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Objectives. The mounting of the plaster casts on articulator procedure is routinely performed in orthognathic surgery to assess canting of the maxillary occlusal plane, but the currently used protocols and reference plane could be source of errors which affect reliability. Nowadays the assessment of canting of the maxillary occlusal plane could be also performed with an entirely digital protocol. Aim of the study was to propose a method to evaluate canting in patients affected by Unilateral Condylar Hyperplasia, comparing the measurements performed on digital models matched on CBCT with those made on traditional articulator. Materials and methods. A retrospective cross-sectional study was designed on 20 patients affected by vertical Unilateral Condylar Hyperplasia treated in the Units of Orthodontics and Maxillo-Facial Surgery. The canting of the maxillary occlusal plane was measured on plaster casts mounted on the conventional articulator and the measures were compared with those made on digital models matched on CBCT, according the protocol developed in our Unit. Molar, canine and basal difference were measured. To compare the two protocols and to test the agreement, we performed descriptive statistics, comparison between means and Bland Altman analysis. P value was set at 0.05. Results. Statistic comparison demonstrated agreement between measurements performed with the digital protocol and conventional physical method. Conclusion. Measurements of canting with digital protocol are comparable to the physical standard method. A total digital protocol allows faster availability and storage of patient's data and better communication between orthodontist and maxillo-facial surgeon, especially in patients affected by three-dimensional malocclusions.

Objective Pierre Robin Sequence (PRS) is a heterogeneous pathological condition characterized by the coexistence of micrognathia, glossoptosis, and cleft palate, resulting in upper airway tract obstruction. Among the treatment modalities, the orthodontic approach is one part of the comprehensive care of those patients and will be present in the treatment modalities during all the growth period of the child. Methods All patients with PRS observed in the period 2013-2017 were treated with a definite functional approach. The results were retrospectively analyzed with regard to functional outcome, total treatment time, and number of plates provided for a single patient. Results In all the patients, the indicated treatment protocol has been applied as early impression and plate supply, stimulation of bottle feeding with the use of the plate, eventual substitution of the plate if no more adequate to the transverse and sagittal growth of the palate, and continuing the use until the surgical closure of the cleft. All the patients showed a positive outcome to the proposed treatment approach, evaluated with regard to the incidence of feeding improvement and weight gain, to the limit for the surgical phase, in the absence of adverse effects. Conclusion The use of a functional obturator plate, removing functional alterations to mandibular growth, reduces and, in some cases, eliminates the need for surgical intervention. As also stated in the literature, if despite the presence of the plate nutritional problems persist, immediate different surgical approaches, mainly mandibular osteodistraction, become necessary.

The management of patients suffering from class III due to syndromic craniosynostosis requires a multidisciplinary team to prevent and correct the complex clinical features related to the syndrome. Among the main clinical features, the midface hypoplasia requires surgical advancement with a rigid external distraction device. The comparison of pre- and postdistraction lateral cephalometries is often difficult in these patients, because the craniofacial advancement mobilizes the landmarks routinely used in cephalometry. Aim of this study is to evaluate occlusal, maxillary, and facial changes obtained after the midface osteodistraction using as reference the PM plane, that does not undergo postsurgical spatial modifications.The before and after surgery lateral X-rays of 12 patients were compared to test the cephalometric protocol: 10 angles and 11 linear distances were evaluated.The cephalometric comparison before and after osteodistractions of syndromic class III, using as reference the Enlow's PM plane, has confirmed the data present in current literature, consisting in forward and downward movements of facial middle 3rd, with clockwise rotation of the splanchnocranium and increase of the facial heights. The use of the PM plane as reference could be the solution to problems that have been an obstacle for the study of occlusal and facial changes in patients affected by craniofacial dysostosis.

Background: The present work starts from a literature review of the evolution of Integrated Management Systems (IMSs), considering different points of view and standards: quality, environmental, occupational health and safety, sustainability and social issues. Even if the benefits are possible, there is not a common approach and a clear link between the integration of management systems and business performance, in particular considering safety performance. Methods: The present study analyzes the application of Risk Assessment in order to realize the integration of management systems. The main objective is to provide a tool for an integrated evaluation of all company performances, starting from the definition of some Key Performance Indicators—KPIs—proposed for a particular case study, even if their choice is not the core of the paper. The assessment team members on the basis of their knowledge, experience and useful literature, could choose the right KPIs for the specific application, able to take a picture of the current state and to suggest a possible recommended action of improving. The proposed Risk Assessment approach is an integration of modern management techniques: Integrated Management System and Improving Cycle DMAIC. Results: The new method, called the Global Performance Index for Integrated Management System—GPI-IMS, has been applied to a real case study in the logistic field in order to evaluate its goodness and possible generalization. Conclusions: The proposed method allows to define the requirements that any company must have to perform the best. The role of the assessment team is very important to evaluate the global performance of the company and to suggest the corrective actions to be adopted.

