Vascular Perspectives of the Midfacial Superficial Musculoaponeurotic System.

Objectives: Presently, data on the vascularization of the superficial musculoaponeurotic system of the face (SMAS) are lacking. Thus, the present study aimed to provide new conclusive data about the topography, density, and relationship of the SMAS blood vessels with other components, namely, the fibrous connective tissue and muscles. Methods: The study included a control lot of 42 cases from the archive of the radiology department. In this group, nuclear magnetic resonance angiography (MRA) was performed in order to identify the main sources of vascular supply. In the second group, tissue samples were collected from the midfacial region of 45 patients from the Oro-Maxillo-Facial and Plastic and Reconstructive Surgery clinics of 'St. Spiridon' County Clinical Emergency Hospital, Iasi. These patients received surgery for excision of tumoral formations that did not involve SMAS components. These samples underwent micro-CT analysis, hematoxylin and eosin (HE) staining, as well as immunohistochemical (IHC) staining for collagen type III, muscle tissue, and the vascular endothelium. Results: We discovered the particular way in which the SMAS components interrelate with vascularization and the regional differences between them. We have discovered a new vascular network specific to the SMAS, highlighted by both the micro-CT technique and microscopy on slides with special IHC staining. Significant differences were observed in the topographic arrangement, density, and relationships of the microscopic vasculature across midfacial regions. IHC staining provided morphological and functional information about the structure and vascularization of SMAS. Conclusions: The MRA technique could not detect the structural blood vessels of the SMAS and other methods for their in vivo visualization must be sought. The blood vessels of the SMAS mainly follow the topography of the muscle fibers. From the SMAS layer where they are found, the distribution branches reach the stroma of the region and the hypoderm. Our data can contribute to the development of surgical techniques tailored to each individual patient, as well as the enhancement of methods for stimulating cutaneous angiogenesis, improving scarring in this region, and advancing biotissue engineering techniques.

Traumatic Dental Injuries among Adolescents and Young Adults in Iași, Romania: Legal and Medical Perspectives.

Adolescents and young adults' active lifestyles make dental trauma a significant medical concern. AIM: This study aims to assess the etiology, frequency, and localization of dental and periodontal trauma in adolescents and young adults, along with these individuals' predisposition based on age, gender, and residence. Materials and Methods This retrospective study included 109 adolescents and young adults from a database of the Emergency and Oral and Maxillofacial Surgery department at "Sf. Spiridon" Hospital, Iasi, Romania. The collected data included demographic details, mechanisms of dental and periodontal trauma, treatment approaches, and clinical outcomes. Statistical analysis was performed using SPSS 26.0, with comparisons based on age, gender, and residence. RESULTS: Enamel fractures (23.9%) and enamel-dentin fractures without pulp exposure (20.2%) were the most frequent dental injuries. Concussion (58.7%), subluxation (21.1%), luxation, avulsion (7.3%), and extrusion (5.5%) were common periodontal injuries. The anterior region of the dental arch accounted for the majority (60.6%) of injuries. Adolescents under 17 years were more prone to enamel-dentin fractures without pulp exposure (23.8%), enamel-dentin fractures with pulp exposure (20.6%), and root fractures (20.6%), while young adults over 18 years had a higher incidence of enamel fractures (32.6%) and crown-root fractures (30.4%). Falls (66.7%) were the predominant cause of trauma for female patients, whereas male patients were more often injured during sports activities (49.3%). The younger age group was 0.29 times more likely to sustain enamel-dentin fractures without pulp exposure (p = 0.049, OR = 0.291) and root fractures (p = 0.047, OR = 0.241). CONCLUSIONS: Traumatic dental injuries are more prevalent in young adults compared to adolescents, with falls and sports activities being the most common causes, particularly among males. These findings emphasize the need for targeted preventive programs aimed at reducing the incidence of dento-periodontal trauma in these age groups.

The Effect of Cigarettes Smoke on the Color and Properties of a Silicone for Maxillofacial Prostheses.

