Quantified analysis of facial movement: A reference for clinical applications.

Most techniques for evaluating unilateral impairments in facial movement yield subjective measurements. The objective of the present study was to define a reference dataset and develop a visualization tool for clinical assessments. In this prospective study, a motion capture system was used to quantify facial movements in 30 healthy adults and 2 patients. We analyzed the displacements of 105 reflective markers placed on the participant's face during five movements (M1-M5). For each marker, the primary endpoint was the maximum amplitude of displacement from the static position (M0) in an analysis of variance. The measurement precision was 0.1 mm. Significant displacements of markers were identified for M1-M5, and displacement patterns were defined. The patients and age-matched healthy participants were compared with regard to the amplitude of displacement. We created a new type of radar plot to visually represent the diagnosis and facilitate effective communication between medical professionals. In proof-of-concept experiments, we collected quantitative data on patients with facial palsy and created a patient-specific radar plot. Our new protocol for clinical facial motion capture ("quantified analysis of facial movement," QAFM) was accurate and should thus facilitate the long-term clinical follow-up of patients with facial palsy. To take account of the limitations affecting the comparison with the healthy side, we created a dataset of healthy facial movements; our method might therefore be applicable to other conditions in which movements on one or both sides of the face are impaired. The patient-specific radar plot enables clinicians to read and understand the results rapidly.

Conservative management is effective in unicystic ameloblastoma occurring from the neonatal period: A case report and a literature review.

Unicystic ameloblastoma (UA), a benign odontogenic tumor of the jaw, represents less than a third of all ameloblastomas and seems less aggressive than other types of ameloblastoma. We present here the first case of UA that developed prenatally and was successfully managed in the early neonatal period with marsupialization and curettage performed carefully to avoid injury to the tooth germ. BRAF and SMO mutations were not detected. After 2 years of follow-up, complete reossification and normal eruption of deciduous teeth were noted, and there was no recurrence of UA. We recommend conservative treatment of UA in the pediatric population to avoid loss of and/or injury to the tooth germ, provided close follow-up is carried out all through the individual's growth for early detection of potential recurrences, growth impairments, or tooth eruption disorders. The intratumoral somatic mutational status of BRAF, SMO, RAS family, and FGFR2 may help determine personalized targeted treatment, particularly in case of recurrence.

Pediatric Nasal Reconstruction by Washio Procedure.

The use of the Washio retroauricular flap for nasal reconstruction has been infrequently covered in recent literature, particularly concerning the pediatric population. A retrospective study was conducted between 2014 and 2018 and included all pediatric patients who underwent a Washio retroauricular flap procedure for nasal reconstruction operated on by the same surgeon at a referral center for pediatric plastic and maxillofacial surgery. The mean age at the time of the first stage of the Washio procedure was just under 8 years of age (range: 6 years 3 months-8 years 10 months). The Washio retroauricular flap procedure was successfully employed in three patients with three different anatomical defects, including the nasal alae, nasal tip, and columella, without postoperative healing complications. Arguably, the Washio method is sufficiently versatile to be used in various defect types, allows space and planning for subsequent surgical corrections, avoids additional visible scarring of the face, and spares flaps that may be required at the end of the growth, such as the pedicled forehead flap. It is a safe procedure, provided that at least a two-stage procedure is performed, and a progressive postoperative verticalization is prescribed to limit venous drainage complications.

Face graft? Extrapolation of facial allotransplantation to children.

The possibility to imagine a vascularized composite allotransplantation for disfigured children is felt more critical than for adults non on technical point of view but in terms of indications and justifications. The question is not about surgery. It is related to the pathologies themselves for which transplant could be suitable. Moreover the procurement of face transplant will be more difficult because of immunologic criteria but also age and phototype. Specificity of the newborn malformative face is usually not only a question of tissue defect. It is reasonably not an indication for VCA. It should be added that nothing is known about the future of transplantation in terms of duration but also morbidities due to immunosuppression. Indications are rather negative. To rise the question of VCA for children has a double benefit. The first is to point out that surgical innovation often arise from a non imaginable or non imagined clinical situation. The second is the question of VCA in newborn regarding the tolerance.

Calvarial periosteal graft for second-stage cleft palate surgery: a preliminary report.

OBJECTIVE: The objectives of cleft palate surgery are to achieve optimal outcomes regarding speech development, hearing, maxillary arch development and facial skull growth. Early two-stage cleft palate repair has been the most recent protocol of choice to achieve good maxillary arch growth without compromising speech development. Hard palate closure occurs within one year of soft palate surgery. However, in some cases the residual hard palate cleft width is larger than 15 mm at the age of two. As previously reported, integrated speech development starts around that age and it is a challenge since we know that early mobilization of the mucoperiosteum interferes with normal facial growth on the long-term. In children with large residual hard palate clefts at the age 2, we report the use of calvarial periosteal grafts to close the cleft. MATERIAL AND METHODS: With a retrospective 6-year study (2006-2012) we first analyzed the outcomes regarding impermeability of hard palate closure on 45 patients who at the age of two presented a residual cleft of the hard palate larger than 15 mm and benefited from a periosteal graft. We then studied the maxillary growth in these children. In order to compare long-term results, we included 14 patients (age range: 8-20) treated between 1994 & 2006. Two analyses were conducted, the first one on dental casts from birth to the age of 6 and the other one based on lateral cephalograms following Delaire's principles and TRIDIM software. RESULTS: After the systematic cephalometric analysis of 14 patients, we found no evidence of retrognathia or Class 3 dental malocclusion. In the population of 45 children who benefited from calvarial periosteal grafts the rate of palate fistula was 17% vs. 10% in the overall series. CONCLUSION: Despite major advances in understanding cleft defects, the issues of timing and choice of the surgical procedure remain widely debated. In second-stage surgery for hard palate closure, using a calvarial periosteal graft could be the solution for large residual clefts without compromising adequate speech development by encouraging proper maxillary arch growth.

Midface osteotomies lines: evolution by Paul Tessier, the second Tessier classification.

The Tessier collection is an inheritance of a whole career of a surgeon and a life dedicated to cranio-facial malformations. It is a good opportunity to analyse some particular points of the surgical work of Paul Tessier, in particular to understand how the midface advancement procedures were made up and thought out. Medical files, pictures, X-rays and drawings help us to describe step by step the different types of midface osteotomies done by Paul Tessier, from TESSIER I to TESSIER VII osteotomies. The author describes the reason for the surgical lines and their modifications justified by all those files and by Tessier's personal annotations. Based on a single clinical case, Tessier experimented with new surgical procedures, firstly on skulls and dissection then the proposed surgery, the experience of the surgery and the post-operative result for each patient made him decide to change lines and procedures. At each step, the modification was done to improve stability, aesthetics, or to do the procedure in an easier way. Difficulties and mistakes were always new lessons for further patients.