Focuses, Developments, and Publication Trends in Facial Bone Aging and Related Fields: A Systematic Bibliometric Analysis (1990-2023).

There is a current lack of bibliometric analysis in facial bone aging and relevant fields. By providing clear and intuitive references, predictions, and guidance for future research, this study aims to fill the gap in the current field, summarize the related research, and guide the researchers' future work. Literature data were retrieved from the Web of Science Core Collection database. Results Analysis and Citation Report of Web of Science, and CiteSpace software were used to optimize the visualization results, including publication characteristics, disciplines, journals, literature, countries/regions, institutions, authors, research focuses, etc. A total of 277 publications were included after manual screening, and the overall trend of annual publications and citations was increasing. On the basis of the analysis, the characteristics of facial bone aging, aging of facial soft tissue, and facial rejuvenation have been the focuses of research in this field. As stem cell research advances and researchers, deepen their comprehension of facial bone aging, basic scientific research on facial bones has witnessed a growing trend.

Global Research Trends and Focuses on Pierre Robin Sequence From 1992 to 2023: A Bibliometric Analysis of the Past 3 Decades.

There is currently a lack of scientific bibliometric analyses in the field of Pierre Robin sequence (PRS). Pierre Robin sequence is known for its clinical triad of micrognathia, glossoptosis, airway obstruction, and possible secondary cleft palate. These defects can lead to upper airway obstruction, sleep apnea, feeding difficulties, affect an individual's growth and development, education level, and in severe cases can be life-threatening. Through analysis of literature retrieved from the Web of Science Core Collection (WoSCC) database using Results Analysis and Citation Report and Citespace software, 933 original articles and reviews were included after manual screening. The overall trend for the number of annual publications and citations was increasing. On the basis of the analysis, airway evaluation and treatment, mandibular distraction osteogenesis (MDO), as well as descriptions of PRS characteristics have been the focus of research in this field. In addition, with advances in new technologies such as gene sequencing and expanding understanding of diseases among researchers, research on genetics and etiology related to PRS has become a growing trend.

Accuracy of Smartphone-Based Three-Dimensional Facial Scanning System: A Systematic Review.

BACKGROUND: Recently, the integration of 3D face scanning into smartphones has raised vast interest in plastic surgery. With the release of smartphones featuring 3D face scanning technology, users now can capture detailed 3D models of their faces using their smartphones. However, trueness and precision of this system is less well established. METHODS: PubMed, Cochrane Library, Embase, ScienceDirect, Scopus, and Web of Science databases were searched for studies evaluating 3D scanning of smartphone devices and conventional 3D imaging systems from January 1, 2017, to June 1, 2023. A qualitative systematic review was conducted by two review authors after independently selecting studies, extracting data, and assessing the risk of bias of included studies. RESULTS: A total of 11 studies were included, all focusing on the accuracy of smartphone 3D facial scanning. The results show that although smartphones perform poorly on deep and irregular surfaces, they are accurate enough for clinical applications and have the advantage of being economical and portable. CONCLUSIONS: Smartphone-based 3D facial scanning has been basically validated for clinical application, showing broad clinical application prospects in plastic surgery. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Morphological Changes of the Temporomandibular Joint and Masseter Muscle After Mandibular Angle Osteotomy.

Mandibular angle osteotomy with outer cortex grinding is an effective cosmetic procedure for correcting square faces. However, morphological changes in the mandible may also cause temporomandibular joint (TMJ) disorders. This retrospective study aimed to investigate the morphological stabilization of the TMJ and changes in masseter muscle thickness after mandibular angle osteotomy to evaluate the safety of the procedure. Data from patients who underwent mandibular angle osteotomy with outer cortex grinding between January 2016 and January 2019 were retrospectively reviewed. Preoperative and long-term follow-up (~1 y) computed tomography data were collected from these patients, and morphological changes in the TMJ and masseter muscle were analyzed. The results from the computed tomography data showed that the condylar length and condylar height were significantly reduced 1 year after the operation (P < 0.05). In addition, the morphology of the TMJ was stable, and the distance between the mandibular condyle and the glenoid fossa did not change significantly. No significant difference was observed in masseter muscle thickness before and after the operation. After mandibular angle osteotomy with outer cortex grinding, the length and height of the mandibular condyle were functionally restored without any disorders of the TMJ. Moreover, the masseter muscle exhibited stable function. In conclusion, the procedure is safe for occlusal function and suitable for popularization.

