Facial Feminization Surgery: Guidelines for Patient Evaluation and Operative Techniques

Facial feminization surgery (FFS) is one of many gender affirming surgeries that can reduce gender dysphoria and rate of mis-gendering. A multidisciplinary team with experience caring for transgender patients is valuable for generating high quality outcomes and patient satisfaction. In particular, specific technical pearls can assist in improving outcomes of this procedure. This article provides a review of patient and procedure selection for a range of FFS procedures including chondrolaryngoplasty, hairline advancement, forehead reduction and recontouring, orbital opening and brow lift, rhinoplasty, lip lift or augmentation, malar augmentation, and mandibular recontouring and genioplasty. The authors share technical insights and pre- and postoperative management recommendations gained from experiences at 2 institutions performing high volume FFS.

Development and validation of the facial scale (FaceSed) to evaluate sedation in horses

Although facial characteristics are used to estimate horse sedation, there are no studies measuring their reliability and validity. This randomised controlled, prospective, horizontal study aimed to validate a facial sedation scale for horses (FaceSed). Seven horses received detomidine infusion i.v. in low or high doses/rates alone (DL 2.5 μg/kg+6.25 μg/kg/h; DH 5 μg/kg+12.5 μg/kg/h) or combined with methadone (DLM and DHM, 0.2 mg/kg+0.05 mg/kg/h) for 120 min, or acepromazine boli i.v. in low (ACPL 0.02 mg/kg) or high doses (ACPH 0.09 mg/kg). Horses’ faces were photographed at i) baseline, ii) peak, iii) intermediate, and iv) end of sedation. After randomisation of moments and treatments, photos were sent to four evaluators to assess the FaceSed items (ear position, orbital opening, relaxation of the lower and upper lip) twice, within a one-month interval. The intraclass correlation coefficient of intra- and interobserver reliability of FaceSed scores were good to very good (0.74–0.94) and moderate to very good (0.57–0.87), respectively. Criterion validity based on Spearman correlation between the FaceSed versus the numerical rating scale and head height above the ground were 0.92 and -0.75, respectively. All items and the FaceSed total score showed responsiveness (construct validity). According to the principal component analysis all FaceSed items had load factors >0.50 at the first dimension. The high internal consistency (Cronbach´s α = 0.83) indicated good intercorrelation among items. Item-total Spearman correlation was adequate (rho 0.3–0.73), indicating homogeneity of the scale. All items showed sensitivity (0.82–0.97) to detect sedation, however only orbital opening (0.79) and upper lip relaxation (0.82) were specific to detect absence of sedation. The limitations were that the facial expression was performed using photos, which do not represent the facial movement and the horses were docile, which may have reduced specificity. The FaceSed is a valid and reliable tool to assess tranquilisation and sedation in horses.

Morphometry of the Orbit in East-European Population Based on Three-Dimensional CT Reconstruction

Objectives. To determine safe distances within the orbit outlining reliable operative area on the basis of multislice computed tomography (MSCT) scans. Patients and Methods. MSCT of orbits of 50 Caucasian patients (26 males and 24 females, mean age 56) were analysed. Native scans resolutions were in all cases 0.625 mm. Measurements were done in postprocessing workstation with 2D and 3D reconstructions. The safe distances values were calculated by subtracting three standard deviations from the arithmetical average (X=AVG-3 STD). This method was chosen because this range covers 99.86% of every population. Results. The results of the measurements in men and women, respectively, are as follows (1) distance from optic canal to supraorbital foramen, mean 46,49 mm and 43,29 mm, (2) distance from the optic canal to maxillozygomatic suture at the inferior margin of the orbit mean 45,24 mm and 42,8 mm, (3) distance from the optic canal to frontozygomatic suture 46,15 mm and 43,58 mm, (4) distance from the optic canal to anterior lacrimal crest 40,40 mm and 38,39 mm, (5) distance from superior orbital fissure to the frontozygomatic suture 34,06 mm and 32,62 mm, and (6) distance from supraorbital foramen to the superior orbital fissure 42,32 mm and 39,39 mm. Conclusion. The most probable safe distances calculated by adopted formula were for the superior orbital fissure 23,39–30,58 mm and for the orbital opening of the optic canal 31,9–38,0 mm from the bony structures of the orbital entrance depending on the orbital quadrant.

The orbit

Some knowledge of the anatomy of the orbit is required by dental students and practitioners because it forms the upper part of the facial skeleton and some of the nerves and vessels supplying dental structures pass through it. Trauma to the middle third of the face, the upper facial skeleton, frequently involves the orbits and the structures they contain. Infections of the oral region occasionally spread to the orbit. In the following description, the emphasis is on those aspects of orbital anatomy of dental relevance; no description of the structure of the eyeball or the mechanisms of vision is included. The orbital cavities contain the eyeballs (globes), their associated muscles, vessels, nerves, the lacrimal apparatus, and a large amount of fat to cushion and protect the globes. Each cavity is pyramidal in shape. The base is the orbital opening on to the face; the roof, floor, and medial and lateral walls converge to the apex at the posterior aspect of the orbit. The long axis of the orbit from apex to surface runs forwards and laterally. The bones that form the orbit are illustrated in Figure 30.1 ; use the figure and a dried or model skull if possible as you read the following description. Most of the roof of the orbit is formed by the inferior surface of the orbital part of the frontal bone with a small posterior contribution from the lesser wing of the sphenoid ; this is pierced by the optic canal through which the optic nerve exits the orbit. The lateral wall is formed by the orbital surfaces of the zygomatic bone anteriorly and the greater wing of the sphenoid posteriorly. It separates the orbital cavity from the infratemporal fossa anteriorly and from the middle cranial fossa posteriorly. The floor of the orbit is occupied by the thin plate of bone forming the upper surface of the body of the maxilla ; this plate of bone is also the roof of the maxillary paranasal air sinus over most of its extent although the palatine bone forms a minute triangular area at the posteromedial corner.

Cranial anatomy of a new genus of hyperodapedontine rhynchosaur (Diapsida, Archosauromorpha) from the Upper Triassic of southern Brazil

ABSTRACTDetailed description of the cranial anatomy of the rhynchosaur previously known as Scaphonyx sulcognathus allows its assignment to a new genus Teyumbaita. Two nearly complete skulls and a partial skull have been referred to the taxon, all of which come from the lower part of the Caturrita Formation, Upper Triassic of Rio Grande do Sul, southern Brazil. Cranial autapomorphies of Teyumbaita sulcognathus include anterior margin of nasal concave at midline, prefrontal separated from the ascending process of the maxilla, palatal ramus of pterygoid expanded laterally within palatines, dorsal surface of exoccipital markedly depressed, a single tooth lingually displaced from the main medial tooth-bearing area of the maxilla, and a number of other characters (such as skull broader than long; a protruding orbital anterior margin; anguli oris extending to anterior ramus of the jugal; bar between the orbit and the lower temporal fenestra wider than 0·4 of the total orbital opening; mandibular depth reaching more than 25 of the total length) support its inclusion in Hyperodapedontinae. T. sulcognathus is the only potential Norian rhynchosaur, suggesting that the group survived the end-Carnian extinction event.