Juvenile Facial Growth and Mimicry: A Preliminary 3D Study.

Studies focused on facial development during childhood have been conducted by means of 3D technology to provide modifications of anthropometric parameters. Facial mobility was also considered. This study proposed a 3D approach to facial growth changes. Facial surface data of 6 subjects were acquired in T1 (age 7-14 years) and after 7 years (T2), in rest position, and during voluntary movements, by a 3D laser scanner. Linear and angular measurements on rest position scans at T1 and T2 were compared. Each mimic scan was superimposed with the corresponding rest scan. Displacement of significant anthropometric points was measured for each facial gesture and at T1 and T2 statistically compared. Vertical measurements were those most influenced by aging. Some measurements of central facial area were consistent over time. The pattern of soft tissues displacement for each expression was consistent in T1 and T2. These results may be helpful for missing children identification.

The effect of closed septorhinoplasty on nasal functions and on external and internal nasal valves: A prospective study.

BACKGROUND: Because nasal function and shape are so closely intertwined, quantitative assessments can better define their relationship and how they are affected by septorhinoplasty. OBJECTIVE: The aim of this prospective study was to perform an analysis of the nasal airflow resistances and a three-dimensional (3D) evaluation of the soft-tissue changes after closed septorhinoplasty. METHODS: Before surgery (T0) and 6 months after closed septorhinoplasty (T1), 30 patients underwent symptoms evaluation by means of the Italian version of the Nasal Obstruction Symptom Evaluation scale, endoscopic fiberoptic nasal examination, and visual analog scale for subjective assessment of nasal obstruction. Nasal airflow resistances were investigated with active anterior active rhinomanometry. A 3D laser scanner was used to evaluate facial soft-tissues, with specific nasal points and angles. RESULTS: Subjective nasal obstruction decreased. Anterior active rhinomanometry demonstrated a reduction in total inspiratory and expiratory resistances between T0 and T1 but without statistical significance. The significance was still absent after decongestion, excluding turbinate hypertrophy as a cause of failed objective amelioration of nasal resistance. Facial laser scanning showed statistically significant reduction of the superior nasal width and superior alar angle, and a weak negative correlation between the superior alar angle and nasal resistances. CONCLUSION: The absence of objective reduction of nasal airflow resistances could be the result of concurrent surgery on nasal septum and nasal valve. In particular, the ameliorating effect on nasal airflow resistances is counterbalanced by the worsening effect of the narrowing of nasal valve.

Facial Mobility after Maxilla-Mandibular Advancement in Patients with Severe Obstructive Sleep Apnea Syndrome: A Three-Dimensional Study.

Introduction. The functional results of surgery in terms of facial mobility are key elements in the treatment of patients. Little is actually known about changes in facial mobility following surgical treatment with maxillomandibular advancement (MMA). Objectives. The three-dimensional (3D) methods study of basic facial movements in typical OSAS patients treated with MMA was the topic of the present research. Materials and Methods. Ten patients affected by severe obstructive sleep apnea syndrome (OSAS) were engaged for the study. Their facial surface data was acquired using a 3D laser scanner one week before (T1) and 12 months after (T2) orthognathic surgery. The facial movements were frowning, grimace, smiling, and lip purse. They were described in terms of surface and landmark displacements (mm). The mean landmark displacement was calculated for right and left sides of the face, at T1 and at T2. Results. One year after surgery, facial movements were similar to presurgical registrations. No modifications of symmetry were present. Conclusions. Despite the skeletal maxilla-mandible expansion, orthognathic surgical treatment (MMA) of OSAS patients does not seem to modify facial mobility. Only an enhancement of amplitude in smiling and knitting brows was observed. These results could have reliable medical and surgical applications.

Soft, hard-tissues and pharyngeal airway volume changes following maxillomandibular transverse osteodistraction: Computed tomography and three-dimensional laser scanner evaluation.

