Acquired Facial Deformities
Acquired Facial Deformities
An acquired facial deformity is a disfigurement becoming apparent during the course of the patient’s life. These patients have a normal appearance until a sudden event, or a gradually developing medical condition, alters facial esthetics. Emotional distress combined with social anxiety and low self-esteem are frequently encountered. Quite often, the patients are experiencing functional problems as well, which will be an additional cause for the decrease of their overall quality of life.
We can identify three major categories according to the etiology of acquired deformities.
Acquired facial deformities due to trauma.
Motor vehicle accidents, interpersonal violence, self-inflicting wounds, sports injuries, burns, falls, work-related accidents, animal attacks, gunshots and blasts, are some of the causes related to facial trauma. Depending on the severity of the injury, the patient may be treated without any visible “reminder” of the event, or a variable degree of a residual facial deformity may be evident. Many times, a serious facial injury will be complicated by functional impairment as well. Traumatic deformities occur unexpectedly, so it is very hard for the patients to accept the sudden loss of their esthetic and functional integrity.
Acquired facial deformities due to surgery.
Malignant or even some benign diseases may require extensive surgical procedures resulting in loss of facial structures. Facial harmony and balance sometimes may be sacrificed, in an attempt to cure an aggressive tumor. Residual functional problems may also be present. Although the esthetic and functional problems related to these conditions have been discussed with the patient preoperatively, the psychological sequelae are considerable and may be more perplexed when a patient is dealing with a malignant disease.
Acquired facial deformities due to various diseases.
In some situations, an acquired facial deformity may develop gradually due to conditions that may affect facial appearance. Examples of these diseases include idiopathic resorption and rheumatoid arthritis of the mandibular condyles, unilateral condylar hyperplasia, facial hemiatrophy, Duchenne’s muscular atrophy, acromegaly, etc.
Modern facial reconstructive surgery offers a lot to the treatment of these conditions. Recent advances in medical technology combined with the application of specialized surgical techniques, aim towards the correction or improvement of the acquired esthetic and functional abnormalities. Depending on the severity of the condition, the type of tissues lost, the degree of functional impairment and the overall health status of the patient we can utilize the following surgical techniques accordingly for the treatment of acquired facial deformities:
Use of stereolithographic facial models and polyethylene custom made grafts.
When facial fractures heal in a displaced position, usually a deficit in tissue projection is noted. The same problem occurs when parts of the facial structures (e.g., frontal bone, temporalis muscle) are missing. We will obtain a computed tomogram of the patient’s head, which will be sent to a specialized laboratory for the fabrication of a precise acrylic skull model. We will then study the deficit on this model and sculpt a mold of a custom-made polyethylene graft, to augment the projection of the specific area. As the shape and size of the graft are estimated according to the model, it will perfectly fit the anatomical area of interest during the operation, providing an excellent aesthetic result.
Free vascularized tissue transfers
The facial reconstructive surgeons of our clinic are trained in microsurgery. In cases of soft tissue loss, bone loss, or both, they can obtain a graft from other parts of the body along with a feeding artery and two draining veins. The graft is transferred to the area of the deficit and sutured to the tissue bed, while the artery and veins are connected to local vessels with the use of a surgical microscope. By establishing its connection to the systemic circulation, the graft will be perfused immediately, so its vitality is ensured. This technique is utilized for a large amount of tissue loss, or when it is evaluated as a preferred option compared to other reconstructive procedures.
Orthognathic surgery includes a variety of surgical procedures aiming to restore facial imbalances by moving the upper jaw, the lower jaw and the chin into positions where facial esthetic appearance is improved.
In cases of bone loss, surgeons can obtain bone grafts from the pelvis, the tibia, the calvarium, the ribs, to restore bone volume and correct a bony deformity.
Local, regional and distant flaps
In cases of soft tissue defects, surgeons can utilize local or distant flaps to correct or improve residual esthetic abnormalities. A part of the soft tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. These flaps are connected to the donor area and placed on the recipient area without being cut from their original anatomical position.
When the skin is damaged, missing, or diseased, a free skin piece can be transferred to cover the skin defect. Many donor sites can provide free skin grafts. The choice is depended on the necessary amount and the matching of skin type between the donor and recipient site.
Implant-supported facial prostheses
This technique is utilized as a valuable alternative for reconstruction or a missing auricle, eye, or nose. Titanium implants are placed in the adjacent bone at the area of the defect. A silicon prosthesis is fabricated by an anaplastologist, matching exactly the size and shape of the missing organ. The prosthesis, when in place, is stabilized on the titanium implants.
Total temporomandibular joint replacement
In cases of idiopathic resorption or any other pathology of the mandibular condyle that may cause an alteration of facial esthetics and function, we utilize custom-made titanium/polyethylene artificial joints to replace the diseased joint. The prostheses are designed to replicate the movement of a normal, healthy joint. We utilize a stereolithographic skull model to fabricate these joints precisely, according to the patient's anatomy.
Laser technology can be applied in cases of hypertrophic surgical scars as well as in other conditions that the texture of the skin needs to be improved. This treatment modality is a useful adjunct to the overall effort for esthetic improvement of our patients.