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Facial asymmetry is defined as a bilateral difference between facial components. Correction, often desired by the patient, can be performed with the aim of bone born patient-specific solid implants designed using 3D CAD software. This treatment is embedded in the daily practice of today's healthcare. However, an analysis of the implant's accuracy of placement has not been reported. This case series describes the accuracy analysis of bone born aesthetic facial implants manufactured out of polyether-ether-ketone (PEEK). The accuracy analysis was based on postoperative (cone beam) computed tomography ((CB)CT) data and preoperative 3D planning. The analysis showed a median entry point error of 0.7 mm (min: 0.1, max: 3.3, interquartile range: 0.78). The median maximal orientation error was 5.5° (min: 0.1, max: 36.8, interquartile range: 7.13). Both parameters showed an excellent intraobserver and interobserver agreement with an ICC above 0.84. The described cases show that the analysis method is an objective approach for determining the accuracy of PSI placement and indicates that these implants can be placed accurately on the osseous face. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the 1-year skeletal stability of the osteotomized maxilla after Le Fort I surgery, comparing conventional osteosynthesis with patient-specific osteosynthesis. Patients were assigned to a conventional or patient-specific osteosynthesis group using prospective randomization. The primary outcome was the three-dimensional change in postoperative skeletal position of the maxilla between the 2-week and 1-year follow-up cone beam computed tomography scans. Fifty-eight patients completed the protocol for the 2-week postoperative analysis, and 27 patients completed the 1-year follow-up study protocol. Of the 27 patients completing the entire protocol, 13 were in the conventional group and 14 in the patient-specific osteosynthesis group. The three-dimensional translation analysis showed that the use of the patient-specific osteosynthesis resulted in a skeletally stable result, comparable to that of conventional miniplate fixation. For both the patient-specific osteosynthesis and conventional miniplate fixation groups, median translations of less than 1 mm and median rotations of less than 1° were observed, indicating that both methods of fixation resulted in a stable result for the 27 patients examined. For the Le Fort I osteotomy, the choice between patient-specific osteosynthesis and conventional osteosynthesis did not affect the postoperative skeletal stability after 1 year of follow-up. [ABSTRACT FROM AUTHOR]

It is not yet established whether additional orbicularis oculi muscle excision leads to better patient-reported aesthetic outcomes (PRO) compared to a skin-only resection blepharoplasty. A double-blind randomized controlled trial of upper blepharoplasty, with or without muscle excision, was performed on 54 White European patients who assessed the procedure via PRO. FACE-Q questionnaires covering eyes in general, upper eyelids, forehead and eyebrows, overall face, age appearance appraisal, age appraisal, social functioning, satisfaction with the outcome, and adverse effects were completed preoperatively and at 6 and 12 months after upper blepharoplasty. The Patient and Observer Scar Assessment Scale was used to assess scarring. The FACE-Q scores for skin-only and skin/muscle upper blepharoplasty were similar regarding the upper eyelids, forehead and eyebrows, overall face, patient perceived aging and age, social functioning, and satisfaction with the results, and also increased for both procedures with time. The FACE-Q score regarding the eyes in general was higher in the skin-only group at the 12-month follow-up. Scarring and adverse effects did not differ between the groups. Additional muscle resection does not seem to influence patient satisfaction. Thus, when performing an upper blepharoplasty, there is no need for additional muscle resection as a routine procedure to improve patient satisfaction. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to investigate grafting in the osteotomy gap during bilateral sagittal split osteotomy (BSSO), using a xenograft and fibrin glue. Hard tissue defects in the inferior mandibular border were assessed using cone beam computed tomography scans taken 1 week and 1 year postoperatively. The study group of 20 patients underwent bone grafting during BSSO (mean age 26.1 years; mean horizontal displacement 8.5 mm) and the control group of 20 patients did not (mean age 30.2 years; mean horizontal displacement 7.6 mm). The mean height of the mandibular defects was significantly lower in the study group, but there was no significant difference in volume measurements between the groups. Grafting had a negligible effect on large displacements (9.0–15.0 mm), which might have been due to an inadequate amount and/or positioning of the graft, or to poor dimensional stability. This may be resolved by improved graft positioning or by using a different kind of (xeno)graft. [ABSTRACT FROM AUTHOR]

