Background: The use of the acellular dermal matrix is already known in traumas of diverse natures, its presentation for the injectable use has helped in the therapy of several pathologies, and one of them is the Parry-Romberg Syndrome PRS. To present a treatment to facial asymmetry and aesthetic improvement of a patient with the associated treatment of fat graft and injectable dermal matrix. Case Presentation: One female patient, a carrier of the syndrome for ten years, treated several times without success. This time the acellular dermal matrix was applied in hemiface affected by the pathology, to support the facial middle third and to return the lost volume, on the non-affected side was injected for the best symmetrization. The result with fat graft and dermal matrix remain satisfactory after days. It is a rare, autoimmune syndrome which is prevalent in younger than 20 years old patients.
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Background: The use of the acellular dermal matrix is already known in traumas of diverse natures, its presentation for the injectable use has helped in the therapy of several pathologies, and one of them is the Parry-Romberg Syndrome PRS. To present a treatment to facial asymmetry and aesthetic improvement of a patient with the associated treatment of fat graft and injectable dermal matrix.
Case Presentation: One female patient, a carrier of the syndrome for ten years, treated several times without success. This time the acellular dermal matrix was applied in hemiface affected by the pathology, to support the facial middle third and to return the lost volume, on the non-affected side was injected for the best symmetrization. The result with fat graft and dermal matrix remain satisfactory after days.
It is a rare, autoimmune syndrome which is prevalent in younger than 20 years old patients. It has a slight occurrence in females. No racial distinction was observed . Several signs can be observed in its appearance, which according to the severity can be classified as mild, moderate and severe.
These symptoms are diverse, such as skin hardening, mainly above the maxillary region, dyschromic spots on facial or scalp, facial pain, an appearance of white hair.
These can progress to bone deformities, poor tooth and gum formation and alopecia. They can get worse and lead to dermal, bony and muscular atrophies. Sometimes it presents intracranial vascular malformations and convulsive conditions, which indicates cerebral compromise .
Clinical treatment lends itself to control neurological and ocular symptoms, and pharmacotherapeutic treatment seeks better swallowing and phonation. The surgical treatment aims at an aesthetic improvement and correction of the facial asymmetry, and several surgical techniques have been attempted. Dermal, cartilaginous, facial and bone grafts, multiple flap rotation, alloplastic fillers and fat graft may be used .
Most patients need repeated procedures or fat grafts for the correction of asymmetry. The dermal matrix, which was described in by Burke and Yannas , consisting of a layer of acellular bovine dermis covered by a silicone blade, being very used to cover uninfected and nonsecretive traumatic lesions, completing the treatment after a few days with partial skin grafting .
Under went modernization, since if it has a single presentation layer, where the silicone layer was removed and allows the accomplishment of skin grafting in a single procedure in traumatic injuries or burns . Today we have an injectable presentation . That can be used to treat facial asymmetry resulting from the described syndrome. To present a treatment to facial asymmetry and aesthetic improvement of a patient with associated treatment of fat graft and injectable dermal matrix.
Female patient, 45 years old, presenting Parry-Romberg syndrome for 10 years, with seven fat grafts already performed in the plastic surgery service of Sorocaba, presenting important facial asymmetry.
All preoperative exams were performed and were within the parameters of normality. Figure 1: Making of the areas to be treated, the solid lines mark the bony facial protrusions and between the lines is the area to be treated intradermally as dermal filler. With the patient in horizontal dorsal decubitus under narcosis, asepsis, and antisepsis of the entire face, lower limbs and abdominal region were promoted.
A liposuction of 40ml fat was performed on the inner thigh surfaces using a 50ml syringe. After centrifugation of the contents of the liposuction, 9ml of pure fat was separated, adding 9ml of the injectable dermal matrix and reserved for later use in the face Figure 2. Figure 2: A Centrifuge with the tubes with aspirated material. B Homogenization of fat with the injectable matrix. Facial treatment began with Bolus injection using microcannula of 2mm in diameter and length ranging from 10 to 15 cm from the pure injectable dermal matrix in the regions of bony protrusion on the side affected by the pathology to promote abutments and mandibular contour, as shown in Figure 3.
The fan lines demonstrate how the intradermal injections of homogenized fat with matrix. After this maneuver, homogenized fat was used with the matrix as soft part filler, making intradermal injections, in a fan refining the treatment of the middle third. The contralateral side was also treated with fat homogenized with the dermal matrix for an improved symmetrization.
The patient was discharged from hospital 24 hours after the procedure with compressive meshes in the liposuction region, without dressings on the face. Photos of the patient were taken in the pretreatment and serially until the sixth month in which maintenance of the result is observed Figure 4. Figure 4: Patient in the pre-treatment and serially until the sixth month in maintenance of the results. Although rare, Parry-Romberg syndrome is extremely stigmatizing and requires surgical treatment, often in multiple procedures, which increases morbidity.