INTRODUCTION: Maxillomandibular transverse osteodistraction (MMTOD) is an alternative approach to the traditional treatment for transverse maxillary and mandibular deficiencies and crowding. The aim was to report soft and hard-tissues changes and airway volume variation. METHODS: In this study, skeletally mature, non-syndromic patients with transverse maxillary and mandibular hypoplasia, who underwent a MMTOD between 2010 and 2012, were included. Surgical changes were analysed using clinical evaluation, three-dimensional facial surface data and computed tomography analysis before (T0) and after the completion of post-op orthodontic treatment (T1). RESULTS: Nineteen patients (eight males and eleven females; average age: 26.3 years) were enrolled. MMTOD produces facial changes in the cheek, paranasal areas, nasal base and chin. Facial changes are mostly explained by the underlying skeletal movements, which are essentially represented by the transverse enlargement of both the maxilla and the mandible. Following MMTOD, the airway volume and the lateral dimension of the cross-sectional airway increased significantly. CONCLUSIONS: MMTOD is a technique that allows an increase in airway volume and in both maxillary and mandibular arch perimeters simultaneously by increasing skeletal width. Facial appearance is improved and a stable occlusion is obtained.

Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney?

Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of "reverse" informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties.

Unilateral mandibular hypoplasia in adult patients: distraction osteogenesis and conventional osteotomies in a standardized sequence.

INTRODUCTION: This study analyzed the outcomes of nongrowing patients with unilateral mandibular hypoplasia treated according to a specific protocol, which combines distraction osteogenesis, orthodontic treatment, and conventional osteotomies. MATERIALS AND METHODS: The patients treated were objectively evaluated. Patient's satisfaction was assessed by questionnaire. Surgical changes were analyzed using cephalometry and three-dimensional facial surface data before surgery (T0) and at long-term (T1) follow-up. RESULTS: Four patients were included in this study. The normalization of facial proportion and a high increase in symmetry were evident. Residual defects were documented in the postoperative symmetry of the chin. In the questionnaire, all patients gave favorable responses to their facial changes; for most of the objective parameters, all patients improved. CONCLUSIONS: A multistage treatment protocol for the correction of facial deformities in patients with unilateral mandibular hypoplasia is a valid procedure for skeletal and occlusal stability. An evident improvement of the facial appearance is also achieved.

Three-dimensional laser scanner evaluation of facial soft tissue changes after LeFort I advancement and rhinoplasty surgery: patients with cleft lip and palate vs patients with nonclefted maxillary retrognathic dysplasia (control group).

OBJECTIVE: The aim of this study was to analyze the differences in facial soft tissue changes, despite the same extent of upper jaw forward movement, between patients with unilateral cleft lip and palate (uCLP) and those without, after LeFort I osteotomy and secondary rhinoplasty. STUDY DESIGN: Twelve patients with maxillary retrognathic dysplasia and nose deformity were divided in 2 groups, A (uCLP) and B (control), and compared on the basis of the same maxillary advancement. Cephalometry and 3D mean facial model of groups A and B were obtained before and after surgery. Linear and angular measurements were calculated. RESULTS: Upper vermilion and alar base remained unchanged in group A but increased in group B. In both groups, symmetry of the nasal base was improved, and an increase of the sagittal projection of the lips was observed. CONCLUSIONS: 3D analysis showed that surgical procedures for uCLP can provide a satisfactory aesthetic outcome, but some differences are evident in comparison with the control group.

Quantification of facial movements by optical instruments: surface laser scanning and optoelectronic three-dimensional motion analyzer.

The objective of this study was to assess the accuracy of displacements of tracing landmarks in standardized facial movements. Forty healthy persons were evaluated in 2 different groups (20 men and 20 women, aged 18-30 years) with optoelectronic motion analyzer and surface laser scanning. The displacements of tracing landmarks in brow lift and smile were calculated, and the 2 methods (optoelectronic motion analyzer and surface laser scanning) were compared in healthy persons. Side-related differences were found in the tracing landmark (superciliare) during brow lift movements between both methods (the largest movements were found on the right side, P = 0.044), whereas in smile movements the tracing landmark cheilion did not show significant differences between the 2 sides. In both movements, the differences of the tracing landmark displacements between the 2 systems and sexes were on average less than 2 mm, without statistically significant differences (P > 0.05). In conclusion, normal young adult men and women had similar standardized facial movements. The 2 analyzed movements can be measured by both optical instruments with comparable results.

Soft tissue changes after maxillo-mandibular advancement in OSAS patients: a three-dimensional study.

