BACKGROUND:Among several skin fillers developed in recent decades, hyaluronic acid (HA) is a widely used filler for face contouring and is generally believed to be safe, long-lasting, not immunogenic, and cost-effective. However, early and delayed complications can also occur following HA filler injection. Unfortunately, there have been reports of HA-related bone erosion in the chin area without clear scientific data regarding its existence and incidence. Herein, we described the clinical characteristics of HA injection-induced bone resorption in chin augmentation in the south of China. METHODS:A total of 8 patients consisting of males and females who received hyaluronic acid injection for chin augmentation and rejuvenation were enrolled in the study. The authors retrospectively compared the CT scans of patients with mentum augmentation using HA. The bone resorption area was measured as the average length, width, and depth. Injection volume, the number of injections, complications and the measurement data of bone resorption were also recorded. RESULTS:From January 2023 to January 2024, 8 patients were recruited. The postoperative CT scan revealed pronounced deep concavities in the incisive fossa, with no evidence of periapical lesions. No patients complained of any instances of infection or hematoma following the injection, and no clinical symptoms were observed. CONCLUSIONS:Bone resorption from the chin after HA filler injection can occur. To draw a clear conclusion, more adapted and well-designed clinical trials are needed to assess the emergence of this phenomenon.

Mandibular distraction osteogenesis (MDO) is recommended for children with craniofacial microsomia (CFM) and obstructive sleep apnea (OSA). However, its efficacy remains limited, with success rates of 36.4–60

OBJECTIVE:To compare the symmetry of bilateral buccal fat pad(BFP) volumes in patients with prominent zygomatic bones before surgery. METHODS:Fifty cosmetic female patients were selected and scanned using computed tomography. Based on the symmetry of the patients' zygomatic bones prior to surgery, they were divided into the Sym group and the Asym group. The buccal extension of buccal fat pads on both sides were delineated and reconstructed layer by layer using the draw function of MIMICS 26.0, and their volumes were calculated. The Volume Asymmetry Index (VAI) was compared between the Sym group and the Asym group using a t-test. For patients in the Asym group, a paired t-test was used to compare the volumes of the buccal fat pads on the larger (L) and the contralateral side (S). RESULTS:The VAI in the Sym group was smaller than that in the Asym group (15.3 % ± 4.8 % vs 21.7 % ± 6.1, p = 0.02). For the Asym group, the volume of the buccal extension of buccal fat pad on the S side was smaller than that on the L side (S) (1.31 ml vs 1.66 ml p = 0.01). CONCLUSION:For patients undergoing zygomatic reduction surgery, the symmetry of the buccal fat pads prior to surgery should be emphasized, and measures should be taken to adjust the volume symmetry of the buccal fat pads in patients with asymmetric prominent zygomatic bones.

Objective:Pre-bent titanium plates are widely used for internal fixation in L-shaped zygomatic reduction. The aim is to evaluate the effect of pre-bent Z-shaped titanium plate on the narrowing of the zygomatic arch in L-shaped reduction malarplasty.Methods:Thirty cosmetic female patients were selected and scanned using computed tomography (CT). The CT images of pre-operation (T1) and post-operation(T2) were re-established through MIMICS26.0 (Materialise). After the 2 images were registered based on the skull base, the narrowing distance (ZRN) at the posterior end of the free zygomatic arch, as well as the preoperative and postoperative cross-sectional dimensions of the zygomatic arch, were measured. The ZRN and the altitude of the pre-bent titanium plate (TA) were compared using an independent t test, and their correlation was also analyzed using the Pearson coefficient. The preoperative and postoperative longest diameter (L1) and shortest diameter (L2) of the posterior zygomatic arch were compared using a paired t test.Results:The TA was 3.80 +/- 0.82 mm and the ZRN was 3.21 +/- 0.82 mm. The difference value was 0.59 +/- 0.41 mm, which was statistically significant. TA showed a strong correlation with ZRN (r=0.916, P=0.002). The L1 and L2 of the zygomatic arch root were slightly reduced postoperatively.Conclusion:The pre-bent Z-shaped titanium plate does not completely correspond to the zygomatic arch narrowing distance in the actual application of L-shaped reduction malarplasty. However, it can control the narrowing distance of the zygomatic arch predictably, and achieve satisfactory surgical outcomes.