The use of alloplastic material is an option, but the high cost of absorbable materials and the complications in the use of nonabsorbable materials make this practice very difficult.
Translocations of flaps may be necessary in most of the severe cases when is more important local vascular impairment, but morbidity limits the use of this technique, the fat graft is a very used option. However, some patients are very thin, making difficult to obtain the amount of fat for the correction of facial asymmetry, and the possibility of reabsorption of the grafted material, an unpleasant intercurrence, may require repeated procedures for facial symmetry .
The use of dermal substitutes has been aiding in medical treatments since , mainly in the coverage of traumatic injuries, or treatment of burned patients, as we can see in the works of Burke and Yannas . The development of more modern products, capable of being used in a single time as the single layer or more modern products of injectable use, favor in obtaining good results in use in these patients, expanding also the use for patients with sequelae of surgeries for excision of tumors of the skin, or sequelae of several surgeries, with decreased morbidity and mortality of the procedure [31,32].
In the reported case, fat grafting was associated with the use of injectable matrix and compared to previous bad results with the use of the fat graft.
After internal liposuction of thighs, centrifugation and fat homogenization with the dermal matrix, the treatment of facial asymmetry was started. Using the surgical technique indicated by Dr. Filling was performed on the contralateral unaffected side for better symmetrization. Immediately after the procedure, the patient presented an extensive edema, but the volumetric normalization of the face occurred in a relatively short time, the day post-procedure photos showed this standardization.
The 6-month follow-up shows the satisfactory and stable outcome. As it is a recent procedure, new studies should be carried out to improve the understanding and evaluate the result. The use of injectable dermal matrix was shown to be effective and stable as a treatment for facial asymmetry by Parry-Romberg Syndrome in this patient. ROR and MG preparation of the manuscript for submission. All authors read and approved the final manuscript.
Informed written consent form obtained by the patient is available with the corresponding author under confidential cover. Parry-Romberg syndrome associated with homolateral segmental vitiligo. Ann Dermatol Venereol. Progressive hemifacial atrophy Parry-Romberg disease : Study of a case. Arq Neuropsiquiatr. Parry-Romberg syndrome associated with intracranial vascular malformations.
Arch Ophthalmol. Parry-Romberg syndrome: Facial atrophy and its relationship with other regions of the body. Ann Plast Surg. Rev Bras Oftal. Cir Plast Iber-latinoam. Dermatol Argent. Chaves EBF. Main clinical findings in patients with progressive hemifacial atrophy: Parry-Romberg syndrome. Arq Catarin Med. Spraker M. Sclerosing and atrophying conditions. Pediatric dermatology.
Churchill Livingstone. Autologous fat transplantation for the treatment of progressive hemifacial atrophy Parry-Romberg syndrome: case report and review of medical literature.
An Bras Dermatol. Microsurgical transplants for facial depressions. Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury.
Ann Surg. Wartenberg R. Progressive facial hemiatrophy. Arch NeurolPsychiatr. Br J Plast Surg. Use of bilayer matrix wound dressing in the exenterated socket. Aesthetic PlastSurg. PediatrSurg Int. One-stage reconstruction of deep facial defects with a single layer dermal regeneration template. J EurAcadDermatolVenereol. Single-layer Integra for one-stage reconstruction of scalp defects with exposed bone following full-thickness burn injury: A novel technique.
Arch Orthop Trauma Surg. The use of dermal substitutes in burn surgery: Acute phase. Wound Repair Regen. New approach to the treatment of complex injuries: The use of dermal regeneration matrix. Rev Bras Queim. Plast Reconstr Surg Glob Open. Eur Cell Mater. Hemiatrofia Facial de Romberg- Relato de Caso. Soft-tissue reconstruction of the face: A comparison of dermal-fat grafting and vascularized tissue transfer.
Correction of hemifacial atrophy with autologous fat transplantation. Parry-Romberg reconstruction: Beneficial results despite poorer fat take. Therapeutic appro therapeutic approach to the Parry-Romberg Syndrome based on a severity grading system.
Hemiatrofia facial progresiva (Síndrome de Parry-Romberg): a propósito de dos casos
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. La hemiatrofia facial progresiva HFP o sindrome de Parry-Romberg es una entidad poco frecuente que se caracteriza por atrofia e hiperpigmentacion de la dermis con compromiso unilateral de la cara. La baja incidencia de esta patologia nos motivo a la presentacion, estudio y busqueda bibliografica de esta entidad clinica. View PDF.
Hemiatrofia facial progresiva. Síndrome de Parry-Romberg
2015, Número 1