Parry-Romberg syndrome: severity of the deformity does not correlate with quality of life

Successful Treatment and Long-Term Follow-Up of Parry-Romberg Syndrome with Anterolateral Thigh Adipofascial Flap

BACKGROUND

Anterolateral thigh adipofascial free flap transfer is a frequently used method to reconstruct facial symmetry and restore facial soft-tissue contour in patients with Parry-Romberg syndrome, but long-term prognosis and outcomes are unclear.

METHOD

The authors report their treatment experience with 42 patients between 2001 and 2017 using microsurgical free anterolateral thigh adipofascial flap transfer. Long-term follow-up results and final reconstructive outcomes were evaluated.

RESULTS

A total of 42 patients were included. The follow-up ranged from 5 to 21 years. All patients were satisfied with the surgery. Photographic evaluation revealed significant enhancement of postoperative appearance. Numbness or hypesthesia of the local area was the most common symptom noted in long-term follow-up.

CONCLUSIONS

This study evaluated the long-term results of treating Parry-Romberg disease with microsurgery using ALT free flap in the authors' department. Over 20 years of experience and the significant enhancement in overall appearance indicate a long-lasting, excellent outcome.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Facial Fat Graft Injection Reduces Asymmetry and Improves Forehead Contour in Early Infancy Apert Syndrome Patients

BACKGROUND

The objective of this study is to report the outcomes of a modified comprehensive Apert syndrome surgical protocol in which fat injection was performed during early infancy concurrent with postposterior vault distraction osteogenesis (PVDO) distractor removal.

METHODS

A retrospective study was performed on 40 consecutive young patients with Apert syndrome who underwent PVDO and subsequent distractor removal between 2012 and 2022. Of these 40 patients, 12 patients underwent facial fat injection concurrent with distractor removal to treat residual supraorbital bar recession as part of a modified comprehensive Apert syndrome surgical protocol. Preoperative and postoperative severity of recession and irregularity was graded from 1 to 3, with 1 being less severe and 3 being the most severe. Recession severity was correlated with the number and type of suture fusion. The complication rate was stratified via a Clavien-Dindo scale.

RESULTS

The average patient age was 14.3±5 months, with 5 males (41.6%) and 7 females (48.3%). The average hospital stay was 1.08 days. The average volume of free fat graft injection was 8.29±5 mL. According to the Likert scale, forehead morphology improved in 91.67% of the patients. Complete resolution of supraorbital bar recession was achieved in seven patients (58.33%), all of whom presenting a single suture synostosis. One patient with a cloverleaf skull presented a type IIIB complication.

CONCLUSIONS

Facial fat grafting markedly reduces forehead asymmetry and improves forehead contour in Apert syndrome patients following PVDO. Total resolution of forehead recession directly correlated with a single suture fusion.

In Vitro Study on the Biological Characteristics of Adipose-Derived Stem Cells from Liposuction Area in Patients with Progressive Hemifacial Atrophy

OBJECTIVE

In this study, we investigate the biological characteristics of ADSCs from the liposuction area in patients with hemifacial atrophy in vitro.

METHODS

ADSCs were respectively extracted from the donor site of patients with hemifacial atrophy and healthy ones. ADSCs of two groups were respectively tested for proliferation ability, phenotype, multipotency, migration ability, self-repair ability, apoptosis, and autophagy. Exosomes extracted from the supernatant of two groups were detected by NTA particle size, electron microscopy (TEM), and WB for CD63 and TSG10, respectively.

RESULTS

CCK-8 showed a statistically less increase in cell proliferation in PHA-ADSCs after the sixth day. ADSCs in both groups had typical phenotypes and multidirectional abilities. PHA-ADSCs exhibited weaker droplet formation. The cell migration ability in PHA-ADSCs was weaker tested by Transwell assay. The live/dead proportion calculated by ImageJ following calcein-AM/PI double staining revealed live cells in PHA-ADSCs was 46.11% compared with 54.21% in NORM-ADSCs after OGD treatment. A significant down-regulation of ATG7 and ATG12 and a higher percentage of apoptosis were found in PHA-ADSCs. A significant up-regulation of BAX occurred in PHA-ADSCs.ARPC5 expression in the PHA group was extremely distinct down-regulated.CDKN1A and CDKN2A expression in the PHA group was significantly up-regulated.WB analyses confirmed that both groups' ADSCs-Exosomes surface markers CD63 and TSG101 were positively expressed but varied significantly.