Anti-sagging Method in Reduction Malarplasty: Application of the Bracing System with the Preservation of the Zygomaticus Major Muscle Bony Attachment.

BACKGROUND: Cheek drooping after reduction malarplasty remains a concern for patients. OBJECTIVES: To evaluate the anti-drooping effectiveness of the bracing system technique with the preservation of the zygomaticus major muscle (ZMj) bony attachment and to determine the role of ZMj in anti-drooping. METHODS: A retrospective analysis was conducted of patients who accepted this method in our department from February 2016 to May 2021. Patients' subjective evaluation and two plastic surgeons' objective assessment of photographs were performed. The pre- and postoperative three-dimensional (3D) ZMj models were reconstructed and compared. ZMj length and tortuosity were also measured from 3D models. RESULTS: Twenty-two patients (44 ZMjs) met the inclusion criteria. Most patients (21/22, 95.45%) were satisfied with the postoperative appearance without ageing after reduction malarplasty, except for one feeling slightly older after the operation. The objective scoring results showed no deepening of the nasolabial fold in the majority (20/22, 90.91%) of patients. Two patients were one-grade worse, from score 1 to 2. Upward movement of the postoperative ZMj bony attachment was clearly observed compared with the preoperative 3D model. The significantly reduced ZMj tortuosity (p < 0.001) and the slightly increased ZMj length (not significant) after surgery supported the straightening of the ZMj which was also seen in the 3D comparison. CONCLUSIONS: The bracing system technique with preservation of the bony attachment of the ZMj is an effective and cost-effective anti-sagging method for reduction malarplasty. The ZMj was lifted and straightened after reduction malarplasty, which helped to prevent sagging. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Small-Incisional Double Eyelid Blepharoplasty: A Retrospective Study of Our Minimally Invasive Technique with Three Mini Incisions.

BACKGROUND: Small-incisional double eyelid surgery has been increasingly performed these years and achieved good aesthetic results, but the techniques vary greatly between literatures. The authors reviewed the cases of three-small-incisional double eyelid surgery performed in the past three years and introduced their surgical technique in detail. METHODS: A total of 87 patients receiving bilateral three-small-incisional double eyelid surgery were included in this retrospective study. The pretarsal folds were designed meticulously, along which three evenly distributed 2 mm-long incisions were made. A minimal amount of orbicularis oculi muscle and pretarsal soft tissue were removed to expose the pretarsal fascia for further fixation. An appropriate amount of orbital septal fat was removed through the lateral incision if required. The superficial orbicularis oculi muscle and dermis on the lower margin of the incision were fixed onto the pretarsal fascia with some underlying tarsus on the upper margin of the tarsus. The skin was closed by one stitch for each incision. RESULTS: The average follow-up was 9.9 ± 5.2 months (range: 6-27 months). All the patients were satisfied with the result. None of them experienced loss of the pretarsal fold, bilateral asymmetry, scar hyperplasia, or persistent swelling after surgery. CONCLUSIONS: Our three-small-incisional technique with minor soft tissue debulking offers a simple, safe, and reproducible approach to double eyelids. It can create a stable and natural-looking pretarsal fold with a short recovery period. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Screw Misposition and Detachment During Paranasal Augmentation: A Patient Report With Complication and Management.

