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Simultaneous Zygomatic Osteotomies with Reduction Mandibuloplasty - An Approach to Mid- and Lower-Facial Feminization in the Transfeminine Patient. J Craniofac Surg 2021; 33:1569-1573. [PMID: 34855635 DOI: 10.1097/scs.0000000000008386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 11/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Facial feminization surgery (FFS) is effective at treating gender dysphoria associated with anthropometrically masculine facial features. For many transgender women, FFS is a crucial component of the gender transition process. The purpose of this study is to report our experience with a pragmatic technique for simultaneous mid- and lower-face feminization by zygomatic osteotomy malarplasty and reduction mandibuloplasty. METHODS The technique to perform zygomatic osteotomy malarplasty and reduction mandibuloplasty is described, utilizing harvested bone from the mandible for bone grafting the zygomatic osteotomy gap. A retrospective chart review was performed for patients who underwent simultaneous middle and lower FFS using the described technique. Independent reviewers evaluated cropped preoperative and postoperative photographs of the mid and lower face and assigned each photograph a "femininity score." RESULTS Seventeen transgender women underwent simultaneous zygomatic osteotomy malarplasty and reduction mandibuloplasty over the study period with adequate follow-up (average 11.1 months). Transient nerve weaknesses were the primary complications noted. A statistically significant improvement in femininity score was reported in postoperative photographs, compared to preoperative photographs (P < 0.01). CONCLUSIONS The technique described in this study is an effective application of craniofacial approaches and techniques for feminizing the facial skeleton in transgender women by utilizing harvested mandibular bone for simultaneous malarplasty.
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Woo HK, Ajmera DH, Singh P, Li KY, Bornstein MM, Tse KL, Yang Y, Gu M. Evaluation of the relationship between malar projection and lower facial convexity in terms of perceived attractiveness in 3-dimensional reconstructed images. Head Face Med 2020; 16:8. [PMID: 32345357 PMCID: PMC7187519 DOI: 10.1186/s13005-020-00223-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/16/2020] [Indexed: 12/05/2022] Open
Abstract
Background This study aimed to investigate dental student’s perception of facial attractiveness with regard to different combinations of anteroposterior malar-jaw positions using 3-dimensional (3-D) reconstructed images of subjects. Methods Two Chinese young adults (1 male and 1 female) with straight profiles and average malar projections were selected for the study. 3-D facial images and cone-beam computed tomography images of these two subjects were superimposed using 3-D imaging software. Lateral and oblique views of nine different images were created by moving the maxillomandibular complex and/or zygomatic bone by 4 mm either forward or backward along the sagittal plane. One hundred three undergraduate dental students (n = 24, 33, and 46 students from the Year 3, 4, and 5, respectively) then scored lateral and 45° oblique view images of the newly reconstructed faces. Results In the present study, images with a neutral malar and retruded jaws were found to be the most attractive in both male and female subjects. In addition, the Protruded malar (PM) group (p < 0.001), and the Retruded Jaws (RJ) group were rated more attractive (p < 0.001). Furthermore, the Relatively Prominent malar (RP) group was rated more attractive (p < 0.001) when malar-jaw relative positions were compared. Conclusion This study shows that a neutral or a protruded malar favours facial attractiveness in both Chinese male and female subjects. Therefore, an appropriate relationship between malar projection and lower facial convexity should be taken into consideration while designing the orthodontic/orthognathic treatment plans for enhanced aesthetic outcomes.
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Affiliation(s)
- Hon Kwan Woo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | - Pradeep Singh
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Kar Yan Li
- Central Research Laboratories, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Michael Marc Bornstein
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Kwan Lok Tse
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yanqi Yang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Min Gu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Yoon SH, Jeong E, Chung JH. Malar Relocation with Reverse-L Osteotomy and Autogenous Bone Graft. Arch Craniofac Surg 2018; 18:264-268. [PMID: 29349052 PMCID: PMC5759662 DOI: 10.7181/acfs.2017.18.4.264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/18/2017] [Accepted: 11/02/2017] [Indexed: 11/15/2022] Open
Abstract
The zygomaticomaxillary complex (ZMC) functions as a buttress for the face and is the cornerstone to a person's aesthetic appearance, by both setting the midfacial width and providing prominence to the cheek. Malar deficiency is often acquired by blunt injury incurred in a traumatic accident, resulting in ZMC fracture. A 48-year-old male patient presented a right ZMC fracture after contusion injury by a baseball. He only received conservative management and later he suffered discomfort during mouth opening at the moment of mastication, due to trismus involving the temporomandibular joint. In the current case, we describe a surgical technique, by which the malar body is shifted anteriorly and laterally after combined oblique-vertical osteotomy. The technique presented, eventually restored the former aesthetic position of the malar complex and symmetry, and, moreover, improved mastication function.
