Management of head and neck defects in a radiated field can be quite challenging owing to the dearth of vasculature and significant degree of post-radiation fibrosis. In this setting, arteriovenous (AV) loop vascular grafts can bypass nonviable local vessels to provide viable and reliable inflow and outflow vessels for free tissue transfer in an otherwise hostile environment. Prior reports of the Corlett loop utilizing a cephalic vein transposition has been described however a common carotid-to-internal jugular AV loop has not been recently reported. Three patients underwent carotid artery to internal jugular vein AV loop creation to facilitate free-flap reconstruction secondary to radiation-induced vessel depletion. The specific technique described utilizes the saphenous vein as a donor and spares the cephalic vein for the possibility of flap complication. All three cases resulted in successful reconstruction, maintaining healthy tissue, vascular flow, and flap viability at all follow-up intervals. In our described utilizes the saphenous vein as a donor and spares the cephalic vein for the possibility of flap complication. All three cases resulted in successful reconstruction, maintaining healthy tissue, vascular flow, and flap viability at all follow-up intervals. In our experience, vascular augmentation via AV loop formation provides reliable vascular inflow and outflow in the vessel-depleted neck to facilitate microvascular reconstruction. Sparing the cephalic vein yields an additional salvage mechanism in the event of venous congestion.
  The chin represents one of the most important determinants of the facial aesthetics. Like many aesthetic parameters, the "ideal" chin has changed in history regarding projection and prominence. From the retrusive profiles of the Renaissance, stronger and more defined mandibular contour are nowadays desired both by masculine and feminine population.This change in the ideal references plays an important role in diagnosis and treatment planning. Various techniques for chin augmentation have been described, using both alloplastic materials and osteotomies.An interesting osteotomy variant, so-called chin shield osteotomy, has been described by Triaca et al to avoid a deep mentolabial fold. The authors describe herein the use of a shield plate, very similar in his form to Captain America's shield, that can at the same time provide bone fixation and soft tissues sustain in the mentolabial fold region, preventing the invasion of the gap between the bone fragments by the connective tissue, as it happens in a guided as it happens in a guided bone regeneration procedure.
  Gender affirming facial surgery is a valuable option for patients with gender dysphoria. Traditionally, procedures for the upper third of the face focus on hairline position and contour of bony prominences via a coronal or trichophytic incision. These traditional approaches require large incisions and extensive dissection, which is not desirable for many patients and potentially avoidable in specific situations.
 
  We utilized a standard blepharoplasty approach to access the superior orbital rim in patients who desired isolated lateral orbital contouring as part of their gender affirming facial surgery.
 
  A subset of patients who require bony contouring of the orbital rim as part of their treatment for gender dysphoria will benefit from a less invasive approach to the upper face. A standard blepharoplasty incision is safe and effective to access the orbital rims in select patients, with decreased recovery and comparable results to traditional approaches.
 A subset of patients who require bony contouring of the orbital rim as part of their treatment for gender dysphoria will benefit from a less invasive approach to the upper face. A standard blepharoplasty incision is safe and effective to access the orbital rims in select patients, with decreased recovery and comparable results to traditional approaches.
  Speech has a very significant impact on the life quality of people with cleft and lip palate. Restore tissue anatomy and functionality is the main aim of primary palatal surgery. Multiple factors are associated with successful handling, including the need for a velopharyngeal insufficiency (VPI) secondary surgery.  https://www.selleckchem.com/products/ipilimumab.html  The study's aim is to determine speech and velopharyngeal function outcomes in children with cleft palate operated in our institution and to determine VPI secondary surgery outcomes, if appropriate. Clinical records of nonsyndromic patients with cleft palate born between January 2009 and December 2012, who performed their multidisciplinary care on our institution, were analyzed retrospectively. One hundred forty-two patients received primary palatal surgery. Eighty (56%) were male and 62 (44%) female. Twenty-two had soft cleft palate, 9 hard and soft cleft palate, 84 unilateral, and 27 bilateral cleft lip and palate. Twelve percent of patients presented palatal fistula, with a significantly higherd in 85% of patients. Nasometry decreased from 45% to 31%. Hyponasality increased by 10%. One case presented total flap dehiscence. Preoperative planning must be done carefully and individualized to succeed. Future prospective research that considers all the variables for a correct analysis is advisable, to improve our results.
  This study aimed to evaluate the mandibular canal course in individuals with cleft lip palate (CLP) and mandibular prognathism in terms of the sagittal split-ramus osteotomy using cone-beam computed tomography.
 
  Individuals with CLP older than 16 years of age and planned to undergo Le fort I + SSR osteotomies and those with class III occlusion planned to undergo Le fort I + SSR osteotomies were included. The measurements on the cleft side of CLP patients were compared with both their noncleft sides and those with class III occlusion. The course of the inferior alveolar nerve and its position in the mandible were evaluated starting from the mandibular foramen, the first entrance to the mandible, to the mental foramen, the exit from the mandible.
 
  The distance between the mandibular canal and the buccal surface of the mandible (B3) on the plane tangent to the distal of the mandibular first molar and perpendicular to the occlusal plane was found to be greater in individuals with CLP (P = 0.011). Buccal cortex thickness (C4) at the level of the mandibular canal on the plane tangent to the distal of the mandibular second molar and perpendicular to the occlusal plane was found to be lower in individuals with CLP (P = 0.