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**23** 

*Italy* 

*La Sapienza/ Roma* 

**Facial Remodelling and Biomaterial** 

G. Fini, L.M. Moricca, A. Leonardi, S. Buonaccorsi and V. Pellacchia

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

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

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 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

for the soft tissues. Some representative clinical cases are presented.

patients) of the total were presented in all cases the bony atrophy of the jaw.

**1. Introduction** 

therapeutic plan for the specific facial