The detection of cancer biomarkers at an early stage of tumor development is vital for effective diagnosis and treatment of cancer. Current diagnostic tools can often detect cancer only when the biomarker levels are already too high, so that the tumors have spread and treatments are less effective. It is urgent therefore to develop highly sensitive assays for the detection of such biomarkers at the lowest possible concentration. In this context, we developed a sandwich immunoassay based on surface-enhanced Raman scattering (SERS) for the ultrasensitive detection of alpha-fetoprotein (AFP), which is typically present in human serum as a biomarker indicative of early stages of hepatocellular carcinoma. In the immunoassay design, molybdenum disulfide (MoS2) modified with a monoclonal antibody was used as a capture probe for AFP. A secondary antibody linked to an SERS-encoded nanoparticle was employed as the Raman signal reporter, that is, the transducer for AFP detection. The sandwich immunocomplex "capture probe/target/SERS tag" was deposited on a silicon wafer and decorated with silver-coated gold nanocubes to increase the density of "hot spots" on the surface of the immunosensor. The developed SERS immunosensor exhibits a wide linear detection range (1 pg mL(-1) to 10 ng mL(-1)) with a limit of detection as low as 0.03 pg mL(-1) toward AFP with good reproducibility (RSD < 6%) and stability. These parameters demonstrate that the proposed immunosensor has the potential to be used as an analytical platform for the detection of early-stage cancer biomarkers in clinical applications E.E. is grateful for a fellowship from the Scientific and Technological Research Council of Turkey (TUBITAK). A.C. and A.S. thank MINECO for their research grant (Juan de la Cierva.Incorporacion/no. IJCI-2016-31113, Juan de la Cierva. Formacion/no. FJC2018-036777-I, respectively). We thank Dr. Judith Langer for support in the interpretation of SERS results. This work was supported by the European Union's Horizon 2020 research and innovation program under Grant Agreements 785219 and 881603 Graphene Flagship. L.M.L.-M. acknowledges funding from the European Research Council (ERC-AdG-2017#787510). M.P., as the recipient of the AXA Bionanotechnology Chair, is grateful to the AXA Research Fund for financial support. This work was performed under the Maria de Maeztu Units of Excellence Program from the Spanish State Research Agency.grant no. MDM-20170720

Objective Our aim is to test the Nahoum Index as a support in the cephalometric study of vertical dimension and therapeutic orientation in adult patients suffering from Class II malocclusion, deep bite, or short face syndrome. Methods Twenty-three patients with molar Class II and an overbite >4 mm were stratified into two groups: orthodontic (G2) and surgical orthodontic (G1). The ANB angle and Nahoum Index were calculated for cephalometric tracing pre- and post-treatment. The difference between the ANB and Nahoum Index values were analyzed using the Statistical Package for the Social Sciences software. Results In G1, the Nahoum Index decreased from 0.954 to 0.797, and the ANB angle decreased from 5.2° to 3.2°. In G2, the Nahoum Index decreased from 0.825 to 0.817, and the ANB angle decreased from 4.4° to 4°. Conclusion In G1, the difference between before and after treatment was significant for the Nahoum Index only. The difference between before and after values was not significant in the G2 group. It is possible to indicate the Nahoum Index of 0.934 as the limit value in case of which a patient may be treated with orthodontics only. This limit is the opposite of the limit proposed by Nahoum for vertical excess cases and respect the same interval. Therefore, we can consider the range 0.81-0.934 to indicate borderline patients, and >0.934 to indicate surgical patients. If the ratio is close to the normal value as 0.81, the treatment will be orthodontic; if it is further increased, the treatment will be surgical.

The development of new molecules able to efficiently act as long-circulating computed tomography (CT) contrast agents is one of the most crucial topics in the biomedical field. In the last years, the chance to manipulate materials at the nano-size level gave new boost to this research, with the specific aim to design innovative nanoprobes. Gold nanoparticles (AuNPs) have showed unique X-rays attenuation properties which, combined with their easy surface functionalization, makes them ideal candidates for the next generation of contrast agents. In this paper, we present a rational and facile approach to synthesize engineered and water-stable AuNPs, achieving concentrated colloidal solution with high Hounsfield Units (HU). An accurate control of reagents ratio allowed us to design AuNPs with different shapes, from symmetrical to anisotropic morphology, in a convenient ‘one-pot’ fashion. Their activity as efficient and reliable CT contrast agents has been evaluated and compared. Moreover, glucosamine-functionalized gold nanoparticles have been developed ([Au] = 31.20 mg/mL; HU = 2453), in order to obtain a CT contrast agent able to combine spatial resolution with metabolic information. Copyright © 2016 John Wiley & Sons, Ltd.

Purpose Cone-beam computed tomography (CBCT) is widely used for 3-dimensional assessments of cranio-maxillofacial relationships, especially in patients undergoing orthognathic surgery. We have introduced, for reference in CBCT cephalometry, an anatomical mid-sagittal plane (MSP) identified by the nasion, the midpoint between the posterior clinoid processes of the sella turcica, and the basion. The MSP is an updated version of the median plane previously used at our institution for 2D posterior-anterior cephalometry. This study was conducted to test the accuracy of the CBCT measures compared to those obtained using standard posterior-anterior cephalometry. Materials and methods Two operators measured the inter-zygomatic distance on 15 CBCT scans using the MSP as a reference plane, and the CBCT measurements were compared with measurements made on patients' posterior-anterior cephalograms. The statistical analysis evaluated the absolute and percentage differences between the 3D and 2D measurements. Results As demonstrated by the absolute mean difference (roughly 1 mm) and the percentage difference (less than 3%), the MSP showed good accuracy on CBCT compared to the 2D plane, especially for measurements of the left side. However, the CBCT measurements showed a high standard deviation, indicating major variability and low precision. Conclusion The anatomical MSP can be used as a reliable reference plane for transverse measurements in 3D cephalometry in cases of symmetrical or asymmetrical malocclusion. In patients who suffer from distortions of the skull base, the identification of landmarks might be difficult and the MSP could be unreliable. Becoming familiar with the relevant software could reduce errors and improve reliability.

Purpose Facial asymmetries due to unilateral condylar hyperactivity are often a challenge both for maxillo-facial surgeons and for orthodontists; the current literature shows different opinions about aetiology, classification, treatment approach and timing. We made a retrospective study on patients suffering from unilateral condylar hyperactivity between 1997 and 2015 in our Department; clinical features and treatment options were grouped and compared with literature. Methods The descriptive analysis investigated variables like sex, age, side and direction of the asymmetry, condylar activity and type of intervention. Results The population was composed of 128 patients. The hemimandibular hyperactivity occurs equally in both sexes around the second decade, although the range of the first consultation goes from 7 to 49 y.o. The vertical hyperdevelopment group is almost equal to the horizontal. All the patients with horizontal hyperactivity showed negative scintigraphy and were treated with pre-surgical orthodontics and orthognathic surgery; patients with vertical hyperactivity and positive scintigraphy were treated with condylectomy and post-surgical orthodontics. Conclusion In our group of patients, direction of the hyperactivity and results of the scintigraphy lead to treatment choice and timing. Further studies are necessary to explain why, in our group, all the patients with horizontal involvement are negative to scintigraphy.

Capsular contracture, implant malposition and displacement, breast asymmetry, improper contour, and symmastia may compromise the aesthetic outcome of breast augmentation and usually require surgical correction. Correction of these deformities may be achieved by accommodating a new implant in a novel pocket created in the precapsular space in either the subpectoral or subglandular plane. This article describes a modality to correct adverse results of augmentation mammaplasty and evaluates patient satisfaction. Precapsular reaugmentation was performed in 49 patients who underwent cosmetic breast surgery revisions from 2004 to 2009. All patients had previously received breast implants but complained of implant malposition and dislocation, implant size change, capsular contracture, and symmastia. A precise neoprecapsular pocket was developed above the old anterior implant capsule wall, with dissection limited to create only the space necessary for proper placement of the implant. Patients were evaluated for resolution of symptoms, satisfaction, and complications. Implant malposition and rippling, capsular contracture, breast asymmetry, and symmastia were the most common complaints from the first augmentation. Nineteen women had subpectoral implant placement, 12 had subglandular, and the rest (n = 18) had “dual-plane” location of their implants. We used textured silicone implants in 17 cases and polyurethane-coated prostheses in the remaining 32 cases. The average follow-up time was 24.1 months. Breast augmentation-related complications had resolved in all patients without any recurrence to date. The overall complication rate was very low and patient satisfaction with this procedure was extremely high. The creation of a neoprecapsular pocket combined in peculiar cases with the placement of polyurethane-coated implants is a versatile option that offers an effective one-stage solution for the correction of cosmetic mammaplasty-induced deformities.

