Microneurovascular decompression in patients with hemifacial spasm caused by vascular compression of facial nerve at cisternal portion

Background  

Hemifacial spasm is commonly caused by arterial compression of the facial nerve. Although vascular compression usually occurs at the facial nerve exit zone, in some cases, the facial nerve is compressed more distally. We analyzed the clinical outcome of microneurovascular decompression in patients with hemifacial spasm caused by either distal or proximal compression.     

Outcomes following parotidectomy for metastatic squamous cell carcinoma with microscopic residual disease: implications for facial nerve preservation

Background.

Metastatic cutaneous squamous cell carcinoma (SCC) of the parotid is an aggressive disease, requiring combined modality treatment of surgery and adjuvant radiotherapy to achieve cure. This study aims to determine whether facial nerve preservation followed by radiotherapy is a reasonable option in patients with microscopic residual disease involving the facial nerve.

Methods.

One hundred seventy‐six patients with metastatic cutaneous SCC involving the parotid were analyzed.

Results.

In this cohort, 15 patients who underwent nerve‐sparing surgery and adjuvant radiotherapy were found to have involved margins adjacent to the facial nerve. Comparing this group to patients with clear margins showed no difference in local recurrence or survival. Only 3 patients in this group developed local recurrence, and all successfully salvaged by further surgery.

Conclusion.

This study suggests that patients with metastatic cutaneous SCC to the parotid with microscopic residual disease involving the facial nerve and normal function can be successfully treated with a facial nerve–sparing approach and timely postoperative radiotherapy. © 2008 Wiley Periodicals, Inc. Head Neck, 2009     

Excision of sympathetic ganglia and the rami communicantes with histological confirmation offers better early and late outcomes in Video assisted thoracoscopic sympathectomy

Background  

Video-Assisted Thoracoscopic Sympathectomy (VATS) is an established minimally invasive procedure for thoracic sympathetic blockade in patients with hyperhidrosis, facial flushing and intractable angina. Various techniques using clips, diathermy and excision are used to perform sympathectomy. We present our technique of excision of the sympathetic chain with histological proof and the analysis of the early and late outcomes.     

Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery

Background  

Preservation of facial nerve function is one of the most important goals in acoustic neuroma surgery. We have been using intraoperative continuous monitoring of evoked facial nerve electromyograms (EMGs) since 1997 in acoustic neuroma surgery. We therefore investigated surgically treated patients to clarify the usefulness of this monitoring, and to determine safety criteria for preserving facial nerve function.     

Effets de l’hydroxyzine sur l’acceptation du masque à l’induction de l’enfant

Objective

To evaluate the effectiveness of hydroxyzine as a premedication agent for the acceptance of facial mask during induction of general anaesthesia in children.

Study design

Prospective randomized single-blind study including ASA 1 and 2 children, aged between 1 and 9 years and undergoing outpatient surgery.

Patients and methods

Patients were randomly allocated to receive orally either 1 mg/kg hydroxyzine (G1) or water 0.1 ml/kg (G2) one hour before induction of standardized inhalational anaesthesia. Tolerance of facial mask was assessed with a 3-points scale (good, moderate or poor). Chi-square and Student's t-test were used in statistical analysis; p values less than 0.05 were considered statistically significant.

Results

One hundred patients were included (G1 = 49, G2 = 51). Demographic data were similar in both groups. Acceptance of facial mask was significantly better in G1 than in G2 (p = 0,002).

Conclusion

Hydroxyzine provided better acceptance of facial mask than placebo during induction of general anaesthesia in children.     

Facial sculpting: Comprehensive approach for aesthetic correction of round face

Context:

Standards for an aesthetic face are dynamic. The current trend is towards a leaner looking face with preservation of the inverted triangle of youth. Procedures that have been reported to be employed for correction of a chubby face include buccal fat pad excision, facial liposuction and injection lipolysis. In addition to giving the face an aesthetic triangular cut, chin and malar augmentation may be performed. The rounded appearance at the angles may further be reduced by injection of Botulinum toxin into the masseter.

