients with head tilt and head turn, the mean facial angle was 1.78º ± 1.01º and 1.19º ± 0.84º, respectively (P = 0.004) and the mean relative facial size was 1.027 ± 0.018 and 1.018 ± 0.014, respectively (P = 0.018). The frequencies of one-sided nostril compression, cheek compression, face compression, and columella deviation in patients with pure head tilt were found in 19 (58%), 21 (64%), 19 (58%), and 19 (58%) patients, respectively, and in patients with pure head turn the frequencies were observed in 42 (72%), 37 (63%), 27 (47%), and 43 (74%), respectively. All quantitative and qualitative facial asymmetry parameters and facial asymmetry frequencies were significantly higher in head tilt and head turn patients as compared to the control group (P < 0.001). Conclusion: All facial asymmetry parameters in patients with head tilt and head turn were significantly higher than orthotropic subjects. The quantitative parameters such as relative facial size and facial angle were significantly higher in patients with pure head tilt than pure head turn. The results revealed that pure head tilt was associated with a higher prevalence of facial asymmetry than pure head turn.

Percepción de las asimetrías del mentón entre ortodoncistas, odontólogos especialistas, estudiantes y pacientes / Perception of chin asymmetries among ecuadorian orthodontists, specialist dentists, students and patients

Introducción: Estudios previos han demostrado diferencias en la percepción de asimetrías dentales y faciales entre profesionales de la odontología y personas no expertas. Sin embargo, la literatura sobre las diferencias en la percepción de las asimetrías del mentón es limitada. Objetivo: Comparar la percepción estética de las asimetrías del mentón entre ortodoncistas, odontólogos especialistas, estudiantes y pacientes de la Facultad de Odontología de la Universidad Central del Ecuador. Métodos: Estudio observacional, analítico y transversal. El universo estuvo conformado por 36 ortodoncistas, 77 odontólogos especialistas, 96 estudiantes y 2580 pacientes de esta Facultad. El tamaño de la muestra fue de 30 participantes para cada grupo. Se modificó digitalmente la posición transversal del mentón de 0° a 6° en las fotografías de dos sujetos (hombre-mujer) ecuatorianos. La evaluación se realizó por medio de una escala visual análoga. Resultados: Las fotografías de asimetrías del mentón con 0° de desviación fueron calificadas como muy estéticas y las asimetrías con 6° fueron poco estéticas para los cuatro grupos. Los ortodoncistas, odontólogos especialistas y estudiantes consideraron como límite estético los 2° de desviación del mentón para la fotografía del sujeto femenino y masculino. Los límites estéticos fueron los 2° de desviación para el sujeto femenino y 3° para el sujeto masculino. Se encontraron diferencias significativas entre los grupos de evaluadores y las fotografías (p < 0,05). Conclusiones: Los ortodoncistas percibieron la estética facial cercana a la norma de la asimetría del mentón, que tiene un papel importante en la percepción de la estética facial(AU)

Introduction: Previous studies have shown differences in the perception of dental and facial asymmetries between dental professionals and non-experts. However, the literature on differences in the perception of chin asymmetries is limited. Objective: Compare the aesthetic perception of chin asymmetries among orthodontists, specialist dentists, students and patients of the Faculty of Dentistry of the Central University of Ecuador. Methods: Observational, analytical and cross-sectional study. The universe was made up of 36 orthodontists, 77 specialist dentists, 96 students and 2580 patients from this Faculty. The sample size was 30 participants for each group. The transverse position of the chin was digitally modified from 0° to 6° in the photographs of two Ecuadorian subjects (male-female). The evaluation was carried out by means of an analogous visual scale. Results: The photographs of asymmetries of the chin with 0° of deviation were qualified as very aesthetic and the asymmetries with 6° were unsightly for the four groups. Orthodontists, specialist dentists and students considered as an aesthetic limit the 2nd deviation of the chin for the photography of the female and male subject. The aesthetic limits were 2° of deviation for the female subject and 3° for the male subject. Significant differences were found between the groups of evaluators and the photographs (p < 0.05). Conclusions: Orthodontists perceived facial aesthetics close to the norm of chin asymmetry, which has an important role in the perception of facial aesthetics(AU)

Tratamiento ortodóncico-quirúrgico de pacientes con asimetría facial / Orthodontic-surgical treatment of patients with facial asymmetry