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Affiliation(s)
- Se Hoon Yoon
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Euicheol Jeong
- Department of Plastic Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jee Hyeok Chung
- Department of Plastic Surgery, Myongi Hospital, Goyang, Korea
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Triplett RG, Berger J, Jensen O, Louis P. Dental and Craniomaxillofacial Implant Surgery. J Oral Maxillofac Surg 2017; 75:e74-e93. [PMID: 28728740 DOI: 10.1016/j.joms.2017.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION This prospective study aims to evaluate the reliability of a reconstructive technique, which uses autologous J-shaped graft (J-graft) harvested from the mandibular ramus. MATERIALS AND METHODS Thirty-six maxillary defects among 32 patients (20 women and 12 men) were treated. All patients presented enough bone volume at the donor site to perform the harvesting procedures needed for the autologous reconstruction. All patients underwent clinical and radiographical evaluations through standardized radiographs taken before the intervention, immediately after the bone grafting, 6 to 7 months, and 1 year later. The loss of tooth vitality, the alterations of skin and mucosa sensibility, and the patients' subjective perception of discomfort related to the surgical procedure were investigated. RESULTS We found an overall success rate of 91.66% with a mean bone gain of 4.8 mm vertically and 5.6 mm horizontally, assessed through computed tomography. According to clinical examinations, 35 sites completely recovered with proper incorporation of the graft, whereas 33 sites reached enough bone volume to allow the implant placement. CONCLUSION The described technique explains how to harvest and shape a J-graft. It achieves the simultaneous restoration of the horizontal and vertical bone loss with a single bone block.
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Sheikh Z, Sima C, Glogauer M. Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation. MATERIALS 2015. [PMCID: PMC5455762 DOI: 10.3390/ma8062953] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.
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Affiliation(s)
- Zeeshan Sheikh
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, Fitzgerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-514-224-7490
| | - Corneliu Sima
- Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA 02142, USA; E-Mail:
| | - Michael Glogauer
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, Fitzgerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada; E-Mail:
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Smith RA, Block MS, Sclar AG. Dental and craniomaxillofacial implant surgery. J Oral Maxillofac Surg 2012; 70:e72-106. [PMID: 23128008 DOI: 10.1016/j.joms.2012.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim YI, Park SB, Son WS, Hwang DS. Midfacial Soft-Tissue Changes After Advancement of Maxilla With Le Fort I Osteotomy and Mandibular Setback Surgery: Comparison of Conventional and High Le Fort I Osteotomies by Superimposition of Cone-Beam Computed Tomography Volumes. J Oral Maxillofac Surg 2011; 69:e225-33. [PMID: 21496986 DOI: 10.1016/j.joms.2010.12.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/26/2010] [Accepted: 12/28/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Yong-Il Kim
- Department of Orthodontics, Pusan National University College of Dentistry, Pusan National University Hospital, Busan, South Korea
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Restoration of Facial Symmetry in Hemifacial Microsomia with Mandibular Outer Cortex Bone Grafting Combined with Distraction Osteogenesis. Plast Reconstr Surg 2011; 127:1997-2004. [DOI: 10.1097/prs.0b013e31820cf485] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Local intraoral autologous bone harvesting for dental implant treatment: alternative sources and criteria of choice. Keio J Med 2009; 58:24-8. [PMID: 19398881 DOI: 10.2302/kjm.58.24] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Dental implants are established alternatives for replacing missing teeth. In case of alveolar bone resorption, implant placement may be prevented unless the volume of hard tissues is increased before or during implantation. Autologous bone graft is still regarded as the "gold standard" in alveolar reconstruction., but many factors may influence the final outcome. The success of intraoral bone grafts, in fact, depends, among other factors, on the choice of donor graft material as well as on how the material is handled. The evidence supporting the use of autogenous intramembranous bone with or without the use of barrier membranes is briefly reviewed. The rational of donor site choice is also presented. Advantages and disadvantages of different harvesting site are discussed.
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Nkenke E, Vairaktaris E, Kramer M, Schlegel A, Holst A, Hirschfelder U, Wiltfang J, Neukam FW, Stamminger M. Three-dimensional analysis of changes of the malar-midfacial region after LeFort I osteotomy and maxillary advancement. Oral Maxillofac Surg 2008; 12:5-12. [PMID: 18600355 DOI: 10.1007/s10006-008-0094-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM It has been the objective of the present prospective study to assess visible volume changes of the facial soft tissue after LeFort I osteotomy with advancement and to determine the soft-tissue-to-hard-tissue ratios of advancement. PATIENTS AND METHODS Twenty adult patients (ten female, ten male, mean age 33.9 +/- 14.9 years) received a LeFort I osteotomy with advancement because of a maxillary protrusion. Lateral skull radiographs and optical three-dimensional (3D) scans of the facial surface were assessed preoperatively and 12 months after surgery. The lateral skull radiographs were used to carry out standard linear and angular cephalometric measurements. The pre- and postoperative optical 3D surface scans were registered. A well-defined area in the malar region was used to determine the visible volume changes for each side separately. The mean accommodation vector that transforms the preoperative into the postoperative surface was assessed for each facial half separately. The soft-tissue-to-hard-tissue ratios between the incision superius and the labrale superius, the maximal parasagittal advancement of soft tissue, and the accommodation vectors were calculated. RESULTS A mean advancement of the incision superius of 5.3 +/- 2.1 mm was accompanied by a volume increase of 5.2 +/- 4.1 cm(3) in the right malar-midfacial region and 4.6 +/- 4.7 cm(3) on the left side, respectively, revealing a symmetrical volume change (p = 0.370). The soft-tissue-to-hard-tissue ratios were 80 +/- 94% for labrale superius and incision superius, 56 +/- 79% (right) and 51 +/- 56% (left) for accommodation vector and incision superius and 97 +/- 79% (right) and 98 +/- 89% (left) for maximal parasagittal advancement of soft tissue and incision superius. DISCUSSION The determination of volume changes and accompanying accommodation vectors complete the cephalometric analysis during the follow-up of patients undergoing LeFort I osteotomy. The data show that maxillary advancement leads to a more pronounced shifting of the soft tissues in the malar-midfacial area than of the upper lip. The new parameters will help to assess normative soft tissue data based on 3D imaging with a view to an improved three-dimensional prediction of the operative outcome of orthognathic surgery away from the midline.
