Cheek

The histological changes following removal of 2 cm discs of buccal mucosa by CO2 laser and conventional surgery were studied over a period of 42 days. The laser wound differed from the conventional wound: there was minimal damage to the adjacent tissue; initially a coagulum of denatured protein formed on the surface; the inflammatory reaction was less; fewer myofibroblasts were present and there was little wound contraction; less collagen was formed and epithelial regeneration was delayed and more irregular.

Background: Poly-L-lactic acid gained U.S. Food and Drug Administration approval for use in human immunodeficiency virus-related facial lipoatrophy in August of 2004. Since that time, it has become available for use in the United States for human immunodeficiency virus facial lipoatrophy patients and for off-label uses in other areas for soft-tissue contouring. This article is intended to enumerate reconstitution, injection techniques, management, and avoidance of complications. Methods: The authors have pooled their experiences to arrive at a consensus opinion for recommendations on treatment protocols for injectable poly-L-lactic acid use. Results: This article prescribes techniques to achieve safer, consistent results while minimizing risks of complications with injectable poly-L-lactic acid. Although the product has been used widely in Europe since 1999, physicians in the United States have only recently begun to explore the uses of Sculptra as a volumizing agent in the face and the body. U.S. physicians have benefited from the European experience with this product, including early problems secondary to overaggressive use, low-volume reconstitution, higher volume injection of product at one session, and inadequate time between injection sessions. Conclusions: The authors therefore have opted for a more conservative approach in their treatment recommendations. Higher volume dilution (8 to 12 cc), fewer vials used at each session, injections placed in the subcutaneous plane without any product being placed in the dermis, adequate time between injection sessions (at least 6 weeks), and postinjection patient massage should decrease the risks and avoid the potential complications associated with poly-L-lactic acid soft-tissue augmentation.

Betel quid (BQ) chewing is strongly associated with the occurrence of oral leukoplakia, oral submucous fibrosis, and oral cancer. There are about 200-600 million BQ chewers in the world. Previous animal studies support the potential carcinogenicity of BQ in different test systems. However, little animal experiment has let hamsters or rats to chew BQ directly, similar to that in humans. In the present study, we established a hamster model of chewing BQ or areca nut (AN). A total of 81 2-week-old hamsters were randomly divided into three groups: 25 for control group, 28 for BQ-chewing group, and 28 for AN-chewing group. These animals were fed with powdered diet with/without BQ or AN for 18 months. Although the consumption of BQ or AN showed some variations, hamsters fed with powdered diet could chew and grind AN or BQ into small pieces of coarse fibers during the entire experimental period. The survival rate of AN-chewing hamsters decreased significantly after 6 months of exposure. The mean survival time was 15.6 ± 0.9 months for control animals, 13.6 ± 0.98 months for AN-chewing animals, and 15.7 ± 0.55 months for BQ-chewing animals. The body weight of BQ-or AN-chewing animals also decreased after 4-13 months. Hamsters fed with AN for 18 months showed hyperkeratosis in 80% and acanthosis in 50% of cheek pouches. Animals fed with BQ for 18 months also showed hyperkeratosis in 93% and acanthosis in 14% of cheek pouches. These results indicate that AN and BQ components may induce alterations in proliferation and differentiation

Few studies have focused on the impact of malocclusion on lip - tooth relationships during smiling and speech. To evaluate the impact of different malocclusions on lip - tooth relationships during smiling and speech, using video images. One hundred and three subjects with Class I (N = 31), Class II division 1 (N = 26), Class II division 2 (N = 16) and Class III malocclusions (N = 30) were asked to repeat the same sentence and then smile in front of a video camera. Nine frames were extracted from each subject's video clip: at rest, posed smile, unposed smile and during the pronunciation of the sounds: 'che', 'fa', 'se', 'chee', 'tee' and 'mee'. On each frame, up to 10 parameters describing the lip - tooth relationships were measured. In all frames, there were no statistically significant differences in the upper central incisor display ratios among the malocclusion groups (p > 0.05). The buccal corridor ratio in the posed and unp...

