Aesthetic Approaches to Zygomatic Fracture Management: Achieving Optimal Outcomes With Minimal Scarring.

The zygomaticomaxillary complex is integral to facial aesthetics and is frequently involved in facial fractures. These injuries often necessitate surgical intervention, with open reduction and internal fixation being the standard treatment. This article presents a novel philosophy for managing zygomatic fractures, emphasizing the "Scarless Surgery" technique. The authors' approach prioritizes minimal osteosynthesis material and fixation points while utilizing the least visible surgical access. For isolated zygomatic arch fractures, an intraoral technique is preferred, whereas the frontozygomatic suture is approached through an upper eyelid crease for optimal aesthetic outcomes. The zygomaticomaxillary buttress is accessed through a vestibular mucosal incision and the infraorbital rim benefits from a transconjunctival approach. The findings suggest that fewer fixation points can still yield satisfactory stability and cosmetic results, aligning with literature supporting the efficacy of 1 and 2-point fixations. This modern technique not only minimizes visible scarring but also conforms to the contemporary push for minimally invasive surgical methods. The authors' experience and the existing literature support the efficacy of this approach, reinforcing its viability as a standard practice in the surgical management of facial trauma.

The Incidence of Obstructive Sleep Apnea in Patients with Dento-Skeletal Malformation.

Purpose: The aim of this article is to analyze the incidence of undiagnosed obstructive sleep apnea (OSA) in patients affected by dento-skeletal malformation. We also evaluated the patterns most affected by the condition and calculated the post surgical changes. Methods: We conducted a retrospective cohort study on 71 patients including 35 men and 36 women. The patients studied were affected by dento-skeletal class II and III malformations and underwent bimaxillary orthognathic surgery in all cases. Patients were evaluated with polysomnography before surgery and at least 6 months after surgery to assess any improvement or worsening of the apnea hypopnea index (AHI) index. Regarding AHI evaluation criteria, an AHI > 5 was considered indicative of OSA, 4 < AHI < 5 was considered borderline and AHI < 4 was considered indicative of non-OSA. We also considered demographic variables like age at the time of intervention and gender, and anatomical variables like the pattern of the dento-skeletal deformity and the presence or absence of maxillary hypoplasia. Qualitative variables were described as absolute and relative frequencies, while quantitative variables were summarized as mean and standard deviation. To quantitatively express the relationship between two variables, the correlation coefficient was calculated. The covariance array was used to evaluate multiple correlations. Results: Our study shows that there is a significant percentage (33%) of patients who undergo orthognathic surgery with an AHI > 5 and also a percentage of patients (11%) who can be considered to be "borderline." It emerges that the pattern most at risk is the one characterized by retruded maxilla and patients with dento-skeletal class II. Considering the post surgical period, the statistical analysis shows that after surgery, only 8% of malformed patients present an AHI > 5, compared to the 20.5% described in the Italian population. Conclusions: In patients who receive orthognathic surgery, the presence of obstructive sleep apnea is significantly higher than in the general population. When planning the surgical correction of a dento-skeletal malformation, the surgeon must aim not only for the esthetics results, but also for proper stomatognathic and respiratory function; this cannot be achieved without taking polysomnography information into account.

Luteal phase support in assisted reproductive technology centers: Italian survey.

BACKGROUND: In assisted reproductive cycles (ART), the fine balance of controlling corpus luteum function is severely disrupted. To challenge this iatrogenic deficiency, clinicians aim to provide exogenous support. Several reviews have investigated progesterone route of administration, dosage and timing. METHODS: A survey about luteal phase support (LPS) after ovarian stimulation was conducted among doctors in charge in Italian II-III level ART centers. RESULTS: With regards to the general approach to LPS, 87.9% doctors declare to diversify the approach; the reasons for diversifying (69.7%) were based on the type of cycle. For all the most important administration routes (vaginal, intramuscular, subcutaneous) it appears that in frozen cycles there is a shift towards higher dosages. The 90.9% of the centers use vaginal progesterone, and when a combined approach is required, in 72.7% of cases vaginal administration is combined with injective route of administration. When Italian doctors were asked about the beginning and duration of LPS, 96% of the centers start the day of the pickup or the day after, while 80% of the centers continue LPS until week 8-12. The rate of participation of the centers confirms the low perceived importance of LPS among Italian ART centers, while may be considered quite surprising the relatively higher percentage of centers that measures P level. Tailorization to women's needs is the new objective of LPS: self-administration, good tolerability are the main aspects for Italian centers. CONCLUSIONS: In conclusion, results of Italian survey are consistent to results of main international surveys about LPS.

The use of real time strain endometrial elastosonography plus endometrial thickness and vascularization flow index to predict endometrial receptivity in IVF treatments: a pilot study.