Although deterioration of silicone maxillofacial prostheses is severely accentuated in smoking patients, the phenomenon has not been systematically studied. To address a gap in the literature concerning the stability of maxillofacial prostheses during service, in this contribution, the effect of cigarette smoke on the aspect and physical properties of M511 silicone elastomer was evaluated. The aspect, surface, and overall properties of the silicone material, pigmented or not, were followed by AFM, color measurements, FTIR, water contact angle measurements, TGA-DTG and DSC, hardness and compression stress-strain measurements. The types of the contaminants adsorbed were assessed by XRF, ESI-MS, MALDI-MS, and NMR spectral analyses. Important modifications in color, contact angle, surface roughness, local mechanical properties, and thermal properties were found in the silicone material for maxillofacial prostheses after exposure to cigarettes smoke. The presence of lead, nicotine, and several other organic compounds adsorbed into the silicone material was emphasized. Slight decrease in hardness and increase in Young's modulus was found. The combined data show important impact of cigarette smoke on the silicone physical properties and could indicate chemical transformations by secondary cross-linking. To our knowledge, this is the first study making use of complementary physical methods to assess the effect of cigarette smoke on the aspect and integrity of silicone materials for maxillofacial prostheses.

An Observational Study on the Management of Medico-Legal Maxillofacial Trauma Cases by General Practitioners.

Maxillofacial trauma, as seen from a medico-legal point of view, is an integral part of medical practice in emergency departments. Therefore, general practitioners should have sufficient knowledge about their roles and responsibilities in managing these cases. This study aimed to assess general practitioners' knowledge, practices, and attitudes regarding managing medico-legal cases (MLCs). MATERIAL AND METHOD: This study included 113 general practitioners from St. Spiridon Hospital in Iasi, Romania. Participants completed a self-administered structured questionnaire assessing the knowledge, attitudes, and practices of general practitioners regarding the handling of medico-legal cases. RESULTS: The scores obtained for the level of knowledge, attitudes, and practices indicate a good level of knowledge on the part of the responding doctors, with the average value being 38, in a range from 0 to 49 (min. value 28-max wave. 47). The score regarding the attitudes of doctors related to the management of medico-legal cases is modest, with the average value being 37 points out of a maximum of 60 points (min. 14-max. 51). The same situation is recorded in the case of practices regarding the management of medico-legal cases, with the average value being 68 out of a maximum value of 90 (min. 38-max. 84). CONCLUSION: This study's results revealed the absence of a well-defined protocol for the recognition and handling of medico-legal cases among general practitioners from Iasi and the need to improve the level of attitudes and practices regarding the management of medico-legal cases. The limitations of this study included the relatively small sample from a single hospital and the use of a methodology based on self-administered questionnaires, which may be subjective. Accordingly, future studies should involve larger and more diverse samples to monitor changes in knowledge and practices over time and qualitative methodologies to gain deeper physician-related insights into medical case management.

Color Modifications of a Maxillofacial Silicone Elastomer under the Effect of Cigarette Smoke.

Although it is known (from the observations of medical professionals) that cigarette smoke negatively affects maxillofacial prostheses, especially through staining/discoloration, systematic research in this regard is limited. Herein, the color modifications of M511 maxillofacial silicone, unpigmented and pigmented with red or skin tone pigments, covered with mattifiers, or with makeup and mattifiers, and directly exposed to cigarette smoke, were investigated by spectrophotometric measurements in the CIELab and RGB color systems. The changes in color parameters are comparatively discussed, showing that the base silicone material without pigmentation and coating undergoes the most significant modifications. Visible and clinically unacceptable changes occurred after direct exposure to only 20 cigarettes. By coating and application of makeup, the material is more resistant to color changes, which suggests that surface treatments provide increased protection to adsorption of the smoke components. The dynamic water vapor sorption (DVS) measurements indicate a decrease of the sorption capacity in pigmented versus unpigmented elastomers, in line with the changes in color parameters.

Silicones for Maxillofacial Prostheses and Their Modifications in Service.