Candida-associated denture stomatitis was demonstrated by its cultivation m 171 out of 240 patients examined with partial or total dentures, After taking smears from lesions of the oral mucosa (tongue, cheeks, palate) and the coatig~ous demure surface by cotton wool swabs and inoculating them onto Sabouraud glucose agar and CHROMagar Candtda, individual yeast species were identified by a germ tube. filamentous, and assimilation tests employing the coin-mercial kit AuxaColor. Seven Candtda species were identified

Background Malar mounds may be accentuated by chronic lid edema, with the development from malar edema to malar mounds and finally to malar festoons. Because standard techniques do not seem effective and not specifically proposed for the treatment of malar festoons, subperiosteal vertical upper-midface lift associated with lower blepharoplasty overcomes these shortcomings. Methods Twelve patients (3 males and 9 females, age = 47 ± 6 years) underwent video-assisted endoscopic subperiosteal vertical upper-midface lift (SUM-lift) in conjunction with a lower blepharoplasty between 2006 and 2007 for treatment of malar festoons. This includes simultaneous lower blepharoplasties and video-assisted transtemporal subperiosteal and sub-SMAS tissue release. Results All patients healed uneventfully without any major postoperative problems. The surgical outcome was evaluated according to the analysis of photographs obtained before and after surgery and the analysis of preand postoperative measurements. The technique we used (SUM-lift) achieved a significant rejuvenation of the midface and the malar festoons. Conclusion Subperiosteal vertical midface lift resuspends and redrapes the facial network that originates at the level of the orbital rim. It seems to improve the permeability characteristics of the malar septum in the treatment of malar festoons and malar mounds by freeing the cheek tissue from underlying bone and redraping the malar septum. It is a reliable technique to improve malar mounds, palpebral bags, or festoons.

Background A conventional superficial musculoaponeurotic system (SMAS) face-lift is well established because it allows the skin envelope to be rotated in a bit more lateral direction than the cephalad redirection of the SMAS flap. This ensures an individualization of the treatment plan according to the needs of the patient and avoids a postoperative stretched look. However, this technique has some limitations with respect to its long-term effects on the sagging tissue, inadequate lifting of the malar fat pad, and flattening of the nasolabial fold. Methods The procedure described by the authors consisted of a modified approach to conventional SMAS flap dissection for 327 patients with facial aging signs undergoing a face-lift. A pointing tongue-shaped flap of zygomaticotemporal fascia was dissected and preserved in the posterior half of the upper edge of the SMAS flap and anchored to the deep temporal fascia, enhancing the vertical support of the facial soft tissues. Outcomes were determined by case notes, clinical review, and a questionnaire. Results The study investigated 327 consecutive modified SMAS face-lifting procedures. Few complications were observed. Only two patients experienced small hematomas needing evacuation. Some patients reported bearable pain in the temporal region and tension during mouth opening. Temporary weakness in the branches of the facial nerve experienced by two patients resolved completely within some months. Two patients presented with dehiscence of the scar, and one patient experienced punctual retroauricular skin necrosis, which healed uneventfully with conservative treatment. Two patients reported that the knot in the temporal region was palpable through the skin. One patient experienced retroauricular infection. Only two patients required additional procedures. One mild hypertrophic scar responding to steroid injection over the mastoid area was observed in the entire series. With the reported technique, the authors achieved pleasing, natural, durable results with minimal morbidity and an overall complication rate of 3.9%. All the patients were sent a satisfaction questionnaire or contacted for a telephone interview. A total of 235 patients replied. The patients reported high levels of satisfaction after treatment. Conclusions The authors believe that the rhytidectomy technique described in this report has several beneficial attributes. High vertical elevation of the SMAS flap delivers a long-lasting benefit and addresses the problem of neck laxity and platysma redundancy, leading to a correction of the neck contouring and jowls. Nasolabial folds appear to be smoothed, and malar flattening is restored by imbrications of the SMAS flap over the cut edge in the malar prominence. This investigation demonstrates that the rhytidectomy technique is safe and produces highly predictable results.

