Altered cortical thickness of the superior frontal gyrus and fusiform gyrus in individuals with subthreshold social anxiety.

Subthreshold social anxiety (SSA) is a condition in which individuals experience social anxiety that does not reach the threshold required for a clinical diagnosis of a social anxiety disorder (SAD). Although SSA may not impair lives as severely as SAD, it can affect social functioning. However, only a few studies focused on structural neural correlates of SSA. We recruited 65 individuals with SSA and used the Leibowitz Social Anxiety Scale to assess their social and performance anxiety levels and other relevant measures of social anxiety. Voxel-wise whole-brain correlational analyses showed a positive association between the cortical thickness (CT) of the superior frontal gyrus (SFG) and social anxiety levels and a negative correlation between the CT of the fusiform gyrus (FG) and performance anxiety levels in individuals with SSA. Exploratory Pearson's correlation analyses showed significant positive correlations between the CT of the SFG and Generalized Anxiety Disorder-7 total scores and negative associations between the CT of the FG and Beck Anxiety Inventory total scores. Our study provides insight into the neural basis of SSA, particularly performance anxiety, by highlighting the association between CT in specific brain regions and SSA characteristics.

Asymmetric nasomaxillary expansion induced by tooth-bone-borne expander producing differential craniofacial changes.

OBJECTIVES: To evaluate three-dimensional (3D) craniofacial changes induced by a non-surgical tooth-bone-borne rapid palatal expander (TBB-RPE) according to the symmetrical pattern of expansion, to investigate the 3D changes between the sides in patients with asymmetric expansion, and to identify the related factors of asymmetric expansion. SETTING AND SAMPLE POPULATION: Sixty-six patients (mean age: 19.3 ± 5.7 years) treated with TBB-RPE were divided into a symmetric expansion group (Group S, n = 46) or asymmetric expansion group (Group A, n = 20). Group S was subdivided into Group Ss (n = 27), with bilateral frontomaxillary suture (FMS) split, and Group Sn (n = 19), with no FMS split. MATERIALS AND METHODS: Pre- and post-expansion cone-beam computed tomography images were superimposed, and the common coordinated system was set. All landmarks were designated as coordinate pairs, and treatment changes were automatically calculated. Analysis of variance was conducted for intergroup comparison of craniofacial changes, and logistic regression analysis was performed to identify the related factors of asymmetric expansion. RESULTS: The frequency of asymmetric expansion was 30.3%. Group A with unilateral FMS split showed less craniofacial changes than Group Ss and more changes than Group Sn. Group A exhibited different nasomaxillary displacement between the two halves, showing greater changes in the FMS-split side. Among the tested six variables (age, gender, Angle's classification, unilateral crossbite, maxillary cant and chin deviation), chin deviation was uniquely associated with asymmetric expansion. CONCLUSIONS: Tooth-bone-borne rapid palatal expander had a risk of asymmetric expansion, especially in facial asymmetric patients with chin deviation, producing different craniofacial changes from symmetric expansion.

Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry.

Facial asymmetry can be classified into the rolling-dominant type (R-type), translation-dominant type (T-type), yawing-dominant type (Y-type), and atypical type (A-type) based on the distorted skeletal components that cause canting, translation, and yawing of the maxilla and/or mandible. Each facial asymmetry type represents dentoalveolar compensations in three dimensions that correspond to the main skeletal discrepancies. To obtain sufficient surgical correction, it is necessary to analyze the main skeletal discrepancies contributing to the facial asymmetry and then the skeletal-dental relationships in the maxilla and mandible separately. Particularly in cases of facial asymmetry accompanied by mandibular yawing, it is not simple to establish pre-surgical goals of tooth movement since chin deviation and posterior gonial prominence can be either aggravated or compromised according to the direction of mandibular yawing. Thus, strategic dentoalveolar decompensations targeting the real basal skeletal discrepancies should be performed during presurgical orthodontic treatment to allow for sufficient skeletal correction with stability. In this report, we document targeted decompensation of two asymmetry patients focusing on more complicated yaw-dependent types than others: Y-type and A-type. This may suggest a clinical guideline on the targeted decompensation in patient with different types of facial asymmetries.

Natural Head Postures of Patients With Facial Asymmetry in Frontal View Are Corrected After Orthognathic Surgeries.