The biomedical applications of silicones are countless due to their outstanding properties. In dentistry, silicone for maxillofacial and plastic surgery has become indispensable, from both physiological and aesthetic points of view. In this mini-review, silicone materials for dentistry and facial prostheses are discussed, focusing on their properties and alterations when exposed for long periods to different environments. A significant number of studies reported in the literature have been conducted in vitro, mimicking some of the main degradative factors which have been identified as triggers for discoloration and deterioration of the mechanical properties. Among these, in artificial aging and accelerated natural aging studies, UV radiation is considered the most important. Other weathering factors, biological contamination, and disinfection agents may have dramatic effects as well. Several general properties of silicones are described at the beginning, with a focus on biocompatibility, cross-linking mechanisms, and applications in dentistry and maxillofacial prosthetics. We discuss the ongoing cross-linking and/or possible exudation after manufacturing, which also affects the stability of the prosthesis over time, and possibly the patient. Next, the main environmental factors that affect the prostheses in service are presented, including the role of cigarettes smoke, which has been discussed very little so far. A few aspects, such as biofilm formation, its negative effects, and proposed solutions to overcome this phenomenon regarding silicones, are also described. We conclude by proposing a set of topics for future research and development based on the gaps that have been identified in the literature. Although silicones are probably irreplaceable in maxillofacial prosthetics, improvements in terms of base materials, additives, surface treatments, and maintenance are possible and necessary for long-lasting and safer prostheses.

Aging of Superficial Musculoaponeurotic System of the Face-Novel Biomarkers and Micro-CT Relevance of Facial Anti-Gravity Support.

The soft superficial tissues of the face are against gravity through an intricate network of ligaments and ligamentous attachments. The aim of this investigation is to delineate the relationship between the muscular, fibrous, and vascular components of the superficial musculoaponeurotic system of the face (SMAS) at the level of its periosteal fixation areas from advanced radiological and novel biomarkers' perspectives. These areas represent key points underlying skin aging and the longevity of restorative surgery results. Methods: This study was carried out on 37 surgical specimens, excised from patients admitted for surgery. On the excised specimens, we used special immunohistochemical techniques, such as markers for collagen type III, angiogenesis, vascular endothelium (I-CAM2) and muscle fibers (MYH2). We performed a micro-CT evaluation of these 37 specimens. Results: The results of this study showed different radiologic and IHC characteristics of the means of periosteal fixation of the SMAS. Evidence of morphohistological and radiological peculiarities of the retaining ligaments highlights new data for future functional studies of these structures. Our research must be continued with larger groups of subjects and through detailed methodological studies of vascular microperfusion and could represent an important new step in biotissue engineering and the customization of surgical techniques involving the sub-SMAS layers.

A Rare Case of Dirofilariasis in the Genian Region.

Dirofilariasis is an infectious disease caused by species of the Dirofilaria genus. It is manifested by the appearance of a subcutaneous swelling, especially in the eye region. We present the case of a 29-year-old patient who presented with facial asymmetry in the right genian region. Following clinical and paraclinical evaluations, the diagnosis of a parasitic cyst was established in the context of dirofilariasis with Dirofilaria repens (D. repens). Treatment consisted of surgical excision of the formation associated with prophylactic antibiotic medication. Macroscopic analysis of the excision piece revealed a structure that contained a cystic cavity and a filamentous form with a length of approximately 10 mm and a diameter of 1 mm. This is the first case of dirofilariasis located in the genian region reported in Romania. The overview of this pathology is important to raise awareness among physicians about its presence and clinical variations. Understanding such cases helps healthcare professionals enhance diagnostic skills, refine treatment strategies, and provide valuable insights into the prevalence and clinical presentation, fostering early detection and timely intervention. Detailed case reports contribute to the understanding of the disease's epidemiology, including risk factors and transmission patterns, which is essential for effective public health strategies.

Morphofunctional and histological patterns of blood vessels in the superficial cervicofacial musculoaponeurotic system in midlateral face regions.

OBJECTIVE: The superficial cervicofacial musculoaponeurotic system (SMAS) is a complex network formed by mimic muscles and conjunctive tissue of the superficial fascia of the face.This study aimed to introduce new anatomofunctional data on the importance of the trans-SMAS distribution pattern of the skin microperfusion of the face and to underline the role of SMAS in maintaining the homeostasis of the vascular network that crosses it. Considering the fibrous and muscular matrix of the SMAS, using COLIII and MyoH2 antibodies, together with endothelial immunohistochemistry(IHC)intercellular adhesion molecule 2 marker, we determined the correlation of these structures and their interaction. METHODS: This study included 33donors of SMAS tissues, which have been stained withregular hematoxylin and eosin (HE), and three different IHC markers have been used (collagen III, muscular tissue, and blood vessels). The samples were collected from parotid, masseteric, jugal, and zygomatic regions. Magnetic resonance angiography was used to identify the main vascular sources of the midlateral regions of the face of another 47 patients. RESULTS: Significant differences in topographic arrangement, density, and relations of the microsopic vasculature were observed between each of the four regions. Major differences were identified between the role of SMAS in each of these regions, from the parotid capsule to masseteric fascia, transition mobile part, and attaching manners in the zygomatic subunit. CONCLUSIONS: Blood vessel topography must be related with the surrounding conjunctive and muscular tissue, especially regarding facial SMAS. Intrinsic relations between these three components of the SMAS and nervous fibers can provide us important hints on the functionality of the whole system.

