Biomedical Engineering Reference
In-Depth Information
23
Facial Remodelling and Biomaterial
G. Fini, L.M. Moricca, A. Leonardi, S. Buonaccorsi and V. Pellacchia
La Sapienza/ Roma
Italy
1. Introduction
Facial remodelling comprises all the surgical techniques able to reconstruct the correct
proportion between soft and hard tissues of the face. In order to obtain facial harmony
maxillo-facial surgeons have at disposal many surgical techniques such as reconstructive,
orthognatic, aesthetic surgery and camouflage. In the study of a patient who presents facial
asymmetry two base evaluations are necessary: aesthetic analysis and cephalometric
analysis. The first is an evaluation of the skeleton in association to the evaluation of the soft
tissues according to the harmonic proportions of the face, while the second consists in the
evaluation of the skeletal relationships with respect to the basicranium through the
identification of specific craniometrical points. It is possible to establish a specific
therapeutic plan for the specific facial
asymmetry by means of the combination of these analyses and the addition of the
radiographies study . There are various pathologies that need facial remodelling: acquired
syndromes, congenital syndrome such as the Hemifacial Microsomiae, autoimmune
disorder or atrophic disease such as Perry-Romberg Syndrome, traumas, demolitive surgery
and infectious pathologies. In these clinical conditions the choice of a therapeutic treatment
of camouflage instead of corollary surgery and conventional aesthetics techniques is made
when there is a specific request from patients. This decision is also made when there is an
increased operative risk and the deficits to fill are not massive. The described surgical
treatments present the advantage of being not invasive, easy to position, not much traumatic
and with immediate results. The complications can be the following: shifting of the
biomaterial , chronic inflammation, quick reabsorption of the used materials, infections and
reject. The camoufflage is growing as a surgical technique for the continuos scientific
studies, on the new bio-materials. The studied filling bio material are the porous
polyethylene and the bio-bone for the hard tissues, the Polyalkylimide and Polyacrylamide
for the soft tissues. Some representative clinical cases are presented.
During our experience, patients have been treated with the following bio materials: porous
polyethylene, bio-bone, polialkylimide, polyacrylamide, and with a combined treatment
with polyacrylamide and porous polyethylene. The patients treated with porous
polyethylene presented pathologies deriving 50% from traumas, 40% from malformation
and a 10% from congenital asymmetries. The patients treated with bio-bone (7% of the total
patients) of the total were presented in all cases the bony atrophy of the jaw.
Patients suffering from infectious pathologies (HIV) were included among the patients
treated with polialkylimide, others with autoimmune pathologies (PRS) and with
malformative syndromes were included too. The treatment with polyacrylamide was
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