bluuebunny/crossref_metadata_2025 huggingface dataset:
Stapes Surgery Outcomes in Patients With Concurrent Otosclerosis and Superior Semicircular Canal Dehiscence
Authors: McClellan Joseph , Nguyen Anthony , Hamilton Bronwyn , Jethanamest Daniel , Hullar Timothy E. , Gupta Sachin
Published: May 2020

Objective:

To review outcomes of stapes surgery in patients with concurrent otosclerosis and superior semicircular canal dehiscence.

Study Design:

Retrospective case series.

Setting:

Tertiary referral center.

Patients:

Patients with concurrent otosclerosis and superior canal dehiscence, confirmed by computed tomography (CT) imaging.

Intervention(s):

Stapes surgery for conductive hearing loss.

Main Outcome Measure(s):

Postoperative air-bone gap (ABG), as well as the number of patients in whom surgery was deemed successful (postoperative ABG <10 dB HL).

Results:

Five patients with superior canal dehiscence and concomitant otosclerosis who underwent surgical repair were identified. Mean preoperative ABG was 29.0 ± 6.4 dB HL. Mean postoperative ABG was 13.0 ± 13 dB HL. Three patients (60%) had a successful outcome, defined as postoperative ABG less than 10. One patient experienced unmasking of superior canal dehiscence vestibular symptoms.

Conclusions:

Patients with concurrent otosclerosis and superior canal dehiscence appear to have a lower likelihood of successful hearing restoration following stapes surgery. Patients should be counseled accordingly. Routine preoperative CT imaging before stapes surgery may be helpful to identify patients at risk for poor outcomes.
Diagnosis of Stapedial Myoclonus Using Endoscopic Visualization
Authors: Barber Samuel R. , Barbarite Eric , Corrales C. Eduardo
Published: May 2020

Background:

Stapedial myoclonus is an uncommon condition involving the rhythmic contraction of the stapedial tendon that may result in a host of symptoms, including tinnitus (1–3). There is a dearth of robust diagnostic modalities to diagnose stapedial myoclonus(4–7), and most patients are treated without definitive diagnosis(8-12). Herein, we hypothesize that stapedial myoclonus can be readily diagnosed by awake otoendoscopy (see Video, Supplemental Digital Content 1, http://links.lww.com/MAO/A997).

Case Report:

A 21-year-old healthy male professional singer presented with a rhythmic “thumping sound” heard in both ears for 5 years. Symptoms were triggered by singing and were worse on the right side. Work-up, including otologic exam, audiologic testing, and high resolution imaging, was unrevealing. Given symptomatology, stapedial tendon myoclonus was suspected.

While awake in the operating room, an inferior myringotomy was made, and both 1.9 mm 0 and 30 degree 3-CCD Hopkins rod endoscopes were used to visualize the middle ear space using a transcanal approach. There was robust movement of the tendon with patient vocalization that corresponded precisely with the timing of tinnitus. The patient subsequently underwent transection of the right stapedial tendon under general anesthesia using otoendoscopic visualization. The pyramidal eminence was also removed to avoid future regeneration. The patient underwent an identical procedure on the contralateral ear 3 months later with complete resolution of symptoms bilaterally.

Conclusion:

Stapedial myoclonus was diagnosed by transtympanic otoendoscopy in an awake patient. This approach may be readily applied in awake patients suspected of having stapedial myoclonus. Transection of the stapedial tendon in these patients resolves tinnitus.
Patient-specific 3D-printed Model-assisted Supracochlear Approach to the Petrous Apex
Authors: Takahashi Kuniyuki , Morita Yuka , Aizawa Naotaka , Ogi Manabu , Nonomura Yoriko , Kitazawa Meiko , Yagi Chihiro , Ohshima Shinsuke , Izumi Shuji , Yamagishi Tatsuya , Horii Arata
Published: May 2020

Objective:

To present a case of pediatric cholesteatoma that invaded the petrous apex (PA) and discuss the usefulness of preoperative three-dimensional (3D) surgical simulation on a personal computer (PC) and patient-specific 3D printed model-assisted surgery.

Patient:

A 5-year-old boy with congenital cholesteatoma underwent a planned two-stage canal wall up mastoidectomy. The cholesteatoma had invaded the PA from a small space anterior to the superior semicircular canal (SSCC). During the removal of this lesion in the first surgery, the tip of a 1-mm round knife broke off and fell into the PA. The surgeon could not remove it, as it was thought that opening the space might damage the SSCC and the facial nerve (FN).

Intervention:

Before the second surgery, a preoperative 3D surgical simulation on a PC was performed, and an approach to the PA via the triangle surrounded by the SSCC, FN, and middle cranial fossa, namely, the supracochlear approach, was discovered. A patient-specific 3D-printed model, which had been drilled to make each surface of the triangle including the SSCC, FN, and middle cranial fossa visible in the PC simulation surgery, was then created and a 3D-printed model-assisted surgery was planned.

Results:

By placing the sterilized patient-specific 3D model close to the surgical field, the cholesteatoma and iatrogenic foreign body could be successfully removed from the PA without damaging the important surrounding structures.

Conclusions:

Preoperative 3D surgical simulations and intraoperative patient-specific 3D-printed model-assisted surgeries are new, powerful tools that aid in performing challenging surgeries on temporal bones.
Utility of Postoperative Prophylactic Antibiotics in Prepectoral Breast Reconstruction
Authors: Holland Michael , Lentz Rachel , Sbitany Hani
Published: May 2020

Background

Immediate tissue expander placement remains a preferred method for breast reconstruction after mastectomy. The use of prophylactic postoperative antibiotic administration is thought to reduce rates of surgical site infection and reconstructive failure, but has not been studied in patients undergoing reconstruction in the prepectoral plane.