CONCLUSIONS

PHA-ADSCs exhibited a poorer proliferation ability, higher apoptosis percentage, weaker lipid droplets formation, weaker cell migration, poorer intolerance to OGD, aging earlier, and weaker self-renewal and repairability.PHA-ADSCs-Exosomes showed low expressions of CD63 and TSG101.This study provides strong evidence that the addition of exosomes with specific cytokines can improve the fat survival rate after fat filling in patients with hemifacial atrophy.

NO LEVEL ASSIGNED

This journal requires that authors 42 assign a level of evidence to each submission to which 43 Evidence-Based Medicine rankings are applicable. This 44 excludes Review Articles, Book Reviews, and manuscripts 45 that concern Basic Science, Animal Studies, Cadaver 46 Studies, and Experimental Studies. For a full description of 47 these Evidence-Based Medicine ratings, please refer to the 48 Table of Contents or the online Instructions to Authors 49 https://www.springer.com/00266 .

Craniofrontonasal dysplasia: hypertelorism correction in late presenting patients

BACKGROUND

Craniofrontonasal dysplasia (CFND) is a rare congenital craniofacial syndrome characterized by single suture synostosis, hypertelorism, other clinical facial features, and abnormalities in the upper extremities. There are only a few studies in the applicable literature that address hypertelorism management for CFND patients and outcomes and complication rates.

METHODS

A retrospective study was performed on consecutive late presenting CFND patients referred to our hospital with substantially completed craniofacial skeleton growth, who underwent hypertelorism correction between 2007 and 2019 following intracranial pressure screening, and who received at least 1 year of follow-up care. None of the patients in this study underwent prior craniofacial surgery. Only those patients with a confirmed mutation of the EFNB1 gene were included in this study. All patients in this study underwent hypertelorism correction by facial bipartition or box osteotomy.

RESULTS

A total of ten late presenting CFND patients (all female) were treated at our hospital during the study period. None of the patients presented signs of elevated intracranial pressure. The average patient age at hypertelorism correction was 13.4 ± 7.68 years of age. Major complications, defined as complications requiring a return to the operating room, were limited to infection of the frontal bone, which required partial bone removal, and cerebrospinal fluid (CSF) leak, which was completely resolved by insertion of a lumbar shunt for a 7-day period.

CONCLUSION

The absence of elevated intracranial pressure enables hypertelorism correction in late presenting CFND patients via facial bipartition or box osteotomy without the need for additional operations that provide for cranial expansion.

Lipofilling as an aesthetic restorative technique for the facial hemiatrophy of Parry-Romberg syndrome: An analysis of 27 cases

•

Progressive haemifacial atrophy, also known as Parry-Romberg syndrome.

•

Lipofilling provides an option for voluminous flaps, improving skin quality and preserving the natural contours of the face.

•

Fat reinjection is a simple, efficient and reproducible procedure.

•

Physical appearance and psychological well-being should be considered as a part of the general management.

Introduction

The aim of this paper is to present our experience using autologous fat transplantation for facial augmentation and to evaluate the effectiveness of lipofilling in different regions of the face for the reconstruction and aesthetic improvement of the facial contouring.

Case presentation

Data in term to the age, gender distribution, harvest and injection sites, degree of satisfaction with post-surgical facial, and complications were recorded.

Discussion

Progressive haemifacial atrophy, also Known as Parry Romberg's disease, is a common craniofacial disease that conventionally affects the subcutaneous tissue on one side of the face. We report here a series of 27cases of hemifacial atrophy (Parry-Romberg syndrome), admitted to our department, and treated with lipofilling in conformity with Coleman's guidelines. The volume of fat grafting was assessed by an attempt to reach symmetry with the controlateral side within a single procedure.