A conventional superficial musculoaponeurotic system (SMAS) face-lift is well established because it allows the skin envelope to be rotated in a bit more lateral direction than the cephalad redirection of the SMAS flap. This ensures an individualization of the treatment plan according to the needs of the patient and avoids a postoperative stretched look. However, this technique has some limitations with respect to its long-term effects on the sagging tissue, inadequate lifting of the malar fat pad, and flattening of the nasolabial fold. The procedure described by the authors consisted of a modified approach to conventional SMAS flap dissection for 327 patients with facial aging signs undergoing a face-lift. A pointing tongue-shaped flap of zygomaticotemporal fascia was dissected and preserved in the posterior half of the upper edge of the SMAS flap and anchored to the deep temporal fascia, enhancing the vertical support of the facial soft tissues. Outcomes were determined by case notes, clinical review, and a questionnaire. The study investigated 327 consecutive modified SMAS face-lifting procedures. Few complications were observed. Only two patients experienced small hematomas needing evacuation. Some patients reported bearable pain in the temporal region and tension during mouth opening. Temporary weakness in the branches of the facial nerve experienced by two patients resolved completely within some months. Two patients presented with dehiscence of the scar, and one patient experienced punctual retroauricular skin necrosis, which healed uneventfully with conservative treatment. Two patients reported that the knot in the temporal region was palpable through the skin. One patient experienced retroauricular infection. Only two patients required additional procedures. One mild hypertrophic scar responding to steroid injection over the mastoid area was observed in the entire series. With the reported technique, the authors achieved pleasing, natural, durable results with minimal morbidity and an overall complication rate of 3.9%. All the patients were sent a satisfaction questionnaire or contacted for a telephone interview. A total of 235 patients replied. The patients reported high levels of satisfaction after treatment. The authors believe that the rhytidectomy technique described in this report has several beneficial attributes. High vertical elevation of the SMAS flap delivers a long-lasting benefit and addresses the problem of neck laxity and platysma redundancy, leading to a correction of the neck contouring and jowls. Nasolabial folds appear to be smoothed, and malar flattening is restored by imbrications of the SMAS flap over the cut edge in the malar prominence. This investigation demonstrates that the rhytidectomy technique is safe and produces highly predictable results.

Temporomandibular joint (TMJ) ankylosis is a pathological condition characterized by articular bony or fibrous tissue fusion. TMJ ankylosis developing during childhood can lead to growth complications because of the loss of mandibular function. Hard and soft autogenous tissue grafting has been used for TMJ reconstruction in the growing patient. However, in cases where autogenous tissue grafts fail either due to unpredictable growth or ankylosis, total alloplastic temporomandibular joint replacement (TMJ TJR) can provide a viable option. The case of a 7-year old female suffering from recurrent bilateral TMJ ankylosis resulting from birth trauma, and with concomitant obstructive sleep apnea syndrome (OSAS) is presented. Due to prior surgical and autogenous graft failures, the decision was made to complete her joint reconstructions utilizing patient-fitted TMJ prostheses. Questions have been raised about the longevity of TMJ TJR devices as well as their lack of growth potential, but children with TMJ ankylosis do not have condyle-related growth potential and that replacing failed autogenous tissue graft material with more autogenous tissue will result in the same adverse outcomes. Therefore, in growing patients with recurrent TMJ ankylosis and/or failed autogenous tissue grafts, there may be a role for TMJ TJR.

No complete scientific study has yet investigated the incidence of surgical-site infections in plastic surgery operations. However, it has been noted that in the case of wound infection, the aesthetic and sometimes the functional results become invalidated by delay and an alteration of the healing processes, thus necessitating surgical correction. This study aimed to evaluate the effectiveness of applying tissue adhesive on surgical wounds in plastic surgery as a protection capable of reducing the onset of infection, and to verify the existence of a statistically significant difference between treated and untreated wounds, and to determine patients' satisfaction with their cicatricial results.

Lateral cephalometric radiograph produces a two-dimensional image with several drawbacks. Cone beam computed tomography (CBCT) allows obtaining a three-dimensional representation of the craniofacial structures and seems to overcome the problems of superimposition and magnification, providing more precision than two-dimensional methods. The aim of the current study was to test the intraobserver and interobserver reliability of linear and angular measurements performed on two-dimensional conventional cephalometric images and CBCT-generated cephalograms, and to evaluate if there is a statistically significant difference between the 2 methods of measurements. The sample group consisted of 24 adolescents with a pretreatment digital lateral radiograph and a corresponding CBCT image. A total of 16 cephalometric landmarks were identified and 17 widely used measurements (9 angular and 8 linear) were recorded by 2 independent observers. Intraobserver and interobserver reliability were assessed by calculating Pearson correlation coefficient. Student t-test was used to compare the 2 methods. The threshold for significance was set at P ≤ 0.05.Concerning the intraobserver and interobserver reliability, data showed a statistically significant correlation between all two-dimensional and three-dimensional measurements. The linear and angular measurements of two-dimensional and three-dimensional cephalometry were not statistically different. The results of the current study showed the reliability of both conventional two-dimensional and three-dimensional cephalometry. Linear and angular measurements from CBCT were found also to be similar to conventional measurements. Considering that conventional images deliver the lowest radiation doses to patients, the use of CBCT for orthodontic purposes should be limited.