Paranasal concavity is esthetically displeasing and interferes with the overall outline of the face. Paranasal augmentation with alloplastic implants is a minimally invasive procedure with significant esthetic effects for paranasal concavity. When fixing the implants, the screws should be placed on the nasofrontal column, but are occasionally mispositioned on the anterior wall of the maxillary sinus. Here, the authors introduce a case of paranasal augmentation in which the self-tapping screw accidentally penetrated through the implant, broke through the anterior and medial walls of the maxillary sinus, and entered the nasal cavity. The screw was located by a computed tomography scan and was successfully removed under a nasal endoscope. The causes of this intraoperative complication were analyzed, emergent management was introduced, and a further preventive strategy was proposed.

The Efficacy of Tranexamic Acid in Craniomaxillofacial Surgery: A Systematic Review of Randomized Controlled Trials.

This study aimed to evaluate the use of tranexamic acid in craniomaxillofacial surgery by meta-analysis. A comprehensive search was performed for randomized controlled trials (RCTs) mainly in 3 electronic databases (PubMed, EMBASE, and Cochrane Library) before August 2022. We collected and managed data for weighted mean difference of intraoperative blood loss, transfusion requirement, and operation time for the study. A total of 13 randomized controlled trials were included in the analysis. Compared with the control group, the tranexamic acid group showed a reduction in intraoperative blood loss of 198.67 ml (95% CI: -258.84 to -138.50 ml, P <0.00001), with blood transfusion requirement decreased by 7.77 ml/kg (95% CI: -10.80 to -4.73, P <0.0001) and less operation time (weighted mean difference= -10.39 min; 95% CI: -16.49 to -4.30 min, P =0.0008).

Nutritional metabolism evaluation and image segmentation of the chicken muscle and internal organs for automatic evisceration.

The chicken is rich in various proteins, fatty acids, polysaccharides, trace elements, and other human essential nutrients that contribute to its high nutritional value. In this study, the expression levels of nutrition-related genes (acetyl-CoA acyltransferase, ACAA) of native chicken breeds were investigated. The level of GgalACAA1-2 transcripts expression in the liver of chicken was significantly higher than that of muscle and heart. Moreover, three protein extracts were isolated from the muscle, heart, and liver tissues from the chicken, and their nutritional function was evaluated in the present study. These protein extracts had excellent DPPH and hydroxyl radical scavenging capacities and exhibited significant superoxide anion scavenging ability. Moreover, the protein extracts of muscle tissue showed an important mouse splenocyte proliferation activity and could be used as an immunomodulator of natural origin. In addition, this report presented an automatic visual inspection of chicken viscera using the active contour algorithms and the image processing method for eviscerating by the parallel robot. The recognition and positioning rate of chicken viscera obtained by the proposed method could reach 96.45%. These methods provided basic data for automated poultry slaughter and segmentation, avoiding unnecessary health risks by a pathogenic microorganism, such as avian influenza, Newcastle disease virus, and coronavirus. Moreover, the internal organs of the chicken could be fully harvested by the image segmentation of automatic evisceration, which also facilitated the processing value of these internal organs as by-products of poultry.

Small-Incisional Techniques for Double-Eyelid Blepharoplasty: A Systematic Review.

BACKGROUND: Small-incisional double-eyelid surgery has increasingly gained popularity. In the published studies, the number of incisions, the debulking method, and the pretarsal fixation differ significantly among studies. Hence, this article was conducted to summarize the different techniques and compare their surgical results and complications. METHODS: The literature review was conducted using the PubMed and Cochrane databases from their inception to June 1, 2022. Clinical studies of small-incisional blepharoplasty with available full-text and extractable data were included and were grouped depending on the number of incisions. The number, length and location of the incisions, debulking method, fixation technique, and skin closure were concluded. The complications were statistically analyzed and compared. RESULTS: Finally, 13 articles and 4177 patients were eligible for reviewing, among which 5 studies (2460 patients) described single-incisional technique, 2 studies (645 patients) described two-incisional technique, 5 studies (700 patients) described three-incisional technique, and 1 study (372 patients) described four-incisional technique. Through the small incisions, the pretarsal soft tissue can be removed as appropriate, and the pretarsal fixation can be firm and exact. Both the single- and three-incisional studies had a pooled total complication rate of 5% and a pooled foldloss rate of 2%. No significant difference was found between groups. CONCLUSIONS: The small-incisional techniques offer a simple, safe, and reproducible approach to double-eyelids. It reduces post-op recovery time and allows a tenacious fixation. The fold-loss rate and other complication rate are acceptable when compared with the non-incisional and full-incisional techniques. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Orbicularis-Tarsus-Orbital Septum Fixation Technique in Asian Double-Eyelid Blepharoplasty: a Retrospective Study.

