Periosteal incisions for mentoplasty.
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Following craniofacial procedures that involve stripping of the periosteum and soft tissue over the zygomatic maxillary complex, descent of soft tissue with a decrease in anterior projection over the malar area and increase in fullness in the nasolabial fold have been seen to be a problem by these authors. Simple repositioning of the soft tissues to their normal anatomic position may be used to alleviate this problem.
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BACKGROUND: Brow elevation is one of the goals of surgical rejuvenation procedures. In this article, the authors evaluate the results of a frontotemporal suspension-fixation technique by means of temporoparietalis fascia/galeal/periosteal flap imbrication through an open or endoscopically assisted approach. METHODS: A total of 32 female patients aged between 44 and 72 years were operated on under local anesthesia and sedation. In 23 cases, the frontotemporal lift was associated with a cervicofacial lift through separate incisions and in 19 with an upper/lower blepharoplasty performed at the same time or subsequently. The open approach was used in 26 cases and a combined approach with endoscopic assistance and reduced temporal incisions was used in six cases. Preoperative and postoperative measurements were taken between the lower hairline of the eyebrow and the medial and lateral canthal angles. RESULTS: Lateral brow elevation ranged from 3 to 7 mm, with an average of 5 mm. A lasting result was observed during the follow-up period, with partial relapse in five cases. Complications consisted of two transient frontal paresthesias, remarkable periorbital bruising in four cases, and a transient decrease in temporal hair density in six cases (6 to 8 months). No permanent alopecia was observed. CONCLUSIONS: Brow elevation is an essential feature for a pleasing aesthetic result in the periorbital region. The best results are those achieved in association with blepharoplasty. This technique produces stable results, and the incidence of sequelae and complications is acceptable.
Homologous recombination in embryonic stem cells was used to prepare transgenic mice with an inactivated Col2a1 gene for collagen II, the major protein component of the extracellular matrix of cartilage. Heterozygous mice had a minimal phenotype. Homozygous mice developed into fetuses that were delivered vaginally but died either just before or shortly after birth. The cartilage in the mice consisted of highly disorganized chondrocytes with a complete lack of extracellular fibrils discernible by electron microscopy. There was no endochondrial bone or epiphyseal growth plate in long bones. However, many skeletal structures such as the cranium and ribs were normally developed and mineralized. The results demonstrate that a well-organized cartilage matrix is required as a primary tissue for development of some components of the vertebrate skeleton, but it is not essential for others.
Lipopolysaccharide (LPS) was extracted from Porphyromonas gingivalis (W83) by the Westphal procedure, nuclease-digested and ultracentrifuged. Fibroblasts were obtained from human gingival tissue and rat periosteum, grown to confluence then stimulated in serum-free medium with 0.1, 1.0 and 10.0 micrograms/ml LPS. The levels of prostaglandin E2 (PGE2) and interleukin-1 beta (IL-1 beta) released were measured after 2, 4 and 6 d by specific radioimmunoassays. Unstimulated gingival fibroblasts produced low levels of PGE2 (24.5 +/- 1.5 (SD) ng/ml) and IL-1 beta (0.34 +/- 0.29 ng/ml). LPS stimulated statistically significant dose-related increases in PGE2 and IL-1 beta at the concentrations of LPS tested. At 10.0 micrograms/ml, LPS-stimulated fibroblasts produced 363.5 +/- 40.3 ng/ml PGE2 and 1.81 +/- 0.1 ng/ml IL-1 beta in 6 d. These results demonstrate that LPS from P. gingivalis is capable of stimulating PGE2 and IL-1 beta release from fibroblasts. This would appear to be an additional mechanism by which LPS can induce tissue breakdown in periodontal disease.
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A 24-year-old Chinese woman who has undergone staged surgery for craniofacial deformity secondary to beta-thalassemia major is presented. Local clusters of Gaucher-like cells were found in the periosteum of the mandible. The histologic and ultrastructural features of these cells are described and the pathogenesis and differential diagnoses discussed. To the best of our knowledge, this is the first reported case of Gaucher-like cells occurring outside the lymphohematopoietic system in thalassemic patients.
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