PURPOSE: Although orthognathic surgeries focus on adjustment of facial asymmetry (FA), many clinicians know by experience that the natural head posture (NHP) also is corrected after the surgery. The authors examined whether this was indeed the case by the measuring the NHP during the course of orthognathic treatment. Factors associated with NHP correction also were evaluated. PATIENTS AND METHODS: In this retrospective study, clinical features, including the NHP, of patients with FA and those with facial symmetry (FS) were compared. They were outpatients of a private orthodontic dental clinic from December 2008 to March 2012. The degree of NHP tilt was evaluated using an interpupillary (IP) horizontal angle. The NHP of patients with FA were analyzed further before presurgical orthodontic treatment, after presurgical orthodontic treatment, after orthognathic surgery and postsurgical orthodontic treatment, and 1 year after completion of postsurgical orthodontic treatment. The NHP difference at each time point was analyzed using 1-way analysis of variance. An analysis of factors that influence NHP tilt correction was performed by linear regression. RESULTS: Thirty-one patients with FA and 27 with FS were evaluated. The NHP tilt was more profound in the FA group compared with the FS group. There were more patients with skeletal Class III in the FA group. The degree of NHP tilt in the FA group was decreased after orthognathic surgery and postsurgical orthodontic treatment and remained when measured 1 year later. Women were less prone than men to NHP tilt correction by orthognathic surgery. CONCLUSION: Patients with FA have a tilted NHP compared with those with FS. Orthognathic surgery for FA might correct a tilted NHP to a lesser degree in women.

Paraplegia following intercostal nerve neurolysis with alcohol and thoracic epidural injection in lung cancer patient.

The goal of cancer treatment is generally pain reduction and function recovery. However, drug therapy does not treat pain adequately in approximately 43% of patients, and the latter may have to undergo a nerve block or neurolysis. In the case reported here, a 42-year-old female patient with lung cancer (adenocarcinoma) developed paraplegia after receiving T8-10 and 11(th) intercostal nerve neurolysis and T9-10 interlaminar epidural steroid injections. An MRI results revealed extensive swelling of the spinal cord between the T4 spinal cord and conus medullaris, and T5, 7-11, and L1 bone metastasis. Although steroid therapy was administered, the paraplegia did not improve.

Three-dimensional mandibular change after sagittal split ramus osteotomy with a semirigid sliding plate system for fixation of a mandibular setback surgery.

OBJECTIVE: This study proposes a new plate system, a sliding plate, after sagittal split ramus osteotomy (SSRO). The sliding plate was designed to adjust the spatial relationship between the proximal and distal segments during the postoperative period. This plate was used for mandibular setback surgery to minimize forward early relapse. STUDY DESIGN: Twenty-six Korean subjects who had undergone mandibular setback surgery by SSRO were included in this study. Skeletal stability was evaluated with lateral cephalograms and 3-dimensional cone-beam computerized tomography. RESULTS: Forward mandibular movement during the postoperative period was ~2 mm. The condyles rotated inward on the axial view after surgery. Postoperatively, the condyle rotated outward on the axial view, inward on the coronal view, and forward on the sagittal view by a statistically significant amount. CONCLUSIONS: The fixation method with sliding plates after SSRO was stable and convenient for the operators during surgery and postoperative care.

Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy -A case report-.

We report a rare case of a 72-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum after a percutaneous dilatational tracheostomy. The patient's T-cannula was accidentally connected to the oxygen line with a non-perforated connector. The patient rapidly developed respiratory insufficiency and subcutaneous emphysema in the neck and both shoulders. The bilateral pneumothoraces were managed using a chest tube. CT scans of the chest, abdomen, and pelvis revealed an extensive distribution of air throughout the chest and abdomen. The patient was treated successfully with supportive care. This case illustrates the rare occurrence of air passing into multiple body compartments, highlighting the potentially serious complications of a tracheostomy and the importance of intensive care during the recovery period.

Preliminary three-dimensional analysis of tooth movement and arch dimension change of the maxillary dentition in Class II division 1 malocclusion treated with first premolar extraction: conventional anchorage vs. mini-implant anchorage.

OBJECTIVE: This study aimed to compare the effects of conventional and orthodontic mini-implant (OMI) anchorage on tooth movement and arch-dimension changes in the maxillary dentition in Class II division 1 (CII div.1) patients. METHODS: CII div.1 patients treated with extraction of the maxillary first and mandibular second premolars and sliding mechanics were allotted to conventional anchorage group (CA, n = 12) or OMI anchorage group (OA, n = 12). Pre- and post-treatment three-dimensional virtual maxillary models were superimposed using the best-fit method. Linear, angular, and arch-dimension variables were measured with software program. Mann-Whitney U-test and Wilcoxon signed-rank test were performed for statistical analysis. RESULTS: Compared to the CA group, the OMI group showed more backward movement of the maxillary central and lateral incisors and canine (MXCI, MXLI, MXC, respectively; 1.6 mm, p < 0.001; 0.9 mm, p < 0.05; 1.2 mm, p < 0.001); more intrusion of the MXCI and MXC (1.3 mm, 0.5 mm, all p < 0.01); less forward movement of the maxillary second premolar, first, and second molars (MXP2, MXM1, MXM2, respectively; all 1.0 mm, all p < 0.05); less contraction of the MXP2 and MXM1 (0.7 mm, p < 0.05; 0.9 mm, p < 0.001); less mesial-in rotation of the MXM1 and MXM2 (2.6°, 2.5°, all p < 0.05); and less decrease of the inter-MXP2, MXM1, and MXM2 widths (1.8 mm, 1.5 mm, 2.0 mm, all p < 0.05). CONCLUSIONS: In treatment of CII div.1 malocclusion, OA provided better anchorage and less arch-dimension change in the maxillary posterior teeth than CA during en-masse retraction of the maxillary anterior teeth.

