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Seminars in Plastic Surgery Nov 2020Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for... (Review)
Review
Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.
PubMed: 33380909
DOI: 10.1055/s-0040-1721760 -
British Journal of Nursing (Mark Allen... Feb 2019to explore the factors affecting quality of life in patients who experience facial disfigurement resulting from surgical treatment for head and neck cancer.
AIM:
to explore the factors affecting quality of life in patients who experience facial disfigurement resulting from surgical treatment for head and neck cancer.
BACKGROUND:
the number of people diagnosed with head and neck cancers has been rising over the past 30 years. This, combined with the improved survivorship of cancer patients, has led to a need to understand how these patients adapt to the physical, social and emotional toll of cancer and facial disfigurement and how these affect quality of life.
METHODOLOGY:
a systematic search of four nursing and psychological-focused databases was undertaken using pertinent keywords.
FINDINGS:
following a thematic analysis, four main themes and one subtheme emerged; changes within the self, social support; social reintegration; and help from healthcare professionals, which had the subtheme of information.
CONCLUSION:
facial disfigurement has a significant effect on patients' quality of life. Nurses are ideally placed to identify, inform and support patients and their family and friends.
Topics: Adaptation, Psychological; Body Image; Face; Head and Neck Neoplasms; Humans; Quality of Life
PubMed: 30746969
DOI: 10.12968/bjon.2019.28.3.180 -
American Journal of Optometry and... Feb 1982Fitting a comfortable and cosmetically attractive prosthetic device is a challenge, one which many people in the ophthalmic field seem to hesitate to undertake. Based on...
Fitting a comfortable and cosmetically attractive prosthetic device is a challenge, one which many people in the ophthalmic field seem to hesitate to undertake. Based on my experience, I provide practical guidelines for this important task. Artificial eyes which are required after enucleation are not discussed, but contact lenses and shells for disfigured blind or seeing eyes are.
Topics: Blindness; Contact Lenses; Corneal Diseases; Eye, Artificial; Humans; Middle Aged; Strabismus
PubMed: 7065110
DOI: 10.1097/00006324-198202000-00009 -
Eye and Brain 2018Optic nerve sheath meningiomas are rare benign neoplasms of the meninges surrounding the optic nerve. They are a significant cause of morbidity. While the mortality rate... (Review)
Review
Optic nerve sheath meningiomas are rare benign neoplasms of the meninges surrounding the optic nerve. They are a significant cause of morbidity. While the mortality rate is practically zero, these tumors can blind or disfigure patients. Given that the clinical course can be variable, and treatment has the capacity to cause morbidity itself, the management of these patients can be difficult. We review the literature to discuss the prevalence of optic nerve sheath meningiomas, the association with neurofibromatosis type 2, natural history, and management options and strategies.
PubMed: 30498385
DOI: 10.2147/EB.S144345 -
Plastic and Reconstructive Surgery Jan 2012In adults with severe congenital facial disfigurement, assessment of long-term psychological impact remains limited. This study determines the long-term psychological... (Comparative Study)
Comparative Study
BACKGROUND
In adults with severe congenital facial disfigurement, assessment of long-term psychological impact remains limited. This study determines the long-term psychological functioning in these patients and evaluates differences compared with patients with acquired facial disfigurement and a non-facially disfigured reference group. Also explored is the extent to which psychological functioning of the congenital group is related to satisfaction with facial appearance, fear of negative appearance evaluation by others, self-esteem, and severity of the facial deformity.
METHODS
Fifty-nine adults with severe congenital facial disfigurement, 59 adults with a traumatically acquired facial deformity in adulthood, and 120 non-facially disfigured adults completed standardized psychological, physical, and demographic questionnaires, including the Fear of Negative Appearance Evaluation Scale, the Rosenberg Self-Esteem Scale, the Hospital Anxiety and Depression Scale, the Achenbach Adult Self-Report, the 36-Item Short-Form Health Survey, and a visual analogue scale.
RESULTS
Adults with severe congenital facial disfigurement had relatively normal psychological functioning but appeared more prone to internalizing problems than the non-facially disfigured adults. Compared with patients with an acquired facial deformity, the congenital group displayed fewer problems on the physical component score of quality of life only. Satisfaction with facial appearance, fear of negative appearance evaluation, and self-esteem were good predictors of the different aspects of psychological functioning, with the exception of the physical component score of quality of life.
CONCLUSIONS
Improving satisfaction with facial appearance (by surgery), enhancing self-esteem, or lowering fear of negative appearance evaluation (by psychological support) may enhance long-term psychological functioning. Future research should focus on the individual patient and risk factors for maladjustment.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, II.
Topics: Adult; Aged; Craniofacial Abnormalities; Cross-Sectional Studies; Face; Facial Injuries; Female; Health Status Indicators; Humans; Male; Middle Aged; Personal Satisfaction; Quality of Life; Plastic Surgery Procedures; Self Concept; Young Adult
PubMed: 21915083
DOI: 10.1097/PRS.0b013e3182361f64 -
European Journal of Cancer Care Mar 2018The purpose of this study was to determine factors associated with self-perceived body image in female patients with head and neck cancer (HNC), and factors associated...