Methods

We retrospectively identified all patients undergoing immediate prepectoral tissue expander placement after mastectomy by a single plastic surgeon from 2015 to 2018. We identified 2 cohorts of patients: one group that received prophylactic antibiotics at the time of discharge and one group that did not. We collected treatment and outcomes data to compare rates of postoperative complications between cohorts.

Results

We identified 69 patients with 115 breasts who received discharge antibiotics and 63 patients with 106 breasts who did not. The antibiotic cohort had significantly lower rates of tissue expander loss (4.3% vs 17.0%, P = 0.003), unplanned operation (10.4% vs 24.5%, P = 0.007), and infection (7.0% vs 24.5, P < 0.001).

Conclusions

The use of prophylactic postoperative antibiotics in prepectoral breast reconstruction is associated with significantly lower rates of postoperative complications. Further randomized controlled studies are warranted to explore the effect of antibiotic therapy on outcomes and to determine what the optimal duration of antibiotic therapy may be.
The Effect of Distal Transfer of the Spinal Accessory Nerve to the Suprascapular Nerve on the Shoulder Reanimation in Spontaneously Partially Recovered Obstetric Brachial Plexus Lesion
Authors: Abdelmaksoud Islam Mohamed , Ahmad Mohammad Hasan , Semaya Ahmed Elsayed , Ahmed Adel Refaat
Published: May 2020

Background

Spontaneous recovery of elbow flexion in obstetric brachial plexus palsy at 4 to 6 months of age is sufficient to exclude the child from the early microsurgical intervention. However, lack of complete active external rotation of shoulder is a common finding in such cases despite ongoing other arm and shoulder functions. Nerve transfer is proposed to manage such cases before the age of 18 months.

Aim

The aim of this study was to study the distal transfer of the spinal accessory nerve to the suprascapular nerve through posterior approach and its effect on the shoulder reanimation in patients with obstetric brachial plexus lesion who had spontaneously recovered biceps function but not shoulder function before the age of 18 months.

Patients and methods

This prospective study included 20 patients admitted to Elhadra University Hospital with obstetric brachial plexus lesion aged between 10 and 18 months with spontaneous recovery of biceps function, weak active shoulder abduction grade 4 or grade 5 and deficient active shoulder external rotation. All patients were assessed preoperative and postoperative by Active Movement Scale.

Results

Active shoulder external rotation improved in all patients at the end of follow-up period, whereas the shoulder abduction improved in 80%. Early surgery in patient younger than 16 months shows better results.

Conclusions

The distal transfer of spinal accessory nerve to suprascapular nerve is an effective method for active shoulder abduction and external rotation recovery in spontaneously recovered elbow flexion in obstetric brachial plexus lesions. Better results are obtained in patients younger than 16 months old. Early transfer balances the forces around the shoulder joint, preventing shoulder internal rotation contracture.
Anatomical Evaluation of Zygomaticus Major Muscle With Relation to Orbicularis Oculi Muscle and Parotid Duct
Authors: Elvan Özlem , Bobuş Örs Alev , Tezer Mesut Sabri
Published: May 2020

Objectives:

To evaluate morphological properties of the zygomaticus major (ZMj) and demonstrate its detailed anatomical relationships with the orbicularis oculi (OOc) and the parotid duct (PD).

Methods:

Fifteen formalin fixed adult cadaver heads (7 males /8 females) aged between 45 and 92 years were dissected to reveal the ZMj, OOc, PD. Shape, lengths and thickness of the ZMj, positional relationships of the ZMj with respect to the OOc and PD (overlap, neighboring, being separate) were determined. Topographic localization of the ZMj according to lateral and medial canthi, tragus, mental tubercle and angle of mandible was evaluated.

Results:

The shape of the ZMj was observed as band like in 15/29 (51%), fan like in 10/29 (34%) and bifid in 4/29 (13%) sides. Position of the ZMj with respect to the OOc and distal part of the PD was not constant. The ZMj was overlapped by the OOc in 15/29 (52%) sides while they were adjacent in 14/29 (48%) sides. The ZMj overlapped the distal part of PD in 16/29 (%55) sides. They were separate in 10/29 (35%) sides and adjacent in 3/29 (10%) sides. Topographic location of the ZMj with respect to lateral and medial canthii, tragus, angle of mandible and mental tubercle was demonstrated. No statistically significant relationships were found between the ZMj measurements with head circumference and face length. No statistically significant differences were found between sides and gender in terms of the ZMj morphology (P > 0.05).

Conclusion:

This study demonstrates the morphological features and topography of the ZMj along with its relationships with the OOc and PD that would be essential for clinical implications.
Postauricular Island Flap in Reconstruction of Auricula Tumor Defects
Authors: Mehel Dursun Mehmet , Özdemir Doğukan , Çelebi Mehmet , Saraç Nalan , Aydemir Samet , Özgür Abdulkadir
Published: May 2020

The most common malignant tumor in humans is skin cancers. Skin cancers are most commonly seen in the head and neck region due to direct exposure to sunlight. Most frequently seen skin cancer in the auricula are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The aim of this study is to evaluate the results of postauricular island flap after resection of tumors in the auricula.

