Postsurgical Volumetric Airway Changes in Class III Patients Receiving Bimaxillary Orthognathic Surgery.

The purpose of the present study was to investigate the pharyngeal airway space (PAS) changes in class III patients receiving bimaxillary orthognathic surgery and correlate the PAS volume and minimum axial section changes with the magnitude of the surgical movement. This research involved a retrospective sample composed of 38 patients with class III skeletal occlusions. Three-dimensional measurements of the PAS volume and minimum axial section were conducted. Cephalometric points were used to verify the extent of jaw-hyoid bone movement. No significant differences were found between pre and postoperative total PAS volume (P = 0.280), nasopharyngeal volume (P = 0.545), oropharyngeal volume (P = 0.297), and minimum axial section (P = 0.568). Anterior movement of point A and posterior nasal spine were significantly associated with an increase in total PAS volume, oropharyngeal volume, and minimum axial section (P < 0.05). However, the posterior movement of menton was significantly associated with a decrease in total PAS volume, oropharyngeal volume, and minimum axial section (P < 0.05). The results of the present study indicated that PAS is not negatively affected by bimaxillary surgery in class III patients. However, the planning of class III patients who are prone to the development of airway problems should be done carefully.

Traumatic Orbital Compression Syndromes: A Comprehensive Study Into Etiologies, Intervention Strategies, and Clinical Outcomes.

Facial fractures and their historical link to potential blindness have been well-documented, often attributed to optic canal injuries or retinal vascular occlusion. This dire consequence can result from both direct and indirect ocular trauma, including retrobulbar hemorrhage. Traumatic orbital compression can manifest in various forms, such as hematomas, fractured bone fragments, and emphysema, all posing a significant threat to vision, necessitating immediate intervention. In this study, 9 clinical cases of traumatic orbital compression are presented, each characterized by distinct etiologies. The study delves into traumatic orbital compressive syndromes, underscoring the critical imperative of early recognition and treatment to prevent vision loss. Orbital compression, whether from edema, hematoma, or emphysema, collectively culminates in elevated intraorbital pressure and the potential for optic nerve ischemia. Through the presentation of these 9 clinical cases, the article emphasizes the pressing need for timely intervention in addressing orbital compressive syndromes to avert vision loss. Various surgical techniques are elucidated, highlighting the pivotal role of expeditious medical intervention. This article offers invaluable insights into the diagnosis, management, and outcomes of traumatic orbital compressive syndromes.

Atrophic Maxilla Reconstruction With Autogenous Iliac Graft and Guided Dental Implants.

Oral rehabilitation with osseointegrated implants is frequently the best alternative for replacement of lost teeth. Several techniques and materials allow achievement of excellent function and esthetics. In the case of maxillary or mandibular atrophy, extensive grafting may be necessary before implants can be properly placed. This is a case of maxillary reconstruction with autogenous iliac crest bone grafts, followed by placement of guided implants. After integration of the grafts, planning and insertion of implants allowed installation of an implant-supported prosthesis, recovering the morphology, function, and esthetics.

Rabdomyosarcoma of the Mandible: An Uncommon Clinical Presentation.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. Most patients present with a mass in the head and neck region, urogenital region, or with distal extremity involvement. The authors describe a challenging case of a 6-year-old male patient presenting with mandibular RMS. The clinical/radiographic/tomographic evaluations classified the tumor as an advanced stage (stage IV), with a mass of 6.0 cm involving the left side of the mandible and parotid region. The biopsy revealed round, spindled, and pleomorphic cells with hyperchromatic nuclei and rare larger rhabdomyoblasts with eosinophilic cytoplasm. The diagnosis was of embryonal RMS. The patient was referred for treatment with cycles of chemotherapy; however, pulmonary and bone marrow metastasis were identified. Radiotherapy and local surgery with microvascular reconstruction were performed later; however, the patient died after a few months. Early diagnosis is critical for a good prognosis and cure of patients with RMS. Correct diagnosis considering also the histological subtype is important for adequate treatment, which according to the literature is not uniform probably because of the rarity of this neoplasm.

Aggressive Osteoblastoma in the Maxilla: Unusual Lesion in the Craniofacial Skeleton.

Osteoblastomas are benign bone tumors, which are unusual in the craniofacial skeleton, being most often observed in the axial skeleton and long bones. The most common site in the maxillofacial region is the mandible and the involvement of the maxilla and paranasal sinuses is extremely rare. Although it is a benign lesion, the aggressive variant raises concerns due to its huge local destructive potential and tendency to relapse. In this clinical case, an aggressive osteoblastoma is described in a 7-year-old patient. The lesion was large and fully involved the left maxilla, including the maxillary sinus and the nasal cavity. Recurrent volume increase was observed 2 months following enucleation of the lesion and en bloc resection of the maxillary segment was performed. Histological and immunohistochemical evaluation associated with clinical and imaging findings allowed to define the tumor as an aggressive variant of osteoblastoma and not osteosarcoma, despite the aggressive behavior. The patient recovered well and no relapses were observed after 12 months following maxillary resection.

Evaluation of Nasal Obstruction in Various Sagittal Skeletal Deformity of Jaws.

Nasal obstruction (NO) is a common symptom present in 25% of the general population, which significantly interferes with the quality of life. The different facial profiles and malocclusion patterns could be associated with the degree of NO. In order to evaluate the nasal function in patients with different facial morphology patterns, the authors developed a prospective study in which 88 patients from a dentofacial deformities center were included. These patients were submitted to fibrorhinoscopy (Mashida, ENT PIII) with a 3.2-mm cannula under topical anesthesia to evaluate septal deviation, inferior and medium turbinates, and pharyngeal tonsils. The 88 patients included in the study were divided into 3 groups according to the classification of the facial profile, distributed as follows: 32 class I, 28 class II, and 28 class III; the data collected was statistically analyzed by analysis of variance and the results are shown. The patients included in this study presented similar prevalence of NO with the reduction of airway function efficiency. Although it was not a statistically different, the group II presented higher mean Nasal Obstruction Syndrome Evaluation scores.

Treatment of mandibular condyle fractures. A 20-year review.

BACKGROUND/AIM: The condylar fracture is among the most frequent facial fractures. Despite all the published studies, its treatment remains controversial. The aim of this retrospective study was to evaluate the epidemiology and complications of mandibular condyle fractures managed by surgical and conservative treatments, over a period of twenty years. MATERIAL AND METHODS: The files of 262 patients with 318 condyle fractures were included in this study. One hundred and seven patients had conservative management, and 155 had surgical management for the condylar fractures. The outcomes were assessed by reviewing the patient's clinical records. RESULTS: The prevalence was higher in males and most patients were Caucasians in the third decade of life. The mean age was 30.17 years old. The main causes were motorcycle accidents followed by bike accidents, and the mean follow-up time was 226.5 days. The number of complications found in the two modalities of treatment was low and similar. CONCLUSION: Both treatments achieved their goals. There was no statistical difference in the complication rate between the two groups.

Mandibular angle fractures: a comparative study between one- and two-plate fixation.

BACKGROUND/AIM: The mandibular angle fracture is a challenging fracture to manage. Over time, the literature has shown many types of treatment modalities and different kinds of internal fixation. The aim of this study was to evaluate the outcomes and complications of mandibular angle fractures managed by Champy's technique and two-plate fixation, over a period of 20 years. MATERIAL AND METHODS: The files of 149 patients with 155 angle fractures fulfilled the inclusion criteria and were chosen for this study. Data were collected regarding gender, age, race, date of trauma, addictions, etiology, signs and symptoms, fracture management, and complications. RESULTS: Prevalence was higher in males (82%), Caucasians (62%), and during the third decade of life (62%). Mean age was 26.5 years. The main cause was interpersonal violence, and the mean follow-up period was 232 days. The main signs and symptoms were pain, edema, and mouth-opening restriction. The most often associated fracture involved the mandibular condyle, and the most common complication was infection. CONCLUSION: There was no difference between the two modalities of treatment. However, the one-plate fixation technique had fewer complications.

Pathologic Mandibular Fracture as First Sign of Multiple Myeloma.

Multiple myeloma (MM) is a neoplasia characterized by the proliferation of plasmacytoid cells, which produce abnormal immunoglobulins. It frequently creates local and systemic complications such as pathologic fractures and renal disease. This article reports the case of a 70-year-old man presenting a pathologic fracture of the right mandibular angle secondary to a plasmocytoma. He had a history of a previous pathologic fracture of the left mandibular angle 13 years before that was treated elsewhere, but no documentation was available. Investigation revealed the disease to be a MM and evolution led to renal failure and death. Differential diagnosis is necessary for this kind of pathologic presentation because MM presents a survival rate of 5.7% in 5 years and mandibular involvement happens in the advanced stage of the disease.