Hemifacial microsomia (HFM) is a common congenital malformation of the craniofacial region, including mandibular hypoplasia, microtia, facial palsy and soft tissue deficiencies. However, it remains unclear which specific genes are involved in the pathogenesis of HFM. By identifying differentially expressed genes (DEGs) in deficient facial adipose tissue from HFM patients, we hope to provide a new insight into disease mechanisms from the transcriptome perspective. RNA sequencing (RNA-Seq) was performed with 10 facial adipose tissues from patients of HFM and healthy controls. Differentially expressed genes in HFM were validated by quantitative real-time PCR (qPCR). Functional annotations of the DEGs were analyzed with DESeq2 R package (1.20.0). A total of 1,244 genes were identified as DEGs between HFM patients and matched controls. Bioinformatic analysis predicted that the increased expression of HOXB2 and HAND2 were associated with facial deformity of HFM. Knockdown and overexpression of HOXB2 were achieved with lentiviral vectors. Cell proliferation, migration, and invasion assay was performed with adipose-derived stem cells (ADSC) to confirm the phenotype of HOXB2. We also found that PI3K−Akt signaling pathway and human papillomavirus infection were activated in HFM. In conclusion, we discovered potential genes, pathways and networks in HFM facial adipose tissue, which contributes to a better understanding of the pathogenesis of HFM.

This study aimed to evaluate the effect of mandibular distraction osteogenesis (MDO) on respiratory function in CFM patients with obstructive sleep apnea (OSA) according to polysomnography (PSG). This study retrospectively analyzed patients with CFM who underwent PSG before surgery and after completion of mandible distraction. Patients who met the inclusion criteria were selected. The Pediatric Sleep Questionnaire (PSQ) was used to assess patients' signs and symptoms related to OSA. The obstructive apnea-hypopnea index (OAHI) and lowest oxygen saturation (LSaO2) were imported into SPSS version 26.0. The Wilcoxon signed-rank test was used to assess the differences in PSG before and after MDO. Other data were described using descriptive statistics. A P-value less than 0.05 was considered statistically significant.A total of 25 unilateral CFM patients were included in this study. Most patients (72%) had mild OSA; moderate and severe OSA were 12% and 16%, respectively. Snoring (52%) was the most common symptom among these patients. After completion of mandibular distraction, snoring and other OSA-related symptoms were significantly improved. Twelve patients had normalized PSG and the severity of OSA improved significantly in 3 patients. The total effective rate of MDO for OSA was 60%. The statistical results showed that OAHI (P = 0.045) decreased and LSaO2 (P = 0.009) increased significantly compared to preoperative values.MDO can improve OSA-related symptoms in CFM patients. In addition, respiratory function was improved in most patients after MDO, based on PSG. CFM patients, especially those with OSA, can benefit from MDO.& COPY; 2023 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The aim of this study was to investigate the characteristics of condylar resorption in craniofacial microsomia (CFM) patients following mandibular distraction osteogenesis (MDO). Patients with unilateral type-IIa and type-IIb CFM, who had completed MDO and mandibular distractor extraction (MDE), were recruited. The height and volume of the condyle were measured on three-dimension models created by the analysis of computed tomography (CT) data. Normality analysis was performed using the Shapiro-Wilk test. Data for the affected and unaffected sides were compared using the paired t-test or Wilcoxon signed-rank test. Data for both type-IIa and type-IIb CFM were compared using the independent-samples t-test or Mann-Whitney U test. The Pearson or Spearman correlation was used to determine the correlations of condylar resorption rate with related measurements. In total, 48 type-IIa and 48 type-IIb CFM patients were included. The condylar resorption rate in type-IIa CFM (0.35 ± 0.32) was significantly associated with the height of the condyle (r = 0.776, p < 0.001) and distraction distance (r = 0.447, p = 0.001), while the condylar resorption rate in type-IIb CFM (0.49 ± 0.46) was significantly associated with the height of the condyle (r = 0.924, p < 0.001). However, there was no significant difference in condylar resorption rate between type-IIa and type-IIb CFM (p = 0.075). In addition to occlusal changes, no other negative symptoms of the TMJ were observed with condylar resorption. Condylar resorption was evident in CFM patients following mandibular distraction osteogenesis, and the condylar resorption rate showed a relationship with distraction distance and condylar height.

