Autologous fat transfer to the cranio-maxillofacial region: updates and controversies.

BACKGROUND: Autologous fat grafts have gained popularity among Cranio-Maxillofacial surgeons within the past years. Most publications report favourable outcomes but lack quantifiable evidence of graft survival. OBJECTIVES: To assess autologous fat transfer for facial asymmetry, and review the literature focusing on current indications, techniques, complications, fat survival and patient satisfaction. PATIENTS AND METHODS: Nine patients presented facial asymmetry due to onchological resection, congenital anomaly, or craniofacial traumatism. A total of 11 autologous fat transfers were performed. Four procedures followed the Coleman technique; in the other seven procedures, fat centrifugation was obviated. RESULTS: No significant complications derived. Progressive volumetric decrease was evidenced for up to 6 months after surgery. A second procedure was performed in two patients. No clinical differences in cosmetic outcomes or graft survival were observed between centrifuged and non-centrifuged grafts. Patients reported high satisfaction. CONCLUSIONS: Facial recontouring with autologous fat transfer restores volumetric defects with high patient satisfaction. The scientific literature offers inconsistent results. The authors did not find clinical differences between centrifuged and non-centrifuged grafts. Volume gain may result from induced fibrosis, inflammation and native adipocyte growth or differentiation. The heightened interest in these procedures should instigate further investigation to refine surgical procedures and improve predictability.

Bilateral synovial chondromatosis of the temporomandibular joint.

PURPOSE: To report an exceptional case of bilateral synovial chondromatosis (SC) of the temporomandibular joint (TMJ) and discuss diagnostic approaches, treatment options and follow-up data. PATIENTS AND METHODS: A 38-year-old woman presented with left preauricular swelling. Initial imaging studies revealed TMJ effusion only. Six years later, synovial calcifications were detected in the left TMJ; the right TMJ space was widened and presented incipient calcium deposits. Open arthrotomy of the left TMJ was performed, with removal of multiple cartilaginous loose bodies and complete synovectomy. Periodic controls proved the asynchronic development of intra-articular bodies in the right TMJ. RESULTS: SC is a metaplastic arthropathy that is uncommon in the TMJ. Bilaterality is exceptional. Diagnosis is often delayed due to the non-specific symptoms, progressive developmental stages and clinicians' lack of awareness of the condition. Magnetic resonance imaging (MRI) is particularly helpful in defining disease extension, excluding a possible tumour and detecting internal derangement. Definitive diagnosis requires arthroscopic or open examination and histopathological analysis. Recurrences are infrequent after arthrotomy, removal of loose bodies and complete synovectomy. CONCLUSION: SC is an uncommon condition in the TMJ. Bilateral involvement is extremely rare. MRI is effective for diagnosis and postoperative follow-up. Complete synovectomy usually yields an excellent prognosis.