**Facial Remodelling and Biomaterial**

G. Fini, L.M. Moricca, A. Leonardi, S. Buonaccorsi and V. Pellacchia *La Sapienza/ Roma Italy* 

### **1. Introduction**

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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

Facial Remodelling and Biomaterial 447

**Clinical case 2:** E.M, female of 45 years referred about the appearance of a progressive facial asymmetry alterations interesting the lower third of the face in particular in the last 3 years. The tissue deficit was becoming clearer without any symptoms or alterations in the facial motility**.** (FIGURE 1) Therefore a Computed Tomography Scan of the face was performed, in order to evaluate the entity of such deficit. It shows marked deficit of the soft tissue, which was extending partially to the skeletal structures". During the objective exam conduced even with a photographic study, the loss of the symmetry was appreciating, in particular to the third lower of the hemiface. Problems related to the function of the facial nerve, were not

Therefore the patient underwent to fill of the facial soft tissues with biomaterial. The biomaterial was implanted in the left middle and inferior third of the hemiface; moreover it has been noticed a partial resorption of the biomaterial at the end of treatment. A total of 3

**Clinical Case 3:** E.D.E, male of 55 years old, immuno-compromised patient, affected by HIV from 20 year. He had underwent to the Highly Active Anti-Retroviral Therapy treatment (HAART) from about ten years. The patient referred the appearence of an atrophy in the middle third of face, he had developed a lypodistrophy lesion of soft tissues**.** (FIGURE 3)

infiltration has been performed for a tot of 8ml of infiltrated biomaterial. (FIGURE 2)

noticed, and the patient did not refer facial hypoesthesia.

Fig. 2. Lateral view of the patient after treatmet

Fig. 3. Particular of the lypodistrophy area

carried out in patients with autoimmune syndrome (Scl and PRS), LPS results people, HIV affected, and patients with congenital malformation (HMF). We have a diagnostic and therapeutic procedure uniform for all the patients; the first clinical evaluation concerns radiographic and laboratory examination, such as head and neck Dimensional Computed Tomography, Magnetic Resonance, Ultrasonography, Orthopanoramic x-rays, searches for ANA-ENA-Anti Cardiolipina anticorpal; specialized infective and immunologic consulence relating to the single patient has been committed. The 7% of the patients has been treated with a replenishment composed of the combination with porous polyethylene and polyacrylamide because of the wide loss of both skeleton and soft tissues. Some other representative clinical cases are presented:
