Surgical and histological evidence of case reports showing Schwannomas in the nasal area

Introduction and importance: Schwannomas are benign neurogenic neoplasms with an uncommon involvement of the nasal cavity and paranasal sinus, which usually appear as a painless formation. We report two cases of nasal schwannoma that was successfully treated by surgical excision with satisfactory functional outcomes. The aim of this study is to discuss the clinical assessment and imaging, (CT, MRI) differential diagnosis, histological examination, surgical approaches of this rarely encountered neoplasm in the sinus-nasal area. Case presentation: Case 1: a 53 years-old Caucasian male, hospitalized in the ENT Department with a 5-month progressive history of right nasal obstruction without epistaxis was diagnosed as a Schwannoma following clinical, histology and ENT endoscopy examination. Case 2: a 45 years-old Caucasian male with asymptomatic swelling arising 4 months before in the nasal tip area with progressive nasal deformity, diagnosed as a schwannoma and analyzed with MRI. Clinical discussion: Case 1: The patient had an uneventful post-operative course and a follow-up examination at 36 months showed no recurrence of the neoplasm with satisfactory functional result. Case 2: The patient had an uneventful post-operative course and a follow-up examination at 5 years showed no recurrence of the neoplasm and satisfactory aesthetic result. Conclusions: Schwannomas arising from sinonasal area are extremely rare, painless and with slow-growing evolution. The surgical option and histologic analysis are mandatory for a correct diagnosis

Chin Microgenia: A Clinical Comparative Study

Background: The aesthetic relevance of the chin and its relatively simple correction through different approaches make genioplasty one of the most performed aesthetic procedures of the face. Sliding genioplasty is extremely rewarding, particularly when performed as an adjunction to rhinoplasty, rhytidectomy, or jaw surgery. In the scientific literature, many different surgical techniques are described, but the biological implications and the economical impact can shape the surgeon’s decision on which can be the best treatment: surgical correction with osteotomy, chin implants, or with fillers. Objective: The authors propose a decision making protocol for correcting chin microgenia based on a revision of 345 treated cases. Methods: A retrospective review of 345 cases of chin microgenia was undertaken to understand the proper preoperative assessment and therapeutic planning. A total of 135 patients were treated with surgical sliding genioplasty (group A): 60 patients (group B) have been grafted with alloplastic implants and the remaining 150 patients (group C) with hyaluronic acid. We recorded clinical indications, complications, and long-term aesthetic results at 3-year follow-up. Results: The analysis of the results based on the entity of the chin’s sagittal defect, the chin soft-tissue thickness, the patient’s age, and self-judgment allows for simplified treatment planning for sagittal chin deformities showing a greater predictability and a more stable long-term aesthetic result regarding sliding genioplasty compared to alloplastic implant placement and fillers. Conclusions: Our proposal for a simple and versatile protocol of chin microgenia aims to simplify the therapeutic indications for a predictable and a stable long-term aesthetic result. Level of Evidence IIThis journal requires that authorsassign a level of evidence to each article. For a fulldescription of these Evidence-Based Medicine ratings,please refer to Table of Contents or the online Instruction

Surgical Treatment of Unilateral Condylar Hyperplasia With Piezosurgery

Introduction: Unilateral condylar hyperplasia (UCH) is a disorder of unknown etiology mainly seen in growing patients, which results in facial asymmetry. High condylectomy alone or in associationwith orthognathic surgery can improve the occlusion and the facial aesthetics. Materials and Methods: Between 2005 and 2012, a total of 5 patients underwent high condylectomy for UCH using a piezoelectric cutting device. All patients were treated postoperatively with functional rehabilitation. Results: The long-term follow-up showed that all patients had a satisfactory temporomandibular joint articular function associated with stable occlusion without any recurrence of further condylar growth. Conclusions: High condylectomy in the surgical treatment of unilateral UCH seems to be the procedure of choice in growing patients. The use of a piezoelectric cutting device allows a safe and less invasive high condylectomy

3-D laser scan reconstruction of the face and jaws: a new approach in cranio-maxillofacial surgery

