Prediction of Permanent Enophthalmos Using 3-Dimensional Integral Model in Blowout Fractures.

BACKGROUND: The objective of this study is to validate the possibility of setting volumetric surgical indications by predicting permanent enophthalmos using a simplified formula. METHODS: The volume difference of bilateral orbits in a CT scan was automatically measured, and permanent enophthalmos was predicted by substituting the volume difference into a formula made using the 3-dimensional (3D) integral model. RESULTS: The predicted enophthalmos showed a strong positive correlation with the permanent enophthalmos of 52 blowout fracture patients. Analyzing CT of 768 pure blowout fracture patients, the mean predicted enophthalmos was 1.84 mm, and both the size of the fracture area and the degree of EOM herniation showed the absence of correlations. CONCLUSIONS: Through the digitized orbital volume analysis and formula using the 3D integral model, blowout fracture patients who require surgery in the early post-traumatic period can be identified with convenience and reproducibility.

A prospective clinical study evaluating the efficacy and safety of a Laminin-5 fragment contained soothing cream in post-laser treatment care.

BACKGROUND: Photothermolysis effect, resulting from laser procedures, can cause redness/erythema, skin irritation and burning sensation, these symptoms may persist more than several days after the procedure and leading to discomfort for patients. Proper management is necessary for the better outcome, especially in early period after the laser procedure. Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®), is believed to have the calming/soothing effect on overheated/irritated skin after undergoing the laser treatment. It is assumed that cream can help alleviate the redness, erythema and burning sensation commonly experienced after laser treatments. This study aimed to assess the effectiveness and safety of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) during the early post-laser care period. MATERIALS AND METHODS: This prospective split-face study involved 28 patients who underwent CO2 laser procedures and met inclusion criteria. The laser treatment was performed on both sides of the midface, and subsequently, the Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) was applied to one side of the midface. The efficacy of the cream was evaluated through objective measures, including photographic evaluation by two independent evaluators and assessment using an automatic skin analysis device. Subjective evaluations were also conducted. RESULTS: The objective evaluation, based on the erythema score, revealed a statistical significant difference (p < 0.05) between the side treated with Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) and the control side. The erythema score was 1.34 ± 2.469 after the laser treatment with subsequent application of the cream for 10 min and 0.7 ± 2.28 on the second day after the procedure. The subjective evaluation showed a statistically significant high of patient satisfaction. No complications were observed during the follow-up period. CONCLUSION: The application of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) after the CO2 laser treatment was found to be effective, particularly when applied for 10 min after the laser treatment and on the second day after the procedure. Both objective and subjective evaluations yielded significantly different results. Patients reported a high satisfaction rate with the characteristics of the cream during the follow-up period.

Preoperative Planning and Simulation in Patients With Cleft Palate Using Intraoral Three-Dimensional Scanning and Printing.

BACKGROUND: In cleft palate, surgery is necessary for recovering important functions of the normal palate, such as speech and feeding. Herein, a three-dimensional (3D) scanning program with an intraoral scanner was used to evaluate the palate status of patients with cleft palate before palatoplasty. Further, a 3D cleft palate printed model of the patients' palate using 3D printing technology was produced. METHODS: Three patients with cleft palate were included (1 male and 2 female patients with a mean age of 13 months). Extended scanning from the maxillary arch to the soft palate was conducted, without any direct contact of the scanner with the tissues of the palatal area. The maxillary arch dimensions and cleft size of the scanned data were measured using a 3D analysis software. After all 3D analyses, the scanned data were printed to a 3D cleft model, which was used as a training and simulation model. RESULTS: The overall contour and size of the cleft were observed on the scanned 3D images. There was a large inter-individual range in the cleft dimensions among the subjects. Double-opposing Z-plasty was then simulated on the printed 3D cleft palate model completely. CONCLUSIONS: The present study concentrated on the possibility of an intraoral scanner as a novel diagnostic tool for recording data of patients with cleft palate; 3D cleft palate models created using 3D printers can be used as training models for surgical trainees.

A novel photonumeric hand grading scale for hand rejuvenation.

BACKGROUND: Few scales are currently available to evaluate changes in hand volume. We aimed to develop a hand grading scale for quantitative assessments of dorsal hand volume with additional consideration of changes in skin texture; to validate and prove the precision and reproducibility of the new scale; and to demonstrate the presence of clinically significant differences between grades on the scale. METHODS: Five experienced plastic surgeons developed the Hand Volume Rating Scale (HVRS) and rated 91 images. Another five plastic surgeons validated the scale using 50 randomly selected images. Intra- and inter-rater agreement was calculated using the weighted kappa statistic and intraclass correlation coefficients (ICCs). Paired images were also evaluated to verify whether the scale reflected clinical differences. RESULTS: The intra-rater agreement was 0.95 (95% confidence interval, 0.922-0.974). The interrater ICCs were excellent (first rating, 0.94; second rating, 0.94). Image pairs that differed by 1, 2, and 3 grades were considered to contain clinically relevant differences in 80%, 100%, and 100% of cases, respectively, while 84% of image pairs of the same grade were found not to show clinically relevant differences. This confirmed that the scale of the HVRS corresponded to clinically relevant distinctions. CONCLUSIONS: The scale was proven to be precise, reproducible, and reflective of clinical differences.

The Application of Three-Dimensional Simulation Program and Three-Dimensional Printing in Secondary Rhinoplasty.

BACKGROUND: In recent years, efficacy of 3-dimensional (3D) simulation, in preoperative planning of aesthetic and reconstructive surgeries and prediction of the postoperative result, has been reported in many clinical studies. Especially in rhinoplasty, it can be used not only for prediction the outcome but also for fabricating implants that will strictly match with the anatomical needs of patient. CLINICAL REPORT: A 30-year-old male after traffic accident visited emergency room complaining on painful swelling and contour deformity of nose. Under the diagnosis of nasal bone fracture and deviated nose, he had been admitted to our hospital. Considering his medical history of rhinoplasty, which was performed in the local aesthetic clinic 6 years ago, the authors decided to perform the operation with 3D simulation program and 3D printed implant. There were no specific complications, such as hematoma, infection, or necrosis. Patient was discharged on fourth postoperation day. DISCUSSION: There is no doubt that creating an ideal dorsal aesthetic line is critically important in rhinoplasty. Therefore creating individual implants for certain patient's anatomical nasal structure is highly significant in the rhinoplasty. Although usefulness of primary rhinoplasty using patient-specific 3D implant is introduced in previous study, the authors successfully applied the patient-specific 3D implant to patient who has fracture of nasal bone and primary rhinoplasty history. It means that the patient-specific implants are stable and can be used not only in primary rhinoplasty patients but also for the patients who had primary rhinoplasty previously.