Although upper blepharoplasty is a common cosmetic surgical intervention, a better scientific understanding of the aesthetic results and the preferred surgical technique to achieve the best aesthetic results is still needed. A systematic search using four search engines (PubMed, Embase, CINAHL, and Cochrane) was performed to identify any study on the aesthetic outcome of a solitary upper blepharoplasty; these were subjected to quality assessment for possible inclusion. Eligible studies were randomized controlled trials, controlled trials, cohort studies, and case series (n ≥ 10). A total of 4043 studies were assessed, of which 26 were included. Aesthetic outcomes included patient-reported outcome measures, scarring, eyebrow height, tarsal platform show, and panel or expert evaluation. Meta-analysis was not possible. Patients were generally satisfied with the aesthetic result and scar formation after an upper blepharoplasty. The amount of tarsal platform show increases, which positively affects the aesthetics. The eyebrow seems to move down slightly. The surgical technique used (skin only or skin/muscle removal) did not influence patient satisfaction or the physician-assessed aesthetic outcomes. Patients are generally satisfied after an upper blepharoplasty. The optimal design of the skin excision is still a matter of debate, especially when addressing lateral hooding. Further objective research is advised. [ABSTRACT FROM AUTHOR]

The accuracy of orthognathic surgery has improved with three-dimensional virtual planning. The translation of the planning to the surgical result is reported to vary by >2 mm. The aim of this randomized controlled multi-centre trial was to determine whether the use of splintless patient-specific osteosynthesis can improve the accuracy of maxillary translation. Patients requiring a Le Fort I osteotomy were included in the trial. The intervention group was treated using patient-specific osteosynthesis and the control group with conventional osteosynthesis and splint-based positioning. Fifty-eight patients completed the study protocol, 27 in the patient-specific osteosynthesis group and 31 in the control group. The per protocol median anteroposterior deviation was found to be 1.05 mm (interquartile range (IQR) 0.45–2.72 mm) in the patient-specific osteosynthesis group and 1.74 mm (IQR 1.02–3.02 mm) in the control group. The cranial–caudal deviation was 0.87 mm (IQR 0.49–1.44 mm) and 0.98 mm (IQR 0.28–2.10 mm), respectively, whereas the left–right translation deviation was 0.46 mm (IQR 0.19–0.96 mm) in the patient-specific osteosynthesis group and 1.07 mm (IQR 0.62–1.55 mm) in the control group. The splintless patient-specific osteosynthesis method improves the accuracy of maxillary translations in orthognathic surgery and is clinically relevant for planned anteroposterior translations of more than 3.70 mm. [ABSTRACT FROM AUTHOR]

Abstract Objective Various functional outcomes after upper blepharoplasty are reported in the literature. We systematically reviewed the literature to assess the objective and subjective functional effects of upper blepharoplasty. Methods After a systematic search of four search engines (Pubmed, Embase, Cinahl and Cochraine), any study on objective and subjective (patient reported) functional outcome after upper blepharoplasty was subjected to a quality assessment for possible inclusion in the review. The intervention was defined as a solitary surgical upper blepharoplasty containing the removal of skin, with or without the removal of a strip of orbicularis oculi muscle and/or upper orbital fat. Eligible studies were randomized controlled trials, controlled trials, cohort studies and case series (n ≥ 10). Results A total of 3525 studies were assessed, of which 28 studies were included in this systematic review. Favorable outcomes after an upper blepharoplasty were reported and included enlarged visual field, enhanced quality of life related to fewer headaches and improved vision. Furthermore, sensitivity of the eyelids decreased, with differences in recovery. Outcomes for eyebrow height, astigmatism, contrast sensitivity and eyelid kinematics were not consistent between the studies. No meta-analysis could be performed due to the limited scope of included studies and the great variety in outcomes and blepharoplasty techniques. Conclusions Upper blepharoplasty is accompanied by a great variety of beneficial functional outcomes including an increased visual field and improvement in headache- and vision-related quality of life. Further research is needed, especially where results are conflicting (effects on eye dryness and eyebrow height) and/or the data are limited (contrast sensitivity, astigmatism). [ABSTRACT FROM AUTHOR]

To analyse the accuracy of maxillary positioning after Le Fort I osteotomy, we retrospectively assessed the outcome in three patients (mean (range) age 40 (21 – 60) years) who had been treated with patient-specific CAD-CAM osteosynthesis plates as part of a bimaxillary osteotomy. Virtual surgical planning in each case was based on cone-beam computed tomography (CT) (Simplant® O&O, Dentsply Implants NV, Kessel-Lo, Belgium), and patient-specific CAD-CAM drilling guides and osteosynthesis plates were produced for maxillary positioning and fixation. We evaluated the accuracy of the placement by virtual comparison of the preoperative and postoperative images. In the upper dentition, postoperative analysis showed a mean (SD) deviation of 1.3 (1.4) mm from the preoperative plan. The method enables accurate placement of the maxilla, independent of the condyle or mandible, without the need for extraoral reference points. [ABSTRACT FROM AUTHOR]

Several surgical techniques based on corticotomy and dental distraction have been developed to improve the movement of teeth and reduce the duration of orthodontic treatment. In this systematic review we have critically assessed published studies on the experimental movement of teeth to find out whether operations such as corticotomy and dental distraction osteogenesis increase the rate of movement, and to find out which biological mechanisms are engaged during surgically facilitated orthodontics, and which complications may be seen. We searched PubMed and Embase for publications until January 2014 and screened the titles and abstracts. Articles that met the inclusion criteria were retrieved in full and assessed independently by 2 of the authors. A total of 22 studies were included, and corticotomy and distraction techniques were the main surgical methods. Generally, all studies reported that movement of teeth was faster after operation than with conventional orthodontics. The peak velocity was always at an early postoperative stage regardless of the surgical technique used. Immunohistological data showed simultaneous regional increases in catabolic and anabolic activity. Histomorphometric data showed more direct resorption of bone and less hyalinisation after operation, and a reduced bone volume density around the surgical site. When present, complications such as root resorption or periodontal problems were minimal. Current experimental animal studies show that procedures such as corticotomy and dental distraction can accelerate the movement of teeth without severe complications because of the regional increase in catabolic and anabolic remodelling. [ABSTRACT FROM AUTHOR]

Biodegradable fixation systems could reduce or eliminate the problems associated with removal of titanium plates. A multicenter randomised controlled trial (RCT) was performed in the Netherlands from December 2006-July 2009, and originally 230 injured and orthognathic patients were included. The patients were randomly assigned to either a titanium control group (KLS Martin) or to a biodegradable test group (Inion CPS). The aim of the present study was to compare the long-term skeletal stability of advancement bilateral sagittal split osteotomies (BSSO) of a biodegradable system and a titanium system. Only patients from the original RCT who were at least 18 years old and who had a BSSO advancement osteotomy were included. Those who had simultaneous Le Fort I osteotomy or genioplasty were excluded. Analysis of skeletal stability was made by digital tracing of lateral cephalograms. Long-term skeletal stability in BSSO advancement did not differ significantly between patients treated with biodegradable plates and screws and those treated with titanium plates and screws. Given the comparable amount of relapse, the general use of Inion CPS in the treatment of BSSO advancement should not be discouraged. On the basis of other properties a total picture of the clinical use can be obtained; the short-term stability, the intraoperative switches, the number of plates removed and cost-effectiveness. Trial registration of original RCT: http://www.controlled-trials.com; ISRCTN 44212338. [ABSTRACT FROM AUTHOR]

Abstract: Accumulating evidence suggests involvement of the endocannabinoid system in the pathophysiology of schizophrenia, which signifies a potential application for this system in the treatment of this disorder. However, before new research can focus on potential treatments that work by manipulating the endocannabinoid system, it needs to be elucidated how this system is involved in symptoms of schizophrenia. Here we review human studies that investigated acute effects of cannabis or ∆9-tetrahydrocannabinol (THC) on brain functions that are implicated in schizophrenia. Results suggest that the impact of THC administration depends on the difficulty of the task performed. Impaired performance of cognitive paradigms is reported on more challenging tasks, which is associated with both activity deficits in temporal and prefrontal areas and a failure to deactivate regions of the default mode network. Comparable reductions in prefrontal activity and impairments in deactivation of the default mode network are seen in patients during performance of cognitive paradigms. Normal performance levels after THC administration demonstrated for less demanding tasks are shown to be related to either increased neural effort in task-specific regions (‘neurophysiological inefficiency’), or recruitment of alternative brain areas, which suggests a change in strategy to meet cognitive demands. Particularly a pattern of performance and brain activity corresponding with an inefficient working memory system is consistently demonstrated in patients. These similarities in brain function between intoxicated healthy volunteers and schizophrenia patients provide an argument for a role of the endocannabinoid system in symptoms of schizophrenia, and further emphasize this system as a potential novel target for treatment of these symptoms. [Copyright &y& Elsevier]

Abstract: In a recent RCT comparing biodegradable (Inion CPS) with titanium (KLS Martin) plates and screws for fixation of osteotomies or fractures, we found that in 21% of the cases the surgeon decided intra-operatively to switch from biodegradable to titanium. The aim of the current retrospective cohort study was to analyse the reasons for these switches in order to find predictor variables that may be helpful in the decision to use biodegradable devices or not. The surgeons' opinion about the biodegradable system, and if there was a learning curve in the application of the biodegradable system were also investigated. All variables were assessed during the original RCT by using a questionnaire that was completed by the OMF surgeon directly post-operatively. For the outcome variable “surgeons' opinion” a separate questionnaire was used. Regarding the predictor variables a mandibular fracture had a higher risk of switching compared to a BSSO. However, looking at the reasons for these switches no firm conclusions can be drawn. There was a subjective learning curve to acquire the application-skills for the biodegradable system. There were no changes in isolated Le-Fort-I osteotomies despite the fact that the biodegradable system seems more difficult to apply in the midface. Inadequate stability was the main reason for switching. This can be material-related, or related to inexperience with or lack of confidence in the system, or impatience of the surgeon. A learning curve and personal preferences probably play an important role in the decision to switch. We think that with more patience and more experience it should be possible to increase both user comfort and confidence in the biodegradable system of Inion CPS, which likely will decrease the number of intra-operative switches. [Copyright &y& Elsevier]

Background: Evidence indicates involvement of the endocannabinoid (eCB) system in both the pathophysiology of schizophrenia and working memory (WM) function. Additionally, schizophrenia patients exhibit relatively strong WM deficits. These findings suggest the possibility that the eCB system is also involved in WM deficits in schizophrenia. In the present study, we examined if perturbation of the eCB system can induce abnormal WM activity in healthy subjects. Methods: A pharmacological functional magnetic resonance imaging study was conducted with a placebo-controlled, cross-over design, investigating effects of the eCB agonist Δ9-tetrahydrocannabinol on WM function in 17 healthy volunteers, by means of a parametric Sternberg item-recognition paradigm with five difficulty levels. Results: Performance accuracy was significantly reduced after Δ9-tetrahydrocannabinol. In the placebo condition, brain activity increased linearly with rising WM load. Δ9-Tetrahydrocannabinol administration enhanced activity for low WM loads and reduced the linear relationship between WM load and activity in the WM system as a whole and in left dorsolateral prefrontal cortex, inferior temporal gyrus, inferior parietal gyrus, and cerebellum in particular. Conclusions: Δ9-Tetrahydrocannabinol enhanced WM activity network-wide for low loads, while reducing the load-dependent response for increasing WM loads. These results indicate that a challenged eCB system can induce both abnormal WM activity and WM performance deficits and provide an argument for the possibility of eCB involvement in WM deficits in schizophrenia. [ABSTRACT FROM AUTHOR]

Abstract: Over the past decade, facial cosmetic procedures have become more commonplace in dentistry and oral and maxillofacial surgery. An increasing number of patients seek minimal invasive procedures. One of the most requested procedures is treatment with botulinum toxin type A (BoNTA). Treatment of dynamic rhytids and lines with BoNTA is effective and produces high rates of improvement with rapid onset and long duration of action (longer than 4 months for some patients) compared with placebo. This paper considers the history and pharmacology of this neurotoxin, and focusses on the literature concerning the treatment of different facial areas with BoNTA. It also presents clinical guidelines on the treatment of glabellar lines, the frontalis muscle, peri-orbital lines, gummy smile and masseter muscle hypertrophy. Knowledge about the mechanisms of action and the ability to use BoNTA as an adjunctive treatment are mandatory for those working in the field of cosmetic facial surgery. [Copyright &y& Elsevier]

Abstract: Neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) is the most common complication after bilateral sagittal split osteotomy (BSSO) and distraction osteogenesis (DO) of the retrognathic mandible. It is suggested that the risk is lower after DO than after BSSO. This retrospective study compared both techniques with regard to long-lasting NSD and overall patient satisfaction. 91 patients (representing 182 IANs) were included, they completed a questionnaire and underwent an objective neurosensory test. In the BSSO-group (90 nerves), long-lasting NSD was reported in 27 cases (30%) versus 21 cases (23%) in the DO group (92 nerves). In 39 cases (24 BSSO, 15 DO) the long-lasting NSD was reported in the lower lip, the chin or both. Of these cases, 9 (5 BSSO, 4 DO) were objectively tested positive. The overall prevalence was 8% in the BSSO group and 10% in the DO group. There was no significant difference in subjectively reported and objectively measured NSD between the groups. In this study patients seemed to over-report the NSD compared with the objective findings. For both procedures, overall patient satisfaction was high. [Copyright &y& Elsevier]

Abstract: The aim of this study was to evaluate satisfaction with treatment among cleft lip and palate patients who underwent maxillary advancement using a rigid external distraction (RED) device. Nine patients (four boys, five girls), mean age 17.7 years (SD 4.0), were included in the study. Outcome measures included satisfaction with facial appearance and function (sensitivity/pain, discomfort during daily functioning, daily activities, speech, eating and/or drinking, expression of affection) before, during and after treatment with the RED device assessed by a self-administered questionnaire. Before treatment, the majority of patients were not satisfied with their facial appearance. Some received negative remarks about their appearance and experienced minor functional problems. Dissatisfaction with appearance, negative remarks and functional problems increased significantly during active treatment, and the majority of patients experienced pain or sensitivity. After treatment all patients but one were satisfied with their appearance and level of function. Overall patient satisfaction after treatment with a RED device is high, but the active treatment period, during which the frame is worn, significantly compromises function and may be painful. For most patients, satisfaction with the final result and appearance outweighs the negative factors they reported. [Copyright &y& Elsevier]

Abstract: Bilateral sagittal split osteotomy (BSSO) and distraction osteogenesis (DO) are the most common techniques currently applied to surgically correct mandibular retrognathia. It is the responsibility of the maxillofacial surgeon to determine the optimal treatment option in each individual case. The aim of this study was to review the literature on BSSO and mandibular DO with emphasis on the influence of age and post-surgical growth, damage to the inferior alveolar nerve, and post-surgical stability and relapse. Although randomized clinical trials are lacking, some support was found in the literature for DO having advantages over BSSO in the surgical treatment of low and normal mandibular plane angle patients needing greater advancement (>7mm). In all other mandibular retrognathia patients the treatment outcomes of DO and BSSO seemed to be comparable. DO is accompanied by greater patient discomfort than BSSO during and shortly after treatment, but it is unclear whether this has any consequences in the long term. There is a need for randomized clinical trials comparing the two techniques in all types of mandibular retrognathia, in order to provide evidence-based guidelines for selecting which retrognathia cases are preferably treated by BSSO or DO, both from the surgeon''s and the patient''s perspective. [Copyright &y& Elsevier]

Abstract: A number of recent studies of human brain activity using blood-oxygen-level-dependent (BOLD) fMRI and EEG have reported the presence of spatiotemporal patterns of correlated activity in the absence of external stimuli. Although these patterns have been hypothesized to contain important information about brain architecture, little is known about their origin or about their relationship to active cognitive processes such as conscious awareness and monitoring of the environment. In this study, we have investigated the amplitude and spatiotemporal characteristics of resting-state activity patterns and their dependence on the subjects'' alertness. For this purpose, BOLD fMRI was performed at 3.0 T on 12 normal subjects using a visual stimulation protocol, followed by a 27 min rest period, during which subjects were allowed to fall asleep. In subjects who were asleep at the end of the scan, we found (a) a higher amplitude of BOLD signal fluctuation during rest compared with subjects who were awake at the end of the scan; (b) spatially independent patterns of correlated activity that involve all of gray matter, including deep brain nuclei; (c) many patterns that were consistent across subjects; (d) that average percentage levels of fluctuation in visual cortex (VC) and whole brain were higher in subjects who were asleep (up to 1.71% and 1.16%, respectively) than in those who were awake (up to 1.15% and 0.96%) at the end of the scan and were comparable with those levels evoked by intense visual stimulation (up to 1.85% and 0.76% for two subject groups); (e) no confirmation of correlation, positive or negative, between thalamus and VC found in earlier studies. These findings suggest that resting-state activity continues during sleep and does not require active cognitive processes or conscious awareness. [Copyright &y& Elsevier]