Materials and Methods:

Forty patients who presented to us for correction of chubby (round) faces were analysed and treated by facial sculpting surgery, which included at least two of the procedures in combination. The procedures included facial liposuction, buccal fat pad excision, chin augmentation, malar augmentation and injection lipolysis. All cases were followed-up for a minimum of 6 months after surgery.

Results:

Aesthetic expectations of the patients were met in 39 cases, one patient complained of facial asymmetry following facial liposuction and was subjected to a touch-up injection lipolysis.

Conclusions:

A combination of procedures is necessary to give the face an attractive contour. All the individual procedures have stood the test of time and are safe, proven and are put in mainstream. However, a thorough analysis of the face preoperatively and then subjecting the patient to a combination of these procedures in a single surgical sitting has yielded good results as seen in this study.KEY WORDS: Chubby face, facial restructuring, facial sculpting, round face     

Polyacrylamide Gel for Facial Wasting Rehabilitation: How Many Milliliters per Session?

Background

Facial lipoatrophy is most distressing for HIV patients in pharmacologic treatment. Nonabsorbable fillers are widely used to restore facial features in these patients. We evaluated the safety and aesthetic outcomes of two samples of HIV+ patients affected by facial wasting who received different filling protocols of the nonabsorbable filler Aquamid^® to restore facial wasting.

Methods

Thirty-one HIV+ patients affected by facial wasting received injections of the nonabsorbable filler Aquamid for facial wasting rehabilitation. Patients were randomly divided into two groups: A and B. In group A, the facial defect was corrected by injecting up to 8 ml of product in the first session; patients were retreated after every 8th week with touch-up procedures until full correction was observed. In group B, facial defects were corrected by injecting 2 ml of product per session; patients were retreated after every 8th week until full correction was observed.

Results

Patients of group A noted a great improvement after the first filling procedure. Patients in group B noted improvement of their face after four filling procedures on average. Local infection, foreign-body reaction, and migration of the product were not observed in either group during follow-up.

Conclusion

The rehabilitation obtained with a megafilling session and further touch-up procedures and that with a gradual build-up of the localized soft-tissue loss seem not to have differences in terms of safety for the patients. However, with a megafilling session satisfaction is achieved earlier and it is possible to reduce hospital costs in terms of gauze, gloves, and other items.     

Clinical Characteristics of Facial Keloids Treated With Surgical Excision Followed by Intra- and Postoperative Intralesional Steroid Injections

Background  

The physiopathogenesis of keloid scars is not well understood. This report aims to present the authors’ experiences with facial keloids, to evaluate their treatment outcomes via a prospective study, and to identify risk factors involved in facial keloid recurrence.     

Do cleft lip and palate patients opt for secondary corrective surgery of upper lip and nose,frequently?

Purpose

This prospective study was aimed at assessing cleft lip and palate (CLP) patients’ opinions and attitudes towards their upper lip and nose and the number of secondary corrective surgical interventions electively undertaken to upper lip and nose that were carried out during a 2 year follow-up period.

Materials and methods

During a 2 year follow-up period CLP outpatients were recruited for the study who attended follow-up examinations at a cleft lip and palate craniofacial center and received a recommendation for secondary corrective facial surgery. The participants filled in a questionnaire that included questions regarding the patients’ opinions and attitudes towards appearance of lip and nose and need for secondary corrective facial surgery. During an additional interval of 2 years the rate of patients who underwent secondary corrective surgery to lip and nose was documented.

Results

Out of 362 CLP patients 37 (mean age 13.6?±?7.6 years) received a recommendation for secondary corrective surgery to upper lip and/or nose. 22 patients (mean age 12.6?±?6.3 years) filled in the questionnaire (response rate of 62.1%). The satisfaction with the overall facial appearance following the first corrective operation was statistically significantly better than the satisfaction with the nose (p?=?.016). The satisfaction with facial symmetry (5.6?±?2.0) did not differ statistically significantly from the overall satisfaction with the facial appearance (6.2?±?1.8; p?=?.093). Significantly fewer patients (n?=?9) opted for corrective surgery compared to the number of patients who got the recommendation to have secondary corrective surgery done (n?=?22, p?<?.0005).

