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Reiss S, Kulker D, Laure B, Paré A. Reconstruction of the orbitozygomatic framework: State of the art and perspectives. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101788. [PMID: 38281701 DOI: 10.1016/j.jormas.2024.101788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 01/30/2024]
Abstract
The reconstruction of the whole orbitozygomatic framework (OZF) is complex and can be encountered in cases of congenital midface deformity, after tumor ablative surgery and in severe facial trauma. Nowadays, surgeon has a wide range of available techniques that have continually grown over the past years, optimizing the surgical management and the aesthetical outcomes. Among them, the autologous bone graft (ABG) remains one of the most suitable options : ABG is easy to harvest and has optimal biological properties for bone healing. It can be tailored to the patient anatomy thanks to the recent advances in computer-assisted surgery. However, substantial drawbacks remain such as the early resorption of the non-vascularized graft, the need of a donor site and its potential morbidity. Alloplastic reconstruction is another option that can resolve both the resorption issue and the donor site morbidity. Moreover, the 3D-printing technologies also allows the manufacturing of patient specific implants. However, alloplastic materials have a variable success, especially due to the high risk of infection or exposure. Consequently, regenerative medicine is a promising field that aims to find a procedure without the disadvantages of ABG or alloplastic based reconstructions, but displaying similar or even higher success rate. Indeed, recent tissue engineering strategies have demonstrated encouraging results for bone regeneration using natural or synthetic biomaterials, patient cells and synthetic bioactive substances. The objective of this review is to present the etiologies of OZF defect, the available reconstruction procedures as well as the current state of the research.
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Affiliation(s)
- Ségolène Reiss
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France
| | - Dimitri Kulker
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France
| | - Boris Laure
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France
| | - Arnaud Paré
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France.
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Raposo-Amaral CE, Menezes PT, Lemes MV, Medeiros ML, Raposo-Amaral CA, Ghizoni E. Facial Fat Graft Injection Reduces Asymmetry and Improves Forehead Contour in Early Infancy Apert Syndrome Patients. J Craniofac Surg 2023; 34:1934-1937. [PMID: 37594030 DOI: 10.1097/scs.0000000000009610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
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.
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Affiliation(s)
- Cassio E Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
- Division of Neurosurgery, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Priscila T Menezes
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Marcela V Lemes
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Mateus L Medeiros
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Cesar A Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Enrico Ghizoni
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
- Division of Neurosurgery, University of Campinas (UNICAMP), São Paulo, Brazil
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Suzuki C, Komiya T, Inoue H, Yoshimoto T, Matsumura H. Adding collagen to adipose tissue transplant increases engraftment by promoting cell proliferation, neovascularisation and macrophage activity in a rat model. Int Wound J 2021; 19:1102-1110. [PMID: 34699134 PMCID: PMC9284645 DOI: 10.1111/iwj.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
To clarify the effect of collagen addition to transplanted adipose tissue on angiogenesis, cell proliferation and tissue remodelling process and reveal whether collagen addition contributes to improving transplanted adipose tissue engraftment in rats. Adipose tissue was harvested from the inguinal and injected into the back of the rat, in addition to collagen. Engraftment tissue was harvested, semi-quantitatively evaluated and underwent haematoxylin and eosin or Perilipin staining. Moreover, we evaluated viable adipocyte counts and neovascularisation. Macrophages were evaluated using flow cytometry, and the adiponectin or vascular endothelial growth factor (VEGF) mRNA was detected using real-time polymerase chain reaction. By collagen addition to transplanted adipose tissue, higher engraftment rate semi-quantitatively and a greater number of new blood vessels histologically were identified. Perilipin staining revealed a higher adipocyte number. The total cell, M1 macrophage and M2 macrophage count were higher. There was increased adiponectin mRNA significantly at week 4 compared to that at week 1 after transplantation. Note that the expression levels of VEGF mRNA increased. In rats, adding collagen enhanced cell proliferation, induced M2 macrophages, which are involved in wound healing, and promoted adipocytes and neovascularisation. Therefore, collagen addition to transplanted adipose tissue could increase the engraftment rate of adipose tissue.