INTRODUCTION: Maxillo-mandibular advancement (MMA) is the most successful surgical treatment for OSAS. This study prospectively evaluated soft tissue changes in typical OSAS patient before and after MMA. MATERIAL AND METHODS: Ten patients with severe OSAS, who underwent MMA, were considered. Age, BMI, polysomnographic recordings and cephalometric data were examined. Facial surface data acquired using a 3D laser scanner before (T0) and 1 year (T1) after surgery were pooled by electronic surface averaging to obtain the mean T0 and T1 facial model. A virtual optimal face (V) was used as control group. Mean T0, T1 and V models were compared. RESULTS: The mean AHI improved from 69.8 ± 35.2 to 17.3 ± 16.7. The mean maxillary advancement was 9.2 mm ± 1.2 and the mean mandibular advancement was 10.4 mm ± 2.2. The comparison between T0 and T1 showed an overall increase of the sagittal projection of the cheeks, lips and of the chin. The comparison between T1 and V showed a transversal increase of the cheeks at the cross section through ch (cheilon). CONCLUSION: MMA is a highly effective treatment for OSAS. The evaluations of 3D laser scanning showed that surgery in OSAS patients didn't cause an impairment of the facial appearance.

Soft tissue changes after orthodontic surgical correction of jaws asymmetry evaluated by three-dimensional surface laser scanner.

Aesthetic improvement is an essential goal of treatment of facial asymmetry, and it is often difficult to achieve. Reliable three-dimensional measurements are required to support outcome studies. In this study, 15 white adult subjects, 9 females and 6 males, with maxillomandibular asymmetry and malocclusion were studied. The patients were treated with orthodontics and different surgical procedures in single or multiple steps. All patients received double-jaw surgery, except 1 patient who underwent only maxillary osteotomy. Nine of the 15 patients received additional procedures (genioplasty and rhinoplasty) to achieve better symmetry. Posterior-anterior and lateral cephalometry and three-dimensional facial surface data were obtained before (T0) and 1 year (T1) after surgery. Scan data at T0 and T1 were pooled by electronic surface averaging to obtain the mean pretreatment and posttreatment facial model. A symmetric model was constructed by averaging the actual T0 scans and their mirrored models to obtain the virtual optimal symmetric face. Different linear and angular measurements were then calculated for comparison of the mean T0 and T1 models. The normalization of facial proportion and a high increase in symmetry were evident. Residual defects were documented in the postoperative symmetry of the chin. Treatment of facial asymmetry, combined with dental occlusion problems, is still a challenge for maxillofacial surgeons. Orthognathic surgery provides an important improvement of symmetry, but further refinements of technique are still required. Three-dimensional evaluation results in an effective method to support outcome studies on the surgical correction of complex facial deformities.

Facial mobility after bimaxillary surgery in class III patients: a three-dimensional study.

Quantifying soft tissue changes after orthognathic surgery is increasingly important in surgical planning, but little is actually known about the changes in facial mobility after surgery. In the current study, we investigated facial mimics in patients before and after orthognathic surgery. Eleven patients with jaw discrepancy requiring maxillary and/or mandibular surgery were considered. Facial landmarks were applied, and facial surface data were acquired using a three-dimensional laser scanner before surgery and after 3, 6, and 12 months. The facial movements were frowning, eye closure, grimace, smiling, and lip purse. They were described in terms of surface and landmark displacements. Mean and SD were calculated for the right and left sides of the face and compared with normal values previously obtained in control subjects. We compared the results in 4 groups of patients: all the patients together (group A), bimaxillary surgery (group B), basal surgery without ancillary procedures (group C), and basal surgery plus rhinoplasty and/or genioplasty (group D). After surgery, modifications of symmetry were evident in many subjects, but after 1 year, facial movements were statistically similar to presurgical registrations. In smiling, the single case observations revealed a postsurgical improvement of amplitude in 8 subjects. In conclusion, orthognathic surgery did not significantly modify facial mobility in the long term. On the contrary, the amplitude of movement during smiling seems to increase in the majority of subjects. Our evaluation of three-dimensional laser scanning of facial movement showed that it can detect small posttreatment changes on soft tissues.

Quantification of facial movements by surface laser scanning.