BACKGROUND: The skin-tarsus-skin and orbicularis-levator fixation approaches are the 2 most applied techniques for double-eyelid blepharoplasty in China. However, both approaches have their own disadvantages. To achieve stable and dynamic upper eyelid creases, we take the merits of the 2 techniques. In this study, our orbicularis-tarsus-orbital septum fixation technique is introduced and evaluated. METHODS: By transversely opening and turning down the anterior orbital septum, we created the septum roll anchored to the tarsus and the pretarsal muscular flap. As the motion transmitter, the roll could receive the pulling power of the levator aponeurosis transmitted to the tarsus and the septum respectively. With the help of the skin-septum roll-skin sutures, the roll passed on the pulling power directly to the pretarsal skin and thus the upper eyelid crease was formed. RESULTS: This study identified 105 Chinese patients (210 eyes) who underwent this technique in our department between September 2020 and May 2021. The follow-up ranged from 7 to 15 months. 90, 6, and 7 patients were satisfied, somewhat satisfied, and somewhat unsatisfied with the postoperative outcome, respectively. The satisfaction rate was 91.43% (96/105). Two patients were unsatisfied with the outcome, including 1 case of bilateral crease disappearance and 1 case of sunken upper eyelid. CONCLUSIONS: The orbicularis-tarsus-orbital septum fixation technique is safe and effective for double-eyelid blepharoplasty. This technique helps to form stable upper eyelid creases. Meanwhile, it is easy to achieve ideal curve and symmetry. By preserving the pretarsal tissue and using the orbital septum, sunken scar formation can be avoided.

Interleukin-10-Modified Adipose-Derived Mesenchymal Stem Cells Prevent Hypertrophic Scar Formation via Regulating the Biological Characteristics of Fibroblasts and Inflammation.

Hypertrophic scar causes serious functional and cosmetic problem, but no treatment method is known to achieve a satisfactory therapeutic effect. However, mesenchymal stem cells show a possible cure prospect. Here, we investigated the effect of interleukin-10-modified adipose-derived mesenchymal stem cells (IL-10-ADMSC) on the formation of hypertrophic scar. In vitro, IL-10-ADMSC could highly express IL-10 and exhibited stronger inhibition of hypertrophic scar fibroblasts (HSFs) proliferation, migration, and extracellular matrix synthesis (the expression of collagen I, collagen III, FN, and α-SMA protein) than ADMSC. In vivo, we found that IL-10-ADMSC speeded up wound healing time and reduced scar area and scar outstanding height. Same as in vitro, IL-10-ADMSC also exhibited stronger inhibition of extracellular matrix synthesis (the expression of collagen I, collagen III protein) in wound than ADMSC. In addition, we also found that IL-10-ADMSC is also a stronger inhibitory effect on inflammation in wound than ADMSC, and IL-10-ADMSC inhibited TGF-ß/Smads and NF-κB pathway. In conclusion, IL-10-ADMSC demonstrated the ability to prevent hypertrophic scar formation. And its possible molecular mechanism might be related to IL-10-ADMSC inhibiting the proliferation and migration of the synthesis of extracellular matrix of HSFs, and IL-10-ADMSC inhibited the inflammation during the wound healing.

Craniofacial and Upper Airway Development in Patients With Treacher Collins Syndrome.