Objective: This observational retrospective cross-sectional study aimed to investigate the morphological characteristics of the temporomandibular joint (TMJ) in type IIa hemifacial microsomia (HFM). Methods: We recruited 88 patients with unilateral type IIa HFM. Data relating to the length, distance, and angle of the TMJ, were measured on 3-dimensional models created by the analysis of computed tomography data. Normality analysis was performed by using the Shapiro-Wilk test. Data were compared with the paired t test and Wilcoxon signed-rank test. Results: The height, long axis, and short axis of the affected condyle were significantly shorter than the unaffected side (P<0.001); the ratios were 0.41±0.15, 0.75±0.20, and 0.95±0.24, respectively. The spaces between the condyle and the glenoid fossa were significantly larger in affected TMJs (P<0.001). The ratio between the ipsilateral and contralateral anterior space in the sagittal plane was 4.62±2.59; this was significantly different than the ratio of inner space (1.50±1.70), superior space (1.70±0.97), and lateral space (1.28±0.62) in the coronal plane (P<0.001) and the ratio of superior space (1.43±1.05) and posterior space (1.47±0.98) in the sagittal plane (P<0.001); there were no statistical differences between the 5 spaces (P>0.05). The breadth and depth of the glenoid fossa were significantly shorter in affected TMJs (P<0.001), the ratio of the breadth in the affected and unaffected glenoid fossa was between 0.5 and 1 and the depth of the affected glenoid fossa was almost half of that on the unaffected side. The ratio between the ipsilateral and contralateral height of the condyle was significantly different when compared with the length of the mandibular ramus (P<0.001). The ratio between the ipsilateral height of the condyle and the length of the mandibular ramus was significantly different when compared with that of the contralateral side (P<0.001). The height of the affected condyle were significantly different (P=0.005) among different ages. Conclusions: We found that hypoplasia was more severe in terms of the height of the condyle than the long axis and short axis of the condyle. The degree of condyle deformity was more severe than the mandible. And the affected condyle still had growth potential in the vertical direction with age.

The treatment for severe hemifacial microsomia (HFM), especially type III case, is extremely difficult. Mandibular distraction osteogenesis (MDO) was rarely used as the primary choice in the treatment of severe type cases. The authors sought to observe the short-term therapeutic outcomes of patients with severe unilateral HFM who underwent MDO first. A retrospective study of children underwent MDO or later received costochondral graft (CCG) for severe unilateral HFM from 2009 to 2019 was conducted. Cephalometric measurements and clinical variables were analyzed to evaluate the effectiveness of MDO first strategy for severe cases and compare disparity between Pruzansky-Kaban classification type IIb and type III groups. Thirty-six patients (23 males and 13 females) underwent MDO first for severe HFM were included for analysis in the present study. The average age at MDO was 8.33 +/- 2.03 years. At the last follow-up, MDO acquired significant improvement in mandibular height, maxillary cant, chin deviation, lip commissural line tilt, and clinical chin deviation (P < 0.05). Distraction results were stable during the short-term follow-up in terms of the mandibular height ratio and maxillary cant (P > 0.05). MDO is a proper primary method for suitable type IIb and type III HFM cases. MDO can immediately and significantly improve the facial skeleton deficiency, extend the associated soft tissue at the same time, and lay foundation for secondary surgery. MDO can achieve the downgrade of HFM deficiency severity. MDO followed by costochondral graft can get satisfactory esthetic and structural consequence for type III patients.