The aim of this study was to finely adjust a method for the construction of a 3D-textured digital model of the face and dental arches of the maxilla and mandible from a laser scan of the face and plaster casts of the mouth and dental arches of patients with craniofacial malformations, and reconstruction after facial trauma or resection for neoplasm of facial skeleton. This is motivated by the need to obtain a virtual copy of the patient\u2019s face at no biological cost as an alternative to the method which involves using CT. The method based on CT provides a great deal of information, but the radiation absorbed by the patient is very high. Materials and methods The 3-D Laser scanner Konica Minolta VIVID 910 is used to scan the surface of the patient\u2019s face from different perspectives. These scanning perspectives are then recombined to reconstruct the three-dimensional facial features with minimal error in order to reconstruct the 3D-textured model of the face. A bite fork adapted to the purpose is used as the 3-D reference mark for repositioning the scan of the maxillar and mandibular arch plaster casts within the face model. The acquisition method was validated by verifying the consistency of several anthropometric measurements recorded in vivo with the corresponding measurements recorded on the virtual computer model. Results The patient\u2019s virtual face reconstructed by means of meshes can, be analysed as it is or can be later on converted into a NURBS (Nonuniform Rational B-Splines) surface. This virtual model is used not only to extrapolate isoparametric curves reproducing facial sections in the three spatial planes, but also to obtain further metric information regarding surface and volumes. This enables the patient\u2019s profile to be studied in the usual way, but also provides other useful anthropometric features, its volumetric characteristics and the changes induced by cranio-maxillofacial surgery. Conclusions The facial skin surface may serve as a sufficiently stable and invariable entity for registering patients for computer-assisted cranio-maxillofacial surgery. The proposed method proves an excellent way to study all the morphological facial features of patients with cranio-facial malformation or after facial trauma or resection for neoplasm of facial skeleton. The collection of an appropriate database of case studies, before and after surgical treatment, will enable us to implement a software for correlating dental arch displacements with changes in the corresponding facial surface

A 3-Dimensional Facial Morpho-Dynamic Database in the development of a Prediction Model in Orthognathic Surgery

Current methodologies in the prevision of post-surgical features of the face in orthognathic surgery are mainly 2-D. An improvement is certainly given by the introduction of CT, but its acceptance is controversial due to its high biological cost. As an alternative, in this study an effective procedure for the construction of a 3-D textured digital model of the face and dental arches of patients with dentofacial malformations using a 3-D laser scanner at no biological cost is presented. A 3-D Laser scanner Konica-Minolta VIVID 910 is used to obtain multiple scans from different perspectives of the face of patients with dentofacial malocclusions requiring orthognathic surgery. These multiple views are then recombined, integrating also the maxillary and mandibular arch plaster casts, to obtain the 3-D textured model of the face and occlusion with minimal error. A viable methodology was identified for the face and occlusal modeling of orthognathic patients and validated in a test case, confirming its effectiveness: the 3-D model created accurately describes the actual features of the patient's face; the proposed methodology can be easily applied in the clinical routine to accurately record the steps of the surgical treatment and to perform accurate anthropometric analyses of the facial morphology, and thus constitute the necessary database for the development of previsional tools in orthognathic surgery. The proposed method is effective in recording all the morphological facial features of patients with dentofacial malformations, to develop a facial modification database and tools for virtual surgery

Histology and long-term clinical outcome of crushed cartilage with double-layer gelatin sponge membrane for dorsum refinement in primary rhinoplasty

This article demonstrates the ability to use autologous crushed cartilage grafts in rhinoplasty with rapid recovery and optimal nasal functionality without any tissue damage and allows its rapid rejuvenation. Eligible patients underwent primary rhinoplasty using autologous crushed cartilage graft followed by microscopy imaging of the grafted tissue after recovery. Tissue and cytological analysis using optical microscopy, transmission electronic microscopy (TEM), and scanning electronic microscopy (SEM) showed complete viability of chondrocytes, formation of new collagen fibers, neo-perichondrium, neo-angiogenesis, and exhibiting optimal aesthetic outcome. The surgical approach is easy to perform, feasible, and less time-consuming, with excellent tissue rejuvenation and rapid recovery

Variations of the profile of the nose of the upper lip

BACKGROUND: The aim of this study is to analyze the path needed to achieve a good aesthetic and functional result in patients treated with orthognathic surgery. METHODS: Seventy-three patients with only III class malocclusion were treated with sagittal split ramus osteotomy and with Le Fort I in only one piece. Through the analysis of anatomical cephalometric tracings, changes in the skeletal base, upper incisor and nose's shape were evaluated. The statistical analysis measurements were calculated for each length and for each angle at T0 (preoperative value) and at T1 (postoperative value). RESULTS: A significant statistical correlation was found mainly between forward movement of the upper maxilla and the outline of the nose, the nasal projection, and the naso-labial angle (NLA ). The upper incisor in movements of verticality and inclination did not show any significant correlations with modifications of the NLA. CONCLUSIONS: A significant correlation can be seen between the forward movements of the upper maxilla with the outline of the nose, the nasal projection and the Naso-Labial Angle