Clinical and morphofunctional identity of the nasal SMAS.

The fascial system of the face (superficial musculo-aponeurotic system, SMAS) in the nasal part is a sustained layer that connects the nearby regions. In this paper, we aimed to emphasize the presence of SMAS in different areas of the nasal region: ala nasi, nasolabial fold, nasal dorsum and radix. We performed three studies (anatomical, histological, and radiological) to demonstrate the existence of nasal SMAS. The study group consisted of cadaveric analyses and retrospective analysis of the patient radiological data. The nasal SMAS was identified as a superficial fascia and a subcutaneous adipose layer. The anatomical dissection study together with histological and radiological evaluations demonstrated the presence of SMAS in the nasal region. We identified peculiarities of the nasal SMAS in two areas: in the ala nasi where it is thinner, and the deep part of the dermis does not adhere to the underlying structures and at the radix and dorsum nasi, where the adipose layer is very thin. The results of our research define nasal SMAS as a unit of great value in facial surgeries, such as facial rejuvenation, the resolution of malformations, or tumor removal.

Anatomical Variants of Internal Carotid Artery-Results from a Retrospective Study.

Background and Objectives: The internal carotid artery (ICA) is a vascular structure that can be easily injured during sinus endoscopic procedures, and surgeons should be familiar with its anatomic variants. The aim of this study was to describe the anatomical variations in the internal carotid artery in relationship to sphenoidal sinuses, using computed tomography (CT). Materials and Methods: In this retrospective study, we evaluated the variations of the ICA in relationship to sphenoidal sinuses in a cohort of 600 patients who were assessed between January 2020 and December 2022 in 'Saint Spiridon' Emergency Hospital, Iasi, Romania. Descriptive statistics were used to characterize our data. Results: The most prevalent anatomical variant was represented by intrasinusal septa with posterior insertion on the ICA (58.6%), followed by procident ICA (58%) and dehiscent ICA (52%). We could not find any statistical significance regarding demographic characteristics among groups. Conclusions: A thorough CT examination should be performed before functional endoscopic sinus surgery, with the identification of anatomical variants of the ICA, in order to prevent its injury with potentially fatal consequences.

Patterns and Characteristics of Midface Fractures in North-Eastern Romania.

Midface fractures are common injuries that are the result of interpersonal violence, traffic accidents, falls, work-related accidents, sports-related accidents, or animal aggression. In the northeastern part of Romania, these injuries are a significant health concern that, if left untreated, may lead to functional and esthetic sequelae. Background and Objectives: This study aims to update the statistical data available to help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence. Materials and Methods: This research was conducted over five years and included 651 patients of both sexes, with ages between 3 and 95 years, that addressed our center for midface fracture treatment. Results: The authors of this study found that men are more predisposed to fractures of the middle third of the face, with anterior laterofacial fractures being the most common type of fracture. Interpersonal violence was the most incriminated etiology for all midface fractures. Conclusions: The present study regarding midfacial fractures shows similar results compared to the medical literature. These findings could help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence.

Crisis Preparedness: A Systems-Based Framework for Avoiding Harm in Surgery.