Twelve patients aged 58 to 84 years were included in the study. Eight patients had BCC, 3 had SCC, and 1 had basosquamous carcinoma (BSC). The tumor was located at the cavum concha in 7 cases, antihelix in 3 cases, triangular fossa in 1 case and scapha in 1 case. Surgical procedure was performed under local anesthesia in 7 patients and under general anesthesia in 5 patients. Postauricular island flap was used in all cases. There were no early complications. Three patients had non-apparent narrowing of the auriculomastoid angle. The patients were followed for an average of 2.6 years between 1 and 9 years. Only one patient with basosquamous carcinoma of the cavum concha had recurrence at 19 months.

We believe that the postauricular island flap may be a good alternative for the reconstruction of the defect after resection of tumors in the auricle due to its proximity to the surgical site, color matching, adequate thickness, good vascularization, aesthetic acceptance by the patient and completion of the procedure in one session.
Heminasal Reconstruction Utilizing Presurgical Planning, Template-Based Cartilage Reconstruction and Tissue Expansion
Authors: Bryant Justin R. , Stein Jason R. , Boyajian Michael K. , Manrique Monica , Mantilla-Rivas Esperanza , Aivaz Marudeen , Rogers Gary F. , Oh Albert K. , Boyajian Michael J.
Published: May 2020

Heminasal aplasia is a rare congenital nasal anomaly in which there is unilateral deficiency in both the external nasal anatomy and nasal airway. Unilateral failure in development of a nasal placode in embryogenesis is thought to be the underlying cause of this anomaly. The authors describe the reconstruction of heminasal aplasia in a teenager utilizing a templated cartilaginous framework and tissue expansion. The authors feel the satisfactory results of this technique will be of benefit to other surgeons who may encounter this rare anomaly.
Evaluation of Surgical Approaches for Tumor Resection in the Deep Infratentorial Region and Impact of Virtual Reality Technique for the Surgical Planning and Strategy
Authors: Zawy Alsofy Samer , Sakellaropoulou Ioanna , Stroop Ralf
Published: May 2020

Objective:

Tumors in the deep infratentorial region can be accessed via the supracerebellar-infratentorial (SCIT) or suboccipital-transcerebellar (SOTC) approaches in the sitting or prone position. Diagnosis of tumors in this region and review of their therapies are inseparably connected with cranial tomographic imaging. We retrospectively evaluate a cohort of patients who underwent tumor resection in this region and correlate complication rates to the literature, and evaluate the potential influence of a virtual reality (VR) visualization technique on surgery planning and strategy.

Methods:

Patient files were retrospectively analyzed regarding operative performance parameters, histopathological findings, surgical outcomes, and complications. Preoperative magnetic resonance imaging scans were visualized via VR software. The influence of 3-dimensional VR images compared to 2-dimensional magnetic resonance imaging scans on surgical planning and surgical strategy was evaluated using a questionnaire.

Results:

Ninety-three patients were included, 80% placed in a sitting and 20% in a prone position. The SCIT approach was performed in 59% patients and SOTC approach in 41%. Surgical tumor resections were associated with an overall complication rate comparable to the literature. Image presentation using VR had a significant influence on the recommended surgical approach (P = 0.02), but no influence on the recommended patient positioning (P = 0.37) or placement of craniotomy (P = 0.09).

Conclusion:

Tumor resection in the deep infratentorial region, despite frequent use of the sitting position and SCIT approach, was associated with a complication rate comparable to the literature. Preoperative surgical planning using VR technology may increase understanding of the anatomy and pathology, and thus influence operation planning.
Le Fort III Distraction Osteogenesis Without Bicoronal Incision
Authors: Sakamoto Yoshiaki , Tamada Ikkei , Sakamoto Teruo , Ishii Takenobu , Kishi Kazuo
Published: May 2020

Purpose:

Recently, midfacial hypoplasia for syndromic craniosynostosi has been corrected by Le Fort III distraction osteogenesis. During conventional Le Fort III osteotomy, osteotomy is performed via bicoronal incision. In contrast, the authors have developed a technique for performing Le Fort III osteotomy using internal devices but without bicoronal incision.

Patients and Methods:

The authors performed the Le Fort III distraction technique in 22 patients. Of these, 17 patients underwent an approach using conventional coronal incision; the others underwent an approach without coronal incision. This new approach was performed using a McCord incision, a brow incision, and gingivo-buccal sulcus incisions. We then performed osteotomy and attached the internal device.

Results:

The age of patients ranged from 6 to 21 years (mean: 14.1 ± 5.0 years) and 6 to 38 years (mean: 19.6 ± 11.5 years) in the groups with or without coronal incision, respectively. Mean operative time was 410 ± 196 minutes in the group with coronal incision and 357 ± 121 minutes in the group without coronal incision. Mean blood loss (per unit of body weight) was 51.3 ± 38.5 and 33.9 ± 9.9 ml/kg) in the groups with or without coronal incision, respectively. There were no complications, except in the case of a 38-year-old patient, the oldest patient, who lost vision in the left eye after surgery.