The purpose of this study was to determine factors associated with self-perceived body image in female patients with head and neck cancer (HNC), and factors associated with healthcare professional's rating of disfigurement, as well as the correlation between patient and observer ratings. This cross-sectional study recruited 105 women with HNC at a large medical centre. Measures of facial disfigurement and body image, as well as demographic and clinical characteristics, were collected. Multivariate multiple linear regression modelling was used to identify factors associated with healthcare professional's rating of disfigurement and patient self-perceived body image. Disfigurement ratings by healthcare professionals were positively associated with patient self-perceived body image. Medical treatment, cancer stage, radiation dose and cancer site were significantly associated with disfigurement. Medical treatment was an important predictor of perceived body image. These findings indicate a moderate prevalence of disfigurement among women with HNCs. Patients with more disfigurement were more likely to have dissatisfaction with their body image. Nursing professionals need to carefully assess the appearance of women with HNC. Camouflage interventions can be used to help appropriately cope with the disfigurement, and to achieve improved satisfaction with their body image.
Topics: Adult; Aged; Attitude of Health Personnel; Body Image; Cross-Sectional Studies; Face; Female; Head and Neck Neoplasms; Humans; Middle Aged; Patient Satisfaction; Self Concept; Young Adult
PubMed: 28488375
DOI: 10.1111/ecc.12710 -
Journal of Cosmetic Dermatology Dec 2006Although many skin conditions are amenable to treatment, on certain occasions dermatology and plastic surgery have not much to offer and patients are left with... (Review)
Review
Although many skin conditions are amenable to treatment, on certain occasions dermatology and plastic surgery have not much to offer and patients are left with disfigurements. Cosmetic camouflage is a therapy that has been developed to alleviate the suffering of those who have been disfigured by a congenital or an acquired lesion and who have no other choice than living with their deformity.
Topics: Cosmetics; Humans; Skin Diseases
PubMed: 17716248
DOI: 10.1111/j.1473-2165.2006.00274.x -
The Journal of Nervous and Mental... Apr 2012It is of clinical interest to investigate the degree to which patients with facial disfigurement use defense styles. Therefore, 59 adults born with rare facial clefts,... (Comparative Study)
Comparative Study
It is of clinical interest to investigate the degree to which patients with facial disfigurement use defense styles. Therefore, 59 adults born with rare facial clefts, 59 patients with facial deformities acquired at an adult age, and a reference group of 141 adults without facial disfigurements completed standardized questionnaires. There was a significant difference between the group with and the group without disfigurements on immature defense styles, with the disfigured group using the immature style more frequently. There was a trend for the nondisfigured group to use more mature defense styles. No difference between congenital and acquired groups was seen on individual types of defense style. Self-esteem had the strength to differentiate mature and immature defense styles within our disfigured groups. The association of low self-esteem and the utilization of immature defense styles suggests that professional help may tailor treatment on discussing immature defense style and problems triggering or maintaining this style.
Topics: Adult; Congenital Abnormalities; Defense Mechanisms; Empirical Research; Face; Facial Injuries; Fear; Female; Humans; Male; Middle Aged; Personal Satisfaction; Self Concept; Severity of Illness Index; Surveys and Questionnaires
PubMed: 22456586
DOI: 10.1097/NMD.0b013e31824cb378 -
Paediatric Drugs Dec 2019Juvenile localized scleroderma (jLS) is an orphan disease that can lead to cosmetic disfiguration and orthopedic problems. Two recent publications review the current... (Review)
Review
Juvenile localized scleroderma (jLS) is an orphan disease that can lead to cosmetic disfiguration and orthopedic problems. Two recent publications review the current recommendations regarding diagnosis, assessment, follow up and treatment of pediatric localized scleroderma cases, both of which suggest the Localized Scleroderma Cutaneous Assessment Tool as an important instrument to assess activity and damage. This review focuses on the systemic treatment of jLS. Systemic treatment includes synthetic and biologic disease-modifying antirheumatic drugs. Systemic therapy is indicated if the lesion crosses any joint, or leads to potential cosmetic disfiguration or orthopedic problems. The only controlled trial of systemic treatment has shown the efficacy of methotrexate, which is the first choice of treatment. It appears superior to phototherapy according to a recently published meta-analysis. In case of methotrexate intolerance, mycophenolate mofetil is an option. In case of methotrexate nonresponse, addition of mycophenolate mofetil, tocilizumab or abatacept seems to be effective. Future treatment options derived and extrapolated from adult trials regarding treatment of skin involvement of systemic scleroderma or fibrosis are promising, as the final pathway in the skin seems to be similar in both diseases.
Topics: Antirheumatic Agents; Child; Humans; Methotrexate; Mycophenolic Acid; Phototherapy; Scleroderma, Localized
PubMed: 31667717
DOI: 10.1007/s40272-019-00363-5 -
The Journal of Burn Care &... 1988Cosmetic disfigurement was measured reliably by averaging the ratings of four or more viewers of color slide photographs of severely burned children and young adults....
Cosmetic disfigurement was measured reliably by averaging the ratings of four or more viewers of color slide photographs of severely burned children and young adults. Raters were clinical and nonclinical staff at a burn hospital. Reliability for four-person rating of overall cosmetic disfigurement (unclothed) was .94; for overall disfigurement (clothed) it was .86; for irregularity, thickness, and discoloration it was .78, .79, and .72, respectively. Profession, sex, and years of contact with burned patients did not influence inter-rater agreement. Any randomly selected panel of four raters produced reliable average ratings. The effect of impaired skin texture on overall ratings of cosmetic disfigurement (both clothed and unclothed) was three to five times as important as the effect of impaired color. Despite its subjectivity, cosmetic disfigurement can be measured reliably. This report describes a formal procedure for such measurement and discusses ways of using that procedure to improve patient care.
Topics: Adolescent; Burns; Child; Female; Humans; Male; Photography; Skin
PubMed: 3220850
DOI: 10.1097/00004630-198807000-00011