BACKGROUND: Highly performing healthcare organizations benefit from robust failure management systems. This involves the ability to respond and recover from critical events, as well avoiding harm in the first place (crisis preparedness). Currently, the surgical community may lack an integrated toolbox for crisis readiness. The study aims to create a practical framework for crisis preparedness in surgery. STUDY DESIGN: A multimethod qualitative study was designed to identify and translate crisis preparedness interventions from high-reliability industries to clinical practice. The tools and strategies identified were subsequently developed and clinically adapted for healthcare use. The study used (1) observational fieldwork in commercial aviation; (2) semi-structured interviews with senior airline pilots, and (3) mixed focus groups with healthcare and aviation safety experts. A crisis preparedness framework was derived by thematic analysis using the framework method. Clinical adaptation was achieved using expert consensus methodology. RESULTS: Twenty-two aviation and healthcare experts participated in 17 interviews and 3 focus groups. A framework for crisis preparedness was derived, consisting of 6 behavioral interventions: (1) anticipate threats and errors by building situational awareness using cognitive tools; (2) brief teams about goals, deviations, operational risks, and contingency plans; (3) implement standard operating procedures using checklists; (4) rehearse emergency drills before critical phases of work; (5) set the tone for a positive working environment by establishing cultural norms and empowering individuals to speak up about safety issues; and (6) debrief performance outcomes to derive learning lessons. CONCLUSIONS: Surgical crisis preparedness requires integrated systems rather than isolated safety interventions. This study provides a framework and the tools to achieve this.

Improving the Treatment Outcome of Naso-Orbito-Ethmoido-Maxillary Fractures Using Virtual Three-Dimensional Anthropometric Data.

BACKGROUND: Naso-orbito-ethmoido-maxillary (NOEM) fractures are usually the result of a high or moderate intensity impact to the upper midface. These types of fractures are difficult to treat and are frequently misdiagnosed. Craniometric analysis can be of real aid in the treatment of NOEM complex fractures by establishing midfacial proportions. AIM: This study aims to establish the distances between selected anthropometric points and midfacial proportions found in the adult Caucasian population and to determine if any differences exist between genders. METHODOLOGY: Measurements between anthropometric points, nasion (N), dacryon (D), infraorbital foramen (IOF), frontomalare orbitale (FMO), rhinion (Rhi) and porion (Po), were made on 3D models obtained using patients' CT exams. RESULTS: Significant differences were found between genders for the orbital dimensions represented by N-FMO (p = 0.000), N-IOF (p = 0.000), Rhi-FMO (p = 0.000), Rhi-IOF (p = 0.000), nose bridge width N-D (p = 0.001), Rhi-D (p = 0.016), D-D (p = 0.038) and the projection of the nose evaluated by Rhi-Po (p = 0.000), N-Po (p = 0.000), while a t-test showed that there are no significant differences between males and females for the N-Rhi (p = 0.254). CONCLUSIONS: The values of these measurements can be utilized during skeletal reconstruction after NOEM fractures, especially for bilateral comminuted fractures where no points of comparison are available.

Comprehensive review on the pathophysiology, clinical variants and management of pemphigus (Review).

Pemphigus represents a group of chronic inflammatory disorders characterized by autoantibodies that target components of desmosomes, leading to the loss of intercellular adhesion between keratinocytes and causing intraepithelial blistering. The pemphigus group consists of four main clinical types with several variants: pemphigus vulgaris (with pemphigus vegetans and pemphigus herpetiformis as variants), pemphigus foliaceus, paraneoplastic pemphigus and IgA pemphigus (with two clinical variants: intraepidermal neutrophilic IgA dermatosis and subcorneal pustular dermatosis). Genetic factors are involved in the pathogenesis, with HLA-DR4 (DRB1*0402) and HLA-DRw6 (DQB1*0503) allele more common in patients with pemphigus vulgaris, HLA class II DRB1*0344 and HLA Cw*1445 correlated with paraneoplastic pemphigus, and HLA-DRB1*04:01, HLA-DRB1*04:06, HLA-DRB1*01:01, HLA-DRB1*14, associated with a higher risk of developing pemphigus foliaceus. Autoantibodies are conducted against structural desmosomal proteins in the skin and mucous membranes, mainly desmogleins, desmocollins and plakins. Cell-mediated immunity may also play a role, especially in paraneoplastic pemphigus. Patients may present erythema, blisters, erosions, and ulcers that may affect the skin, as well as mucosal surfaces of the oral cavity, eyes, nose, leading to severe complaints including pain, dysphagia, and fetor. Oral mucosal postbullous erosive lesions are frequently the first sign of disease in pemphigus vulgaris and in paraneoplastic pemphigus, without skin involvement, making the diagnosis difficult. Treatment options classically include immunosuppressive agents, such as corticosteroids and corticosteroid-sparing agents such as azathioprine, mycophenolate mofetil, cyclophosphamide, methotrexate or dapsone. Newer therapies focus on blocking cell signaling events induced by pathogenic autoantibodies and/or targeting specific autoantibodies. The disease evolution is conditioned by the treatment with maximum doses of corticosteroids and the side effects associated with long-term immunosuppressive therapy, which is why patients need a multidisciplinary approach in following the treatment. In this review, we provide a comprehensive overview of the epidemiology, pathophysiology, clinical aspect, diagnosis and management of the main intraepidermal blistering diseases from the pemphigus group.