BACKGROUND: The usefulness of endometrium strain elastosonography (SE) for the evaluation of endometrial receptivity in women undergoing in vitro fertilization (IVF) remains controversial. The objective of this prospective, observational study was to evaluate the correlation between endometrial thickness (EMT) and its related strain (ESR) on the day of ovulation triggering (hCG-d) and in vitro fertilization outcomes. Additionally, 3D Power Doppler vascular indices (3DPDVI) were also analysed. METHODS: We included all the patients undergoing fresh IVF-single blastocyst transfer cycle from January 2021 to August 2021 at our center. On hCG-d, after B-mode scanning was completed to measure the EMT, the mode was changed to elastosonography to evaluate the ESR (ratio between endometrial tissue and the myometrium below). At the end of examination, the Endometrial Volume (EV) and 3DPDVI (vascularization index [VI], flow index [FI] and vascularization flow index [VFI]), were assessed. Statistical analysis was completed using STATA MP16 software. RESULTS: A total number of 57 women were included. Based on the EMT on hCG-d, women were divided into two groups, Group 1: <7 mm and Group 2 ≥ 7 mm. Women with EMT < 7 mm had a significantly higher ESR (p = 0.004) and lower pregnancy rate (p = 0.04). Additionally, low ESR values were correlated with high VFI values (rho = -0.8; 95% CI = -0.9- -0.6; p < 0.0001) and EMT ≥ 7 mm could be predicted by low ESR (OR = 0.01; 95% CI = 0.01-0.30; p = 0.008, area under the ROC curve: 0.70). After all, in multiple logistic regression analysis, low values of ESR (p = 0.050) and high values of EMT (p = 0.051) on hCG-d had borderline statistical effects on pregnancy rate. CONCLUSIONS: The ESR may be useful to improve the ultrasound evaluation of the endometrial quality in infertile women candidates to IVF/ICS. Given the small sample size of our study, the usefulness of strain elastosonography in this patients, needs further investigation.

Corifolitropin-Alfa plus Five Days Letrozole Versus Daily Recombinant-FSH in Expected Normo-Responder Patients: A Retrospective Comparative Study.

Background: In recent times, different novel GnRH-antagonist protocols with various combinations of gonadotropins and other molecules (e.g., aromatase inhibitors, selective estrogen receptor modulators) have been proposed for expected normal ovarian responders undergoing assisted reproductive treatments. The purpose of this study was to evaluate the effectiveness of a novel ovarian stimulation protocol based on the combination of corifollitropin-alfa plus five days of letrozole in E-NOR women undergoing IVF as compared with a daily recombinant-FSH regimen. Methods: We conducted a retrospective-controlled study on 182 couples undergoing their first IVF attempt. In Group A (experimental), letrozole (2.5 mg daily) was administered from day 2 (up to day 6 of the cycle), followed by corifollitropin-alfa on day 3 and daily recombinant FSH from day 10. In Group B, recombinant FSH from day 2 were administered (150 IU-225 IU daily). Statistical analysis was completed using SPSS Statistics. The primary outcome was the total number of MII oocytes retrieved. Results: Group A showed similar results compared to Group B in terms of MII oocytes, live birth, implantation, and clinical pregnancy rates (p = ns). Nevertheless, the experimental group was associated with a trend towards a higher number of developing follicles, total oocytes, and embryos (p < 0.05) with lower estradiol and progesterone values at ovulation induction compared to Group B, resulting in an increased chance of performing a fresh embryo transfer (p < 0.05). Conclusions: The combination of CFα plus five days of letrozole was associated with a trend towards a higher number of developing follicles, total oocytes, and obtained embryos. Moreover, the experimental protocol resulted in lower estradiol and progesterone values at ovulation induction compared to daily rFSH, with an increased chance of performing a fresh embryo transfer (with no OHSS occurrence). Given the observational design of our study, further well-conducted RCTs are needed.

Salivary Protein and Electrolyte Profiles during Primary Teeth Eruption: A Cross-Sectional Study.

This study aimed to assess the qualitative changes in the saliva during the process of primary teeth eruption. This cross-sectional study was conducted on 147 children from 2 to 48 months, of which 49 were in group A (no erupted primary teeth), 53 were in group B (at least one active erupting primary tooth), and 45 were in group C (eruption of all 20 primary teeth was completed). Salivary proteins were evaluated by sodium dodecyl sulfate electrophoresis with polyacrylamide gel, while the concentrations of salivary sodium, potassium, chloride, and calcium ions were evaluated by ion selective electrodes. The data were analyzed using ANOVA and Bonferroni tests (alpha = 0.05). The concentration of proteins with molecular weights of 20-30 KDa was significantly higher in group A, and it gradually decreased with age. The concentration of proteins with molecular weights of 50-60 KDa in group B was significantly lower than those of groups A and C. The calcium ion concentration in group A was significantly higher than that of the other groups. The concentration of potassium ions was minimal in group C. The proteins and electrolyte profiles of the subjects' saliva changed in the process of primary tooth eruption. The highest concentrations of proteins such as statherin, histatin, P-B peptide, and cystatin and the lowest concentrations of proteins such as amylase were present in group B.