Conclusion:

A direct facial approach for Le Fort III distraction was useful because of its reduced operative time and blood loss. However, down fracture following incomplete osteotomy or inadequate dissection of the orbit may cause blindness. Consequently, this technique requires careful attention.
Ascher Syndrome: Acquired Double Lower Lip Combined With Epulis Fissuratum
Authors: Ozdede Melih , Dere Kadriye Ayca
Published: May 2020

Ascher syndrome is characterized by double lip, blepharochalasis, and non-toxic goiter triad. This condition of unknown etiology usually occurs in patients younger than 20 years of age. In this case report, the authors present the diagnostic process of Ascher syndrome and surgical procedure of double lower lip in a female patient who applied to our clinic for prosthetic reasons. A 70-year old female patient was referred to our clinic with the chief complaint of incompatible dentures. The patient had been using the same complete dentures for 40 years. Extraoral clinical examination revealed protruded, bulged lower lip at rest and bilateral blepharochalasis, defined as atrophy of the upper eyelid skin. The upper lip and lower eyelids were not affected. Intraoral examination revealed complete edentation of both jaws and a double lower lip, an accessory fold of excess mucosae inside the vermillion border. Furthermore, epulis fissuratum was observed in the lower jaw. There was no family history of double lip. The patient stated that she had noticed another lip inside her lip for several years. As Ascher syndrome was suspected, the patient was referred to the endocrinology department for thyroid examination, and the non-toxic goiter diagnosis was confirmed. Surgical removal of the redundant tissues was necessary because of deficiencies in speech, chewing, and aesthetics. The excess tissues were excised by transverse ellipse incision technique. Dentists should be familiar with Ascher syndrome, as they may be the first physicians to encounter patients with double lip.
A Footprint-Like Intracranial Solitary Fibrous Tumor/Hemangiopericytoma With Extracranial Extension and Acute Intratumoral Hemorrhage
Authors: Zhang Zhen , Li Yuping , She Lei , Wang Xiaodong , Yan Zhengcun , Sun Shuwen , Antony Andrea , Zhang Hengzhu
Published: May 2020

Background:

Intracranial solitary fibrous tumors/hemangiopericytomas (ISFTs/HPCs) are extremely rare spindle-cell tumors that are mostly benign and derived from mesenchymal tissue. Extracranial metastasis and intratumoral hemorrhage are considered to be special manifestations of malignant tumors, of which extracranial metastases of ISFTs/HPCs have been reported, while tumor hemorrhage has rarely been described. Here, the authors present an interesting case of ISFTs/HPCs with acute intratumoral hemorrhage.

Clinical presentation:

A 72-year-old woman underwent brain magnetic resonance imaging (MRI) for recurrent headaches and nausea. The MRI scan showed a footprint-like space-occupying lesion in the bilateral parietooccipital lobe. This lesion had multiple cystic components and invaded the superior sagittal sinus, destroying adjacent cranial bones. While waiting for routine surgery, the patient suddenly developed acute tumor bleeding and then underwent emergency surgery. Postoperatively, the diagnosis of ISFT/HPC was confirmed by pathological and immunohistochemical analysis.

Discussions and conclusions:

The diagnosis of ISFT/HPC mainly depends on pathological and immunohistochemical results. Malignant cases with cystic necrosis may be prone to acute hemorrhage. Early total surgical excision can provide a good clinical prognosis. Adjuvant radiotherapy is an effective supplement to surgical treatment. Metastasis and recurrence require long-term follow-up monitoring.
The Efficacy of Electro-Acupuncture Added to Standard Therapy in the Management of Bell Palsy
Authors: Gökçe Kütük Sinem , Özkan Yasemin , Topuz Muhammet Fatih , Kütük Mustafa
Published: May 2020

Objective:

To investigate the comparative efficacy of electro-acupuncture when added to standard therapy in patients with Bell palsy in terms of clinical and neurophysiologic outcomes.

Methods:

A total of 88 patients with Bell palsy who received standard treatment (ST group; n = 40, mean ± standard deviation age: 39.2 ± 6.6 years, 60.0% were males) or standard treatment plus electro-acupuncture (ST-EA group; n = 48, mean ± standard deviation age: 39.5 ± 6.9 years, 58.3% were males) were included. Data on patient demographics, symptoms, comorbidities, and 3-month outcomes on treatment response assessed via House-Brackmann grading system and facial nerve recovery profile and electromyography were recorded.

Results:

Application of ST-EA versus ST was associated with a significantly higher rate of normal nerve function on 12th week electromyography (66.7% versus 25.0%, P = 0.020), higher frequency of patients with House-Brackmann grade ≤2 in the 3rd week (79.2% versus 45.0%, P = 0.029), 6th week (87.5% versus 45.0%, P = 0.004), and 12th week (95.8% versus 50.0%, P = 0.001), and those with facial nerve recovery profile scores ≥8 in the 6th week (83.3% versus 45.0%, P = 0.011) and 12th week (87.5% versus 50.0%, P = 0.009) of treatment.

Conclusion:

In conclusion, our findings in patients with Bell palsy revealed superiority of electro-acupuncture added to standard therapy over standard therapy alone in terms of improvement of nerve dysfunction, decrease in paralysis severity, and better functional recovery. This seems to indicate the likelihood of electro-acupuncture to be a safe and promising adjunct in the achievement of more satisfactory clinical outcomes in the management of Bell palsy when used in combination with standard medical and physiotherapy.
Study Between Panoramic Radiography and Cone Beam-Computed Tomography in the Diagnosis of Ameloblastoma, Odontogenic Keratocyst, and Dentigerous Cyst
Authors: Cardoso Lyzete Berriel , Lopes Ivna Albano , Ikuta Carla Renata Sanomiya , Capelozza Ana Lúcia Alvares
Published: May 2020

Objective:

To determine how the diagnosis may or may not be influenced by cone-beam computed tomography (CBCT), comparing the diagnostic hypotheses obtained using images of panoramic radiographs and CBCT in cases of ameloblastoma, odontogenic keratocyst, and dentigerous cyst.