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Affiliation(s)
- Chika Suzuki
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takako Komiya
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hana Inoue
- Department of Physiology, Tokyo Medical University, Tokyo, Japan
| | - Takayuki Yoshimoto
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
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Chauvel-Picard J, Allavena J, Beuriat PA, Di Rocco F, Gleizal A, Paulus C. Lipofilling of the lower eyelids: A craniofacial tool to postpone the facial advancement in craniofacial syndromes. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:448-451. [PMID: 34649014 DOI: 10.1016/j.jormas.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Many genetic diseases are responsible for a defect in the growth of the maxilla. Craniofacial syndromes such as Crouzon syndrome or Apert syndrome are typically associated with a major hypoplasia in the midface responsible for exophthalmos, leading to palpebral malocclusion and frequent corneal complications. Several treatments have been used to manage ocular protection in craniofacial syndromes such as tarsorrhaphy, a fronto-orbital advancement and/or a Lefort III osteotomy with or without distraction. We describe a new approach as a waiting solution to relieve exophthalmos: the autologous fat grafting of the lower eyelids. MATERIAL AND METHODS Children operated from lipofilling of the lower eyelids at the Referral Center for craniosynostosis of Femme-Mère-Enfant Hospital in Lyon, were included. All the patients suffered from midface hypoplasia and exophthalmos with insufficient eyelid closure responsible of multiples episodes of keratitis and corneal ulcerations. RESULTS Four children were included: three suffered from Crouzon Syndrome and one suffered from Apert Syndrome. The fat was reinjected at the level of the infraorbital rim, the nasolabial fold or the palpebrojugal fold, in the different planes, according to the patients' needs. Six months after surgery, a second surgery was performed for the patients whose lagophtalmos persisted. Six months after the second procedure, the results are satisfactory with a good eyelid closure. CONCLUSION The lipofilling, well used in pediatric surgery to restore facial symmetry, can also be used, as a waiting solution or complement to treat complicated exophtalmos with visual prognosis involved in congenital craniofacial syndromes.
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Affiliation(s)
- Julie Chauvel-Picard
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000 SAINT-ETIENNE, France.
| | - Julie Allavena
- Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000 SAINT-ETIENNE, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France
| | - Arnaud Gleizal
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000 SAINT-ETIENNE, France
| | - Christian Paulus
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France
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Craniofrontonasal dysplasia: hypertelorism correction in late presenting patients. Childs Nerv Syst 2021; 37:2873-2878. [PMID: 33864106 DOI: 10.1007/s00381-021-05134-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/15/2021] [Indexed: 02/05/2023]
Abstract
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.
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Assessment of craniofacial and dental characteristics in individuals with treacher collins syndrome. A review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:511-515. [DOI: 10.1016/j.jormas.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
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Fat Grafting into Younger Recipients Improves Volume Retention in an Animal Model. Plast Reconstr Surg 2019; 143:1067-1075. [PMID: 30730498 DOI: 10.1097/prs.0000000000005483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Soft-tissue deficits associated with various craniofacial anomalies can be addressed by fat grafting, although outcomes remain unpredictable. Furthermore, consensus does not exist for timing of these procedures. Whereas some advocate approaching soft-tissue reconstruction after the underlying skeletal foundation has been corrected, other studies have suggested that earlier grafting may exploit a younger recipient niche that is more conducive to fat graft survival. As there is a dearth of research investigating effects of recipient age on fat graft volume retention, this study compared the effectiveness of fat grafting in younger versus older animals through a longitudinal, in vivo analysis. METHODS Human lipoaspirate from three healthy female donors was grafted subcutaneously over the calvaria of immunocompromised mice. Volume retention over 8 weeks was evaluated using micro-computed tomography at three experimental ages: 3 weeks, 6 months, and 1 year. Histologic examination was performed on explanted grafts to evaluate graft health and vascularity. Recipient-site vascularity was also evaluated by confocal microscopy. RESULTS The greatest retention of fat graft volume was noted in the youngest group compared with both older groups (p < 0.05) at 6 and 8 weeks after grafting. Histologic and immunohistochemical analyses revealed that improved retention in younger groups was associated with greater fat graft integrity and more robust vascularization. CONCLUSION The authors' study provides evidence that grafting fat into a younger recipient site correlates with improved volume retention over time, suggesting that beginning soft-tissue reconstruction with fat grafting in patients at an earlier age may be preferable to late correction.
