Clinical investigation of botulinum toxin (prabotulinumtoxin A) for bruxism related to masseter muscle hypertrophy: A prospective study.

This study aims to confirm the effectiveness and safety of a prabotulinumtoxin type A (praBTX-A) injection in patients with bruxism and masseter hypertrophy. The study included patients who ground or clenched their teeth while sleeping and had computed tomography (CT) scans that showed a maximum thickness of the masseter muscle of 15 mm or more. The praBTX-A was administered bilaterally into the masseter muscles; 15 U/side for group 1, 25 U/side for group 2, and 35 U/side for group 3. CT scans and bruxism questionnaires were conducted before and eight weeks after the injection. Thirty-seven patients were enrolled, but three dropped out due to loss of follow-up. After injection, masseter thickness decreased to 15.1 ± 2.0 mm for group 1, 14.3 ± 2.9 mm for group 2, and 13.4 ± 1.8 mm for group 3 (p = 0.043). Group 3 showed a statistically significant lower masseter thickness compared to group 1 (p = 0.039). Both subjective and objective frequencies of bruxism decreased for all groups, but there were no significant differences in either subjective (p = 0.396) or objective frequencies (p = 0.87) between the groups after the injection. The results of this study suggest that praBTX-A injection is a safe and effective treatment for bruxism and masseter hypertrophy. A dosage of 35 IU/side can effectively decrease masseter thickness and relieve bruxism symptoms. Even the minimum dosage of 15 IU/side can contribute to improvements in bruxism symptoms. This investigation provides valuable information for managing bruxism that is associated with hypertrophic masseter muscles.

Enhanced see-through near-eye display using time-division multiplexing of a Maxwellian-view and holographic display.

In this paper, we suggest the improved integration of a holographic display and a Maxwellian-view display using time-division multiplexing and describe an image rendering process for the proposed system. In general, the holographic displays have a resolution limit when used to represent a virtual 3D scene. In the proposed system, the holographic display processed relatively few layers of the virtual 3D scene, while the remaining objects were processed with a Maxwellian-view display to which was applied a Gaussian smoothing filter. Hence, we obtained the retaining holographic image quality, expanding the field of view, and reducing the computation time of the proposed system. The holographic display of the proposed system had an image size of 28 mm × 28 mm with a field of view of 1.02° and a 10.8 mm eye box. The Maxwellian-view display had an image size of 230 mm × 230 mm with a field of view of 22.6 ° and a 0.9 mm eye box diameter. Each display was integrated in time-division multiplexing of 40 Hz, and the proposed system was successfully verified.

Intraoperative burn from a grounding pad of electrosurgical device during breast surgery: A CARE-compliant case report.

RATIONAL: Burns at the site of the return electrode (i.e., grounding pad) are possible effects of electrosurgery. Despite this knowledge, however, ignorance or negligence with regards to proper handling of the grounding pads still often occurs. Burn injuries can be easily prevented by taking the necessary precautions; thus, during plastic surgery, careful attention should to be paid. PATIENT CONCERNS: A 38-year-old female patient was admitted to our ward to be performed augmentation mammoplasty. Before the start of the procedure, the grounding pad was placed on the surgical table and the left calf of the patient was placed on the grounding pad. Before using the endoscope, we found a burn on patient's left calf, where the grounding pad had been placed. DIAGNOSIS: It was a 3-cm-by-3-cm-sized full thickness burn. The surrounding areas had no painful sensation with noninfectious sign. INTERVENTION: Debridement and direct closure was performed with elliptical incision of eschar. OUTCOMES: The patient did not require additional surgical procedure anymore and satisfied with the scar. LESSONS: Through this case, we present the appropriate management of electrical burns from a grounding pad, and emphasize the understanding of the mechanism of burn because of electrosurgery, and how to use the grounding pad optimally to minimize the patient's risk.

Three-dimensional circumferential liposuction of the overweight or obese upper arm.

UNLABELLED: Due to recent trends in liposuction, anatomic consideration of the body's fatty layers is essential. Based on this knowledge, a circumferential approach to achieving maximal aesthetic results is highlighted. In the upper arm, aspiration of fat from only the posterolateral region can result in skin flaccidity and disharmony of the overall balance of the upper arm contour. Different suction techniques were applied depending on the degree of fat accumulation. If necessary, the operation area was extended around the axillary and scapular regions to overcome the limitations of the traditional method and to achieve optimal effects. To maximize skin contracture and redraping, the authors developed three-dimensional circumferential liposuction (3D-CL) based on two concepts: circumferential aspiration of the upper arm, to which was applied different fluid infiltration and liposuction techniques in three anatomic compartments (anteromedial, anterolateral, and posterolateral), and extension of liposuction to the periaxillar and parascarpular areas. A total of 57 female patients underwent liposuction of their excess arm fat using this technique. The authors achieved their aesthetic goals of a straightened inferior brachial border and a more slender body contour. Complications occurred for five patients including irregularity, incision-site scar, and transient pigmentation. Through 3D-CL, the limitations of traditional upper arm liposuction were overcome, and a slender arm contour with a straightened inferior brachial border was produced. LEVEL OF EVIDENCE IV: 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 at http://www.springer.com/00266.

Total nose reconstruction using superselective embolisation and a forehead flap: overlooked in recurrent massive vascular malformations of the nose.

OBJECTIVES: Massive vascular malformations of the nose cause serious cosmetic, functional and psychological problems. Generally, no single treatment modality to date has provided satisfactory results. Therefore, multidisciplinary treatment approaches are being standardised. In spite of standard multidisciplinary treatments, especially postoperative outcomes in massive nasal vascular malformation cases are often aesthetically and functionally unsatisfactory due to the unique characteristics of the nose. While several studies report on the management of facial vascular malformations using local and distant flaps, none is specific to the nasal region. MATERIALS AND METHODS: The present article describes the treatment of four patients with recurrent massive nasal vascular malformation (which invades more than two-thirds of the nose) using a combined-procedure approach involving preoperative superselective embolisation, extensive (en bloc) malformation resection and nasal reconstruction using a paramedian forehead flap. Patients were followed up for a mean of 19 months. Preoperative assessments included MR angiography, selective angiography and physical examination, including Doppler sonography. Preoperative superselective embolisation was then performed by a radiologist. On post-embolisation day 2, patients underwent en bloc resection and total nasal reconstruction with paramedian forehead flap hitherto overlooked in the treatment of nasal vascular malformation. RESULTS: Satisfactory results were achieved in all four patients. Three patients suffered a high-flow malformation and one suffered a low-flow malformation. As confirmed by the radiologist, no recurrences were noted. Colour matching and nasal contouring were satisfactory in all cases. There were no major complications such as serious infection, recurrent ulceration, postoperative bleeding or flap failure. All patients responded positively. CONCLUSIONS: The present novel treatment of massive vascular malformations of the nose using selective embolisation, en bloc resection and a paramedian forehead flap was successful. The findings indicate that this treatment of massive nasal vascular malformations leads to successful functional and aesthetic outcomes. The patients were followed up for an average of 2 years and ongoing follow-up is scheduled.