A facial reconstruction method based on new mesh deformation techniques

This article presents a new numerical method for facial reconstruction.The problem is the following:given a dry skull,reconstruct a virtual face that would help in the identification of the subject.The approach combines classical features as the use of a skulls/faces database and more original aspects:(1)an original shape matching method is used to link the unknown skull to the database templates;(2)the final face is seen as an elastic 3D mask that is deformed and adapted onto the unknown skull.In this method,the skull is considered as a whole surface and not restricted to some anatomical landmarks,allowing a dense description of the skull/face relationship.Also,the approach is fully automated.Various results are presented to show its efficiency.

Contemporary reconstruction after complex facial trauma

Complex facial trauma requires complex repair and solutions.This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result.Historically,the use of pedicled flaps,and then free tissue transfer,were the primary techniques utilized.Advancements in soft-tissue reconstruction,such as perforator flaps and pre-expanded and prefabricated flaps,allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage.The advent of contemporary technologies,such as virtual surgical planning,stereolithography and customized implants and plates,facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction.When surgical and technological techniques are combined in complementary multistage reconstructions,better reconstructive and aesthetic outcomes are achievable than ever before.In this review,the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience.Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed.A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result.We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.

Expanded Forehead Stepped Flaps for Delayed Three-Stage Repair of Midface Skin Lesions

Background The forehead flap is the best flap for nasal defect repair and nasal reconstruction.It is also an ideal option for repairing skin lesions in the midface(including the nasal area,inner area of the cheek,and upper lip of the perioral area).However,the traditional frontal myocutaneous flap is relatively bulky for repairing pure skin lesions.In addition,the original forehead flap is generally not sufficient to cover a large wound area.If a large forehead flap is removed,the donor site cannot be sutured in one stage.In this study,an expanded forehead stepped flap was used to overcome the shortcomings of the traditional frontal myocutaneous flap.Methods In stage one surgery,a rectangular expander(80–100 mL)was implanted on the side of the forehead.The expansion pot was built-in,and the excess expansion amount was 160–200 mL.After 4 weeks of rest,stage two operation was performed to remove the skin lesions in the midface.The pulsation point of the supratrochlear artery on one side was used as the pedicle,and the flap was designed diagonally to the upper region of the opposite side.The flap was designed according to the size and shape of the wound.The distal portion of the flap was separated in the superficial layer of the frontalis muscle,approximately 1.7 cm above the superior orbital edge,and cut into the submuscle.The flap pedicle was cut from the superficial layer of the periosteum to form a stepped flap.Then,the flap was rotated downward to repair the wound in the midface.Five weeks later,stage three of the operation which involved flap pedicle division,was performed.Results Expanded forehead stepped flaps were used in 12 cases with 6–36 months of follow-up.In all cases,the blood supply to the flaps was good,and their color,texture,and thickness matched well with those of the surrounding skin.All patients were satisfied with the outcome of the repair.Conclusion Expanded forehead stepped flaps present an ideal option for repairing wounds after large skin lesion resections in the midface since they have multiple edges from a reliable blood supply,easiness to transfer,and well-matched color,texture,and thickness to those of the surrounding skin of the face to no need for many auxiliary incisions.

Aesthetic reconstruction of the severely disfigured burned face:a creative strategy for a"natural"appearance using pre-patterned autogenous free flaps

The author reviews his pioneering work in aesthetic restoration of the severely disfigured burn face first introduced in 1995 and refined over the past two decades. The reader will be exposed to the step by step approach to achieving cosmetic enhancement and functional rehabilitation of advanced facial burns. The"keystone"of the autogenous reconstruction is the pre-patterned, sculpted microvascular free flap designed to fit like the"piece of a puzzle"into the aesthetic units of the face to replace disfiguring burn scars. Aggressive intraoperative"sculpting"is employed both"in situ"at the donor site and during the flap transfer to simulate the normal facial contours and planes. Comparisons of the author's approach are made to the whole spectrum of reconstructive modalities ranging from conventional grafting to expanded pre-fabricated flaps and even to CTA face transplants;advantages/disadvantages of each are discussed. The pre-patterned, sculpted microvascular (MV) free flap offers the benefit of a single-stage transfer of composite skin/soft tissue hiding the seams at the junction of facial planes. When harvested from distant donor sites, the donor deformities can easily be concealed. The MV free tissue transfer offers the substrate that can be sculpted into nuanced facial components as well as the"palette"upon which the face can be painted with creative camouflage makeup. The soft contour and texture of the autogenous patterned transfers translates into a"natural"facial appearance while preserving fluid motions of facial expression.

