Facial Feminization Surgery Review: Diagnosis, Preoperative Planning, Surgical Techniques, and Outcomes

FACE ◽  
2021 ◽  
pp. 273250162110572
Author(s):  
Joshua Choe ◽  
Sajni Parikh ◽  
Sarah L. Barnett ◽  
Sabrina Sam ◽  
Kevin Chen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Patient Satisfaction ◽  
Surgical Procedures ◽  
Soft Tissues ◽  
Preoperative Planning ◽  
Surgical Techniques ◽  
Facial Features ◽  
Virtual Planning ◽  
Objective Outcome ◽  
Aesthetic Preferences

Facial Feminization Surgery (FFS) broadly encompasses a series of surgical procedures offered by craniomaxillofacial surgeons designed to modify facial features and transform both skeletal and soft tissues to create a more feminine appearance. Techniques, initially pioneered by Dr. Douglas Ousterhout, have been modified to include preoperative virtual planning and evolving aesthetic preferences. Computed Tomography (CT) imaging assists with morphologic typing of the brow, supraorbital, chin, and lateral mandible regions. Advancements in instrumentation increase the efficiency and accuracy of FFS procedures. More recently, trends in transgender acceptance have led to improved insurance authorization for FFS procedures. Objective outcome studies have shown success in achieving goals of (1) minimizing mis-gendering in public (appropriately identifying trans-women as female) and (2) reduction in dysphoric feelings (improved patient satisfaction).

scholarly journals Microvasculature of the Plantar Plate Using Nano–Computed Tomography

2018 ◽  
Vol 40 (4) ◽  
pp. 457-464 ◽  
Author(s):  
Fred T. Finney ◽  
Aaron McPheters ◽  
Natalie V. Singer ◽  
Jaron C. Scott ◽  
Karl J. Jepsen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissues ◽  
Proximal Phalanx ◽  
Surgical Techniques ◽  
Phosphomolybdic Acid ◽  
Vascular Density ◽  
Plantar Plate ◽  
Tibial Arteries ◽  
Clinical Conditions ◽  
Mtp Joints

Background: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano–computed tomography (nano-CT) imaging. Methods: Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. Results: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate. Conclusion: There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate. Clinical relevance: The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.

scholarly journals RADIO-FREQUENCY WAVE APPLICATION IN ESTHETIC SURGERY OF HEAD AND NECK

2008 ◽  
Vol 37 (2) ◽  
pp. 137-142
Author(s):  
Vukoje Novak
Keyword(s):  
Head And Neck ◽  
Surgical Procedures ◽  
Soft Tissues ◽  
New Technology ◽  
Surgical Techniques ◽  
Pathological Process ◽  
Wave Form ◽  
Esthetic Surgery ◽  
Frequency Wave ◽  
Radio Frequency Wave

Introduction: Four-megahertz radiowave surgery is a relatively new technology usage of which rapidly expands reaching superior results compared to other surgical techniques. Radiosurgery is an atraumatic metod of cutting and coagulation of soft tissues that uses optimal low heat 4.0 MHz source for numerous plastic,esthetic and cosmetic interventions which reguires surgical precision, penetration control and low temperature. This technology allows us to simultaneously cut and coagulate the tissue with minimal lateral tissue alteration, without burning damage and with better wounds healing.This mode is used by the author in high vascularity anatomical areas and for the deeper tissue of the head and neck. The pure cutting wave-form is ideal for skin excision with otoplasty and blepharoplasty when we expect ideal esthetic result. Coagulation is obviously paramount for any surgeon and can make the difference between a good and poor result. When he coagulates tissues in the head and neck, the surgen is frequently close to significant structures such as nerves and vessels which we must protect. Ellman Sugitron 4.0 offers great advantages. One of the stronges point of the Ellman system is the large array of specialized electrodes. By bending the malleable electrodes we can use them at any angle or even around corners. Material and Methods: The Author has done surgical procedures on over 600 patients using this technique on different esthetic problems with satisfying results. In operative material dominate various skin growths (hemangioma, fibroma, naevus, wart) blepharoplasy, otoplasty, rhinoplasty and other minor surgical procedures. Interventions were done in local anesthesy. The aim of this work is to present our observations about radioablation in heterogenous pathological process on head and neck based of our own experience. Results: Our results show that this technology have great advantage over other techniques (scalpel, electrocouter, laser) from which the most important are simultaneous cutting and coagulation,coagulation in liquid medium, minimal termal damage of latteral tissues, faster healing of wounds with excellent cosmetic results. If we want surgery without cut,cut without scar, Ellman Sugitron is the best choice.