Study Design:

Five cases were selected for each lesion. Panoramic radiographs and CBCT scans were analyzed by 15 dentists for the formulation of the diagnostic hypotheses. Two observers performed the analyses and measurement of qualitative and quantitative features of the lesions evaluated in the CBCT.

Results:

There was no statistically significant difference in correct diagnostic average between panoramic radiography and CBCT, but there was a significant difference in correct diagnostic average in the diagnosis of ameloblastoma using CBCT compared to panoramic radiography. Master's and PhD-level observers had greater correct diagnostic average in the diagnosis of odontogenic keratocyst using panoramic radiograph compared to specialists, with a significant difference.

Conclusion:

Cone-beam computed tomography images revealed that the ameloblastomas were greater in size and expansion compared to the odontogenic keratocyst and the dentigerous cysts. Ameloblastomas showed a higher incidence of multiloculated aspects compared to odontogenic keratocyst and dentigerous cysts. There were no differences between quantitative and qualitative features of odontogenic keratocyst and dentigerous cysts.
Outcomes of Treatment for Elderly Patients With Trigeminal Neuralgia: Percutaneous Balloon Compression Versus Microvascular Decompression
Authors: Ni Hongyan , Wang Yuanlin , Chen Xin , Gu Weiguo
Published: May 2020

Objective:

The study aimed to evaluate the surgical outcomes of percutaneous balloon compression (PBC) and microvascular decompression (MVD) in the treatment of elderly patients with trigeminal neuralgia (TN).

Methods:

A total of 30 patients who underwent PBC surgery (PBC group) and 30 patients who received MVD surgery (MVD group) were included. The treatment efficacy, Barrow Neurological Institute (BNI) pain intensity score, inflammatory response, the rates of complication and recurrence were analyzed respectively.

Results:

The total efficacy was 93.33% in the PBC group and 90.00% in the MVD group (P > 0.05), respectively. The pain relief rate was 90.00% and 86.67% after PBC and MVD surgery, respectively (P > 0.05). The levels of IL-1β, TNF-α, and IL-6 were significantly decreased at post-operative 3 days and 5 days compared with pre-operation in the 2 groups (P < 0.05). The post-operative complication rates regarding masticatory muscle weakness and facial numbness in the PBC group were higher than MVD group (P < 0.05). Nevertheless, the incidences of herpes simplex and keratohelcosis were similar between the 2 groups (P > 0.05). The recurrence rates were also similar between the 3 groups (P > 0.05).

Conclusion:

Percutaneous balloon compression and MVD are effective in the treatment for elderly TN, which can effectively improve the post-operative cure rate of pain prognosis and reduce the inflammatory response. However, PBC is a minimally invasive, safe and effective method for patients in poor general condition and refused treatment with craniotomy.
The Use of Three-Dimensional Photography and Printing in the Fabrication of a Nasal Prosthesis
Authors: Denour Erika , Woo Albert S. , Crozier Joseph , Van Dongen Craig
Published: May 2020

Objective:

Facial prosthetic rehabilitation using additive manufacturing technology relies on data acquisition from computed tomography or magnetic resonance imaging. Three-dimensional (3D) photography has become widespread in craniofacial and plastic surgery due to its ability to provide more comprehensive topographical data than radiographic techniques. Despite the rising popularity of 3D photography in preoperative planning, reports on the use of this technology for facial prosthetic rehabilitation are lacking. The present clinical report demonstrates the indirect fabrication of a nasal prosthesis using 3D surface-imaging by the VECTRA-M5 360 Head System.

Design:

A 61-year-old woman presented with a nasal defect due to a partial rhinectomy secondary to multiple resections of recurrent basal cell carcinoma. After opting out of any further surgical intervention, the patient expressed a preference for prosthetic rehabilitation. Prosthesis fabrication using CAD/CAM technology typically relies on patient data from computed tomography or magnetic resonance imaging scans for the 3D printing of the replica of the nasal defect. In this case, facial data was acquired by a 3D surface-imaging system using a 3D photograph captured by the VECTRA-M5 360 Head System.

Conclusions:

Acquisition of facial data using 3D surface-imaging systems may be recommended for patients with external facial deformities to decrease subsequent radiation exposure. The integration of 3D photography and 3D printing provides a promising method for prosthetic rehabilitation that decreases total production time while minimizing radiation exposure.
To Serve Those Who Served: Advances in Plastic and Reconstructive Surgery During War and Peace
Authors: Levine Lance , Spielman Amanda , Al Bayati Mahmood J. , Mathew Prakash J. , Habal Mutaz B. , Thaller Seth R.
Published: May 2020

The industrialization of modern warfare dating back to WWI led to an increase in combat-related injuries with unprecedented levels of severity. The necessity of addressing the clinical challenges that ensued led to the emergence of modern reconstructive surgery and subsequently a robust healthcare initiative for veterans in the form of the Department of Veterans Affairs. In the following article, a literature review was conducted to examine the interplay between combat injuries, veterans’ care, and reconstructive surgery. We found that the relationship between military trauma and reconstructive surgery has led to an increase in survival rates and advances in mass casualty response while allowing the survivors to maintain a high quality of life. The relationship between the Veterans Affairs hospitals and plastic surgery has only strengthened over time as these hospitals play a major role in training the next generation of plastic surgeons throughout the nation. It is imperative to maintain this cooperative relationship to ensure a high level of care for our veterans and a comprehensive training experience for plastic surgery residents.
Giant Ventral Lipoma of the Neck
Authors: Woo Soo Jin , Hong Ki Yong , Chang Hak
Published: May 2020