Objective: Mandibular distraction osteogenesis (MDO) is a powerful tool for the correction of hemifacial microsomia (HFM). The temporomandibular joint (TMJ) is the focus of attention in the diagnosis and treatment of HFM. This observational retrospective cross-sectional study aimed to investigate morphologic changes in TMJ post-MDO in type IIa HFM. Methods: We recruited 48 patients with unilateral type IIa HFM who had completed MDO and mandibular distractor extraction (MDE). Data relating to the length, distance, angle, and volume of the TMJ were measured on 3-dimension models created by the analysis of computed tomography data. Normality analysis was performed by using the Shapiro-Wilk test. Data were compared with the paired t test and Wilcoxon signed-ranks test. Results: The spaces between the affected condyle and the affected glenoid fossa before MDO were all significantly larger than before MDE (P<0.05). The breadth of the affected glenoid fossa before MDO was significantly longer than before MDE (P<0.001). The height of the affected condyle before MDO was significantly longer than before MDE (P<0.001). The volume of the affected condyle before MDO was significantly larger than before MDE (P<0.001). The ratio between the volume of the affected condyle and unaffected condyle before MDO was 0.20±0.13. The ratio between the volume of the affected condyle before MDE and MDO was 0.65±0.32. The resorption rate of the affected condyle post-MDO was 0.35±0.32. Conclusion: Herein, we characterized anatomic changes of the TMJ in type- IIa HFM post-MDO. Condylar resorption and the compression of space between the condyle and the glenoid fossa on the affected side were 2 typical manifestations. Our findings enhanced the understanding of the application of MDO on HFM.

Objective:Analyzing the morphological and functional changes of the temporomandibular joint (TMJ) post L-shaped reduction malarplasty. And evaluating the surgical safety.Methods:The female cosmetic patients who underwent L-shaped reduction malarplasty in the Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from December 2015 to March 2019 were recruited as the study object. Three-dimension models of pre-operation and post-operation were created by the analysis of computed tomography (CT) data via Materialise ProPlan CMF 3.0. Seventeen groups of data relating to the length and angle of the TMJ were measured in the axial plane, coronal plane and sagittal plane. These measurements included condylar anteroposterior diameter in the axial plane and condylar anterior space, superior space and posterior space in the sagittal plane. Data were analyzed via SPSS 22.0 statistical software.Results:Thirty female cosmetic patients who underwent L-shaped reduction malarplasty were included. Patient age ranged from 21 to 36 years and the mean age was (26.19±4.08) years. Fifteen patients were less than 25 years old, and other fifteen patients were more than or at least 25 years old. The condylar anteroposterior diameter post-operation was significantly longer than pre-operation in the axial plane [(9.406±1.241) mm vs.(9.259±1.276) mm], and the difference was (0.146±0.388) mm. The condylar anterior space, superior space and posterior space post-operation were all significantly smaller than pre-operation in the sagittal plane [(1.080±0.537) mm vs.(1.193±0.533) mm/(1.598±0.591) mm vs.(1.907±0.755) mm/(1.239±0.568) mm vs.(1.670±0.926)mm], and the differences were (0.113±0.409) mm, (0.309±0.711) mm, and(0.431±0.786) mm, respectively. Other thirteen measurements showed none significant differences when compared to pre-operation and post-operation ( P>0.05). Conclusions:L-shaped reduction malarplasty could trigger slight morphological changes to the TMJ. However the TMJ could adapt these changes and reach to a new balance due to compensated adaptation. The normal physiological function would not be impacted. Surgery itself could be considered as a safe contour cosmetic surgery.

嗅觉是人最重要的生理功能之一,面部轮廓整形术后出现嗅觉障碍的情况偶有发生,严重影响了患者的生活质量.本文回顾了有关面部轮廓整形术后出现嗅觉障碍的相关研究报道,对其发生的可能原因及处理进行综述.

OBJECTIVE:This thesis addresses a neglected aspect of bioinformatics research of hemifacial microsomia (HFM). Existing research stops short of prediction based on big data. This study combines multiple databases to explore underlying pathogenesis using bioinformatic approach.METHODS:The research consisted of multiple bioinformatic methods, included pathogenic genes analyses, protein-protein interaction network construction, functional enrichment, and mining target genes related miRNA, for studying pathogenic genes of HFM.RESULTS:Total of 140 genes were identified as potential genes in the study. The protein-protein interaction networks for pathogenic genes were constructed, which contained 138 nodes and 243 edges with RAF1, MAP2K1, MAP2K2, MAPK3, MAPK1, EGFR, BRAF, LMNA, ESPR1, and SFN as the hub genes. These genes were discovered significantly enriched in MAPK pathway. Besides, the whole of interactions between miRNAs and the top 5 hub genes were revealed.CONCLUSIONS:Our results indicated that occurrence of HFM is attributed to a variety of genes. Furthermore, the interactions of pathogenic genes were further elucidated by using bioinformatics approach. It reveals the MAPK pathway play an essential role in its pathogenesis. It may provide a novel perspective on better understanding the pathogenesis and more accurate early screening of HFM.

Objective:To investigate the morphological characteristics of skull base in children with hemifacial microsomia (HFM) by three-dimensional reconstruction and measurement of skull base.Methods:Three-dimensional spiral CT data of HFM children with unilateral involvement who had not received any treatment from the First Center of Maxillofacial Plastic Surgery, Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from February 2010 to December 2020 were collected. The patients were divided into four groups according to the Pruzansky-Kaban classification standard: Ⅰ, Ⅱa, Ⅱb and Ⅲ. The three-dimensional reconstruction and measurement of the skull base were performed using Mimics 17.0 software. Linear measurements of the skull base included the distance from tuberculum sellae to optic canal (OT), foramen rotundum (FrT), foramen ovale (FT), internal acoustic meatus (IT), hypoglossal canal (HT), and the distance from anterior clinoid process to the lesser wing of the sphenoid bone (ClS) and the petrous ridge of the temporal bone (ClP). The measurement indexes of skull base angle included anterior cranial angle (ACA), middle cranial angle (MCA), posterior cranial angle (PCA), and petrous ridge angle (PRA). SPSS 26.0 software was used for statistical analysis of the measurement result. Paired t-test was used for comparison within each group, and one-way ANOVA was used for comparison between different types. P<0.05 was statistically significant. Results:A total of 40 children with HFM were collected, with 10 cases in each group. The result of skull base angle measurement showed that the MCA of the healthy side of typeⅠHFM was significantly larger than that of the affected side, and the MCA and PRA of the healthy side of type Ⅲ HFM were larger than those of the affected side ( P<0.05). There was no significant difference in the angle of skull base between the healthy side and the affected side of typeⅡa andⅡb HFM ( P>0.05). In terms of linear distance measurement of skull base, FrT and HT on the healthy side of typeⅠHFM were longer than those on the affected side; FrT, IT, HT and ClP on the healthy side of typeⅡa HFM were significantly longer than those on the affected side; IT, HT and ClP on the healthy side of typeⅡb HFM were longer than those on the affected side; and HT on the healthy side of type Ⅲ HFM was longer than those on the affected side ( P<0.05). The difference between FrT and ClP (affected / healthy) of four types of HFM was statistically significant ( P<0.05). Conclusions:The morphology of HFM is different between the affected side and the healthy side. As for the angle of skull base, MCA was obvious smaller in the affected side than that in the healthy side in the type Ⅰ and type Ⅲ HFM. As for the linear measurement, the distance from the hypoglossal canal to the tuberculum sellae on the affected side is shorter than that on the healthy side in each type HFM, indicating that the growth and development of the cranial base on the affected side is affected in a certain degree.

目的 探讨轮廓美容术后感染的相关因素.方法 回顾性分析2016年11月至2019年11月,中国医学科学院北京协和医学院整形外科医院整形十三科接受轮廓美容533例手术患者,总结分析术后感染发生因素.结果 本组患者术后出现感染13例.其中性别因素,男性占8.7％(4/46)、女性占1.84％(9/487),P<0.05;手术时长<3 h占1.88％(3/159),≥3 h占2.67％(10/374),P>0.05;手术部位因素,单部位手术占1.34％(3/224)、2个部位手术占2.60％(6/231)、3个部位手术占5.13％(4/78),P>0.05.13例确诊感染患者细菌培养结果,铜绿假单胞菌2例(15.38％),金黄色葡萄球菌2例(15.38％),链球菌1例(7.69％),8例未检出;术前预防性使用抗生素种类,头孢西丁钠1.84％(9/489)、克林霉素1.23％(4/32),P<0.05.结论 轮廓美容手术术后感染与患者性别相关,与手术时长、手术部位无关;术前预防性应用头孢西丁效果优于克林霉素;术后10 d内易发生轮廓美容术后感染.