Quantification of facial mimic ability represents a need for comparative investigation in facial medicine and surgery. The aim of the current study was to develop a simple, noninvasive, repeatable three-dimensional method for measuring facial mobility in clinical and research setup. The faces of 20 healthy adult subjects (10 men and 10 women) and 12 primary school children (6 boys and 6 girls), without craniofacial pathologic injuries or previous treatments, were captured by a Cyberware 3030RGB laser scanner (Cyberware, Inc, Monterey, CA) in rest position and during voluntary movements. Data were processed by Cyberware Echo (Cyberware, Inc) and Inus Rapidform 2004 software (INUS Technologies Inc, Seoul, South Korea). Each movement was assigned a main landmark. The facial movements were described for surface displacement using clearance vector mapping and three-dimensional tracing of the skin landmarks. The mean landmark displacement vector was also calculated for every movement. The study showed that movements were characterized by similar displacement in the same facial areas in all subjects. Minor differences were recorded between adult subjects and children. Descriptive statistics concerning the amount and direction of movements were provided. A case of unilateral postsurgical nerve palsy was prospectively analyzed to test applicability of the method in clinical investigation. A numerical scale based on the mean movements was constructed and used to monitor recovery of function.The method developed seems easy, noncontact, and effective to quantify facial movements in normal and pathologic conditions. It may be usefully applied to the investigation and the clinical monitoring of different medical and surgical pathologic conditions.

History of facial reconstruction.

We briefly describe the history of facial reconstruction in the deceased, starting from the skull. Facial reconstruction has passed through many phases and has been variously motivated, from religion and ancestor worship, through anthropology, to the identification of lost persons for forensic purposes. Renaissance artists used this technique for modelling and teaching. Techniques changed over the centuries but the ultimate goal was to create a convincing likeness of the dead. The two current activities are forensic facial reconstruction and reconstructing the personal appearance of ancient people.

Growth-associated protein-43 immunoreactivity in human oral mucosa in dentate subjects, in edentulous patients and after implant-anchored rehabilitation.

OBJECTIVES: This study investigates expression of the neural growth-associated protein 43 (GAP-43) in the oral mucosa of (A) normal dentate subjects, (B) edentulous patients rehabilitated with conventional denture and (C) those rehabilitated with mandibular implant-retained overdentures (MIR-OVD), in the long term. This study evaluates morphological changes in the distribution and representation of sensory terminations and corpuscles in the alveolar mucosa under the action of different masticatory or prosthetic loads, in the three clinical groups. MATERIAL AND METHODS: GAP-43 immunoreactivity (-ir) was compared with the distribution of nerves fibres in the mucosa, as visualised using anti-protein gene product 9.5 (PGP 9.5), a general marker for peripheral nerves and terminals. RESULTS: GAP-43-ir was found to be highly expressed in the corium and submucosa in specimens from edentulous subjects wearing conventional denture and presenting a reduced number of PGP 9.5-ir nerves in the mucosa, but not in specimens from control subjects or patients wearing MIR-OVD, which on the contrary show a higher number of PGP 9.5-ir mucosal sensory fibres. CONCLUSION: As the mucosa under traditional denture has been shown to possess reduced innervation and the histological aspect of chronic overloading, these results may be considered indicative of a tentative induction to nerve re-growth in the under-innervated epithelium, or as a response to chronic inflammation. The detection of GAP-43-ir suggests that human oral mucosa presents signs of potential nerve plasticity also in the elderly, and that the type of rehabilitation and the condition of masticatory load transfer to the mucosa have important effects on the nerves underneath.

Distribution of GAP-43 nerve fibers in the skin of the adult human hand.

Skin is an important region of somatic sensory input, and is one of the most innervated areas of the human body. In this study, we investigated in human hand skin the distribution of nervous structures immunoreactive for the growth-associated protein 43 (GAP-43) and the protein gene product 9.5 (PGP 9.5). GAP-43 is a neuronal presynaptic membrane protein that is generally considered to be a marker of neuronal plasticity. PGP 9.5 is a neuron-specific soluble protein that is widely used as general marker for the peripheral nervous system. The entire neural network of the dermis and epidermis was stained with antibody to PGP 9.5. In the dermis, there were fewer GAP-43-immunostained nerve fibers than PGP 9.5-immunostained nerve fibers, whereas in the epidermis the numbers were equal. Only some Merkel cells and Meissner corpuscles were GAP-43-immunoreactive. In conclusion, our results show that GAP-43 protein is expressed in a subset of PGP 9.5-immunoreactive nerve structures.