Introducción: la asimetría facial es una condición notoria en el tercio inferior de la facie del sujeto y entre los tercios medio y superior, en este último será menos evidente esta condición, de tal manera que podría considerarse como una de las molestias de mayor incidencia en pacientes con necesidades o no de terapia or- todóncica. Objetivo: evaluar mediante una revisión de la literatura los tratamientos ortodóncico-quirúrgicos de pacientes con asimetría facial. Material y métodos: la literatura se seleccionó mediante una búsqueda en las bases de datos electrónicas: PubMed, Scopus, Web of Science. Las palabras clave utilizadas fueron: facial asymmetry, asymmetry, surgical treatment, surgical orthodontic treatment. La búsqueda se restringió a artículos en inglés publicados del año 2011 al 2021. Resultados: después de aplicar los criterios de inclusión y exclusión en total se obtuvieron y revisaron 27 artículos. Se realizó la revisión de literatura del tratamiento ortodóncico-quirúrgico en pacientes con asimetría facial. Conclusión: es preciso el abordaje ortodóntico quirúrgico para la corrección de la asimetría facial, del protocolo dependerá la situación clínica y la elección de tratamiento ortodóntico quirúrgico, lo que brindará mejoras significativas en la simetría facial (AU)

Introduction: facial asymmetry, is a notorious condition in the lower third of the subject's facie and between the middle and upper thirds, in the latter this condition will be less evident; in such a way, it could be considered as one of the discomforts of greater incidence in patients with needs or not of orthodontic therapy. Objective: to evaluate by means of a literature review the orthodontic-surgical treatment of patients with facial asymmetry. Material and methods: the literature was selected through a search in the following electronic databases: PubMed, Scopus, Web of Science. The keywords used were: facial asymmetry, asymmetry, surgical treatment, surgical orthodontic treatment. The search was restricted to articles in English published from 2011 to 2021. Results: after applying the inclusion and exclusion criteria, a total of 27 articles were obtained and reviewed. The literature review of orthodontic-surgical treatment in patients with facial asymmetry was performed. Conclusion: surgical orthodontic approach is necessary for the correction of facial asymmetry, the protocol will depend on the clinical situation, the choice of surgical orthodontic treatment, which will give significant improvements in facial symmetry (AU)

Coleta de fáscia lata para uso em retalho ortodrômico temporal no tratamento da paralisia facial / Harvest of fascia lata for use in a temporal orthodromic flap in the treatment of facial paralysis

Introdução: A paralisia facial necessita de um tratamento multidisciplinar e as opções cirúrgicas são individualizadas para cada paciente e conforme a experiência da equipe médica. O Retalho Ortodrômico Temporal (ROT) é uma forma de correção bem documentada na literatura, com resultados satisfatórios. Um dos passos de sua realização é a coleta da fáscia lata para ponte entre o tendão temporal e os lábios. O objetivo é propor uma padronização da quantidade necessária de fáscia lata e técnica de coleta simplificada. Métodos: Descrição cirúrgica da medida de fáscia necessária para o procedimento e sua coleta. Resultados: Procedimento replicável e seguro conforme experiência do autor sênior. Conclusão: A tática de coleta proposta pode facilitar a realização deste procedimento e torná-lo mais seguro para os pacientes em diferentes serviços de saúde.

Introduction: Facial paralysis requires a multidisciplinary treatment, and surgical options are individualized for each patient according to the medical team's experience. The Temporal Orthodromic Flap (TOF) is a well-documented form of correction in the literature, with satisfactory results. One of the steps of its accomplishment is the collection of the fascia lata to bridge between the temporal tendon and the lips. The objective is to propose a standardization of the required amount of fascia lata and a simplified collection technique. Methods: Surgical description of the fascia measure necessary for the procedure and collection. Results: Replicable and safe procedure according to the senior author's experience. Conclusion: The proposed collection tactic can facilitate the performance of this procedure and make it safer for patients in different health services.

Métodos para medir asimetrías sagitales y transversales en los modelos de estudio de ortodoncia / Methods to measure sagittal and transverse asymmetries in orthodontic study models