Objective: Alcohol is a recognized teratogen, and alcohol exposure increases the risk for hemifacial microsomia (HFM) of the fetus during maternal pregnancy. The present study aimed to explore potential mechanisms and verify hub genes of HFM associated with alcohol by bioinformatics methods. Methods: First, HFM and alcohol pathogenic genes were obtained. Thereafter, a protein-protein interactional (PPI) network was constructed. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses and molecular complex detection were performed by Metascape. Finally, we used the cytoHubba plugin to screen the hub genes. Results: A total of 43 HFM genes and 50 optimal alcohol candidate genes were selected. The PPI networks for pathogenic genes contained 93 nodes and 503 edges. Functional enrichment analysis largely focused on tissue formation and development. Two modules were identified from the PPI network, and 10 hub genes were screened out. The genes most relevant to alcohol-induced HFM pathogenesis included CTNNB1, TP53, MYC, HDAC1, and SOX2. Conclusions: This study identified some significant hub genes, pathways, and modules of HFM related to alcohol by bioinformatics analyses. Our results suggest that the CTNNB1, TP53, MYC, HDAC1, and SOX B1 gene subfamilies may have played a major role in alcohol-induced HFM.

目的 通过生物信息学方法预测维甲酸影响广义颅面短小畸形(expanded spectrum of craniofacial macrosomia,eCFM)的致病基因.方法 2021年5月,中国医学科学院整形外科医院颅颌面中心基于文献检索到eCFM的致病基因43个,结合比较毒理基因组学数据库(comparative toxicogenomics database,CTD)获得维甲酸作用的靶点基因.通过STRING数据库获取维甲酸靶点基因和致病基因的蛋白互作(protein-protein interaction,PPI)网络.通过子网络排序分析,预测潜在的致病基因.结果 ⑴通过文献检索获得43个eCFM致病基因.⑵CTD数据库中检索获得6027个维甲酸作用靶点基因.⑶构建PPI网络中包括73个节点蛋白和313条互作关系.平均节点度为8.58,聚集系数0.541.分析节点基因本体和通路.⑷筛选出15个维甲酸致畸最关键的基因:TP53、JUN、CTNNB1、MAPK1、CREB1、HIF1A、PPARG、RELA、SMAD3、NFKB1、SMAD4、GATA4、POU5F1、GATA3、PAX6、NKX2-5、PTPN11.结论 对多病因复杂致病机制的广义颅面短小畸形使用生物信息学方法分析具有可行性.后期将重点研究CTNNB1、NKX2-5、PTPN11在维甲酸致病中的关键作用.

Congenital median cleft lip caused by all kinds of reasons is the most basic presentation of facial median cleft. Although a wide array of options is available, the technique employed will largely depend on the surgeon preference and experience, and lack of uniform standards. The basic surgical treatments of midline cleft lip and nose deformities include exposure of abnormal anatomy, repair soft tissue and skin, anatomic approximation of cartilaginous elements, orbicularis oris muscle repair and craniofacial osteotomy. In addition, there still doesn’ t have a common classification system to stratify the wide variations of midline cleft lip and nasal deformity, which is important to formulate specific surgical method for different types. This article summarized various classifications, recommended to use the Kolker' s classification by which the treatment options were summarized and proposed research prospects to provide ideas for further study.

目的 探讨半侧颜面短小畸形(hemifacialmicrosomia,HFM)患者双侧咬肌方向及机械效益的差异.方法 自2010—2019年,中国医学科学院北京协和医学院整形外科医院颌面整形中心收集23例未经治疗且单侧受累患者的CT数据,输入MIMICs 17.0软件进行三维重建,测量咬肌在矢状面和冠状面的方向角α和β,并计算其机械效益,采用配对t检验比较患侧与健侧的差异.结果 HFM PruzanskyⅡb型患者患侧咬肌倾斜角α小于健侧(P<0.05),HFMⅠ型和Ⅱa型患者患侧咬肌机械效益小于健侧(P<0.01).结论 HFMⅡb患者患侧咬肌在矢状面上相对健侧更加前倾,HFM双侧咬肌机械效益的差异可能与咬(牙合)力的不对称有关.