A Curious Case Report: Should a Clinician Be Worried About Bone Resorption Under a Chin Augmentation Site?

Oftentimes patients are concerned about their facial esthetics and appearance. To achieve the desired look, patients have several augmentation procedures available to them. Appearance of the chin and its morphology plays a crucial role in facial aesthetics. It is an important anatomic component that not only helps in the definition of the jawline and face but is also required from a functional aspect. It is not uncommon in the field of plastic surgery for patients to undergo chin reconstruction and recontouring due to the chin deformities such as microgenia and jaw asymmetry. The treatment options mainly depend on the degree of the defect and the desired functional and esthetic requirements. Along with surgical augmentations like implants and osseous genioplasty, soft tissue augmentations like injectables are also gaining popularity. These procedures can lead to complications like many other augmentation procedures. If proper follow-up is not done on these patients, the complications can cause potential damage to vital structures in the vicinity. This case report shows a patient who underwent a chin augmentation procedure with a silastic implant and never had a follow-up and is now at risk of severe resorption of the underlying bone.

Functional reconstruction of a hand that was severely deformed due to Jaccoud's arthropathy

A 54-year-old woman suspected of having localised systemic sclerosis (SSc) started steroid treatment around 40 years old. She had Jaccoud's arthropathy in her right hand with severe deformities but no bone erosion. The metacarpophalangeal (MP) joint of the index through the little fingers was dislocated palmo-ulnarly with flexion contracture of about 120° and a swan-neck deformity. The palmar skin crease was digging deeply into the skin and was soggy. Severe boutonnière deformity of the thumb was also noted. Due to her severely deformed hand, she could not grasp large objects or show her hand in public. Reconstructive surgery was performed in two stages using finger joint arthroplasty or fusion at the digital joints. After surgery, the appearance as well as the function of the hand was successfully restored. She was able to grasp the steering wheel of her car and was extremely satisfied with the results of the surgery.

Effect of Vocal Fold Implant Placement on Depth of Vibration and Vocal Output

OBJECTIVE

Most type 1 thyroplasty implants and some common injectable materials are mechanically stiff. Placing them close to the supple vocal fold mucosa can potentially dampen vibration and adversely impact phonation, yet this effect has not been systematically investigated. This study aims to examine the effect of implant depth on vocal fold vibration and vocal output.

STUDY DESIGN

Computational simulation.

METHODS

Voice production was simulated with a fiber-gel finite element computational model that incorporates a three-layer vocal fold composition (superficial lamina propria, vocal ligament, thyroarytenoid muscle). Implants of various depths were simulated, with a "deeper" or more medial implant positioned closer to the vocal fold mucosa and replacing more muscle elements. Trajectories of surface and within-tissue nodal points during vibration were produced. Outcome measures were the trajectory radii, fundamental frequency (F₀ ), sound pressure level (SPL), and smoothed cepstral peak prominence (CPPS) as a function of implant depth.

RESULTS

Amplitude of vibration at the vocal fold medial surface was reduced by an implant depth of as little as 14% of the total transverse vocal fold depth. Increase in F₀ and decrease in CPPS were noted beyond 30% to 40% implant depth, and SPL decreased beyond 40% to 60% implant depth.

CONCLUSIONS

Commonly used implants can dampen vibration "from a distance," ie, even without being immediately adjacent to vocal fold mucosa. Since implants are typically placed at depths examined in this study, stiff implants likely have a negative vocal impact in a subset of patients. Softer materials may be preferable, especially in bilateral medialization procedures.

LEVEL OF EVIDENCE

N/A Laryngoscope, 130:2192-2198, 2020.

Medialization laryngoplasty with silastic implant in unilateral vocal cord paralysis

The state of art of Laryngoplastic surgery gaining day to day importance where Rhinoplasty stood almost a century ago. Medialization Laryngoplasty using Silastic Implant for the correction of symptomatic unilateral vocal cord paralysis is discussed.