Unilateral peripheral facial nerve palsy jeopardizes quality of life, rendering psychological consequences such as low self-esteem, social isolation, anxiety, and depression. Among therapeutical approaches, use of Botulinum toxin type A (BoNT-A) on the nonparalyzed side has shown promising results and improvement of quality of life. Nevertheless, the correct technique is paramount, since over-injection of the muscles can result in lack of function, leading to a \"paralyzed\" appearance, and even worse, functional incompetence, which may cause greater distress to patients. Therefore, the objective of this article is to provide a practical guideline for botulinum toxin use in facial palsy. To this aim, adequate patient assessment, BoNT-A choice, injection plan and dosage, and injection techniques are covered.

This article will describe facial asymmetry secondary to facial nerve paralysis (FNP), and review current concepts, guidelines, and future trends. Despite the increasing use of botulinum toxin (BoNTA) in treating FNP, ideal dosage, timing, and additional therapies are not unequivocally established. Facial asymmetry significantly impacts quality of life (QOL) by strongly affecting self-perception and social interactions; injectables may mediate great clinical improvement. This article provides practical guidelines for the use of BoNTA and provides schemes for accurate assessment and documentation. A systematic, stepwise approach is recommended with methodical assessment, meticulous placement, conservative dosage, and careful follow-up. Future trends include the potential use of newly developed toxins, muscle modification with fillers, improved imaging techniques, and targeted QOL studies. Hopefully, a growing number of aesthetic injectors may become technically proficient and join multidisciplinary teams for managing FNP.

Temporomandibular joint (TMJ) ankylosis with secondary dentofacial deformities in adult patients is a severely disfiguring condition and surgical treatment of this disease remains a great clinical challenge. Treatment goals are to restore the joint function, to improve facial appearances and to correct malocclusion, as well as to re-establishing harmony among them. Currently, various surgical techniques, such as arthroplasty with or without interpositional material, orthognathic surgery, distraction osteogenesis, autologous bone or bone replacement materials graft and plastic surgery, have been described in the literature. In most cases these techniques should be used in combination to achieve satisfactory outcomes. The biggest difficulty for most clinicians is to determine the proper sequence of these procedures because no uniform treatment protocol has been established. Based on the published literature and our own clinical experiences, we have prepared this review article to provide some guidelines for the surgical management of TMJ ankylosis with dentofacial deformities in adults, which will be modified and updated periodically to provide the best treatment options to benefit our patients.

TMJ fractures must be focused not only as a cause of direct damage to osseous structures, but also of future disturbances of dentofacial development. Treatment is aimed at restoring normal joint function, occlusion and symmetry. Any disturbance of condylar cartilage will result in alteration of mandibular development. The subsequent deformity of jaw and face will depend not only on the type, intensity extent and chronology of the noxious agent, but also on the particular time of occurrence and growth activity. Thus the effect will be more decided if the disturbance occurs early in life, during childhood, when growth activity is greater and mandibular shape and size have not been assumed yet. This report will include basic information on both prevention and first aid in these types of injuries. The correct application of these precautions immediately following the trauma should improve the short and long-term outcome. Information on diagnosis and treatment of lesions of the bone and soft tissues, which may coexist with dental trauma, a critical first step in the overall management of traumatized patients, will be given. Follow-up procedures of these patients will be illustrated. The guidelines described in this paper for the treatment of traumatic TMJ fractures in children and youths are based on our clinical experience. They are intended as an aid to practioners in the management and treatment of these traumas, by professional must always use professional judgement. There are no guarantees of any positive results associated with the use of these guidelines, although it is felt that time and proper treatment will maximize the chances of success.

Repair of the twisted nose presents a challenge, as often functional problems as well as aesthetic deformities must be addressed. Traditional correction of the deviated nose involves septal correction, separation of both upper lateral cartilages from the septum and bony pyramid manipulation after osteotomies. Nowadays autogenous cartilage grafts are being used for repositioning, reinforcement, recontouring and reconstruction of virtually every component of the nasal skeleton. These restructuring techniques follow the modern principles mentioned above and may well be applied to the deviated asymmetric nose. The grafting manoeuvres increase the stability of the realigned cartilaginous nasal framework, including the nasal septum, but may also be used for camouflaging purposes. The large number of possible individual anatomic variations including facial asymmetry does call for a systematic approach based on succinct individualised analysis.

A concensus conference on the timing of facial osteotomies was held in Jönköping, Sweden. Seven teams consisting of a maxillofacial surgeon and an orthodontist representing five countries discussed treatment planning for young patients with maxillomandibular deformities with special emphasis on timing. Patients with severe syndromic facial deformities were not considered. Consensus was reached that for most deformities it is best advised to wait until growth has ceased, as determined by longitudinal cephalometric data. This rule is less tight for Angle Class II than for Class III cases. For asymmetries often there is still not enough scientific evidence to obtain well-founded uniform agreement.