Introducción Para el diagnóstico acertado en el tratamiento de los pacientes de ortodoncia se requiere de una serie de exámenes auxiliares, que son herramientas esenciales en ortodoncia; sin embargo, encontramos cierto grado de dificultad para la valoración de asimetrías dentarias en los hemiarcos de cada arcada dentaria; la importancia de la correcta valoración de las asimetrías es ya ampliamente mencionada en diferentes estudios, porque nos ayudará con la localización co-rrecta, de los dientes en su arcada,al final del tratamiento En la actualidad existe poca literatura sobre los métodos para evaluar y diagnosticar las alteraciones por hemiarcos, especialmente en el plano transversal. Objetivo acer una revisión de literatura sobre los métodos de medición de las asimetrías dentarias intra-arco para poder identificar y cuantificar las alteraciones dentarias en los tres planos del espacio en su respectiva arcada dentaria, el Método para los términos de búsqueda de la información fueron: dental and facial asymmetry, molar asymmetry in ortho-dontics, arch width prediction indices, as well as transverse discrepancies, para tal efecto se empleó Pubmed, Medline, Scielo, Schoolar Google, de los cuales se recopilaron 80 artículos relacionados con nuestro tema de estudio y solo se eligieron 30 artículos y 6 libros de ortodoncia en los que se sustenta este artículo. Resultados En el presente artículo presentamos las herramientas con las que contamos para el diagnóstico de la asimetría dentaria intra-arcos como la placa de Sthmuch y la placa milimetrada de Korkhaus, y finalmente proponemos un método que nos permite cuantificar objetivamente la asimetría en los tres plano del espacio de una manera sencilla, reproducible y de fácil almacenaje en un computador. Conclusión La etapa del diagnóstico es importante porque permitirá obtener la mayor y mejor información de las alteraciones dentarias que presenta el paciente, siendo las alteraciones transversales las más difíciles de cuantificar por que la mayoría de los estudios e índices, ya que solo evidencian las distancias de dientes contra laterales, los cuales son datos limitados pero que aún así contribuyen en el diagnóstico, el método de la placa de Sthmuch, Korkhaus y Bernklau son propuesta para medir las asimetrías dentarias intraarcos, no en tanto es desgastador para el operador y sus resultados objetivos radica en la experiencia del operador; el método KLO nos permite cuantificar objetivamente la falta de sime-tría dentaria en cada arcada de una manera fácil, reproducible y de almacenaje en un computador o en un archivo.

Introduction The correct diagnosis in the treatment of orthodontic patients requires a series of auxiliary examinations, which are essential tools in orthodontics, however we found a certain de-gree of difficulty in assessing dental asymmetries in the hemiarchs of each dental arch; The im-portance of the correct assessment of asymmetries is already widely mentioned in different stud-ies, because it will help us with the correct location of the teeth in their arch, at the end of the treatment. Currently there is little literature on the methods to evaluate and diagnose hemiarchal alterations, especially in the transverse plane. Objective Is to review the literature on the methods of measuring intra-arch dental asymmetries in order to identify and quantify dental al-terations in the three planes of space in their respective dental arch. Method The search terms of the information were: dental and facial asymmetry, molar asymmetry in orthodontics, arch width prediction indices, as well as cross-sectional discrepancies. Pubmed, Medline, Scielo, Schoolar Google, of which 80 articles related to our study topic were collected and only 30 articles and 6 orthodontic books were chosen on which this article is based, Results Also in this article we present the tolos that we have for the diagnosis of intraarch dental asymmetry such as the Sth-much plate and the Korkhaus millimeter plate, and finally we propose a method that allows us to objectively quantify the asymmetry in the three space plan in a simple, reproducible way and easy to store on a computer. Conclusión The stage of diagnosis is important because it will allow obtain-ing the greatest and best information on the dental alterations that the patient presents, being the transversal alterations the most difficult to quantify because most studies and indices, since they only show the distances of Contralateral teeth, which are limited data but still contribute to the diagnosis, the Sthmuch, Korkhaus and Bernklau plate method are proposed to measure intra-arch dental asymmetries, not as it is wearisome for the operator and his patients. objective results lies in the experience of the operator; The KLO method allows us to objectively quantify the lack of dental symmetry in each arch in an easy, reproducible way that can be stored on a computer or in a file.

Rinoplastia secundaria en pacientes con fisura labiopalatina / Secondary Rhinoplasty in Patients with Clef lip and Palate

Introducción: La deformidad nasal asociada con el labio leporino ha sido vista como uno de los problemas reconstructivos más desafiantes en la rinoplastia, hasta el momento no se ha acordado ningún método único para cuantificar el éxito del tratamiento. En el año 2006 se aprobó oficialmente el protocolo para el tratamiento de las deformidades nasales complejas del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", que están incluidas, las deformidades nasales congénitas secundarias en el adulto, no se recogen antecedentes de resultados en este grupo de pacientes basados en mediciones objetivas. Objetivo: Evaluar los resultados estéticos de la rinoplastia secundaria en pacientes con fisura labiopalatina. Métodos: Se realizó un estudio analítico a través de mediciones nasales angulares y de áreas, comparadas en fotografías estandarizadas entre el pre y posoperatorio y se determinó el índice de asimetría según la fórmula de Nakamura. Un panel de expertos usó la escala de Asher McDade y realizó la evaluación subjetiva de las imágenes, que permitió calcular el índice estético antes y después del tratamiento. Resultados: Se obtuvo una reducción marcada de todos los índices de asimetría nasal entre el pre y posoperatorio, así como una mejoría del índice estético posoperatorio pasándose de una apariencia pobre a muy buena apariencia. Conclusiones: Con la aplicación del protocolo para el tratamiento de las deformidades nasales del paciente fisurado adulto del Hospital Clínico Quirúrgico "Hermanos Ameijeiras" se obtienen buenos resultados estéticos(AU)