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Affiliation(s)
- Emeka Nkenke
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstr. 11, 91054 Erlangen, Germany.
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Silva FMS, Cortez ALV, Moreira RWF, Mazzonetto R. Complications of Intraoral Donor Site for Bone Grafting Prior to Implant Placement. IMPLANT DENT 2006; 15:420-6. [PMID: 17172961 DOI: 10.1097/01.id.0000246225.51298.67] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this prospective study was to evaluate the morbidity and the major complications of intraoral donor sites for bone grafting prior to implant placement. MATERIALS The records of 104 consecutive patients with indication for bone grafting prior to implant installation treated at Piracicaba Dental School by the Department of Oral and Maxillofacial Surgery, from June 2001 until June 2003, were reviewed. RESULTS One hundred three surgical procedures were realized, in which 40% were harvested from mandibular symphysis, 28.8% from mandibular ramus, and 31.2% from maxillary tuberosity. Prevalence of complications among intraoral donor sites was more significant after harvesting the mandibular symphysis. The major complication and discomfort reported by the patients was sensory deficit in lower lip and mental area. It was noted that 16% harvesting procedures involving symphysis and 8.3% involving the mandibular ramus area reported some sensory deficit. No complications were found involving the maxillary tuberosity. CONCLUSION Complications and morbidity were smaller in the ramus than in symphysis, and temporary sensory disturbances were the most common complications, noted in both symphysis and ramus areas.
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Park HD, Min CK, Kwak HH, Youn KH, Choi SH, Kim HJ. Topography of the outer mandibular symphyseal region with reference to the autogenous bone graft. Int J Oral Maxillofac Surg 2004; 33:781-5. [PMID: 15556327 DOI: 10.1016/j.ijom.2004.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2004] [Indexed: 10/26/2022]
Abstract
The mandibular symphysis is preferred as a donor site for the relatively small grafts needed for the autogeneous bone graft procedure. This study was undertaken to determine the morphology and composition of the cortical and trabecular bone in the mandibular symphyseal region using 35 mandible specimens from Koreans. The topographical patterns through the thickness of the cortical plate and the width of the trabecular bone were observed. In this study, the labial cortical plate of the mandible became thicker from the superior to the inferior aspects (P < 0.05). However, the trabecular bone width exhibited a different distribution pattern compared to the thickness of the labial cortical plate. This observation concerning the cortical and trabecular bones assists in determination of the depth of osteotomy. The results provide useful information on the mandibular symphysis graft prior to dental implant placement. These results will enable the volume of the cortical plate in the mandibular symphyseal region and its proper size, depth, and location to be predicted when removing a graft block.
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Affiliation(s)
- H D Park
- Division in Anatomy and Developmental Biology, Department of Oral Biology, College of Dentistry, Oral Science Research Center, Yonsei University, Seoul 120-752, South Korea
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Leonetti JA, Koup R. Localized maxillary ridge augmentation with a block allograft for dental implant placement: case reports. IMPLANT DENT 2003; 12:217-26. [PMID: 14560481 DOI: 10.1097/01.id.0000078233.89631.f8] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Autogenous block bone grafts have been highly successful in treating human periodontal defects, restoring esthetics, and developing adequate bone volume for dental implant placement. Limitations in available donor bone, the need for an added surgical procedure, and other potential complications have made the use of allogenic bone graft materials an important alternative. One patient described in this report presented with fractured root syndrome of the right maxillary incisor with severe resorption of the buccal plate. After atraumatic tooth extraction, a staged treatment approach involving localized ridge augmentation with an allogenic iliac bone block material and dental implant placement was used. The host bone completely incorporated the graft with only minor resorption, which enabled the implant to be placed. The allogenic bone block material used in this study was an effective alternative to harvesting and grafting autogenous bone for implant site development. The cases presented in this article clinically demonstrate the efficacy of using a block allograft in generating effective new bone fill for dental implant placement.
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Misch CM. The harvest of ramus bone in conjunction with third molar removal for onlay grafting before placement of dental implants. J Oral Maxillofac Surg 1999; 57:1376-9. [PMID: 10555807 DOI: 10.1016/s0278-2391(99)90882-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C M Misch
- University of Pittsburgh School of Dental Medicine, PA, USA.
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