Background: When maxillary transversal expansion is needed, two protocols of treatment can be used: a maxillary orthodontic expansion followed by a classical bimaxillary osteotomy or a bimaxillary osteotomy with maxillary segmentation. The aim of this study was to assess the accuracy of segmented Le Fort I osteotomy using computer-aided orthognathic surgery and patient-specific titanium plates in patients who underwent a bimaxillary osteotomy for occlusal trouble with maxillary transversal insufficiencies. Methods: A virtual simulation of a Le Fort I osteotomy with maxillary segmentation, a sagittal split ramus osteotomy, and genioplasty (if needed) was conducted on a preoperative three-dimensional (3D) model of each patient’s skull using ProPlan CMF 3.0 software (Materialise, Leuven, Belgium). Computer-assisted osteotomy saw-and-drill guides and patient-specific implants (PSIs, titanium plates) were produced and used during the surgery. We chose to focus on the maxillary repositioning accuracy by comparing the preoperative virtual surgical planning and the postoperative 3D outcome skulls using surface superimpositions and 13 standard dental and bone landmarks. Errors between these preoperative and postoperative landmarks were calculated and compared to discover if segmental maxillary repositioning using PSIs was accurate enough to be safely used to treat transversal insufficiencies. Results: A total of 22 consecutive patients—15 females and 7 males, with a mean age of 27.4 years—who underwent bimaxillary computer-assisted orthognathic surgery with maxillary segmentation were enrolled in the study. All patients presented with occlusion trouble, 13 with Class III malocclusions (59%) and 9 (41%) with Class II malocclusions. A quantitative analysis revealed that, overall, the mean absolute discrepancies for the x-axis (transversal dimension), y-axis (anterior–posterior dimensions), and z-axis (vertical dimension) were 0.59 mm, 0.74 mm, and 0.56 mm, respectively. The total error rate of maxillary repositioning was 0.62 mm between the postoperative cone-beam computed tomography (CBCT) and the preoperatively planned 3D skull. According to the literature, precision in maxilla repositioning is defined by an error rate (clinically relevant) at each landmark of <2 mm and a total error of <2 mm for each patient. Conclusions: A high degree of accuracy between the virtual plan and the postoperative result was observed.

(1) Background: Accurate knowledge of the dynamic anatomy of facial muscles is crucial for the use of functional and aesthetic botulinum toxin injections. We studied the reliability and relevance of facial painting as a pedagogic tool for the dynamic anatomy of facial muscles. (2) Methods: Different facial expressions were performed by a female model after a professional makeup artist applied makeup to the various facial muscles on her left hemiface. A 3D photograph was taken at the beginning and end of each movement using the VECTRA H2 Imaging System device. Cutaneous movements were visualized using displacement vectors. The correlation between the theoretical and dynamic positions of the makeup–muscle was assessed by two facial anatomy experts, thanks to a correlation scale. (3) Results: The overall average score for the 11 analyzed muscles or muscle groups was 3.36 out of 4, indicating a “strong” to “very strong” estimated correlation. There was a moderate agreement between Evaluator 1 and Evaluator 2 (ICC: 0.64; 95%CI: [0.244; 0.852]; p-value: 0.005). (4) Conclusions: The educational model with facial makeup provides an indirect but nonetheless precise and reliable representation of all facial muscles on the skin’s surface. It is presented as a reliable and reproducible method, which exhibits great potential as a teaching tool.

Background/Objectives: Facial palsy causes both functional and aesthetic impairments, with asymmetry significantly affecting quality of life. Botulinum toxin injections are increasingly used to restore facial balance by reducing contralateral hyperactivity, but outcome assessments remain largely subjective. The objective of this study was to evaluate the ability of three-dimensional (3D) stereophotogrammetry coupled with root mean square (RMS) surface analysis to objectively quantify improvements in facial symmetry following botulinum toxin treatment and to support clinicians in patient care. Methods: Sixteen adults with long-standing unilateral peripheral facial palsy underwent individualized botulinum toxin injections. Three-dimensional images were acquired using the Vectra H2 system before and 2–3 weeks after injection at peak efficacy. Five facial expressions (neutral, surprise, frown, Mona Lisa smile, and forced smile) were analyzed. RMS values were calculated for the whole face and facial thirds. Clinical assessment included House–Brackmann and Sunnybrook scores. Results: Whole-face RMS values decreased significantly after injection (1.51 ± 0.42 vs. 1.35 ± 0.43, p < 0.001). Improvements were observed across all thirds, most notably in the middle third. During expression, symmetry improved for all movements, with the strongest effects for surprise (d = 1.270), Mona Lisa smile (d = 0.870), and frown (d = 0.832). Conclusions: Three-dimensional stereophotogrammetry with RMS analysis provides an objective and reproducible method to quantify changes in facial symmetry after botulinum toxin treatment. This technique may complement clinical scoring systems and support personalized treatment planning in facial palsy patients.

Knowledge of facial anatomy and ageing is essential for safe fillers and botulinum toxin injection procedures with effective aesthetic results. Open book dissection is a reliable and reproducible method of teaching anatomy. It is a visual pedagogical approach based on the layered anatomy of the face. It combines on one hemiface, a dissection of the skin, the superficial fat compartment, the superficial musculo-aponeurotic system and the deep fat compartment and on the contralateral hemiface, a comparative injection demonstration. The ageing processes and the targets of corrective injection are demonstrated. Clinical applications regarding injection sites, their position with skin markers, depth and risk are justified and better visualized.