ABSTRACT: This study evaluated age-associated morphology changes in the cranial base, facial development, and upper airway of patients with Treacher Collins syndrome (TCS). A total of 33 preoperative computed tomographic images (TCS, n = 14; control, n = 19) were included in the study and divided into three age-related subgroups (2-6 years, 7-18 years, and older than 18 years). Linear, angular cephalometric measurements and upper airway volumes were collected. All measurements were analyzed using ProPlan CMF software (version 3.0; Materialize, Leuven, Belgium). The association between aging and upper airway morphology was analyzed. Compared to control subjects, TCS patients had a smaller cranial base, maxilla, and nose; they also had reduced upper airway volume compared to control subjects. The observed differences were most significant in patients between the ages of 7 and 18 years. This study used computed tomography-based three-dimensional analyses to provide a detailed description of age-related changes that occur in craniofacial measurements and upper airway volumes in children, adolescents, and young adult patients with TCS in China. These data can be used to evaluate individual patients with TCS and to select treatment to improve the growth of the craniofacial region.

[Three-dimensional measurement analysis of midface morphology in Treacher Collins syndromes].

OBJECTIVE: To three-dimensionally calculate the craniofacial parameters of midface of patients with Treacher Collins syndrome (TCS) in China, in order to understand the changes in the spatial position relationship between the various anatomical structures of the midface. METHODS: CT imaging data of TCS patients and age- and gender-matched normal populations between January 2013 and July 2020 was retrospectively analyzed. A total of 33 cases met the selection criteria for inclusion in the study, including 14 cases in the TCS group and 19 cases in the control group. ProPlan CMF 3.0 software was used to perform three-dimensional digital reconstruction of the craniofacial bone, measure the anatomical parameters of the midface, and analyze its morphological structure; at the same time perform three-dimensional digital reconstruction of the upper airway for morphological analysis (measure upper airway volume). RESULTS: CT images analysis revealed that all 14 patients with TCS presented the typical features with downward slanting of the palpebral fissures and different degrees of zygomatico-orbital complex dysplasia. Cephalometric and morphological analysis of the midface revealed that, multiple transverse diameters of the midface of TCS patients were significantly decreased when compared with the control group ( P<0.05), such as the width of the maxillary base, the length of the maxillary complex, and some distances related to the nasal morphology; but the distance between bilateral orbitales increased in TCS group ( P<0.05). Several anteroposterior distances in TCS group were decreased significantly when compared to control group and the distance between the skull base point and the posterior nasal spine was the most shortened ( P<0.05). But there was no significant difference of the distance between nasion and anterior nasal spine, which represented anterior midface height, between groups ( P>0.05). The skull base angle and SNB angle (the angle between the sella point-nose root point-inferior alveolar seat point) of the TCS group both decreased when compared with the control group ( P<0.05), but there was no significant difference in SNA angle (the angle between the sella point-nose root point-upper alveolar seat point) between the two groups ( P>0.05). The total volume of the upper airway was (24 621.07±8 476.63) mm 3 in the TCS group, which was significantly lower than that of the control group [(32 864.21±13 148.74) mm 3] ( t=2.185, P=0.037). CONCLUSION: The transverse distances, anteroposterior distances, and multiple craniofacial angles measurement of TCS patients were significantly decreased when compared to the control group, presented with different degrees of zygomatico-orbital complex dysplasia, nasal and maxillary dysplasia, but there was no obvious restriction in face height development. Reduced internal diameters of the upper airway maybe responsible for the decreased upper airway volume of patients with TCS.

Adipose-derived mesenchymal stem cells inhibit cell proliferation and migration and suppress extracellular matrix synthesis in hypertrophic-scar and keloid fibroblasts.