The buccal fat pad is a trigone-shaped adipose tissue located in the cheek that assumes numerous functional and aesthetic clinical uses. It has been studied extensively within the past four decades, and its use in repairing common and debilitating oral defects is the motive for continued research on this topic. It is vital to understand the etiology of any oral defect or of a lesion of the buccal fat pad, for a misdiagnosis can prevent eVective treatment of the underlying problem. In this review, we describe the embryology and anatomy of the buccal fat and its association with clinical condition and clinical procedures.

Cancer of the buccal mucosa is an uncommon and aggressive neoplasm of the oral cavity. Less than 2% of patients treated for cancer of the oral cavity at Roswell Park Cancer Institute (RPCI) from 1971 to 1997 had primary buccal cancers. Because the majority of these patients did not undergo any adjuvant treatment, this group provided us with the opportunity to assess the relationship between margin status and local recurrence for both small (T1-T2) and large (T3-T4) tumors treated with surgery alone.

A 24-month-old female with severe physical and mental retardation is described. Peripheral lymphocytes demonstrated tetraploid/diploid mosaicism. That this does not represent an artifact in vitro was supported by the finding of buccal mucosal cells with two Barr bodies and tetraploid/diploid mosaicism in fibroblasts and bone marrow cells.

An interesting lesion is presented, wherein a tiny traumatic perforation of the buccal mucosa and buccinator muscle forced a large portion of the buccal fat pad to extrude into the oral cavity. Such a situation can alarm any clinician & reinforces the importance of careful history taking and thorough examination, before treating patients.

The aim of the current study was the development of theophylline buccal adhesive tablets using direct compression. Buccal adhesive formulations were developed using a water soluble resin with various combinations of mucoadhesive polymers. The prepared theophylline tablets were evaluated for tensile strength, swelling capacity and ex vivo mucoadhesion performance. Ex vivo mucoadhesion was assessed using porcine gingival tissue and the peak detachment forces were found to be suitable for a buccal adhesive tablet with a maximum of 1.5 N approximately. The effect of formulation composition on the release pattern was also investigated. Most formulations showed theophylline controlled release profiles depended on the grade and polymer ratio. The release mechanisms were found to fit Peppas' kinetic model over a period of 5 h. In general the majority of the developed formulations presented suitable adhesion and controlled drug release.

Background: The malar region has been a crucial target in many facial rejuvenation techniques because the beauty and youthful contour of a convex midface and a smooth eye-lidÀcheek sulcus are key features of a pleasing face-lift result. The full midface subperiosteal lift has helped to address these issues. However, the desire of patients currently for a rapid recovery and return to work with a natural-looking result has influenced procedural selection. Another concern is for safer procedures with reduced potential risk. Progressively fewer invasive techniques, such as the minimal access cranial suspension (MACS) lift, have been a response to these core concerns. Methods: After 3 years of performing the conventional three purse-string suture MACS lift, the author developed a practical procedural modification. For a total of 17 patients, the author combined limited regional subperiosteal lift and periosteal fixation with a simple sling approach to the more fully released malar tissue mass to make a singlepoint suspension just above the lateral orbital rim. Results: The percutaneous sling lift appears to offer a degree and naturalness of rejuvenation of the malar region similar to those of the MACS lift and the full subperiosteal midface lift, but with fewer suspension points and less undermining. Also, the author observed less ecchymosis and edema than with the full midface subperiosteal lift, as would be expected. In all 17 cases, the need for the second and third purse-string sutures was eliminated. Conclusions: The early results for the percutaneous sling lift indicate that it offers promising results, rapid recovery, and reduced risk of serious complications.