The Psychosocial Role of Body Image in the Quality of Life of Head and Neck Cancer Patients. What Does the Future Hold?-A Review of the Literature.

Background and Objectives: It is well known that among all cancers, cancers of the head and neck (HNC) have a major impact on patients' quality of life. Disfigurement, anxiety and disabling physical and psychological symptoms affect people with HNC to such an extent that the suicide rate in this category of patients is exceeded only by that of patients with pancreatic cancer. The aim of this review was to summarize the published literature describing the severity of body image and quality of life impairment in patients with HNC over time, and to examine the psychosocial and functional associations and interventions implemented to improve body image and quality of life. Materials and Methods: We conducted a literature search from 1 January 2018 to June 2021 that included electronic searches of six major databases (PubMed, ScienceDirect, ProQuest, PsycINFO, PsychArticles and Scopus) and review of references of articles screened. Of 620 records, only 9 articles met the eligibility criteria. Results: Numerous studies have been conducted to analyze various psychological variables, but there is still a lack of standardization in the assessment of body image perception (BI) and quality of life, resulting in small-scale testing of interventions with poor results. Conclusions: Expected longitudinal studies describing the flow of body image problems and the mediation and balance factors associated with body image will allow researchers to design methods aimed at limiting body image disorders and thus improving quality of life of patients with head and neck cancer.

High serum level of interleukin-6 is linked with dyslipidemia in oral lichen planus.

Oral lichen planus (OLP) is a complex chronic inflammatory disorder in which autocytotoxic CD8+ T cells, locally present in the affected tissue, induce basal keratinocyte apoptosis, through the release of several cytokines, such as interleukin-6 (IL-6). IL-6 is a proinflammatory cytokine that is related to alterations in lipid metabolism in psoriasis patients. Impaired lipid metabolism together with high serum levels of triglycerides have been found in association with OLP. However, the correlation between serum levels of IL-6 and dyslipidemia has not yet been studied in this disorder. The present study aimed to demonstrate the association between OLP, systemic inflammation through increased release of inflammation mediators such as IL-6 and alteration of lipid metabolism, in order to support the concept of OLP as a marker of systemic inflammation and a potential risk factor of cardiovascular morbidities. For this purpose, we designed a case-control study using a cohort of 18 patients with different clinical forms of OLP compared with 18 control group patients with other oral conditions, to identify a potential correlation between serum levels of IL-6 and serum lipid levels. High plasma serum levels of IL-6 were found to be correlated with cholesterol, high density lipoprotein cholesterol and triglyceride serum levels in the patients with OLP. There was a significant association between erosive and atrophic clinical forms of OLP and the pathological serum values of IL-6 and triglycerides, respectively, making these two parameters good predictive factors of the clinical form of OLP. Further studies of other biomarkers of systemic inflammation using larger cohorts of OLP patients are necessary in order to consider LP as a marker of systemic inflammation and to support the screening of these patients for lipid metabolism changes and treatment with specific antagonists in order to prevent cardiovascular events.

The Impact of 3D Technology in Optimizing Midface Fracture Treatment-Focus on the Zygomatic Bone.