Conclusions

The findings of the present study may reflect a high overall patient satisfaction with the primary treatment outcome following surgery for CLP. Perceived patient need for secondary operation for the lip/nose may be as low as 5%.

     

Survival benefit of coronary-artery bypass grafting accounted for deaths in those who remained untreated

Background  

Currently there are no direct estimates of mortality reduction afforded by coronary-artery bypass grafting (CABG) that take into account the deaths among patients for whom coronary revascularization was indicated but who did not undergo the treatment. The objective of this analysis was to compare survival after the treatment decision between patients who underwent CABG and those who remained untreated.     

Long-term facial nerve function evaluation following surgery for large acoustic neuromas via retrosigmoid transmeatal approach

Purpose  

By evaluating the postoperative facial nerve function of large acoustic neuromas, the purpose of this study was to analyze the factors that influence the facial nerve function outcome and to explore the surgical strategy for large acoustic neuromas.     

Polyacrylamide gel treatment of antiretroviral therapy-induced facial lipoatrophy in HIV patients

Background  

Today, highly active antiretroviral therapy is lifesaving for most HIV-infected patients, but the treatment can result in facial lipoatrophy, which changes the face so radically that patients may develop severe psychological and social problems. Since 2001 polyacrylamide gel (PAAG) has been used successfully in HIV patients abroad. This article describes the results of a Danish study.     

Mechanotransduction: The Missing Link in the Facial Aging Puzzle?

Background  

Craniofacial bony remodeling has been recognized as an important contributor to the facial aging process. Multiple studies have demonstrated significant craniofacial skeletal changes with age. However, no review has assembled this information in a concise, cogent fashion. Furthermore, the etiology of these skeletal changes has not been elucidated. This information is important for understanding the mechanisms of facial aging and for further development of facial rejuvenation.     

Application of porous hydroxyapatite blocks for maxillofacial deformities

Background

In maxillofacial fields, concave deformity often requires hard tissue augmentation. Various types of materials are used for facial augmentation: Hydroxyapatite is the most ideal material because of its remarkable biocompatibility and ability to maintain the desired form for a long period. This article describes a simple surgical procedure to augment facial concavity with porous hydroxyapatite block (pHA-B) and its clinical applications and potential complications.

Method

In this retrospective study, we reviewed 24 patients with facial concave deformity and who underwent surgery using the pHA-B for facial augmentation, from July 1992 to January 2014. These patients underwent 30 pHA-B procedures for facial augmentation and were evaluated for complications and malposition. The study group consisted of 12 male and 12 female patients (age ranged, 15–52 years; mean, 26.7 years). The follow-up periods ranged from 6 to 80 months, with a mean period of 27.3 months.

Results

The primary diagnoses of facial concave deformity consisted of 13 congenital craniofacial deformity cases; eight, esthetic contouring; and three, posttraumatic facial deformity. The augmented sites included the malar and parapiriformis areas and the mandible. There was no malpositioning and nor any obvious infection for which removal of the pHA-B was needed.

Conclusions

Our surgical treatment for facial concave deformity using pHA-B is simple, minimally invasive, provides the desired result in form, and is safe for the long term. Level of Evidence: Level IV, therapeutic study.     

Prediction of Face-Lift Outcomes Using the Preoperative Supine Test

Background  

Patients considering a facelift (facial rhytidectomy) need some means of predicting their surgical outcomes. This will help them decide whether to proceed with the operation.     

Combined Flaps for Reconstructing Wide-Range Facial Defects

Background  

This report aims to describe the technique of using combined flaps for reconstruction of wide-range facial defects.     

Anterior interosseous nerve syndrome: retrospective analysis of 14 patients

Introduction  

The anterior interosseous nerve (AIN) is a only motor nerve innervating the deep muscles of the forearm. Its compression is rare. We present a retrospective analysis of 14 patients with an AIN syndrome with a variety of clinical manifestations who underwent operative and conservative treatment.     

Trauma of facial skeleton in children: An indian perspective

Aims  

Both children and adults are subject to similar types of injuries but fractures of facial bones in children are relatively uncommon. The aim of this study was to evaluate the epidemiology of facial bone fractures among children of <12 years, their management and outcome in an Indian city.