Conclusion

All patients claimed that they were satisfied or very satisfied with the aesthetic results and affirmed that it had a positive psychological impact on their daily life.

Isolated Fat Grafting for Reconstruction of Lower Face Volumetric Asymmetry in Skeletally Immature Patients: A Clinical Outcome Study

BACKGROUND

The purpose of this study was to assess the objective and subjective outcomes of lower face volumetric (contour) asymmetry correction with isolated fat grafting in skeletally immature patients.

METHODS

A prospective analysis was conducted of skeletally immature patients (n = 73) with craniofacial microsomia and Parry-Romberg syndrome who underwent isolated fat grafting (with no previous or concomitant bone surgery) using anatomical surgical principles (facial subunits and fat compartments) for the reconstruction of lower face volumetric asymmetry. Objective ultrasound and photogrammetric lower face symmetry analyses were blindly performed preoperatively and at 3 and 12 months postoperatively. A panel assessment of blinded surgical professionals and laypersons was also obtained to grade the subjective lower face symmetry.

RESULTS

There were significant (all P < 0.05) postoperative objective and subjective lower face symmetry enhancements (preoperative < postoperative) after isolated fat grafting, with no differences (all P > 0.05) between 3 versus 12 months' postoperative comparisons.

CONCLUSIONS

Growing patients with unilateral lower face volumetric asymmetries presented with improvement of objective and subjective symmetry after a single isolated fat grafting procedure.

Long-Term Morphologic Changes on Sagittal Synostosis Patients Who Underwent a Modified Pi Technique

BACKGROUND

There are paucity of studies focused on the long-term assessment of the craniofacial changes after a pi-plasty procedure and self-reported quality of life outcomes. Thus, this study aimed to assess long-term morphologic changes and quality of life of patients with sagittal synostosis who underwent surgery with a modified pi-plasty.

METHODS

Consecutive patients with sagittal synostosis who underwent surgery and had more than 5 years of follow-up and standard preoperative and 1, 3, and 5 years right profile view photographs were included. Nasofrontal angle and angle of total facial convexity were evaluated using computerized photogrammetric measurements. Additionally, quality of life outcome was evaluated by the Quality of Life Scale Short Form.

RESULTS

The total facial convexity angle and nasofrontal angle increased significantly (P < 0.05), with a P-value of 0.013 and 0.012, respectively. Patients had quality of life scores >80 in all of the 4 domains, with the highest scores being: physical health domain 80.0 ± 0, psychologic domain 85.0 ± 5, social relationships domain 86.6 ± 0, and environmental domain 98.13 ± 2.42.

CONCLUSION

Facial angles significantly changed over 5 years of follow-up. Self-reported quality of life instrument showed that patients are satisfied with their own appearance, contributing positively to their quality of life.

Fat Grafting in Managing Craniofacial Deformities

BACKGROUND

The successful correction of craniofacial contour deformities remains a major challenge in plastic surgery. This article reviews important concepts and strategies for craniofacial fat grafting and presents a SOBRAPAR Hospital algorithm focused on achieving craniofacial contour symmetry as early as possible without compromising function.

METHODS

Principle-based methods (i.e., anatomical facial fat compartments, fluid accommodation model, multistage site-specific craniofacial fat grafting, and structural fat-grafting technique) were itemized into an algorithm to aid in planning and selecting the best surgical approach (i.e., bone and/or soft tissue procedures) in order to obtain craniofacial contour symmetry.

RESULTS

The treatment plan and choice of surgical technique implemented to address bone and/or or soft tissue deformities were determined by specific diagnosis, patient age at presentation, and functional status. Bony reconstruction in skeletally immature patients is reserved solely for those patients with functional issues.

CONCLUSION

By adopting principle-based methods and fat compartment theory, we are able to achieve craniofacial contour symmetry and aesthetically pleasing outcomes without compromising function.

Does an ear deformity bring an adverse impact on quality of life of Treacher Collins syndrome individuals?