Oral and peri-oral structures can be traumatized by self-injurious behavior (SIB). Various articles have described prostheses used to prevent SIB-related injuries to the oral tissues of patients who have developmental or medical problems, such as psychological problems, congenital syndromes or mental retardation; however, reports of oral SIB in individuals unaffected by the above conditions are scarce. This case report describes the use of a removable prosthesis to prevent a stress-induced cheek biting habit in 15-year-old girl who did not have any of the commonly related conditions. The report discusses the importance of designing a prosthesis that protects tissues, while considering injury severity and the patient's health as well as her ability to cooperate with treatment.

The authors report the case of a 62-year-old man referred to the department of oral and maxillofacial surgery because of a clinical suspicion of palate carcinoma. Incidentally, diagnostic radiology showed a metallic foreign body in the left maxillary sinus. Anamnestic data revealed that a shot from an air gun accidentally hit the patient's left cheek in 1957. The lead-containing air gun pellet was removed by endoscopic antrostomy and the diagnosis of squamous cell carcinoma was confirmed by histopathological examination. 50 years after the pellet's impact, toxicological blood analysis showed no increased blood lead level. It remains unclear whether the air gun pellet has a potential toxicological effect or is related to the development of the patient's oral carcinoma. In this context the article reviews the literature and discusses the necessity of removing metal-containing foreign bodies, the role of lead in chronic toxicity and its possible carcinogenic effect in humans.

Lipodystrophies are a set of heterogeneous conditions resulting from defective lipid metabolism and characterized by adipose tissue atrophy. We report on a 54-year-old woman who presented at the Department of Oral and Maxillofacial Surgery with an increasing unilateral atrophy of her left cheek for the past 3 years. The patient's history showed that she had sustained a left zygoma fracture 35 years ago but did not have any other disease. According to the patient's wish, a correction of the left cheek was performed by autologous fat injection, which led to a highly acceptable postoperative result. We compare this treatment with different alternatives.

Background. Full thickness defects of the cheek have been conventionally reconstructed using the folded forehead flap, cervical flap, pectoralis major myocutaneous flap, or deltopectoral flap in various combinations. We report a modified technique of folding the radial forearm flap for reconstruction of full-thickness defects of the cheek.Methods. The free radial forearm flap is a type C fasciocutaneous flap based on the radial artery along with its vena commitans and superficial forearm vein. The size and shape of the flap are determined according to the dimensions of the surgical defect. The flap is then lifted off with the fascia of the forearm making it a fasciocutaneous flap, in which the radial artery lies deep to the fascia and gives numerous branches. The flap is disconnected from the donor site only after the recipient vessels have been prepared for anastomosis. Vascular anastomosis is then performed using the operating microscope. This technique was used in 13 patients with carcinoma of the buccal mucosa who underwent full-thickness excision of the cheek.Results. Flap edema was observed in 4 patients in the immediate post-operative period. Necrosis of the outer paddle was seen in 1 patient. Donor site morbidity was seen in 4 patients who required dressings on an outpatient basis for up to 3 weeks.Conclusion. Single-stage reconstruction of full-thickness defects of the cheek with the folded free radial forearm flap is reliable and produces excellent cosmesis with minimal donor site morbidity. © 1995 Jons Wiley & Sons, Inc.

A 30-year-old man was referred to the Dental Department because of a hard, tender swelling of the left cheek. The patient reported that the swelling had gradually increased in size over a period of 2 months but denied any neurosensory deficit associated with the left inferior alveolar nerve. His past medical history and his general physical examination were unremarkable: in particular, the patient did not present any skin lesions suggestive of basal cell nevus syndrome. Laboratory data on admission were within the normal limits. Head and neck examination showed left facial swelling along with an expanded and indurate mandibular left buccal vestibule. There was a small discharge of purulent fluid from an opening in the oral mucosa just behind the mandibular left second molar. The teeth on the left side of the mandible presented some carious lesions and the second left molar was necrotic with grade II mobility.