Pathological scars occur during skin wound healing, and the use of adipose-derived stem cells (ADSCs) is one of the various treatments. The present study aimed to investigate the in vitro effects of ADSCs on the biological properties of hypertrophic scar fibroblasts (HSFs) and keloid fibroblasts (KFs), such as proliferation, migration, and the synthesis of extracellular matrix proteins. Transwell chambers were used to establish a co-culture system of ADSCs with normal skin fibroblasts (NFs), HSFs or KFs. The effect of ADSCs on the proliferation of fibroblasts was evaluated by CCK8 measurement, while the migration ability of fibroblasts was assessed using cell scratch assay. The expression of extracellular matrix proteins was measured by immunoblotting. Co-culture of NFs with ADSCs did not affect cell proliferation and migration, nor the expression of extracellular matrix proteins [collagen-I, collagen-III, fibronectin (FN) and α-smooth muscle actin (α-SMA)] in NFs. However, as with the inhibitor SB431542, ADSCs significantly inhibited cell proliferation and migration and the expression of extracellular matrix proteins (collagen-I, collagen-III, FN and α-SMA), but also suppressed the protein expression of transforming growth factor ß1 (TGF-ß1), phosphorylated (p-) mothers against decapentaplegic homolog (Smad) 2, p-Smad3 and Smad7 in HSFs and KFs. The results show that ADSCs inhibited cell proliferation and migration and the expression of extracellular matrix proteins in HSCs and KFs in vitro, possibly through inhibition of the TGF-ß1/Smad pathway.

Interleukin-10 modified bone marrow mesenchymal stem cells prevent hypertrophic scar formation by inhibiting inflammation.

This study was performed to examine the effect of Interleukin-10 (IL-10) modified bone marrow mesenchymal stem cells (BMSCs) on hypertrophic scar formation on the rabbit ear hypertrophic scar model. Rabbit BMSCs were obtained by whole bone marrow adherence method and IL-10-modified BMSCs (IL-10BMSCs) were established by transfecting BMSCs with an adenovirus. We treated the rabbit ear hypertrophic scar with BMSCs and IL-10-BMSCs, then evaluated the area and measured the height of the hypertrophic scar, and detected expression using real-time PCR and western blot. Compared with wild type BMSCs, the proliferative capability of IL-10 modified BMSCs was significantly reduced, but the expression of IL-10 in IL-10-BMSCs was significantly increased. After treating with a local injection of BMSCs or IL-10-BMSCs in the rabbit ear hypertrophic scar, we found that the time of wound healing, the area and height of scar were all significantly reduced in the IL-10-BMSCs group when compared to those in the BMSCs group. Moreover, the expression of Collagen-I, α-SMA, TNF-α, IL-6 and IL-1ß mRNA, the number of CD45-positive cells, CD3-positive cells and ED-1-positive cells, and the expression of p-IKBα / IKBα, p-p65 / p65, p-JNK / JNK and p-c-JUN / c-JUN in the scar of the IL-10-BMSCs group were significantly lower than those in BMSCs group. IL-10 modified BMSCs prevented hypertrophic scar formation in the rabbit ear hypertrophic scar model, and the results suggest this could be due to the inhibition of inflammation by IL-10 modified BMSCs through the JNK / NF-κB pathway.

Characteristics of denitrifying bacteria in different habitats of the Yongding River wetland, China.

Nitrogen nutrient salts are considered the major environmental factors (RNH4+-N0.92, RTN0.85) affecting the structure and distribution of denitrogen bacteria. We aimed to investigate the mechanisms by which wetland bacteria adapt to environmental factors in different types of habitats. High-throughput sequencing technology was used to study the microbial community structure of sediments in three wetland habitats [fish ponds, surface flow wetlands (cattails and reeds), and ditches] of the Yongding River, China. The microbial community structure differed across different habitats. Species richness of nitrifying bacteria increased, while that of denitrifying bacteria decreased, with ammonium salt and total nitrogen concentrations increasing from surface flow wetland to ditch wetland. The characteristics of the three habitat types and their distribution in the Yongding River wetland are beneficial to the differential distribution of microbial communities across the wetland, and to the existence and denitrification of different dominant bacteria. Overall, these results help explain the natural filtering function of wetlands.

Application of the Bracing System in Reduction Malarplasty in Asian Population.