Treacher Collins syndrome (TCS) is an autosomal dominant disorder with variable expression in which the ear may or may not be absent or with a malformation. Individuals with TCS suffer social stigma that may affect interaction with their peers. Quality of life instruments obtained through self-perception questionnaires are stigma identification tools and can enable social adjustment of these individuals. This study aims to assess the quality of life of individuals with TCS and to gauge the impacts of ear deformity on the quality of life. Twelve volunteers with a clinical and genetic diagnosis of TCS answered the WHO quality of life questionnaire and were divided into groups with normal ears (n = 6) versus affected ears (n = 6), and their results were compared. Siviero's scale was used to stratify the quality of life scores as satisfactory, intermediate and unsatisfactory. The overall score of the normal ears group was 73.13 and 71.81 for the affected ears group, and both were classified as an intermediate quality of life, with no statistically significant differences between them. Ear deformity is not a burden to the quality of life of these individuals, who already show other deformities and overall intermediate quality of life scores.

Autologous Free Fat Grafting for Management of the Facial Contour Asymmetry

BACKGROUND

The purposes of this study were to report autologous free fat grafting as the workhorse procedure to augment the facial soft-tissue envelope and restore facial contour symmetry of patients with asymmetric facial malformations; to detail the SOBRAPAR Hospital algorithm for soft-tissue reconstruction of patients with facial contour asymmetry; and to assess facial symmetry after fat grafting.

METHODS

A retrospective analysis of consecutive patients (n = 178) who underwent fat grafting to restore the facial contour symmetry according to the SOBRAPAR Hospital algorithm between 2009 and 2016 was conducted. Computerized photogrammetric quantitative and qualitative facial symmetry analyses were performed.

RESULTS

There were significant (all P < 0.05) postoperative quantitative facial symmetry enhancement and an overall qualitative facial symmetry enhancement, with a mean fat graft procedures per patient of 1.6 ± 0.7, ranging of 1 to 3.

CONCLUSION

A significant improvement of facial contour symmetry was obtained in a subset of patients using fat grafting according to the SOBRAPAR Hospital algorithm.

Customized acrylic implants for reconstruction of extensive skull defects: an exception approach for selected patients

ABSTRACT Objective: to present our experience in the surgical treatment of extensive skullcap defects with customized acrylic implants. Methods: we conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between 2004 and 2013. We carefully selected all patients and classified surgical results based on three scales (craniofacial esthetics, improvement of facial symmetry and need for additional surgery). Results: fifteen patients underwent cranioplasty with intraoperative acrylic implants, whether manually customized (46.67%) or made with prototyped three-dimensional biomodels (53.33%). There were two (13.33%) complications (one infection with implant withdrawal and one seroma). We considered the craniofacial aesthetics excellent (50%), the degree of improvement of craniofacial symmetry satisfactory (57.14%), and the overall mean of surgical results according to the need for new surgeries was 1.5±0.52. Conclusion: cranioplasties of patients with extensive skullcap defects should obey careful and predetermined criteria, both for selection and for the acrylic implant customization method.

Surgical Management of Progressive Hemifacial Atrophy With De-Epithelialized Profunda Artery Perforator Flap: A Case Report

Progressive hemifacial atrophy (PHA) is a rare disorder characterized by slow, unilateral atrophy of the soft tissues and bones of the craniofacial region. The defect becomes more pronounced with age, leading to esthetic and functional deficits. However, the proper timing and method of surgical reconstruction are still debated. The correction of this defect markedly influencing the quality of life of the patient can be achieved with less invasive to more invasive surgical approaches. A 21-year-old female patient with hemifacial atrophy and extensive alopecia presented to our clinic. Considering the body type and the expectations of the patient, a profunda artery perforator flap was applied for the reconstruction and esthetic improvement of the facial region. The facial asymmetry attenuated after the reconvalescence period. This case shows that in the up-to-date surgical treatment of severe PHA, the use of microvascular free flaps may provide a better approach when trying to achieve an acceptable esthetic result. This is the first time that a profunda artery perforator flap was used to restore facial asymmetry caused by PHA.