Piezosurgery is an alternative surgical technique, now widely tested, that uses ultrasounds for bone cutting. This device uses ultrasounds to section hard tissues without harming surrounding soft tissues. The authors analyzed their experience in craniomaxillofacial procedures with piezosurgery. A comparison between operation timing and complication rates between piezosurgery and traditional cutting instruments has been performed. A total of 27 patients were examined (15 females and 12 males; average age, of 5.5 months) affected by craniosynostosis. The aim of this study was to analyze the advantages and disadvantages of piezosurgery in pediatric craniofacial procedures. Piezoelectric device in this study has shown being a valid instrument for bone cutting in accurate procedures, because it allows performing a more precise and safer cutting, without the risk of harming surrounding tissues.

Background: In the last 3 decades, liposuction has become a mainstay of the plastic surgeon’s armamentarium, and the technique has evolved considerably. We retrospectively review all of the liposuction procedures that we performed over the past 20 years. Methods: The principles of superficial 3-dimensional liposuction with respect to preoperative, intraoperative, and postoperative management of patients scheduled to undergo liposuction of the hips, flanks, and thighs were described. Results: A total of 4000 patient charts were reviewed. The results indicated that 50 patients experienced a postsurgical seroma that was resolved after syringe aspirations. One patient developed a major mycobacterial infection that was resolved after antibiotic therapy. Twenty patients complained of minor asymmetries that were corrected 6 months later under local anesthesia; 18 patients suffered from minor skin irregularities, which improved after lipofilling. In 6 cases, transient hyperpigmentation (6–12 months) of the skin before the use of suction drainages in the removal of large adiposities in patients with light skin was experienced, and in 2 cases, transient paresthesia (8 and 10 months) was experienced. No skin necrosis, deep vein thrombosis, or death occurred. Conclusions: If performed correctly, 3-dimensional superficial liposuction of the trunk, hips, and thighs can yield very satisfying outcomes because of the excellent contour and the enhanced skin retraction provided by the thin cutaneous adipose flap. Three-dimensional liposuction is a reliable method with proven results. A careful application of the technique combined with accurate surgical planning, a thorough preoperative explanation of real expectations, and postoperative care is crucial.

Various interpretations of clinical and cephalometric data lead to different diagnostic and surgical planning in the study of dentoskeletal malformations. Many authors have identified this discrepancy as an incorrect positioning between the skeletal structures and the Frankfurt plane (PFH)--a plane that is used routinely for the sagittal measurement of the upper and lower jaw. The aim of this study was to establish a control method to verify the correct positioning of the sella-nasion point plane (SN) and the PFH. To find a reference plane, the authors concentrated their attention on measuring the intersecting angles between these two planes and the vertical posterior maxillary (PM) plane. Fifty patients (33 women and 17 men), all of whom were aesthetically and structurally harmonious class I dentoskeletal types, were analyzed using this method. Student's t-test, the Kolmogorov-Smirnov test, and Fisher's F-test were used for statistical analysis. The results were compared with those proposed by the University of Michigan. To achieve a correct diagnosis and to obtain good functional and cosmetic results in the treatment of these kinds of malformations, it is necessary to make use of the PM vertical plane during cephalometric analysis.

