Botulinum toxin (BTX) has revolutionized both aesthetic and therapeutic medicine by selectively inhibiting acetylcholine release at the neuromuscular junction, inducing localized muscle relaxation. However, its use can be associated with various complications. As a diagnostic modality, high-resolution ultrasound can better characterize these complications. Here, we present four clinical cases of complications associated with the application of BTX, along with their corresponding ultrasonographic findings. In this study, cases were selected randomly, irrespective of the timing of BTX injections, to illustrate a spectrum of complications observed in clinical practice. Despite its benefits, BTX can have adverse effects ranging from mild to severe, including aesthetic and functional complications, such as hematoma, ptosis, facial asymmetry, nodules, or pseudoaneurysm. High-resolution ultrasound emerges as a crucial tool in the multidisciplinary management of these complications, allowing for accurate evaluation and effective therapeutic guidance.

Unknown in origin, Bell\'s palsy is a common acute facial nerve paralysis that is usually characterized by unilateral facial weakening or paralysis. People of all ages are affected by this illness, which peaks in the fourth decade of life. Although the precise etiology is yet unknown, viral infections - particularly type 1 herpes simplex virus - are frequently linked to the problem. Based on the evidence of abrupt onset facial weakness and the elimination of other neurological diseases, the diagnosis is essentially clinical. The goals of management techniques are to lessen related symptoms, encourage nerve regeneration, and lessen inflammation. Corticosteroids, antiviral drugs, physical therapy, and supportive measures are available as treatment alternatives. The majority of patients experience spontaneous recovery within weeks to months, and the prognosis is generally excellent. Nonetheless, a portion may experience long-term consequences, highlighting the significance of individualized follow-up care. Bell\'s palsy is succinctly summarized in this abstract to aid in better comprehension and well-informed clinical practice decision-making.

Ankylosis of the temporomandibular joint (TMJ) is a pathological condition of the joint. The disease manifests as a limitation to total failure of movement of the TMJ, usually following trauma or surgery or due to local infection. The condition may result in difficulty masticating, speaking, structure of the mouth, face, or jaw, and maintaining oral hygiene to a significant degree. A computed tomography (CT) scan is the best method of evaluating the bony anatomy of the TMJ. The present report shows the surgical correction of the TMJ ankylosis. A 23-year-old female attended the hospital, showing severe mouth opening limitation (9 mm). On investigations, left TMJ ankylosis was diagnosed. The surgical approach consisted of distraction osteogenesis of the left side, followed by vigorous physiotherapy. In patients with TMJ ankylosis, restoration of normal function and jaw movement is difficult. This case report highlights the importance of physiotherapy as an emerging adjuvant therapy in the treatment of TMJ ankylosis. There have also been several treatment methods used to improve the patient\'s self-esteem and confidence, including speech therapy and psychological counseling.

the aim of this paper, is to propose a new reference line: the Frontozygomatic-Infraorbital Line (FZ-IOL). This reference line can guide the surgical team planning mandibular angle harmonization, based on the patient\'s skeletal proportion. The Frontozygomatic-Infraorbital Line has been adopted for symmetrization surgery, masculinization surgery, and in unsatisfactory results of previous orthognathic surgery. From March 2021 to December 2022, 3 patients were treated for severe facial asymmetry affecting mainly the lower third of the face. All cases were planned with the reference FZ-IOL. Patients were treated in the same center, at the Orthognathic Surgery Department of the Instituto Portugues da Face, Lisbon, Portugal. The Frontozygomatic-Infraorbital Line is designed virtually using software to reconstruct a 3D image from a digital imaging and communications in medicine (DICOM) file obtained from a cone beam computer tomography (CBCT). , connecting the two orbital rims. Then, a vertical line, the frontozygomatic line perpendicular to the IOL and passing through the outmost lateral portion of the frontozygomatic suture is drawn. The proposed line demonstrated how establishing appropriate reference lines is crucial for the success of the surgery. The selection of reference lines should be based on the patient\'s anatomy, the symmetrization process\'s complexity, and the surgery\'s desired outcome. The Frontozygomatic-Infraorbital Line represents an adequate reference line for managing mandibular angle lateral projection, improving lower third of the face symmetrization.

Mandibular condyle aplasia and temporomandibular joint (TMJ) ankylosis represent complex challenges in diagnosis and management, affecting jaw function and facial aesthetics. This case report presents a five-year-old female child with a right-sided small jaw and facial asymmetry due to left-sided TMJ ankylosis. The coexistence of mandibular condyle aplasia and TMJ ankylosis underscores the need for comprehensive evaluation and tailored treatment approaches. Syndromic associations, such as Goldenhar syndrome and Treacher Collins syndrome, further complicate diagnosis and management. Surgical intervention involving left-side gap arthroplasty and reconstruction using a costochondral graft/temporalis fascia was performed under general anesthesia. However, postoperative complications, including decreased mouth opening and left-sided lower motor neuron facial palsy, necessitated further surgical debridement and drainage of an abscess. The case emphasizes the importance of a multidisciplinary approach in addressing complex craniofacial anomalies, with treatment strategies such as bone grafting and tailored surgical interventions offering promising outcomes. Understanding the multifaceted etiology of mandibular condyle aplasia and TMJ ankylosis is crucial for optimal management, highlighting the collaborative efforts required for achieving favorable patient outcomes.

