FACE RECONSTRUCTION THROUGH LIPOSTRUCTURE

Grafting adipose tissue to correct the soft parts in the maxillo-facial area was first used and described over 100 years ago by Neuber, in his search for an ideal natural material [1]. By sampling some block of adipose tissue from the abdomen, the author carried out a fine correction of volume flaws at the level of the cephalic extremity. In 1912, Hollander underlines and reports the facial modifications that appear after fat infiltration in the case of patients with facial lipoatrophy [2]. A step forward is taken in 1926 by Miller, who published data based on his own experience regarding fat injection, using his own cannulas [3]. This technique represented a huge step forward compared to the sampling of blocks of fat tissue, being somehow similar to the technique of lipostructure, the essential difference being that the sampled material was not centrifuge

LOCAL FLAPS USED IN FACIAL RECONSTRUCTION AFTER THE EXCISION OF CUTANEOUS CARCINOMAS –RETROSPECTIVE STUDY

The incidence of skin carcinomas on the face varies significantly by geographical area, in Romania being 10 in 100.000 inhabitants. Aim of the study: To determine the incidence, clinical characteristics and histopathological types of facial cutaneous carcinomas, as well as the types of local flaps used in the reconstruction of facial cutaneous defects consecutive to the excision of carcinomatous lesions. Material and methods: The study was conducted on a representative sample made of 342 patients on two main directions: clinical and computer-assisted statistical. Results: Basal cell carcinoma was diagnosticated in 69% cases of whom 51.7% were male, mostly aged over 60. Rotation flap was the first option for most patients requiring local flaps plasty of postoperative defect (51%). Conclusions: The interventions using local flaps provide the possibility of restoring aesthetic function; their colour and texture are similar to the skin of the postoperative defect region

THE VALUE OF 3-D IMAGING IN THE DIAGNOSIS AND PREOPERATIVE PLANNING OF FRACTURES OF THE ZYGOMATIC COMPLEX

Aim of the study Determining the importance of performing a three-dimensional CT reconstruction in the management of various fractures of the zygomatic complex, either isolated or in the context of associated facial fractures. Material and methods 31 cases of zygomatic complex fractures investigated by the use of computed tomography were reviewed regarding the diagnosis, preoperative planning and treatment. Results The 3D reconstruction was useful in determining the degree of comminution, the number, displacement and angulation of fragments as well as the relation with the surrounding tissues. This detailed understanding of the fracture pattern was beneficial in the assessment of the intraoperative situation. Conclusions The use of this technique is valuable in the accurate diagnosis of malar fractures, but also in deciding the appropriate treatment and approximating the amount of reduction needed in order to achieve symmetry of the zygomatic prominence and reconstruction of the facial contours

CONVENTIONAL MAXILLARY RECONSTRUCTION USING SERVICE OBTURATORS

Aim of the study The aim of the paper is to evaluate the outcomes of the conventional method of prosthetic rehabilitation of the midface and its ability to restore acceptable appearance and function. Material and methods We present our experience in making an obturator prosthesis and review the results obtained in 21 patients with defects following maxillectomy. Results Deglutition was successfully restored in all patients provided with obturators. Phonation also improved, but a degree of rhinophonia may persist. In edentulous patients, by prosthetically replacing the dental units, both the mastication and the height of the lower face were re-established. The presence of the obturator provided fullness of the midface. Conclusions The procedure proved to be simple, efficient, cost effective and applicable to a wide range of defects. Good overall results were obtained in restoring facial symmetry and redefining contours together with functional rehabilitation

THE VALUE OF PLATELET RICH FIBRIN IN BONE REGENERATION FOLLOWING TOOTH EXTRACTION

Aim of the study To determine the effect of platelet-rich fibrin (PRF) on hard tissue healing following tooth extraction. Material and methods The study included 63 patients and a total of 183 extractions were performed. The study had a split-mouth design. Each patient had a study side where the sockets were filled with PRF and a control side, where the postextractional sockets underwent natural healing, by clot formation. After 3 months, for the evaluation of hard tissue quality, a bone density measurement was done using a Cone Bean Computer Tomogram (CBCT). Results Statistical analysis revealed a significant increase in bone density in the postextractional sockets where PRF was used as filling material. Conclusions It can be concluded that through the use of PRF as an augmentation material after tooth extraction the hard tissue healing process is significantly enhanced

RARE ETIOLOGY OF TRIGEMINAL NERVE NEURALGIA – METASTATIC ADENOCARCINOMA OF THE COLON

Trigeminal neuralgia is a common condition in elderly patients. In this group of patients, trigeminal neuralgia mainly occurs due to a neurovascular conflict. However, the primary or secondary tumour lesions located at the level of the trigeminal nerve (in Meckel's cave) are rare. The authors are presenting the case of a 70 year old patient who was hospitalized for right trigeminal neuralgia, whose subsequent imaging explorations and anatomopathological examination revealed a metastatic adenocarcinoma of the colon, which is a rare etiology of trigeminal neuralgi

CORRECTION OF SEQUELAE FOLLOWING ORBITO-ZYGOMATIC FRACTURES

Aim: The purpose of this article is to share our experience regarding the late correction of orbito-zygomatic fracture sequelae. Material and Methods: We performed a review including 14 patients that underwent corrective surgery for functional or cosmetic impairment resulted from malunioned orbito-zygomatic fractures, between January 2013 and December 2017. Results: The posttraumatic sequelae were following two orbital blow-out fractures, four terapodal zygomatic bone fractures and eight comminuted orbito-zygomatic fractures. Most patients presented for diplopia and facial asymmetry. The procedures used for the correction of the various defects were titanium mesh reconstruction of the orbital floor, of the orbital contour and zygomatic bone, osteotomy and repositioning of the zygomatic bone, fat transfer and silicone implant placement for facial asymmetry correction, ectropion correction. The postoperative complications encountered were periorbital edema and ecchymoses. Overall, favourable outcomes were achieved postoperative with functional rehabilitation, including the disappearance of diplopia within one month in all involved cases, and the restoration of facial symmetry. Conclusion: Form and function can be accurately restored by performing procedures suitable to the individual defect, targeting the recontouring of the bone frame and the rearrangement of the overlying soft tissues, considering the degree of involvement

Autologous Fat Grafting for Craniofacial Reconstruction in Oncologic Patients

Due to the anatomical and functional complexity of the region, craniofacial tumor removal requires some of the most challenging surgical approaches, often complemented with advanced chemo-radiotherapy techniques. However, these modern therapies often lead to sequelae that can drastically reduce the quality of life for the surviving patients. Recent advances in the field of regenerative medicine opened new avenues for craniofacial reconstruction following head and neck cancer treatment. One of the most promising recent strategies relies on the use of autologous fat transplant. In this mini review, we briefly present some of the fat’s biological properties that make it an ideal tissue for craniofacial reconstruction following cancer treatment. We then outline the recent advances that led to a better understanding of the detailed anatomy of the craniofacial fat depots. Furthermore, we provide a succinct review of the methods used for fat harvesting, processing and engrafting in the craniofacial area after head and neck tumor removal, discussing their main applications, advantages and limitations