Giant lipomas are rarely found in the head and neck region. A 67-year-old male patient presented with a massive ventral swelling of his neck extending from the lower margin of the mandible to the clavicle. The mass had slowly grown over 20 years without causing any symptoms, except for considerable psychological stress because of the disfiguration of the patient's profile appearance. Contrast magnetic resonance imaging suggested a lipomatous soft tissue lesion. The surgically removed tumor measured 32 × 20 × 4 cm. Surgery was completed without any intraoperative complications or injury to the critical structures of the neck. The patient was satisfied with the cosmetic result of the operation, and histopathological examination confirmed a lipoma.
Method for Safely Excising a Large Head and Neck Arteriovenous Malformation in the Hybrid Operating Room
Authors: Pessino Kenneth A. , Ortiz Rafael A. , Bastidas Nicholas
Published: May 2020

Large head and neck arteriovenous malformations are notoriously difficult to manage given their location and propensity for extreme hemorrhage. We propose a unique approach utilizing a Hyperform balloon and percutaneous Surgiflo sclerotherapy to provide intraoperative hemostatic stability during the excision of a left-sided scalp arteriovenous malformation. In a hybrid operating room a microcatheter balloon was fed into the left external carotid artery for occlusion of the malformation's main blood supply, and subsequently followed with digital subtraction angiography guided sclerotherapy of selective vessels. A split thickness graft was used to reconstruct the site of excision. This method offered optimal hemostatic control with a blood loss less than 120 cc. Our approach may offer safety advantages over traditional modalities and allow resection of head and neck lesions previously thought to be inoperable.
The Effect of Immediate Versus Delayed Addition of the Nasal Stent to the Nasoalveolar Molding Plate on Nostrils Shape and Cleft Width in Infants With Unilateral Cleft Lip and Palate
Authors: Jahanbin Arezoo , Jamalinasab Abdollah , Ramazanzadeh Barat Ali , Zarch Seyed Hosein Hoseini , Shafaee Hooman , Shojaeian Reza
Published: May 2020

Objective:

The main aim of this study was to evaluate the effect of immediate versus delayed addition of the nasal stent to the nasoalveolar molding plate on the nose shape and alveolar cleft area in unilateral cleft lip and palate infants.

Method:

Twenty nonsyndromic newborn infants with unilateral cleft lip and palate were scanned 3 dimensionally using Proface software. In the experimental group, the nasal stent was added on the day the molding plate arrived, and in the control group when the alveolar gap reached 5 mm. Two months after adding nasal stents in each group patients’ faces were scanned again and some parameters were measured. In addition, immediately after treatment, 1 month later and at the end of investigation, impressions were taken, and stone casts were scanned by cone-beam computed tomography and the alveolar gap was measured. Fisher exact test, paired t test, and ANOVA were used for data analyses. P < 0.05 was considered as significant.

Results:

In this study, changes in the parameters showed significant differences between the case and controls for the columellar angle, nostril width on the cleft side, nostril height on the cleft side, soft tissue cleft width, and nasal surface area. However, the nostril's width and height in the noncleft side, intercommissural distance, nasal surface area on the noncleft side, nostril area between the cleft and noncleft side after treatment, and the alveolar gap did not show significant differences between the groups (P > 0.05).

Conclusion:

Early use of nasal stents showed more desirable results in decreasing the width of the nostrils and increasing its height and correcting the angle of the columella without any adverse effects on the nostrils after treatment.
Computed Tomography Scan Assessment of the Anatomy of the Pterygomaxillary Junction and Its Relevance in Le Fort I Osteotomy
Authors: Neema Bridget , Olabu Beda Otieno , Butt Fawzia M.A. , Idenya Pamela Mandela , Cheruiyot Isaac , Misiani Musa
Published: May 2020

Knowledge of the morphometry and types of pterygomaxillary junction (PMJ) during Le-Fort I osteotomy is an important consideration in the reduction of intraoperative complications. The PMJ is known to display population variations and with the recent increase in these surgical interventions in Kenya, a detailed description of the PMJ is warranted. Computed tomography scan images of PMJ obtained from 63 patients were analyzed at the level of the posterior nasal spine to assess types and the morphometry of the PMJ. A fissure type of PMJ was present in 65.9% (83/126 sides) while a synostosis type was present in 34.1% (43/126). Bilateral fissures were found in 58.73% (37/63), bilateral synostosis in 26.98% (17/63), and an asymmetric PMJ in 15.25% (9/63). The average height, width, and thickness of the PMJ were 17.45 ± 5.26 mm, 10.24 ± 1.97 mm, and 6.40 ± 1.97 mm respectively. Males had a significantly greater height (P = 0.003) and width (P = 0.000). The average width was greater in cases with a synostosis as compared with those with a fissure (P = 0.019). Average distance of greater palatine canal was 40.41 ± 2.28 mm and 7.19 ± 2.20 mm from the piriform rim and the pterygoid fossa respectively. The PMJ among Kenyans is characterized by a higher occurrence of synostosis, greater height, and thickness compared with previous findings from other populations. The results of this study can be helpful for surgeons in selecting the most appropriate techniques to achieve successful pterygomaxillary disjunction and minimize avoid attendant complications such as vascular and nerve injuries.
Electromyographic, Ultrasonographic, and Ultrasound Elastographic Evaluation of the Masseter Muscle in Class III Patients Before and After Orthognathic Surgery
Authors: Sunal Akturk Ezgi , Eren Hakan , Gorurgoz Cansu , Orhan Kaan , Karasu Hakan Alpay , Akat Bora , Toygar Memikoglu Tülin Ufuk
Published: May 2020

Purpose:

The aim of this study was to examine changes in the electromyographic activity, thickness, width, and hardness of the masseter muscle from before to after orthognathic surgery.