Combined vascular malformation affecting the facial region is an extremely rare clinical entity that is debilitating both functionally and emotionally. Treatment warrants a multidisciplinary approach with the aim of removing the vascular anomalies and ameliorating any functional facial disfigurement. Here, we present a case of a 40-year-old female with combined vascular malformation of the face who was treated successfully with surgical intervention accompanying significant resolution of facial disfigurement.

OBJECTIVE: The study aimed (1) to evaluate the site and severity of facial asymmetry in Class III patients before and after bimaxillary surgery, and (2) to identify the influence of initial severity and positional jaw asymmetry on residual facial asymmetry.
METHODS: Preoperative and postoperative cone-beam computed tomography of 65 patients with Class III facial asymmetry who underwent bimaxillary surgery were evaluated. Five midline and 14 paramedian facial soft tissue landmarks were identified to assess facial asymmetry. The outcomes were compared to a control group consisting of 30 age- and gender-matched Class I subjects. The postoperative positional jaw asymmetry (i.e., shift, roll, yaw) of each osteotomy segment (maxilla, mandible, chin, ramus) was also measured.
RESULTS: Before surgery, the asymmetry was more severe at the chin, middle and lower contour. Bimaxillary surgery effectively corrected facial asymmetry, particularly in achieving normalization of chin deviation. However, significant asymmetry persisted postoperatively in the middle and lower contour (p < 0.001 and p < 0.01, respectively), which was affected by the positional ramus asymmetry in the roll and shift.
CONCLUSIONS: Deviation of the chin, middle and lower contour contributed significantly to overall facial asymmetry in Class III asymmetry. Despite normalization of the chin deviation after bimaxillary surgery, asymmetry persisted at the middle and lower contour, primarily as the result of insufficient correction of the positional ramus asymmetry.
CONCLUSIONS: Understanding the residual asymmetry after bimaxillary surgery is important for minimizing deviation and optimizing the surgical planning for its correction.

Odontogenic space infections are common in dental practice, characterized by localized abscess formation with potential to spread to adjacent anatomical spaces. Neurogenic involvement in odontogenic infections is primarily found to be associated with sensory nerve branches, however involvement of motor nerves in odontogenic space infection leading to facial asymmetry has not been widely reported. In this case report, the authors present an unusual finding of facial asymmetry due to isolated marginal mandibular nerve weakness in a patient with a submandibular space infection.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s12663-023-02019-x.

Parry-Romberg syndrome (PRS) is a rare neurocutaneous and craniofacial disorder characterized by progressive hemifacial wasting and atrophy that predominantly affects children and young adults, with an estimated prevalence of 1 in 700,000 individuals. Despite its rarity, PRS poses significant challenges for patients, their families, and healthcare providers due to its unpredictable course and potential functional and aesthetic impairments. The main aim is to provide a comprehensive overview of PRS, encompassing its clinical features, pathogenesis, and management techniques. We present a case of PRS in a 9-year-old female with pronounced facial asymmetry, with marked wasting and atrophy involving the entire right side of the face. CT scan revealed right sided hypoplasia of maxilla, mandible, and zygomatic arch with enophthalmos of right eye. MRI showed right temporalis, medial and lateral pterygoid, masseter, risorius, buccinator, zygomaticus major and minor, levator labii superioris, levatorangulioris and orbicularis oris muscles atrophy. The clinical presentation of PRS typically involves progressive facial atrophy, predominantly affecting the subcutaneous tissues, muscles and bones. Patients may experience various symptoms as the condition advances, including facial asymmetry, hemifacial pain, dental and ocular abnormalities and neurological manifestations. The exact etiology of PRS remains unknown, although autoimmune, genetic and vascular factors are likely contributors. Treatment of PRS needs a multidisciplinary approach involving dermatologists, plastic surgeons, neurologists, ophthalmologists, and dental specialists. Treatment options aim to alleviate symptoms, improve function and address cosmetic concerns. Surgical interventions such as autologous fat grafting, facial reconstructive procedures and orthognathic surgery have restored facial symmetry and function. Additionally, nonsurgical modalities, including botulinum toxin injections, prosthetic devices and dental interventions, may offer symptomatic relief and enhance overall quality of life.

本文报道1例单侧髁突肥大高位切除术后开(牙合)病例的无托槽隐形矫治过程，以颏部正中与面中线对齐建立初始咬合，于种植体支抗辅助下去除(牙合)干扰后，成功解决患者自然头位下的颏部偏斜及前牙开(牙合)问题，获得患者满意的矫治效果。.