BACKGROUND: In the East, a broad and prominent malar is considered to express an aggressive and unpleasing impression; therefore, patients seek to improve their appearance through malar reduction. Although most of the techniques have been greatly improved, still there are some pitfalls in the form of cheek sagging or bone nonunion. In this study, we performed a reduction malarplasty using a firm bracing system to minimize major postoperative complications. METHOD: This was a retrospective study evaluating the results of a total of 157 patients (139 women and 18 men) who underwent reduction malarplasty using a bracing system via intraoral and periauricular. The age of the patients ranged from 17 to 44 with a mean age of 25.3 years. The mean follow-up period was 9.4 months. All patients underwent routine physical and laboratory examinations. Facial photographs in the frontal, oblique, and submentovertical views were taken. Patients with severe facial asymmetry and facial deformities were excluded from the study. Preoperative states and patients' desires were considered. In some patients, combined malarplasty with mandibular angle reduction or genioplasty was performed. RESULTS: A total of 157 patients who underwent this modified reduction malarplasty between January 2015 and January 2019 were retrospectively reviewed. Decent postoperative facial stability and satisfactory aesthetic results were realized among all patients. Major complications such as severe asymmetry or bone nonunion were not observed in our patients. CONCLUSION: Based on a thorough anatomic understanding of zygoma and masseter action, we modified previous L-shaped reduction malarplasty through constructing a firm bracing system on the malar complex. Satisfactory surgical outcomes were obtained. Our method is an ideal surgical method to effectively reduce the height and width of the zygomatic arch and prevent complications such as bone nonunion and cheek drooping. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Correlation Between Mandible and External Ear in Patients with Treacher-Collins Syndrome.

BACKGROUND: Patients with Treacher-Collins syndrome (TCS) are frequently affected by congenital ear deformities. The external ear in patients with TCS tends to have both abnormal morphology and reduced overall volume. Previous studies considered a correlation exists between TCS mandibular skeletal features and external ear volume. The purpose of this study was to assess the external ear volume in patients with TCS 3-dimensionally. Furthermore, this study evaluated the relationship between mandibular morphology, external ear profile, and external ear volume. METHODS: A total of 36 nonoperated patients with TCS were compared to 39 age- and gender-matched normal controls. Morphologic variables of the mandible and the external ear were compared between TCS group and controls by 3-dimensional cephalometrics. The external ear volume and morphologic variables were analyzed with independent sample T-tests and Pearson correlation coefficient analyses (level of evidence: level III). RESULTS: The external ear volume was reduced by approximately 50% in patients with TCS compared to controls (P < 0.001). External ear length and width were positively correlated with external ear volume (length: r = 0.809, P < 0.001 on left and r = 0.732, P < 0.001 on right; width: r = 0.518, P = 0.001 on left and r = 0.447, P < 0.010 on right). A negative correlation of right ear inclination angle and external ear volume was shown in patients with TCS (r = -0.396, P = 0.027). However, no correlation was shown for the mandibular anatomic variables. CONCLUSIONS: Three-dimensional analysis confirmed that external ear volume is significantly reduced in patients with TCS. The external ear dimensions and orientation correlated significantly with ear volume. There was no intrinsic association between the severity of mandibular deformity and external ear volume.

Incomplete Ear Amputation.

Ear amputations are common in emergency departments as the auricle's protrusion from the lateral aspect of the head makes it particularly susceptible to trauma. Of the numerous approaches for auricle injuries, the classic methods include microsurgical replantation, primary reattachment, composite graft, retroauricular pocket principle, secondary reconstruction with rib cartilage, and methods using postauricular flap. The success of the operation depends largely on choosing the appropriate surgical procedure since many factors can influence surgical outcome. There is no 1 gold standard technique to treat the variety of auricle injuries. Inappropriate choice of surgical approach can be detrimental to subsequent reconstructive surgery. Therefore, the initial choice of optimal surgical approach is particularly important. In this article, a rare report of left subtotal ear laceration with inferior lobule pedicle by nonmicrosurgical primary reattachment was presented. The operation obtained an ideal cosmetic effect.