Robust facial landmark detection and tracking across poses and expressions for in-the-wild monocular video

We present a novel approach for automatically detecting and tracking facial landmarks acrossposesandexpressionsfromin-the-wild monocular video data,e.g.,You Tube videos and smartphone recordings.Our method does not require any calibration or manual adjustment for new individual input videos or actors.Firstly,we propose a method of robust 2D facial landmark detection across poses,by combining shape-face canonical-correlation analysis with a global supervised descent method.Since 2D regression-based methods are sensitive to unstable initialization,and the temporal and spatial coherence of videos is ignored,we utilize a coarse-todense 3D facial expression reconstruction method to refine the 2D landmarks.On one side,we employ an in-the-wild method to extract the coarse reconstruction result and its corresponding texture using the detected sparse facial landmarks,followed by robust pose,expression,and identity estimation.On the other side,to obtain dense reconstruction results,we give a face tracking flow method that corrects coarse reconstruction results and tracks weakly textured areas;this is used to iteratively update the coarse face model.Finally,a dense reconstruction result is estimated after it converges.Extensive experiments on a variety of video sequences recorded by ourselves or downloaded from You Tube show the results of facial landmark detection and tracking under various lighting conditions,for various head poses and facial expressions.The overall performance and a comparison with state-of-art methods demonstrate the robustness and effectiveness of our method.

Current role in facial allograft transplantation:what have we learned?

Face transplant(FT)has evolved enormously in the last 10 years since the successful completion of the first facial transplant.This procedure has become a new reconstructive option for complex facial deformities to restore the anatomy of patients with severely disfigured faces.The authors review the literature and discuss the main surgical,immunological,and ethical aspects as well as the results described in patients undergoing FT.To date there have been more than thirty FT worldwide.The main indication was post-traumatic deformity.In all cases a standard immunosuppression was performed with three drugs,although acute rejection episodes were observed,that could be controlled with conventional immunosuppressive regimen.Overall,functional and aesthetic results have been excellent at short-term and high satisfaction rate exceeded initial expectations,although long-term data are still scarce.Major complications were opportunistic infections.Five deaths that occurred have reopened the ethical debate about the potential complications and concerns of providing informed consent to recipients.Continuous progresses in microsurgical techniques and preoperative planning have promoted the evolution from partial to full FT.All these are on the basis of accurate and careful selection of well-motivated candidates.The next challenge will be getting new immunosuppressive treatment strategies.Although clinical experience has demonstrated the FT viability,it is still considered an experimental procedure in which we have much to learn to define its true role in the current reconstructive surgery and resolve major technical,medical and ethical problems involved.

Designing an evidence-based free-flap pathway in head and neck reconstruction

Background:The use of autologous free-tissue transfer is an increasingly utilized tool in the ladder of reconstructive options to preserve and restore function in patients with head and neck cancer.This article focuses on the evidence surrounding perioperative care that optimizes surgical outcomes and describes one tertiary center's approach to standardized free-flap care.Data Sources:This article examines English literature from PubMed and offers expert opinion on perioperative free-flap care for head and neck oncology.Conclusion:Free-flap reconstruction for head and neck cancer is a process that,while individualized for each patient,is best supported by a comprehensive and standardized care pathway.Surgical optimization begins in the preoperative phase and a thoughtful approach to intraprofessional communication and evidence-based practice is rewarded with improved outcomes.

Recent Advances in Forensic Odontology:An Overview

Forensic odontology is a branch of forensic sciences that uses the skill of a dentist in personal identification during mass calamities,sexual assault,and child abuse to name a few.Forensic odontology is an evolving science and has a greater scope of development.Recent advances in the field of genetics and molecular biology have contributed to the rapid growth of forensic odontology.In case of a crime scene,forensic odontologists play a major role in investigating and interpreting dental evidence.Forensic odontologists utilize the knowledge of dentistry in bite mark analysis,fixation of identity in mass disasters,and age estimation.Thus,the duty and responsibility of forensic odontologists has increased in recent years.Therefore,practicing dentists and dental students should be made aware of the available newer technologies and its use in forensic dentistry.This article gives an overview of recent advances used in identification in forensic dentistry.