Background Complications from osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) include oro-cutaneous fistulas, necrotic bone exposure, soft-tissue defects, and pathologic fractures. The fibula free flap (FFF) is a common free flap method used to reconstruct the mandible in severe cases. Recently, we have used the FFF successfully for the reconstruction of ORN and MRONJ mandibular defects. We report this method as a recommended technique for the treatment of ORN and MRONJ and the management method of postoperative infections. Methods Four patients who were diagnosed with ORN of the mandible and 3 patients who were diagnosed with MRONJ of the mandible were included in the study. Among the 7 patients, 3 patients also had pathologic fractures. Partial mandibulectomy and FFF reconstruction were performed at the Department of Oral and Maxillofacial Surgery, Samsung Medical Center from April 2019 to March 2021. Results All 7 patients recovered following the reconstruction of the defect by FFF. Four patients experienced infections after surgery and pus cultures were performed. All were well healed without flap damage after changing the antibiotics by consultation with infectious medicine experts. Conclusion FFF is a widely used method and can provide an extensive flap to reconstruct the mandible, especially those affected by ORN or MRONJ. If an infection occurs after surgery, appropriate antibiotic changes should be made through cooperation with the infectious medicine department. Therefore, FFF is a well-established and recommended method even in cases of challenging reconstruction.
Since genioplasty was first described by Hofer in 1942, various genioplasty techniques have been developed and modified. However, the literature on sagittal reduction genioplasty is scarce. Most of these are modifications of the traditional two methods-grinding and sliding setback, with potential complications. The purpose of this article is to introduce a novel technique (bow-tie genioplasty) to achieve favorable sagittal reduction of the chin without potential complications from the traditional methods. Bow-tie genioplasty is a technique that uses bilateral wedge-shaped osteotomy on the chin. This osteotomy was designed to rotate the distal segment posteriorly, as shown in the diagrams. We present an example of a patient with a protruding chin treated with bow-tie genioplasty. There were no significant adverse effects or complications that could be triggered by the traditional setback methods, and the surgeon and patients were satisfied with the esthetic results. Bow-tie genioplasty is the most innovative technique for sagittal reduction of the chin. This novel technique may optimize the chin setback effect while minimizing the complications associated with the traditional method.
Background: Filler injections are commonly used to soften deep nasolabial folds (NLF) by restoring volume in the depressed parts of fold. Recently, a combination technique using hyaluronic acid filler and polydioxanone (PDO) thread significantly improves deep NLF and induced changes in smile.Objective: This study retrospectively confirmed the effects of this combination therapy, focusing on smile changes. Methods: The NLF was divided into 3 parts: the lateral folded part (LFP), medial depressed part (MDP), and central creased part (CCP). Between November and December 2021, 14 patients underwent the combination treatment; of these, 11 were enrolled, excluding 3 who were not properly followed up. On average, 5.82±0.87 (right) and 5.73±0.47 (left) PDO mesh threads (6.0 cm length) were sequentially inserted into the LFP, MDP, and under the CCP of each NLF. Following this, an average of 1.82±0.71 ml (right) and 1.92±0.75 ml (left) of the filler was also sequentially injected into each NLF in a similar manner. They were mainly placed in the superficial and deep fat layers in the entire NLF and sub-malar areas. Smile index was measured during the fully expanded smile stage. The follow-up period was 3 months. The results were estimated using pre-and post-operative photographs.Results: Three months after the combination treatment, patients were pleased with the softening of their NLF. As indicated by the increased smile index (inter-commissural width/inter-labial gap), the old and expanded smile changed to younger and less expanded smile. The original smile type (eight and three patients with the commissure and cuspid types, respectively) remained unchanged. The contour changes in each smile varied according to the smile type. This could be explained by combination treatment's NLF correction, which restricts facial expression muscle movement. Conclusion:These results demonstrate definite evidence of softening of the NLF, a youthful smile, and an increased smile index.
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