Gardner Syndrome With Unusual Maxillofacial Manifestation.

Gardner syndrome is a rare autosomal-dominant condition characterized by the presence of intestinal polyposis, multiple osteomas, and tumors of the hard and soft tissues. This paper describes a patient of Gardner syndrome with unusual maxillofacial manifestation with presence of fibromyxomatous injury in jaw, coronoid hyperplasia, and multiple osteomas diffusely distributed in the craniomaxillofacial skeleton. Imaging examinations have identified craniofacial manifestations and the patient was referred to the gastroenterologist who confirmed the diagnosis of Gardner syndrome. The early diagnosis of this syndrome is important since intestinal polyps have high potential for malignant transformation. It is therefore essential that dentists are familiar with the maxillofacial features of this condition, since they precede the intestinal polyposis and encourage early diagnosis. In addition to classic maxillofacial signs of this syndrome, one must consider that, although it is rare, other injuries may be present such as those described in this clinical patient.

Unusual Adenomatoid Odontogenic Tumor.

The adenomatoid odontogenic tumor is a rare benign neoplasm. It can, however, have locally aggressive behavior. This is a case of an adenomatoid odontogenic tumor of unusual location and behavior in a 15-year-old female patient. A panoramic radiograph revealed a large radiolucent lesion involving the retained tooth 33. Teeth involved in this lesion were displaced and with apparent root resorption. A prototype of the mandible showed a marked expansion of cortical bone, fenestration points in the lingual cortex, and fragility of the base of the mandible. Therefore, because of the risk of postoperative pathologic fracture the placement of a 2.4-mm reconstruction plate was indicated. Total enucleation of the lesion, as well as placement of a reconstruction plate were performed. Despite the large bone destruction, with the correct surgical procedure and the use of the reconstruction plate the patient recovered without incidents and a 24-month postoperative radiography showed satisfactory bone formation.

Yeast contribution to melatonin, melatonin isomers and tryptophan ethyl ester during alcoholic fermentation of grape musts.

Melatonin (MEL) has been found in some medicinal and food plants, including grapevine, a commodity of particular interest for the production of wine, a beverage of economic relevance. It has also been suggested that MEL in wine may, at least in part, contribute to the health-promoting properties attributed to this beverage and, possibly, to other traditional Mediterranean foodstuffs. After a preliminary screening of 9 yeast strains in laboratory medium, three selected strains (Saccharomyces cerevisiae EC1118, Torulaspora delbrueckii CBS1146(T) and Zygosaccharomyces bailii ATCC36947(T) ) were inoculated in experimental musts obtained from 2 white (Moscato and Chardonnay) and 2 red (Croatina and Merlot) grape varieties. The production of MEL, melatonin isomers (MIs) and tryptophan ethyl ester (TEE) was monitored during the alcoholic fermentation. The screening showed that the three investigated strains produced the highest concentrations of MEL and two MIs in optimal growth conditions. However, MEL and MIs were not produced in oenological conditions, but the three strains synthesized high concentrations of a new MI and TEE in musts.

Correlation between the Friedman Staging System and the upper airway volume in patients with obstructive sleep apnea.

PURPOSE: This study was designed to evaluate the correlation between computed tomography findings and data from the physical examination and the Friedman Staging System (FSS) in patients with obstructive sleep apnea (OSA). PATIENTS AND METHODS: We performed a retrospective evaluation by reviewing the medical records of 33 patients (19 male and 14 female patients) with a mean body mass index of 30.38 kg/m(2) and mean age of 49.35 years. Among these patients, 14 presented with severe OSA, 7 had moderate OSA, 7 had mild OSA, and 5 were healthy. RESULTS: The patients were divided into 2 groups according to the FSS: Group A comprised patients with FSS stage I or II, and group B comprised patients with FSS stage III. By use of the Fisher exact test, a positive relationship between the FSS stage and apnea-hypopnea index (P = .011) and between the FSS stage and body mass index (P = .012) was found. There was no correlation between age (P = .55) and gender (P = .53) with the FSS stage. The analysis of variance test comparing the upper airway volume between the 2 groups showed P = .018. CONCLUSIONS: In this sample the FSS and upper airway volume showed an inverse correlation and were useful in analyzing the mechanisms of airway collapse in patients with OSA.

Inferior alveolar nerve function after sagittal split osteotomy by reciprocating saw or piezosurgery instrument: prospective double-blinded study.

PURPOSE: The aim of this prospective study was to objectively evaluate inferior alveolar nerve (IAN) sensory disturbances in patients who underwent sagittal split ramus osteotomy (SSRO) by comparing 1 side treated with a reciprocating saw with the other side treated with a piezosurgery device. MATERIALS AND METHODS: Clinical evaluation of IAN sensory disturbance was undertaken preoperatively and at 1 week, 4 weeks, 2 months, and 6 months postoperatively in 20 patients who underwent SSRO at the Division of Oral and Maxillofacial Surgery, Araraquara Dental School, São Paulo State University. The 20 patients were examined at all periods for IAN functionality by Semmes-Weinstein testing; neither the patients nor the examiner knew which side was treated using piezosurgery or a reciprocating saw. RESULTS: The mean age of the patients was 28.4 years (range, 20 to 48 yr). Before surgery, no patient had impaired function of the IAN in any of the 8 zones in the mental and inferior lip areas. All patients reported feeling the first monofilament at the time of the preoperative test. Seven days postoperatively, all patients reported some kind of altered sensitivity in at least 1 zone evaluated. CONCLUSIONS: The results of this study suggest there was no statistically significant difference in the sensitivity of the labiomental area regarding the instrument used to perform the osteotomy. Future studies will focus on enlarging the sample and evaluating the results.

Characterization of Durum-Wheat Pasta Containing Resistant Starch from Debranched Waxy Rice Starch.

Durum wheat spaghetti samples prepared with increasing levels of resistant starch (RS) from debranched waxy rice starch (DWRS; i.e., 0, 5, 10, 15 g/100 g w/w) were analyzed for chemical composition, quality and sensory parameters and in vitro starch digestion. All the DWRS-containing spaghetti was "high in fibre", the dietary fiber content being > 6 g/100 g. In addition, spaghetti with the highest level of DWRS showed the highest RS content (p < 0.05), being 11.4 g/100 g dry matter. The starch hydrolysis index decreased (p < 0.05) as the level of DWRS increased, with a reduction of >20% comparing the 15-DWRS pasta to the control. DWRS had a negative impact on quality parameters, especially at higher DWRS levels. The use of DWRS shortened the optimal cooking time and impacted the samples' cooking loss, firmness, and stickiness. In addition, sensory analysis revealed differences among samples. However, irrespective of the level of DWRS in the recipe, the score for all attributes was > 5, which is considered the limit of acceptability. Substituting part of the semolina flour with DWRS increased the level of RS and the overall nutritional profile and affected the quality of semolina pasta, mainly at higher levels in the recipe.

Italian Grape Ale Beers Obtained with Malvasia di Candia Aromatica Grape Variety: Evolution of Phenolic Compounds during Fermentation.

Italian grape ale (IGA) beers have been categorized by the Beer Judge Certification Program as a sub-category of fruit beers in which grape, or grape must, is added during the brewing process to provide additional characteristics to the final beer. In the present work, IGA beers have been produced with must and pomace of the Malvasia di Candia Aromatica (MaCA) grape variety, which were added before fermentation at two different percentages (10% and 20%). The (poly)phenolic profile of IGA beers have been characterized with HPLC-MS/MS and compared to a golden ale control beer (produced in the same conditions without the addition of grape-derived ingredients). A series of sub-samples have been collected to monitor the (poly)phenol profile at time 0 and during the different phases of the fermentation process (1, 3, 5, 7 30, 65 days). Results demonstrated how the addition of pomace allowed to significantly enrich (p < 0.05) final beers in total (poly)phenols detected by MS, while must addition did not influence that amount if compared to the control sample. However, a PCA cluster analysis identified strong similarities among IGA beers and differentiated them to control beer samples. This study underlined how the addition of must and pomace from the MaCA grape variety improved the (poly)phenolic profile of beer from both a qualitative and quantitative point of view.

A 3-year application of different mycorrhiza-based plant biostimulants distinctively modulates photosynthetic performance, leaf metabolism, and fruit quality in grapes (Vitis vinifera L.).

The use of microbial biostimulants in agriculture is recognized as a sustainable approach to promoting crop productivity and quality due to improved nutrient uptake, enhanced stress tolerance, and improved ability to cope with non-optimal environments. The present paper aimed to comparatively investigate the effect of seven different commercial mycorrhizal-based treatments in terms of yield, phytochemical components, and technological traits of Malvasia di Candia Aromatica grape (Vitis vinifera L.) plants. Metabolomic analysis and photosynthetic performance were first investigated in leaves to point out biochemical differences related to plant growth. Higher photosynthetic efficiency and better PSII functioning were found in biostimulant-treated vines, reflecting an overall decrease in photoinhibition compared to untreated plants. Untargeted metabolomics followed by multivariate statistics highlighted a robust reprogramming of primary (lipids) and secondary (alkaloids and terpenoids) metabolites in treated plants. The analysis of berry yield and chemical components exhibited significant differences depending on the biostimulant product. Generally, berries obtained from treated plants displayed improved contents of polyphenols and sugars, while yield remained unchanged. These results elucidated the significant role of microbial biostimulants in determining the quality of grape berries and eliciting biochemical changes in vines.

Cutaneous sensibility impairment after mandibular sagittal split osteotomy: a prospective clinical study of the spontaneous recovery.

PURPOSE: The aim of this prospective study was to objectively evaluate the inferior alveolar nerve (IAN) sensory disturbances in patients who underwent sagittal split ramus osteotomy (SSRO) and its spontaneous recovery and to define the incidence of sensibility loss, time, and area at which the recovery occurs. PATIENTS AND METHODS: Clinical evaluation of the IAN sensory disturbance was undertaken preoperatively and at the first week, fourth week, 2 months, and 6 months postoperatively in 30 patients who underwent SSRO at the Oral and Maxillofacial Surgery Division of the Araraquara Dental School--Unesp and at the Plastic Surgery Division of the Medical Sciences School--Unicamp. The 30 patients were examined at all periods regarding the IAN functionality by Semmes-Weinstein testing. RESULTS: The mean age of the patients included in this study was 29.36 years old. All patients showed sensibility loss at the 7-day evaluation time. The comparison between sides, gender, and age did not show any significant difference. In most of the examined zone, the data collected at 6 months were statistically similar to the data collected at the preoperative period. All zones presented significant recovery, starting from 30 days after surgery. Twenty patients had total spontaneous recovery at the final period, in all examined zones. CONCLUSIONS: The SSRO presents the disadvantage of temporary paresthesia; however, spontaneous nerve function recovery does occur. The Semmes-Weinstein test is a reliable, inexpensive, and easy-to-apply tool, which can be used for clinical evaluation on a daily basis at offices and hospitals.

Conservative management of a large keratocystic odontogenic tumor in the maxilla.

Keratocystic odontogenic tumor is characterized by high recurrence rates. Conservative or aggressive management has been suggested as a method of treatment. Decompression is a conservative treatment that has been used in the treatment of large odontogenic cysts. The authors report a case of a 14-year-old patient with a keratocystic odontogenic tumor located in the right maxilla, which was treated by decompression followed by enucleation with curettage. The lesion did not recur on follow-up for 3 years after the enucleation surgery.

Mandibular angle fracture treated with new three-dimensional grid miniplate.

Fractures of the mandibular angle deserve particular attention because they represent the highest percentage of mandibular fractures and have the highest postsurgical complication rate, making them the most challenging and unpredictable mandibular fractures to treat. Despite the evolution in the treatment of maxillofacial trauma and fixation methods, no single treatment modality has been revealed to be ideal for mandibular angle fractures. Several methods of internal fixation have been studied with great variation in complications rates, especially postoperative infections. Recently, new studies have shown reduction of postsurgical complications rates using three-dimensional plates to treat mandibular angle fractures. Nevertheless, only few surgeons have used this type of plate for the treatment of mandibular angle fractures. The aim of this clinical report was to describe a case of a patient with a mandibular angle fracture treated by an intraoral approach and a three-dimensional rectangular grid miniplate with 4 holes, which was stabilized with monocortical screws. The authors show a follow-up of 8 months, without infection and with occlusal stability.