Aloe-induced toxic hepatitis.

Aloe has been widely used in phytomedicine. Phytomedicine describes aloe as a herb which has anti-inflammatory, anti-proliferative, anti-aging effects. In recent years several cases of aloe-induced hepatotoxicity were reported. But its pharmacokinetics and toxicity are poorly described in the literature. Here we report three cases with aloe-induced toxic hepatitis. A 57-yr-old woman, a 62-yr-old woman and a 55-yr-old woman were admitted to the hospital for acute hepatitis. They had taken aloe preparation for months. Their clinical manifestation, laboratory findings and histologic findings met diagnostic criteria (RUCAM scale) of toxic hepatitis. Upon discontinuation of the oral aloe preparations, liver enzymes returned to normal level. Aloe should be considered as a causative agent in hepatotoxicity.

Sagittal split ramus osteotomy with mandible reduction.

BACKGROUND: The sagittal split ramus osteotomy is a well-established procedure, and many authors have attempted various modifications of the surgical technique. Nowadays, it is widely acknowledged that people in Korea, Japan, and China prefer an oval face, the lower part of which is slender. Therefore, among facial contouring procedures, the mandible reduction procedure is the most popular procedure in these countries. It is quite difficult for patients to undergo two different procedures on almost the same region separately. METHODS: For patients who underwent sagittal split ramus osteotomy on their mandible for various reasons, the authors performed mandible reduction at the same time if necessary. In the event that two procedures are performed simultaneously, the risk would be higher regarding postoperative stability, but there was no significant problem in achieving stable occlusion after surgery through a rigid fixation technique and 2 weeks of rigid intermaxillary fixation. RESULTS: The authors attained satisfactory aesthetic results and good postoperative stability by performing sagittal split ramus osteotomy and mandible reduction at the same time. CONCLUSION: This procedure is thought to be useful for patients who are to undergo sagittal split ramus osteotomy for various reasons and want to have a slender lower face.

Three-dimensional mandible reduction: correction of occlusal class I in skeletal class III cases.

BACKGROUND: The human face is a three-dimensional structure. However, many studies on mandible reduction procedures are based on a two-dimensional concept, with a particular focus on one dimension: the width of the lower face. Many Korean individuals have class I occlusion with a skeletal class III pattern. When a conventional mandible reduction procedure is used on such individuals to reduce the width of the lower face, an unsatisfactory facial outcome may result because the changes in the other two dimensions of the lower face, vertical height and anteroposterior distance, are disregarded. This is true because the skeleton of the lower face is well developed in all three dimensions. METHODS: Bimaxillary surgery that reduces all three dimensions of the lower face was planned and conducted by the authors. This mandible reduction procedure reduced the protrusion of both the maxilla and the mandible and, at the same time, shortened the lower face height. The procedure consisted of a Le Fort I osteotomy for superior and/or posterior repositioning of the maxilla, followed by mandibular counterclockwise rotation and setback via a bilateral sagittal split osteotomy. Genioplasty was performed as necessary. RESULTS: With this procedure, the entire lower face volume is reduced, and the overall profile is improved. CONCLUSIONS: Three-dimensional mandible reduction greatly enhances the aesthetic outcome by improving the skeletal characteristics of the face common in the Korean population so that the facial measurements more closely approach normal values.

Determinants of successful treatment of bimaxillary protrusion: orthodontic treatment versus anterior segmental osteotomy.

The purpose of this study was to investigate the differences in initial skeletal, dental, and soft tissue characteristics of bimaxillary protrusion (BP) patients to determine poor or good results with orthodontic treatment (OT) or anterior segmental osteotomy (ASO) with extraction of four first premolars. Lateral cephalometric radiographs of 46 adult Korean females with BP were analyzed before treatment (T0) and after treatment (T1). According to the measurements at T1, patients were classified into group 1 (poor result with OT, n = 12), group 2 (good result with OT, n = 11), group 3 (poor result with ASO, n = 5), and group 4 (good result with ASO, n = 18). Sagittal, vertical, dental, and soft tissue variables were measured. The differences at T0 among the four groups were compared by one way analysis of variance test and verified by Scheffe's multiple comparison test. Stepwise discriminant analysis was performed to find decisive predictors. Skeletal class II malocclusion tendency, less developed chin, and vertical facial growth pattern were related with group 1. Overly uprighted and less protrusive upper and lower incisor, near normal interincisal angle (IIA), less protrusive upper lip, and more obtuse lower nasolabial angle (NLA) were related with group 3. IIA, U1-NA distance, combination factor, interlabial gap, lower NLA, pterygomaxillary fissure-N, and posterior nasal spine-anterior nasal spine were selected as significant variables for discriminating the four groups. The percentage of correctly classified cases was 91.3%. In particular, the discriminant function showed the highest accuracy in the prediction of group 4. These variables and discriminant functions contributed to the differential diagnosis on BP to make a procedural decision between OT and ASO.