One-stage augmentation/mastopexy entails the challenge of augmenting breast volume with an implant while resecting excess skin. Although both augmenting and lifting the breast in a one-stage operation is gaining in popularity, its safety and its efficacy are still under debate and merit deeper evaluation. We retrospectively reviewed our experience over a 5-years period with patients who underwent augmentation mammoplasty/mastopexy with the specific objectives of documenting their outcomes and formulating algorithms for safe, simple, and effective operative strategies to manage such patients. Our surgical approach to augmentation/mastopexy breast ptosis was described step by step. Patient satisfaction with the results was also evaluated. One hundred seven patients underwent successful simultaneous augmentation/mastopexy surgery. Sixty-nine underwent primary breast surgery and 38 underwent secondary breast surgery. In 12 cases a periareolar mastopexy scar was used, while in 51 patients a vertical approach was preferred; in 11 and 33 patients a short “T” and an inverted “T” scar mastopexy was necessary, respectively. Few complications were observed, with a very low overall complication rate (14 %) and a reoperation rate of 12.1 % at 14.7 months. Patient satisfaction with the results of this procedure was extremely high. Simultaneous augmentation/mastopexy is an effective and versatile way to lift the NAC, tighten the breast skin, increase breast projection, and fill in the upper pole. Our technique of simultaneous breast mastopexy after augmentation through a lower periareolar approach showed excellent correction of pre-existing ptosis, making this method highly reliable because the intraoperative tailor-tacking was customized to the patient, implant size, and projection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pierre Robin Sequence (PRS) is a congenital abnormality characterized by mandibular hypoplasia, glossoptosis and often secondary palate cleft. It may be an isolated or part of a most complicated syndrome. The genetic syndrome that most frequently co-occurs is Stickler syndrome characterized by skeletal abnormalities, joint pain, congenital myopia and retinal detachment. The authors describe their fast and early mandibular osteodistraction (FEMOD) protocol in severe cases of PRS airway obstruction.

Polyurethane-covered breast implants have been used increasingly for cosmetic and revision breast surgery. The incision for insertion should be of minimal length and the placement of these implants in the pocket can be more difficult than that of conventional implants because of the highly adherent textured surface of the polyurethane external layer that grasps the surrounding tissues. The use of a sterile plastic insertion sleeve that is open on both sides is suggested by the manufacturer to overcome the friction between the polyurethane implant and the skin and surrounding tissues. A new method to facilitate polyurethane implant insertion and adjustment in all cases of primary breast augmentation and revision surgery is presented. After the implant, which is in the sleeve, is located in the pocket, the plastic sleeve is filled with saline and antibiotics so the solution lubricates the surface around the implant. The sleeve is then twisted so that the solution is squeezed inside the pocket while the sleeve itself is pulled back and removed. Between 2010 and 2013, this method was used in 73 cases of primary augmentation and revision breast surgery without any complications. The method described here allows for easier removal of the plastic sleeve during polyurethane implant insertion without any complications or evidence of implant migration or rotation at follow-up. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Objectives The lingual dysfunctions play a considerable role in the pathogenesis of dentoskeletal dysmorphisms. The treatment of dento-maxillofacial dysgnathia implies a functional rehabilitation to re-harmonize the stomatognathic system. This study aims to demonstrate the importance of a rehabilitation protocol of functional orofacial parameters at the end of a surgical-orthodontic treatment in order to achieve long-term success. Materials and methods After orthognathic surgery, facial expression exercises and jaw exercises are prescribed to promote the recovery of neuromuscular function. At the end of treatment, a sample of 30 dysgnathic patients underwent a functional evaluation of the orofacial district to identify any lingual or articulatory dysfunctions. The information gathered led to an individual re-education program that consisted of an active myofunctional-logopedic approach integrated with appliances used as retention. Results 19 patients needed myofunctional therapy to re-educate deglutition and tongue posture. Articulatory disorders were found in 7 patients originally suffering from Class III and/or open-bite skeletal disharmony; 5 of these completed rehabilitation with speech therapy. After rehabilitation the functional parameters were completely normalized in 12 patients; in 5 cases, partial improvements were obtained, while in 2 cases the therapy was ineffective. Conclusions In a patient undergoing post-surgical reconsolidation of his/her functional equilibrium even an uncontrolled speech defect may lead to an instable result. Only through an interdisciplinary approach it is possible to intercept and re-educate all the functions that are not compliant with the structural changes and to eliminate a tendency to relapse of the dysgnathia.

The study analyzed two samples of 10 patients with Class lIl dentoskeletal deformities and maxillary and mandibular involvement. Surgery was performed on both jaws at the same time, using different techniques for the stabilization of bone. In one group, osteosynthesis by wire fixation was performed (WF); and in the other group, bicortical screws were used for the mandible (RIF) and plates for the maxilla. At 20 and 40 days after the operation, radiocephalometric examinations were performed, and the differences in structural stability verified, by comparing the efficiency of the two methods of bone stabilization. Results indicate that in the postoperative period analyzed, dentoskeletal movements in the RIF group were inferior compared with the WF group. On the basis of these results, the advantages and the disadvantages offered by these two techniques of bone stabilization are analyzed. (A M J O RTHOD D ENTOFAC O RTHOP 1994;105:477-82.)