Material and Methods:

The study included 15 patients with Class III dentofacial deformities who were treated with combined orthodontic and orthognathic surgery. Fifteen individuals with normal occlusion and no signs or symptoms of temporomandibular joint dysfunction were used as controls. All records were obtained bilaterally in the study group before surgery (T1), at 3 months after surgery (T2), and in the control group (CG) while at rest and in maximum voluntary contraction (MVC).

Results:

There was no difference in resting masseter muscle activity between T1, T2, and CG. Resting thickness and width of the masseter muscle did not differ significantly between T1 and T2. MVC masseter muscle activity and thickness increased significantly and width decreased significantly from T1 to T2 but did not reach CG values. Muscle hardness increased from T1 to T2.

Conclusions:

The authors’ findings indicate that despite improved muscle activity and dimensions, postoperative 3 months is still early period for adaptation of the masseter muscles to the new occlusion and skeletal morphology.
What Do We Know About COVID-19?: Maxillofacial Surgeons Survey
Authors: Costa Samuel Macedo , Lacerda Guilherme Toledo de , Villafort Rayssa Nunes , Silveira Roger Lanes , Amaral Marcio Bruno Figueiredo
Published: May 2020

Coronavírus disease 2019 (COVID-19) is a virus of mass dissemination, with an impact on international public health, leading to hospitalizations and death. The main symptoms of COVID-19 are fever, fatigue, dry cough; however, myalgia and dyspnea and the transmission routes include direct transmission by cough, sneeze, droplet inhalation, or contact transmission with the oral, nasal, or eye mucous membranes. The dental professionals are the main risk group to COVID-19 due to the transmission routes that are directly related to the dental practice. In addition, the oral and maxillofacial surgeons (OMFS) are even more exposed, due to increased contact with the population in hospitals and emergency services. OMFS should be able to identify a suspected case of COVID-19, its symptoms, risk groups, disease severity, laboratorial and computed tomography alterations, and treatment guidelines. In the present study, the authors performed a nationwide survey with Brazilian OMFS to evaluate the knowledge of these professionals about the pandemic status of the COVID-19. A total of 142 OMFS replied the survey and the results brings light to an incomparable health public problem that the OMFS in Brazil are no able to protect itself, diagnose the suspicious and probable cases, request and interpret the correct laboratorial examinations for the treatment of the COVID-19 patients.
Biofabricating murine and human myo-substitutes for rapid volumetric muscle loss restoration
Authors: Costantini Marco , Testa Stefano , Fornetti Ersilia , Fuoco Claudia , Nie Minghao , Bernardini Sergio , Rainer Alberto , Baldi Jacopo , Zoccali Carmine , Biagini Roberto , Castagnoli Luisa , Vitiello Libero , Blaauw Bert , Seliktar Dror , Święszkowski Wojciech , Garstecki Piotr , Takeuchi Shoji , Cesareni Gianni , Cannata Stefano , Gargioli Cesare
Published: May 2020

The importance of skeletal muscle tissue is undoubted being the controller of several vital functions including respiration and all voluntary locomotion activities. However, its regenerative capability is limited and significant tissue loss often leads to a chronic pathologic condition known as volumetric muscle loss. Here, we propose a biofabrication approach to rapidly restore skeletal muscle mass, 3D histoarchitecture and functionality. By recapitulating muscle anisotropic organization at the microscale level, we demonstrate to efficiently guide cell differentiation and myobundle formation bothin vitroandin vivo. Of note, upon implantation, the biofabricated myo-substitutes support the formation of new blood vessels and neuromuscular junctions – pivotal aspects for cell survival and muscle contractile functionalities – together with an advanced along with muscle mass and force recovery. Together, these data represent a solid base for further testing the myo-substitutes in large animal size and a promising platform to be eventually translated into clinical scenarios.
Time-calibrated genomic evolution of a monomorphic bacterium during its establishment as an endemic crop pathogen
Authors: Richard Damien , Pruvost Olivier , Balloux François , Boyer Claudine , Rieux Adrien , Lefeuvre Pierre
Published: May 2020