scholarly journals Microvasculature of the Plantar Plate Using Nano-Computed Tomography

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0000
Author(s):  
Fred Finney ◽  
Jaron Scott ◽  
Karl Jepsen ◽  
James Holmes ◽  
Paul Talusan
Keyword(s):  
Computed Tomography ◽  
Soft Tissues ◽  
Proximal Phalanx ◽  
Three Dimensional ◽  
Surgical Techniques ◽  
Phosphomolybdic Acid ◽  
Vascular Density ◽  
Plantar Plate ◽  
Tibial Arteries ◽  
Mtp Joints

Category: Basic Sciences/Biologics, Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of very common clinical complaints including metatarsalgia, metatarsal-phalangeal (MTP) joint subluxation and dislocation, hammertoe, crossover toe, etc. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been addressed. We sought to answer this question by employing a novel technique involving microvascular perfusion and nano-computed tomography (Nano-CT) imaging. Methods: 12 human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were dissected and cannulated proximal to the ankle joint and were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The 2nd through 4th toe MTP joints of 12 feet were imaged with Nano-CT at 14-micron resolution. Images were then reconstructed for three-dimensional analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. Results: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The mid-substance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 30% and distal 20% of the plantar plate (Figure 1). Conclusion: There is a vascular network extending from the surrounding soft tissues into approximately the proximal 30% and the distal 20% of the plantar plate. The hypovascular mid-portion of the plantar plate may play an important role in the underlying patho-anatomy and pathophysiology of this area. We believe our findings likely have significant clinical implications for the reparative potential of this region, and therefore the surgical procedures currently described to accomplish anatomic plantar plate repair.

scholarly journals Cross-sectional anatomy, computed tomography, and magnetic resonance imaging of the banded houndshark (Triakis scyllium)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Wha Kim ◽  
Adams Hei Long Yuen ◽  
Cherry Tsz Ching Poon ◽  
Joon Oh Hwang ◽  
Chang Jun Lee ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Soft Tissues ◽  
Imaging Techniques ◽  
Evolutionary Developmental Biology ◽  
Phylogenetic Position ◽  
Ct Scanner ◽  
Resonance Imaging ◽  
Cross Sectional

AbstractDue to their important phylogenetic position among extant vertebrates, sharks are an invaluable group in evolutionary developmental biology studies. A thorough understanding of shark anatomy is essential to facilitate these studies and documentation of this iconic taxon. With the increasing availability of cross-sectional imaging techniques, the complicated anatomy of both cartilaginous and soft tissues can be analyzed non-invasively, quickly, and accurately. The aim of this study is to provide a detailed anatomical description of the normal banded houndshark (Triakis scyllium) using computed tomography (CT) and magnetic resonance imaging (MRI) along with cryosection images. Three banded houndsharks were scanned using a 64-detector row spiral CT scanner and a 3 T MRI scanner. All images were digitally stored and assessed using open-source Digital Imaging and Communications in Medicine viewer software in the transverse, sagittal, and dorsal dimensions. The banded houndshark cadavers were then cryosectioned at approximately 1-cm intervals. Corresponding transverse cryosection images were chosen to identify the best anatomical correlations for transverse CT and MRI images. The resulting images provided excellent detail of the major anatomical structures of the banded houndshark. The illustrations in the present study could be considered as a useful reference for interpretation of normal and pathological imaging studies of sharks.

scholarly journals Immersive 3D virtual reality imaging in planning minimally invasive and complex adult cardiac surgery

2020 ◽  
Vol 1 (1) ◽  
pp. 62-70
Author(s):  
Amir H Sadeghi ◽  
Wouter Bakhuis ◽  
Frank Van Schaagen ◽  
Frans B S Oei ◽  
Jos A Bekkers ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Virtual Reality ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Preoperative Planning ◽  
Operating Time ◽  
Three Dimensional ◽  
Cardiothoracic Surgery ◽  
Planning Tool ◽  
Computed Tomography Images