Introduction Long-term results after orthopedic or surgical treatment of hemifacial microsomia (HFM) have shown a tendency toward recurrence of the facial asymmetry. However, the literature contains a number of successful case reports that show surprising changes in the morphology of the condyles. In addition, patients with similar mandibular asymmetries, treated early with surgery, have excellent long-term follow-ups, especially those who have little or no soft-tissue involvement, but only severe mandibular ramal deformities. The phenotypes of these cases are unexpectedly similar, with a consistent collapse of the condyle against the coronoid and a deep sigmoid notch. The objectives of this article were to help distinguish true HFM from this peculiar type of hemimandibular asymmetry morphologically and to quantify their differences before treatement and in the long term. Methods Panoramic radiographs taken at pretreatment and the long-term follow-up of 9 patients with hemimandibular hypoplasia, characterized by the collapse of the condyle against the coronoid, were compared with those of 8 patients with severe type I and type II HFM; these records were collected before and at least 10 years after distraction osteogenesis. Results Ratios and angular measurements before and after treatment differed significantly between the 2 groups. Conclusions Perhaps these patients were misdiagnosed and actually had secondary injuries of the condyle, which have a normal functional matrix. Therefore, with growth and functional stimulation, they would tend to grow toward the original symmetry. To make a differential diagnosis between true HFM and this peculiar type of hemimandibular hypoplasia, the collaboration between not only orthodontists and surgeons, but also geneticists and dysmorphologists, is of great importance because of the different prognoses.

AIM: To prospectively evaluate the short and long term clinical impact of selective transarterial chemoembolization (TACE) on liver function in patients with hepatocellular carcinoma (HCC). To assess side effects in relation to treatments. To analyze the overall survival and HCC progression free survival probability. METHODS: One hundred and seventeen cirrhotic patients with HCC were enrolled. Baseline liver function included Child-Pugh score and serum levels of alanine-aminotransferase (ALT), prothrombin time (PT) and bilirubin. According to Cancer Liver Italian Program (CLIP) and Barcelona Clinic Liver Cancer (BCLC) staging systems, 71 patients were eligible for TACE; 32 had previously received treatment for HCC. No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions. While hospitalized, patients underwent clinical, hematologic and ultrasonographic assessments. One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed “on demand”. Liver function tests were checked in all patients every four months. RESULTS: After first TACE, the mean Child-Pugh score increased from a mean baseline 5.62 ± 1.12 to 6.11 ± 1.57 at discharge time (P < 0.0001), decreasing after four months to 5.81 ± 0.73 (not significant). ALT, PT and bilirubin significantly (P < 0.0001) increased 24 h after TACE and progressively decreased until discharge. After the second TACE, variations in Child-Pugh score, ALT, PT and bilirubin were comparable to that described after the first TACE. No major complications were observed. The mean follow-up was 14.7 ± 6.3 mo (median: 16 mo). Only one patient died. No other patient experienced important long term worsening of clinical status. The overall survival probability at twenty-four months was 98.18% with a correspondent HCC progression free survival probability of 69%. CONCLUSION: Selective TACE may produce significant, but transitory increases in ALT values, with no major impact on liver function and Child-Pugh score. Preservation of liver function is achievable also in patients previously treated with other therapeutic modalities and in patients undergoing multiple TACE cycles. Liver function can remain stable in the long-term, with optimal medium term survival. This result can be achieved through rigorous patient selection on the basis of tumour characteristics and clinical conditions.

Summary Lower-limb injuries with loss of tissue and exposure of bones and tendons are an increasing problem. The condition of the wound locally and the patient in general does not always allow immediate and adequate coverage of the structures exposed by the trauma. Therefore, new therapeutic solutions are needed. A reduction in the time that bones and tendons are exposed is essential to achieve complete healing of bone fractures, with reduced risks of infection and less disabling outcomes. The effectiveness of vacuum-assisted closure (VAC) therapy in supporting wound healing and of cryopreserved homologous de-epidermalised dermis (DED) in providing an effective template for re-epithelialisation has been previously reported. We carried out a study to evaluate the effectiveness of the synergistic and combined use of the two methodologies. Eighteen patients with traumatic loss of tissue in the lower limbs, involving exposure of bone and tendon structures, were enrolled in the study. All participants had local, general contraindications to first-instance reconstructions, or both. All patients received a combination of VAC therapy and DED implants. Granulation tissue was obtained in all wounds, with complete coverage of exposed structures. No infections were detected in the cohort, and all patients were prepared for further necessary reconstructive treatments. In our experience, the combination of VAC therapy and DED could, in selected cases, constitute an effective treatment for complex lower limb traumatic injuries with bone and tendon exposure.