Introduction: Nasal deformity associated with cleft lip has been seen as one of the most challenging reconstructive problems in rhinoplasty; up to date, no single method has been agreed upon to quantify management success. In 2006, the protocol for managing complex nasal deformities was officially approved by Hermanos Ameijeiras Clinical Surgical Hospital, which includes secondary congenital nasal deformities in adults; however, there is no history of outcomes in this group of patients based on objective measurements. Objective: To assess the aesthetic outcomes of secondary rhinoplasty in patients with cleft lip and palate. Methods: An analytical study was carried out through linear and angular nasal measurements, compared in standardized photographs between the pre- and postoperative period; while the asymmetry index was determined according to Nakamura's formula. A panel of experts used the Asher McDade scale and performed the subjective assessment of the images, which allowed calculation of the esthetic index before and after the procedure. Results: A marked reduction was obtained in all nasal asymmetry indexes between the pre- and postoperative periods; as well as an improvement in the postoperative aesthetic index, from a poor appearance to a very good appearance. Conclusions: With the application of the protocol for managing nasal deformities of the adult cleft patient of Hermanos Ameijeiras Clinical Surgical Hospital, good esthetic outcomes are obtained(AU)

Implante de tela de polipropileno e poliglecaprone para elevação da musculatura na paralisia facial / Polypropylene and poliglecaprone mesh implant for lifting muscles in facial paralysis

Introdução: A paralisia facial é um quadro que pode gerar algumas sequelas, e às vezes apenas as estéticas podem ser melhoradas. Com base nisso, objetivou-se relatar um caso em que foi utilizada uma tela de polipropileno e poliglecaprone com finalidade de elevar as estruturas da hemiface direita. Relato de Caso: A paciente apresentava paralisia em hemiface direita, com selamento palpebral incompetente, desvio de comissura labial e sem movimento da musculatura temporal. Foi realizada uma incisão abaixo da costeleta, pré e retroauricular, com descolamento do retalho cutâneo em toda a hemiface direita. Após levantar o sistema musculoaponeurótico superficial e fixá-lo com fios de mononylon, foi colocada a tela de polipropileno e poliglecaprone na região do terço médio e fixada com monocryl. Foi realizada cantotomia e cantopexia lateral da pálpebra direita. No pós-operatório imediato a paciente evoluiu sem edemas, retrações ou abaulamentos, e após um ano e sete meses apresenta total integração da tela, sem retração, fibrose ou recidiva. Discussão: A escolha do tratamento estético de paralisia facial depende da causa e duração da lesão, mas existem diversas formas de fazê-lo. Entre as ideias mais novas, estão o uso de células tronco e materiais aloplásticos e, seguindo essa segunda linha, a tela de polipropileno e poliglecaprone pode ser pensada como uma técnica viável, como foi neste caso relatado.

Introduction: Facial paralysis is a condition that can cause some sequelae, and sometimes only aesthetics can be improved. Based on this, the objective was to report a case in which a polypropylene and poliglecaprone mesh was used in order to raise the structures of the right hemiface. Case Report: The patient had paralysis in the right hemiface, with incompetent eyelid sealing, deviation of the labial commissure and no movement of the temporal musculature. An incision was made below the cutlet, pre and retroauricular, with detachment of the skin flap across the right hemiface. After lifting the superficial musculoaponeurotic system and fixing it with mononylon threads, the polypropylene and poliglecaprone mesh was placed in the middle third region and fixed with monocryl. Canthotomy and lateral canthopexy of the right eyelid were performed. In the immediate postoperative period, the patient evolved without edema, retraction or bulging, and after one year and seven months, she had complete integration of the mesh, with no retraction, fibrosis or recurrence. Discussion: The choice of aesthetic treatment for facial paralysis depends on the cause and duration of the injury, but there are several ways to do it. Among the newer ideas are the use of stem cells and alloplastic materials, and following this second line, the polypropylene and poliglecaprone canvas can be thought of as a viable technique, as was reported in this case.

Hemifacial Hypertrophy – Report of 2 Cases

Hemifacial hyperplasia (HH) is a rare congenital condition involving enlargement of one or more tissues of the face. The treatment is surgically challenging and requires expertise. This manuscript aims to report two similar appearing HH but warranting different surgical treatment. A 19?year?old female and a 14?year?old boy presented with right facial asymmetry since birth and sought correction of the same. Surgical treatment was planned. Based on clinical history, diagnosis and imaging, HH was diagnosed. The first case was entirely a soft tissue abnormality that was treated with debulking while the second case had involvement of facial bones, necessitating surgical recontouring. The facial asymmetry was addressed. Healing was uneventful. Though the aesthetical concern and appearance of the two cases of HH were same, the treatment vastly differed. This was based on the source of asymmetry. Proper diagnosis and informed decision are a key for successful surgical outcome.

Clinical, tomographic, and topometric outcomes of progressive thickness intracorneal ring segment implantations in duck-type keratoconus

Purpose: To evaluate the visual, refractive, tomographic, and topometric outcomes of progressive thickness intracorneal ring segment (PT-ICRS) implantation in duck-type keratoconus. Methods: This retrospective study included eyes with oval (duck-type) keratoconus treated with PT-ICRS implantation. After the femtosecond laser tunnel creation, one PT-ICRS (Keraring AS 5 with 160° arc length) was implanted along the ectatic, inferior half of the cornea. Data of uncorrected and corrected distance visual acuity (UDVA and CDVA), refraction, asphericity (Q value), and keratometry (K) were compared pre- and postoperatively. Additionally, changes in the topometric indices of corneal irregularity were also evaluated after PT-ICRS implantation. Results: Thirty-one eyes of 30 patients were included in the study with a mean follow-up time of 9.06 months (ranging between 6 and 18 months). UDVA improved from 0.85 ± 0.36 to 0.27 ± 0.14 logMAR (P = 0.001), and CDVA improved from 0.37 ± 0.22 to 0.13 ± 0.11 logMAR (P = 0.001). The mean spherical error decreased from ?3.66 ± 2.60 to ?1.60 ± 1.42 D (P = 0.001), and the mean cylindrical error decreased from ?4.91 ± 2.65 to ? 1.41 ± 1.31 D (P = 0.001). All topographic parameters measured from the anterior cornea demonstrated statistically significant improvements after PT-ICRS implantation (P = 0.001). K mean, K maximum, corneal astigmatism, and Q value showed a significant decrease. Besides the index of height asymmetry, all topometric indices were significantly reduced after PT-ICRS implantation. There were no loss of lines and no complications. Conclusion: PT-ICRS implantation in duck-type keratoconus is an effective and safe treatment. This intervention improves the visual acuity, refractive error, topographical, and topometric parameters significantly by decreasing both eccentricity and steepness of the cone.

Fibromatosis de Colli: Caso clínico / Fibromatosis Colli: A case report

Resumen Introducción: La Fibromatosis Colli es un tumor fibroso congénito benigno que se desarrolla en el músculo esternocleidomastoideo. Se manifiesta clínicamente por hinchazón del cuello y restricción de movimiento del cuello (tortícolis). Objetivo: Describir los aspectos diagnósticos y terapéuticos fundamentales de la Fibromatosis de Colli o Tortícolis Muscular Congénita. Caso Clínico: Se presenta un caso de neonato de sexo femenino de 21 días de nacida mediante parto en presentación podálica. Al examen físico se encuentra masa en cuello de 1,5*2 cm indolora e inclinación de la cabeza hacia la derecha, diagnosticado con ultrasonografía y tomografía de cuello contrastado, sin otros hallazgos. Conclusiones: La Fibromatosis de Colli es una patología que pasa desapercibida en el examen posparto del recién nacido. Es importante que el personal médico la identifique, evitando así complicaciones futuras, como asimetría craneofacial, escoliosis cervical y torácica o alteraciones oculares importantes.

Abstract Introduction: Fibromatosis Colli is a benign congenital fibrous tumor, which develops in the sternocleidomastoid muscle. Its clinical manifestations encompass neck swelling and torticollis (restriction of neck movements). Objective: The aim of this report is to describe the fundamental diagnostic and therapeutic aspects of Fibromatosis Colli or Congenital Muscular Torticollis. Clinical Case: A case of a 21-day-old female neonate is presented, with the presence of a right cervical mass (1.5*2 cm) and the head tilted to the right without other associated symptoms found in the physical examination. A relevant antecedent is breech presentation during the birth. The diagnosis is obtained through ultrasonography and contrasted neck tomography. Conclusions: Fibromatosis Colli is a pathology that could be unnoticed in the postpartum examination of the newborn. It is important that medical personnel identify it in order to avoid future complications, such as craniofacial asymmetry, cervical and thoracic scoliosis, or important ocular alterations.