Isolated Autologous Free Fat Grafting for Management of Facial Contour Asymmetry in a Subset of Growing Patients With Craniofacial Microsomia

BACKGROUND

To report autologous free fat grafting as an isolated procedure to manage facial contour asymmetry of a subset of growing patients with craniofacial microsomia (CFM).

METHODS

A retrospective analysis of CFM patients (n = 11) with low socioeconomic and intellectual status, poor oral hygiene, living far from our center, Pruzansky-Kaban I/II mandibles, without functional concerns, and with no craniofacial skeletal surgery who underwent isolated free fat grafting between 2012 and 2013 was conducted. Surgeon and parent/patient satisfaction were elicited. Computerized photogrammetric quantitative and qualitative facial symmetry analyses were performed.

RESULTS

All patients underwent isolated autologous free fat grafting to restore the facial contour symmetry. Surgeon and patient/parent were mostly satisfied. There were significant (all P < 0.05) postoperative quantitative facial symmetry enhancement and an overall qualitative facial symmetry enhancement.

CONCLUSIONS

A significant improvement of facial symmetry was obtained in this subset of growing CFM patients using only isolated free fat grafting.

Barraquer-Simons syndrome: a unique patient's perspective on diagnosis, disease progression and recontouring treatment

This case report describes a female patient diagnosed with Barraquer-Simons syndrome, a rare form of acquired partial lipodystrophy characterised by symmetrical loss of adipose tissue from face, neck, upper extremities and the trunk with onset in early childhood. Initial symptoms were seen at the age of 8 years. Our patient did not show signs of renal impairment and this may be associated with the syndrome. Treatment of lipoatrophy in these patients is limited to cosmetic restoration, and autologous fat grafting has shown sustained positive effects with no or very little loss of volume at follow-ups. Furthermore, the treatment has resulted in considerable improvements in her quality of life and daily functioning. She has not experienced any adverse effects. Accurate and early diagnosis is important, and clinicians should consider early intervention for these patients. Autologous fat grafting is recommended as a safe procedure.

Matthews device arthroplasty presents superior long-term mouth opening than interpositional arthroplasty in the management of temporomandibular joint ankylosis

BACKGROUND

The aim of this study is to describe the surgical outcomes of a single-institution experience in the surgical management of temporomandibular joint ankylosis, comparing interpositional arthroplasty with autogenous tissue and Matthews device arthroplasty.

METHODS

A retrospective analysis of temporomandibular joint ankylosis patients (n = 15), who underwent interpositional arthroplasty or Matthews device arthroplasty, was conducted. The surgical outcomes (preoperative, recent [4-6 weeks], intermediate [1 year], and late [3 years] postoperative maximal incisal opening, hospital stay, and complication, relapse, and reoperation rates) were compared.

RESULTS

Significant (all p < 0.05) differences were recorded in temporomandibular joint ankylosis patients treated with interpositional arthroplasty with autogenous tissue (53.3%) versus Matthews device arthroplasty (46.7%) according to intermediate (25 ± 7 vs. 34 ± 5 mm) and late (19 ± 8 vs. 33 ± 5 mm) postoperative maximal incisal opening, intermediate (31% vs. 7%) and late (47% vs. 12%) postoperative relapse, and reoperation rate (38% vs. 0%). There was similarity (all p > 0.05) in preoperative (4.8 ± 2.9 vs. 4.9 ± 2.9 mm) and recent (35 ± 4 vs. 37 ± 4 mm) postoperative maximal incisal opening, hospital stay (3.5 ± 0.8 vs. 3.6 ± 0.8 days), and surgery-related complications (13% vs. 14%).

CONCLUSION

Both surgical procedures evaluated were successful in initial management of temporomandibular joint ankylosis, but the Matthews device arthroplasty avoided postoperative relapse.

Evaluating Autologous Lipofilling for Parry-Romberg Syndrome–Associated Defects: A Systematic Literature Review and Case Report

Background

Parry-Romberg syndrome (PRS) is a rare craniofacial disease that causes progressive hemifacial atrophy of the soft tissue before spontaneously entering remission. Autologous fat grafting may provide a less invasive alternative, producing aesthetically pleasing results while avoiding the need for traditional microsurgical free flap coverage.