Purpose: The aim of this study was to clinically evaluate the application of pedicled buccal fat pad (BFP) in the surgical management of stage III and IV oral submucous fibrosis (OSMF). Materials and Methods: Twenty-eight cases of clinically and histologically diagnosed cases of OSMF were divided into 2 groups: group I (n ϭ 15) and group II (n ϭ 13), corresponding to clinical stage III and stage IV, respectively. All the patients underwent incision of fibrotic bands and coverage of the buccal defect with a pedicled BFP flap. Both groups were analyzed separately for mouth opening (interincisal distance in millimeters) preoperatively and 1 year postoperatively, time taken for epithelialization of BFP, time taken for establishment of normal contour, and changes in symptoms (painful ulcerations, burning sensation, and intolerance to spices) 1 year after grafting. Results: The mean preoperative mouth opening was 19.6 mm (SD, 2.43) in group I and 12.92 mm (SD, 1.21) in group II. The mean postoperative mouth opening after 1 year was 35 mm in group I (SD, 1.96) and 31.76 mm in group II (SD, 1.97). The time taken for epithelialization of BFP was 4 weeks in group I and 5 weeks in group II. The mean time taken for establishment of normal contour after grafting was 12.25 weeks (SD, 1.42) in group I and 15.07 weeks (SD, 1.26) in group II. In 2 cases in group II, there was remission of painful ulcerations, burning sensation, and intolerance to spices. Conclusion: BFP is reliable for the treatment of OSMF.

Laxity of cheek and neck skin is a common cosmetic complaint of patients as they age. Improvement of skin laxity can be difficult to achieve without invasive surgical lifting procedures. The object of this study was to evaluate the safety and efficacy of a novel nonablative radiofrequency device in the treatment of cheek and neck laxity. Fifty patients (skin phototypes I to IV) with mild-to-moderate cheek laxity (n=30) or neck laxity (n=20) received one treatment with a radiofrequency device (ThermaCool; Thermage Corp., Hayward, CA). Topical anesthetic cream was applied under occlusion for 60 minutes before treatment of the skin extending laterally and inferiorly from the nasolabial folds to the preauricular regions and mandibular ridge for treatment of the cheeks and from the mandible to mid neck for treatment of the neck. Clinical improvement of treatment areas was independently determined by three masked assessors' evaluations of comparative photographs at baseline, immediately after treatment, at 1 week, and at 1, 3, and 6 months after treatment using a quartile grading scale (0=less than 25%, 1=25% to 50%, 2=51% to 75%, 3=more than 75% improvement). Patient satisfaction surveys were also obtained at each follow-up visit. Significant improvement in cheek and neck skin laxity was observed in the majority of patients. Patient satisfaction scores paralleled the clinical improvements observed. Side effects were mild and limited to transient erythema, edema, and rare dysesthesia. No scarring or pigmentary alteration was seen. Noninvasive radiofrequency bulk dermal heating of skin can achieve safe and effective tissue tightening of the cheeks and neck. Although tightening continued to be evident 6 months after a single treatment, the longevity of clinical results has yet to be determined.

Objectives. The purpose of this study was to evaluate the volumetric changes of the maxillary sinus graft in conjunction with buccal fat pad (BFP) covering the lateral sinus wall. Study design. In this article, the radiographic results are presented on 11 consecutively treated patients using an equal mixture of the autogenous bone harvested from the tuberosity and natural bone mineral (Bio-Oss) used to augment the maxillary sinus. Buccal fat pad was used over the lateral sinus wall in all cases as a membrane to cover the augmentation material. The mean initial bone height (IBH) was 3.82 mm as measured in the posterior maxilla. Three months after sinus elevation, radiographic evaluation was performed for the patients and secondary bone height was measured (SBH 1 ). Fifty-two implants were placed in augmented sinuses. Prosthetic rehabilitation of the patients was done 4 months after inserting the implants. Radiographs were taken 6 months after implant placement and secondary bone height was measured (SBH 2 ). Results. Of 52 implants, 51 (98%) were considered clinically successful. One implant was removed because of mobility at the time of surgical exposure. Clinically, no complications were observed, and all implants were considered clinically osseointegrated after 6 months. Mean bone height was measured as 3.82 mm before sinus grafting. SBH 1 and SBH 2 were measured as 12.22 mm and 10.5 mm respectively. Conclusion. The clinical findings suggested that BFP might be a substitute for bioresorbable collagen membranes in maxillary and sinus floor bone grafts.