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Paré A, Joly A, Queiros C, Goga D, Laure B. Computer-Assisted Bilateral Orbitozygomatic Reconstruction in a Patient With Treacher Collins Syndrome Using Bicortical Calvarial Graft. JAMA FACIAL PLAST SU 2018; 20:523-525. [DOI: 10.1001/jamafacial.2018.0644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Arnaud Paré
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France
- University of Medecine François Rabelais, Tours, France
| | - Aline Joly
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France
- University of Medecine François Rabelais, Tours, France
- Department of Craniofacial Surgery, Clocheville Hospital, University Hospital Center of Tours, Tours, France
| | - Chrystelle Queiros
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France
| | - Dominique Goga
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France
- University of Medecine François Rabelais, Tours, France
| | - Boris Laure
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France
- University of Medecine François Rabelais, Tours, France
- Department of Craniofacial Surgery, Clocheville Hospital, University Hospital Center of Tours, Tours, France
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Guo Y, Lopez J, Yang R, Macmillan A, Dorafshar AH. The Use of Virtual Surgical Planning in Total Facial Skeletal Reconstruction of Treacher Collins Syndrome: A Case Report. Craniomaxillofac Trauma Reconstr 2017; 11:230-237. [PMID: 30087754 DOI: 10.1055/s-0037-1604424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022] Open
Abstract
Facial skeletal reconstruction of patients with severe Treacher Collins syndrome (TCS) requires correction of both midface and mandibular deficiencies. Implementing virtual surgical planning can provide an accurate three-dimensional analysis of craniofacial abnormalities, creating calvarial donors that match the anatomy of the desired malar augmentation and facilitating bimaxillary movements, positioning, and fixation in orthognathic surgery. We present a case of an 18-year-old patient with TCS, who underwent staged zygomaticomaxillary reconstruction and double-jaw osteotomy with sliding genioplasty, using computer-assisted surgical planning. Following these operations, the patient achieved not only improved facial harmony but also class I occlusion.
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Affiliation(s)
- Yifan Guo
- Department of Plastic and Reconstructive Surgery, Brody School of Medicine at East Carolina University, Greenville, South Carolina
| | - Joseph Lopez
- Department of Plastic and Reconstructive Surgery, JHMI, Baltimore, Maryland
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, JHMI, Baltimore, Maryland
| | | | - Amir H Dorafshar
- Department of Plastic and Reconstructive Surgery, JHMI, Baltimore, Maryland
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Baptista C, Bertrand B, Philandrianos C, Degardin N, Casanova D. [Autologous fat grafting in children]. ANN CHIR PLAST ESTH 2016; 61:732-739. [PMID: 27233949 DOI: 10.1016/j.anplas.2016.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
Lipofilling or fat grafting transfer is defined as a technique of filling soft tissue by autologous fat grafting. The basic principle of lipofilling is based on a harvest of adipose tissue, followed by a reinjection after treatment. Lipofilling main objective is a volume defect filling, but also improving cutaneous trophicity. Lipofilling specificities among children is mainly based on these indications. Complications of autologous fat grafting among children are the same as those in adults: we distinguish short-term complications (intraoperative and perioperative) and the medium and long-term complications. The harvesting of fat tissue is the main limiting factor of the technique, due to low percentage of body fat of children. Indications of lipofilling among children may be specific or similar to those in adults. There are two types of indications: cosmetic, in which the aim of lipofilling is correcting a defect density, acquired (iatrogenic, post-traumatic scar) or malformation (otomandibular dysplasia, craniosynostosis, Parry Romberg syndrom, Poland syndrom, pectus excavatum…). The aim of functional indications is correcting a velar insufficiency or lagophthalmos. In the paediatric sector, lipofilling has become an alternative to the conventional techniques, by its reliability, safety, reproducibility, and good results.
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Affiliation(s)
- C Baptista
- Service de chirurgie plastique et réparatrice, hôpital La-Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - B Bertrand
- Service de chirurgie plastique et réparatrice, hôpital La-Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - C Philandrianos
- Service de chirurgie plastique, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - N Degardin
- Service de chirurgie plastique pédiatrique, hôpital La Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - D Casanova
- Service de chirurgie plastique et réparatrice, hôpital La-Conception, 147, boulevard Baille, 13005 Marseille, France.
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