Methods

A systematic review of the literature was conducted. Inclusion and exclusion criteria were applied. The case report highlights the technique using two-dimensional and three-dimensional photography.

Results

Our review yielded 31 articles in addition to our case describing 147 cases of lipofilling to correct PRS soft-tissue defects. Patients underwent an average of 2.2 procedures, receiving on average 95 mL of grafted fat. Disease severity was classified into mild (41%), moderate (42%), and severe (17%) in the identified patients. Increasing disease severity correlated with an increasing number of procedures and fat-grafting volumes to achieve adequate aesthetic outcomes (mean, 1.5 and 38 mL; 2.3 and 81 mL; 3.7 and 129 mL, respectively). Reported benefits over flap-based reconstructions included reductions in cost (40%), operative time (50%), donor-site morbidity (52%), and rate of complications (33%). Aesthetic benefits cited included improved skin quality (65%), more natural contours (1%), and more natural facial expressions (10%).

Conclusion

Fat grafting for correction of PRS-associated soft-tissue defects is receiving heightened acceptance for its ability to restore natural facial contours. While additional fat-grafting procedures may be required with increased disease severity, autologous fat grafting may be a beneficial option as a sole modality to correct PRS-associated soft-tissue atrophy.

Progressive frontal morphology changes during the first year of a modified Pi procedure for scaphocephaly

PURPOSE

The purpose of this study was to quantify the changes in frontal morphology in patients with scaphocephaly treated with a modified Pi procedure.

METHODS

Consecutive scaphocephalic patients (n = 13) who underwent surgery before 12 months of age that had more than 1 year of follow-up and standard preoperative, 3-month, and 1-year photographs were included. Anthropometric measurements were used to document the craniofacial index. Computerized photogrammetric analyses of five craniofacial angles (bossing angle, nasofrontal angle, angle of facial convexity, and angle of total facial convexity) were also performed.

RESULTS

Comparisons of the preoperative and postoperative direct anthropometric measurements of the cephalic index showed a significant (all p < 0.05) increase in the postoperative period, with no significant differences in early versus late postoperative period comparisons. Comparisons of the preoperative and postoperative computerized photogrammetric measurements of the craniofacial angles showed a significant (all p < 0.05) reduction (bossing angle, angle of facial convexity, and angle of total facial convexity) and increase (nasofrontal angle) in the early and late postoperative periods.

CONCLUSIONS

Frontal morphology significantly changed over the first year of the modified Pi procedure.

Injectable carboxymethylcellulose hydrogels for soft tissue filler applications

Disease, trauma and aging all lead to deficits in soft tissue. As a result, there is a need to develop materials that safely and effectively restore areas of deficiency. While autogenous fat is the current gold standard, hyaluronic acid (HA) fillers are commonly used. However, the animal and bacterial origin of HA-based materials can induce adverse reactions in patients. With the aim of developing a safer and more affordable alternative, this study characterized the properties of a plant-derived, injectable carboxymethylcellulose (CMC) soft tissue filler. Specifically, methacrylated CMC was synthesized and crosslinked to form stable hydrogels at varying macromer concentrations (2-4% w/v) using an ammonium persulfate and ascorbic acid redox initiation system. The equilibrium Young's modulus was shown to vary with macromer concentration (ranging from ∼2 to 9.25kPa), comparable to values of native soft tissue and current surgical fillers. The swelling properties were similarly affected by macromer concentration, with 4% gels exhibiting the lowest swelling ratio and mesh size, and highest crosslinking density. Rheological analysis was performed to determine gelation onset and completion, and was measured to be within the ISO standard for injectable materials. In addition, hydrolytic degradation of these gels was sensitive to macromer concentration, while selective removal using enzymatic treatment was also demonstrated. Moreover, favorable cytocompatibility of the CMC hydrogels was exhibited by co-culture with human dermal fibroblasts. Taken together, these findings demonstrate the tunability of redox-crosslinked CMC hydrogels by varying fabrication parameters, making them a versatile platform for soft tissue filler applications.