Purpose: An attractive, well-balanced smile is a paramount treatment objective of modern orthodontic therapy. The purpose of this study was to determine the effects of buccal corridor spaces (BCS) and arch form on smile esthetics as perceived by laypeople, general dentists, and orthodontists. Material: Photographs of 20 women treated by 2 orthodontists were collected: 1 group had narrow tapered or tapered arch forms, and the other had normal to broad arch forms. Photographs of 10 untreated women served as a control sample. All photographs showed the subjects smiling. The photographs were digitized and evaluated for BCS. Then, photographs with BCS were altered to eliminate the dark triangular areas, and those without BCS were altered by the addition of dark triangular areas at the lateral aspects of the smile. The altered photographs were randomized into a survey with the 30 original photographs. Three groups of raters (dentists, orthodontists, and laypeople) used a visual analogue scale to rate the photographs. Results: There was no significant difference in smile scores related to BCS for all samples and for all viewers. Dentists rated broader arch forms as more esthetic than untreated arch forms. Orthodontists rated broader arch forms as more esthetic than narrow tapered arch forms and untreated arch forms. Lay people showed no preference of arch form. Conclusions: This study demonstrates that the presence of BCS does not influence smile esthetics. However, there are differences in how dentists, orthodontists, and laypeople evaluate smiles and in what arch form each group prefers. (Am J Orthod Dentofacial Orthop 2005;127:343-50)

BACKGROUND. Staged interpolation flaps are priceless options in skin cancer reconstruction. Their value lies in their flexibility, reach, reliability, and ability to repair distant, complex facial defects. Familiar interpolation flaps to dermatologic surgeons include the paramedian forehead flap, cheek-to-nose interpolation flaps, and auricular staged flaps. OBJECTIVE. In this special reconstructive issue, the paramedian forehead flap is discussed separately. This article highlights the cheek-to-nose and auricular interpolation flaps as applied to skin cancer defects. Design considerations, anatomic basis, execution, and the distinctions of each repair are presented. MATERIALS AND METHODS. Patients with facial defects from Mohs micrographic surgery serve to illustrate the surgical techniques of each repair. RESULTS. With meticulous planning and thoughtful execution, cheek-to-nose and auricular staged flaps are capable of restoring both function and cosmesis. Several surgical stages are necessary, and an adequate supporting infrastructure is essential for an optimal outcome. CONCLUSION. Skin cancer patients with complex facial wounds from Mohs micrographic surgery may be assured of the highest possible cure rate. Further, their esthetic and functional reconstructive goals may be achieved with staged flaps for the nose and ear.

Mucoadhesive patch releasing the drug in the oral cavity at predetermined rate may present distinct advantages over traditional dosage forms such as tablets, gels and solutions. The present study was concerned with the preparation and evaluation of mucoadhesive buccal patches for the controlled systemic delivery of Salbutamol sulphate to avoid first pass hepatic metabolism. The developed patches were evaluated for the physicochemical, mechanical and drug release characteristics. The patches showed desired mechanical and physicochemical properties to withstand environment of oral cavity. The in-vitro release study showed that patches could deliver drug to the oral mucosa for a period of 7 h. the patches exhibited adequate stability when tested under accelerated conditions.