Abstract Aims Increased complexity in cardiac surgery over the last decades necessitates more precise preoperative planning to minimize operating time, to limit the risk of complications during surgery and to aim for the best possible patient outcome. Novel, more realistic, and more immersive techniques, such as three-dimensional (3D) virtual reality (VR) could potentially contribute to the preoperative planning phase. This study shows our initial experience on the implementation of immersive VR technology as a complementary research-based imaging tool for preoperative planning in cardiothoracic surgery. In addition, essentials to set up and implement a VR platform are described. Methods Six patients who underwent cardiac surgery at the Erasmus Medical Center, Rotterdam, The Netherlands, between March 2020 and August 2020, were included, based on request by the surgeon and availability of computed tomography images. After 3D VR rendering and 3D segmentation of specific structures, the reconstruction was analysed via a head mount display. All participating surgeons (n = 5) filled out a questionnaire to evaluate the use of VR as preoperative planning tool for surgery. Conclusion Our study demonstrates that immersive 3D VR visualization of anatomy might be beneficial as a supplementary preoperative planning tool for cardiothoracic surgery, and further research on this topic may be considered to implement this innovative tool in daily clinical practice. Lay summary Over the past decades, surgery on the heart and vessels is becoming more and more complex, necessitating more precise and accurate preoperative planning. Nowadays, operative planning is feasible on flat, two-dimensional computer screens, however, requiring a lot of spatial and three-dimensional (3D) thinking of the surgeon. Since immersive 3D virtual reality (VR) is an upcoming imaging technique with promising results in other fields of surgery, we aimed in this study to explore the additional value of this technique in heart surgery. Our surgeons planned six different heart operations by visualizing computed tomography scans with a dedicated VR headset, enabling them to visualize the patient’s anatomy in an immersive and 3D environment. The outcomes of this preliminary study are positive, with a much more reality-like simulation for the surgeon. In such, VR could potentially be beneficial as a preoperative planning tool for complex heart surgery.

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

2021 ◽  
pp. 105566562110076
Author(s):  
Maria Costanza Meazzini ◽  
Noah Cohen ◽  
Valeria Marinella Augusta Battista ◽  
Cristina Incorvati ◽  
Federico Biglioli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Efficient Method ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
Face Mask ◽  
Younger Patients ◽  
Good Healing

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). Results: Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. Conclusion: In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

Computed Tomography of the Normal Soft Tissues of the Wrist

1983 ◽  
Vol 18 (6) ◽  
pp. 546-551 ◽  
Author(s):  
ROBERT O. CONE ◽  
ROBERT SZABO ◽  
DONALD RESNICK ◽  
RICHARD GELBERMAN ◽  
JULIO TALEISNIK ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissues

scholarly journals Surgery at Cranio-vertebral (CV) Junction: Our Experience of 32 Cases

1970 ◽  
Vol 29 (2) ◽  
pp. 78-84
Author(s):  
FH Chowdhury ◽  
MR Haque ◽  
NKSM Chowdhury ◽  
MS Islam ◽  
Z Raihan ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Surgical Techniques ◽  
Clinical Findings ◽  
Type I ◽  
College Hospital ◽  
Chiari Malformation Type I ◽  
Female Ratio ◽  
Medical College ◽  
Neoplastic Lesion ◽  
Wide Range

Cranio vertebral (CV) junction is one of the critical sites for surgery. It's anatomy, physiological aspects and pathological involvement varies in a wide range of margins. Common problems are developmental anomalies, traumatic involvement, inflammatory, infective and neoplastic lesion. Management of these problems varies a lot from each other. Aim of the article is to overview the pathologies in this area and to study presentations, investigations, surgical procedures and results of these pathologies. We prospectively analyzed 32 cases of Cranio-vertebral (CV) region surgery in the Department of Neurosurgery Dhaka Medical College Hospital and Mitford Hospital, Dhaka, from 2000 to 2008. In our series, male and female ratio was 7.2:1. Pathologies were atlanto- axial dislocation (AAD), Chiari malformation type –I, schwannoma, meningioma, hydatid cyst and tuberculosis. Common clinical findings were- neck pain, quadriparesis, quadriplegia, hand atrophy, autonomic dysfunction and hypertension. Various types of surgical procedures were done in this series according to the pathology. Death was in 01 case, neurological deterioration seen in one case, 2 cases were neurologically stable and 28 cases (87.5%) improved neurologically where one was non useful improvement (Frankel grade-C). Complete pre operative radiological study is a very important adjunct for a successful surgical result. Proper evaluation of patients with selection of appropriate surgical procedures along with safe surgical techniques are the necessary things for successful surgery in this area. DOI: http://dx.doi.org/10.3329/jbcps.v29i2.7952 (J Bangladesh Coll Phys Surg 2011; 29: 78-84)

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