Background Plastic surgery interventions have increased in terms of frequency, complexity of surgical procedures, and postoperative complications, particularly surgical site infections (SSIs). The aim of the present study was to assess the SSI frequency in plastic and reconstructive surgery settings in Italy and to evaluate the associated risk factors. Methods From June 2004 to June 2005, a prospective multicenter study including 2806 consecutive patients was conducted in 23 Italian plastic and reconstructive units. To assess potential risk factors for surgical site infection, a conditional logistic regression model was used and results were exposed in terms of odds ratio (OR) with their respective 95% confidence interval (CI). Results SSIs occurred in 85/2806 (3%) patients. Sixty (70.6%), 24 (28.2%), and 1 (1.2%) SSIs were classified as superficial, deep, and organ/space, respectively. Sixty-six percent of the SSIs were diagnosed during postdischarge surveillance. At multivariate analysis, diabetes mellitus, chronic obstructive pulmonary disease, preoperative radiotherapy, and use of surgical drains were significantly associated with the occurrence of SSI. Conclusions Our findings, based on a large population including all types of plastic and reconstructive interventions, provided consistent information on potential risk factors for SSI in this surgical setting. Moreover, the high rate of SSI found during the postdischarge surveillance underlines the need for improving active surveillance methodologies in this surgical setting.

The use of a syringe connected to an aspiration cannula is one of the techniques used for liposuction, especially in cases that involve small-volume aspiration of localized adiposities, and for fat graft removal from the donor site for lipofilling. The cannula is connected to the syringe, and the plunger is pulled back, thus creating a vacuum that allows aspiration of the fat. To avoid the loss of the negative pressure created in the syringe, the plunger must be blocked when it is withdrawn. This cannot be done manually when large syringes (50 60 ml) are used. For this reason, there are commercial syringes with locking devices that block the plunger in the right position, but they are very often difficult to obtain, especially in various sizes and in appropriately sterile conditions. Other authors [1,2] have reported some ideas for solving this problem by using surgical instruments such as towel clamps or hemostats. These methods really help the surgeon during the aspiration procedure, allowing the manteinance of a good negative pressure. However, they cause an unbalanced weight increase in the whole device. We had the idea to block the withdrawn aspiration syringe plunger with another plunger smaller in size. In our practice, we use 50or 60-ml syringes for aspiration, and when the vacuum is created, we block the plunger with a 10-ml syringe plunger, as shown in Fig. 1. The procedure is really simple, practical, and inexpensive. Moreover, the absence of additional weight in the posterior part of the whole system, due to the surgical instrument used to block the plunger, makes the procedure more comfortable for the surgeon. We recommend it to all our colleagues.

Purpose: This study evaluates the skeletal response to functional orthodontic therapy in growing children with hemifacial microsomia (HM). A method of classification for mandibular growth subsequent to treatment is also suggested. Materials and Methods: Sixteen growing children with unilateral HM were treated. Each patient was graded according to the skeletal, auricular, tissue (SAT) classification. Patients graded S4-S5 were excluded because the severity of the malformation made them unsuitable for functional orthodontic treatment. All patients initially underwent a period of treatment with an asymmetrical functional activator (AFA). Results: In 7 of 16 cases (43.7%) classified as S 1 -S 2 T 1 , regardless of the value of A, functional therapy brought about mandibular growth greater on the side of the malformation (G3-G4), re-establishing structural and functional harmony of the entire stomatognatic apparatus. Of the five cases (31.2%) classified as S 2 T 2 , four required surgical intervention at about 10 years of age after an initial period of functional therapy that produced mandibular growth classified G1-G2. In the other case, functional treatment was sufficient to correct the malformation. In four patients (25%) classified as S 3 T 3 or S 3 T 2 , it was necessary to combine surgical treatment with functional therapy. Conclusion: Use of the AFA in growing children with HM makes it possible to induce harmonious maxillomandibular growth. Statistically, in S 1 -S 2 T 2 cases, functional therapy brings about an overall resolution of the malformation whereas in more severe cases ( S 2 T 2 ), it needs to be combined with orthodontics using fixed appliances and surgical intervention.

This study analyzes long-term findings in a group of 10 patients with Class II dentoskeletal malrelationship and who have undergone orthognathic surgical procedures. Changes in cephalometric values relative to the bony structures of the upper jaw and of the mandible are discussed in detail. Patients were reexamined on average, 5.8 years after surgery to show possible modification of the skeletal regions in patients who underwent surgical-orthodontic treatment for malformation of the facial continuum. For each case we made a cephalometric analysis of the lateral cephalograms, as well as the superimposition of tracings relative to the various stages of treatment: at the end of preoperative orthodontic treatment, after surgery, and at the long-term control. Cephalometric values for all patients who took part in this long-term control were recorded and a structural assessment was made.