PURPOSE: In the context of the ongoing development and expanding availability of 3-dimensional (3D) printing, there is increasing interest in designing simplified workflows that would encourage more medical practitioners to include 3D printing in their current practice. The purpose of this study is to present our experience regarding the use of 3D printing in the preoperative planning and management of acute midface trauma, an area less explored by existing studies. METHODS: We performed a retrospective case series study including admitted patients who underwent surgical repair of midface fractures, in which 3D-printed stereolithic models were used preoperatively for shaping the osteosynthesis material. We recorded standard information about the patients, imaging method used, and type of midface fracture. We also logged the details and durations of each main step in the preoperative 3D printing workflow and documented the durations and outcomes of each surgical procedure. RESULTS: We identified 29 cases of midface fractures that benefited of a preoperative stereolithic model. From the 2 main methods of obtaining the virtual model, mirroring and virtual fracture reduction, the longest duration was recorded in a case in which the later method was used. The longest stereolithic model printing time was found in a complex midface fracture case. All the prebent osteosynthesis material was used intraoperatively and fitted the reduced fracture sites, also serving as an intraoperative guide for correct fracture reduction. The particularities, benefits, as well as the possible challenges associated with the application of 3D printing in acute trauma cases are discussed. CONCLUSIONS: Our 3D printing protocol was applicable and rendered favorable outcomes in the acute midface trauma setting. Proper understanding of the steps involved in achieving the stereolithic model is key for the adaptation of 3D printing to the current management of acute midface trauma.

Predictive Value of HPV, p53, and p16 in the Post-Treatment Evolution of Malignant Tumors of the Oropharynx and Retromolar Trigone-Oropharynx Junction.

Background and objectives: Knowledge of the interactions and influences of infectious, genetic, and environmental factors on the evolution and treatment response of malignant tumors is essential for improving the management of the disease and increasing patient survival. The objective of this study was to establish the contribution of human papillomavirus (HPV), as well as p53 and p16 tumor markers, alongside associated factors (smoking and alcohol consumption), in the progression of malignancies located in the oropharynx and at the retromolar trigone-oropharyngeal junction. Materials and Methods: We performed a prospective study including 50 patients with malignant tumors of the oropharynx and retromolar trigone-oropharyngeal junction. In all patients, the presence and type of HPV were determined, as well as the status of the tumor markers p53 and p16. The associated risk factors, biopsy results, treatment method, and post-treatment evolution were all documented. Statistical analyses were performed to evaluate the correlations between the determining factors and their influence on the post-treatment evolution. An overall increased survival rate was found in HPV(+) patients. Results: Our study outlined the prevalence of different high-risk subtypes of HPV from the ones presented by other studies, suggesting a possible geographic variation. Correlations between the p53 and p16 statuses and patient survival could be established. The association of smoking and alcohol consumption strongly correlated with an unfavorable evolution. Conclusions: Awareness of the differences in the post-treatment evolution of the patients in relation to the presence of the factors determined in our study could change the future management of such cases for ensuring improved treatment outcomes.

Odontogenic orbital inflammation.

Objective: This study aimed to determine the most frequent clinical aspects in patients with odontogenic orbital inflammation, the computed tomography (CT) aspect, and the most appropriate treatment. Material and Methods: This is a retrospective case-series study conducted on 3 patients with ages between 16 and 55 years old, in the Ophthalmology and Oro-Maxillo-Facial Clinics of "Sf. Spiridon" Emergency Hospital, Iași, Romania. The following investigations were performed in all selected cases: visual acuity (VA), ocular motility examination, anterior segment examination at slit-lamp, fundus examination, intraoral clinical examination, sinus and orbital involvement on CT scan, pathogens involved. Results: All three patients presented swelling of the genic and periorbital regions, conjunctival chemosis, hyperemia of the conjunctiva, proptosis, pain, decreased vision and extraocular movement restriction. The CT examination identified orbital and periorbital cellulitis and ethmoidal expanded maxillary sinusitis or pansinusitis. Dental extraction, transalveolar drainage and orbital decompression were performed in all three cases. The evolution was favorable with remission of proptosis, edema of the genic and periorbital regions and conjunctival chemosis. Visual acuity remained poor in one case due to total optic nerve atrophy. Conclusions: Our study had a small number of patients, but the data was pertinent to ophthalmologists and maxillofacial surgeons who need to be aware of typical clinical features and the most common etiologies. Late treatment of dental infections can lead to severe ocular manifestations such as orbital cellulitis. Odontogenic orbital inflammation management involves a long-term and multidisciplinary approach. Abbreviations: CT = computed tomography, VA = visual acuity, CBCT = cone beam computed tomography, TED = thyroid eye disease, MRI = magnetic resonance imaging, OOC = odontogenic orbital cellulitis, RAPD = relative afferent pupillary defect.