The reconstruction of the evolutionary histories of pathogen populations in space and time has greatly improved our understanding of their epidemiology. However, analyses are usually restricted to the non-recombining genomic regions and, thus, fail to inform on the dynamics of the accessory genome. Yet, horizontal gene transfer is of striking importance to the evolution of bacteria as it can redistribute phenotypically important genes. For bacterial pathogens, those include resistance to antimicrobial compounds and virulence factors. Understanding the gene turnover in genomes at microevolutionary scales is key to apprehend the pace of this evolutionary process. Here we addressed this question for the epidemic lineage of a major bacterial plant pathogen, relying on a dense geographic sampling spanning 39 years of evolution. Gene turnover rate exceeded SNP mutation rates by three orders of magnitude. Accessory genes were preferentially plasmid-encoded, but we evidenced a highly plastic chromosomal region hosting ecologically important genes such as transcription activator-like effectors. We argue that turnover of accessory genes provides a potent evolutionary force in monomorphic bacteria, and exemplify this statement retracing the history of a mobile element conferring resistance to copper compounds widely used for the management of plant bacterial pathogens.
NMR Analysis of the Correlation of Metabolic Changes in Blood and Cerebrospinal Fluid in Alzheimer Model Male and Female Mice
Authors: Stojanovic Filip , Taktek Mariam , Khieu Nam Huan , Huang Junzhou , Jiang Susan , Rennie Kerry , Chakravarthy Balu , Costain Will J. , Cuperlovic-Culf Miroslava
Published: May 2020

The development of effective therapies as well as early, molecular diagnosis of Alzheimer’s disease is impeded by the lack of understanding of the underlying pathological mechanisms. Metabolomics studies of body fluids as well as brain tissues have shown major changes in metabolic profiles of Alzheimer’s patients. However, with analysis performed at the late stages of the disease it is not possible to distinguish causes and consequence. The mouse model APP/PS1 expresses a mutant amyloid precursor protein resulting in early Amyloid β (Aβ) accumulation as well as many resulting physiological changes including changes in metabolic profile and metabolism. Analysis of metabolic profile of cerebrospinal fluid (CSF) and blood of APP/PS1 mouse model can provide information about metabolic changes in these body fluids caused by Aβ accumulation. Using our novel method for analysis of correlation and mathematical ranking of significant correlations between metabolites in CSF and blood, we have explored changes in metabolite correlation and connectedness in APP/PS1 and wild type mice. Metabolites concentration and correlation changes in CSF, blood and across the blood brain barrier determined in this work are affected by the production of amyloid plaque. Metabolite changes observed in the APP/PS1 mouse model are the response to the mutation causing plaque formation, not the cause for the plaque suggesting that they are less relevant in the context of early treatment and prevention then the metabolic changes observed only in humans.
Genome-wide Association Studies Reveal Important Candidate Genes for theBacillus pumilusTUAT-1-Arabidopsis thalianaInteraction
Authors: Cotta Marina Soneghett , do Amaral Fernanda Plucani , Cruz Leonardo Magalhães , Wassem Roseli , de Oliveira Pedrosa Fábio , Yokoyama Tadashi , Stacey Gary
Published: May 2020

The plant growth promoting bacterium (PGPB)Bacillus pumilusTUAT-1 is an indole acetic acid producer that can increase plant growth. Inoculation with this strain has been shown to confer greater plant tolerance to drought and saline conditions. Although the ability of TUAT-1 to enhance plant growth is well documented, little is known about what mechanisms underlie the plant response to this bacterium. Applying genome-wide association study (GWAS), we evaluated the interaction between TUAT-1 andArabidopsis thaliana, screening 288 plant ecotypes for root architecture traits comparing non-inoculated and inoculated plants. Most of the ecotypes were significantly affected by TUAT-1 inoculation (66.7%) for at least one of the root traits measured. For example, some ecotypes responded positively increasing root growth while others showed reduced growth upon inoculation. A total of 96 ecotypes (33.3%) did not respond significantly to PGPB inoculation. These results are consistent with the widely reported strain-genotype specificity shown in many plant-microbe interactions. The GWAS analysis revealed significant SNPs associated to specific root traits leading to identification of several genes putatively involved in enabling theBacillus pumilusTUAT-1 andA. thalianaassociation and contributing to plant growth promotion. Our results show that root architecture features are genetic separable traits associated with plant growth in association with TUAT-1. Our findings validate previous reported genes involved inBacillus spp.-plant interaction, growth promotion and highlight potential genes involved in plant microbe interaction. We suggest that plant-bacterial interaction and the plant growth promotion are quantitative and multigenic traits. This knowledge expands our understanding of the functional mechanisms driving plant growth promotion by PGPB.
Why scaling up uncertain predictions to higher levels of organisation will underestimate change
Authors: Orr James A. , Piggott Jeremy J. , Jackson Andrew , Arnoldi Jean-François
Published: May 2020

Abstract

Uncertainty is an irreducible part of predictive science, causing us to over- or underestimate the magnitude of change that a system of interest will face. In a reductionist approach, we may use predictions at the level of individual system components (e.g. species biomass), and combine them to generate predictions for system-level properties (e.g. ecosystem function). Here we show that this process of scaling up uncertain predictions to higher levels of organization has a surprising consequence: it will systematically underestimate the magnitude of system-level change, an effect whose significance grows with the system’s dimensionality. This stems from a geometrical observation: in high dimensions there are more ways to be more different, than ways to be more similar. This general remark applies to any complex system. Here we will focus on ecosystems thus, on ecosystem-level predictions generated from the combination of predictions at the species-level. In this setting, the ecosystem’s dimensionality is a measure of its diversity. We explain why dimensional effects do not play out when predicting change of a single linear aggregate property (e.g. total biomass), yet are revealed when predicting change of non-linear properties (e.g. absolute biomass change, stability or diversity), and when several properties are considered at once to describe the ecosystem, as in multi-functional ecology. Our findings highlight and describe the counter-intuitive effects of scaling up uncertain predictions, effects that will occur in any field of science where a reductionist approach is used to generate predictions.