Obturator nerve injury in a chemo and radio-resistant patient with a locally-advanced cervical cancer after two previous uterine artery embolizations for severe vaginal bleeding: Case report and review of literature.

Chemo and radiotherapy are actually the gold standard of treatment for locally-advanced cervical cancer. We report a case report showing a repaired (video 1) right obturator nerve after an incidental injury during a right internal iliac artery closure with 10 mm titanium clip for severe pelvic bleeding in a patient with locally-advanced cervical cancer. A 52 year-old postmenopausal woman with a chemo and radio-resistant locally-advanced squamous cervical cancer was admitted at our department for severe vaginal bleeding after two previous uterine artery embolizations. As a consequence of the increasing vaginal bleeding, and after a MRI-scan, an open surgical treatment was decided with a type C radical hysterectomy with bilateral salpingo-oophorectomy. During dissection of obturator, paravescical and pararectal spaces and removal of metastatic pelvic lymphnodes, a severe blood loss that required a right internal iliac artery closure with 10 mm titanium clip was observed. A right obturator nerve incidental injury during this time occurred. After an immediate grasping of the two sides of the lesion, the obturator nerve was succesfully repaired using 4-0 Prolene interrupted sutures (Ethicon, Johnson & Johnson, New Jersey, USA). The patient was regularly discharged four days after the surgical procedure without neurological deficit, paresthesia or side effects. In conclusion obturator nerve repair is an emergency procedure for treatment of patients with advanced cervical cancer, but it should be reserved for oncologic surgeons trained in extensive oncological procedures and repair of nerve and vascular injuries potentially associated with high mortality rate.

Virtual Surgical Planning for Reconstruction of Giant Ameloblastoma of the Mandible.

Ameloblastoma is a histologically benign tumor that behaves aggressively because of its tendency to invade local structures, and it has a high probability of local recurrence. If neglected, ameloblastomas can grow substantially over the course of years, reaching the size of giant ameloblastomas. This large size can lead to deformities in facial appearance and impairments in speaking, swallowing, eating, and breathing.Surgical planning can be challenging because of the extension of the tumor and the consequent reconstructive issues.In this article, we present our experience with the reconstruction of 2 cases of giant ameloblastomas planned on the basis of occlusal casts and acrylic splints. In these patients, computerized planning was rendered complex and potentially inaccurate because of the dimensions of the tumor, the loss of anatomical landmarks, and the loss of occlusal landmarks. The cases were successfully reconstructed, but the technique can be flawed. A 3-dimensional virtual model of the mandible can be used as a template to develop cutting guides for reconstruction with free fibular flaps. This will allow us to overcome limitations, standardize the procedure, and achieve optimal functional and aesthetic results.

Use of Navigation System in Craniofacial Surgery.

The use of navigated surgery in the treatment of craniofacial malformations can help obtain optimal results. In this article, the authors will discuss a case of anterior plagiocephaly, corrected with frontorbital bandeau remodeling. Navigation was used during the osteotomy and the reposition phase to ensure the correct positioning of the osteotomy instruments. It was also used to ensure that the bandeau was correctly repositioned in accordance with the surgical plan determined during the virtual simulation phase of the surgery.

The Rules of Attractiveness: A Study on the Lower Facial Third.

What is considered attractive may not fall into the "norm," and it can vary from culture to culture and depending on the historical time, for this reason the standard cephalometric and antropometric references may not be sufficient in these cases.Lately some techniques have arose to popularity that are aimed to changing the frontal and lateral aspect of the facial lower third, such as V-line or the Chin-Wing Osteotomy technique, but no reference system exists at the moment to define to which extent a modification of the lower third falls within what is considered beautiful, and everything is left to the patient's will or to the surgeon's sensitivity.The aim of this article is to study which antropometric value is considered attractive by the most for what concerns the frontal shape of the lower third of the face.Twenty-four female models were enrolled in this study and the angle taken into consideration was the one at the intersection between the 2 lines connecting the cutaneous gonial angle of each side of the face and the most external part of the chin on the same side. Measures were made on pictures in frontal view.Two hundred two random examiners were asked to see the pictures and rate them as attractive or nonattractive.Results were then paired with the angles values.Among the models the higher angle measured was 107.5° (found in 1 individual) while the lower angle was 76° (found in 1 individual), the average measure calculated was 88.3° while the median angle was 89.5°.According to the result the subjects considered more attractive were those with an angle between 84.5 and 91.5 (92 for male examiners).This could be an important starting point for studies who can evaluate attractiveness from a numerical point of view.

Mild ovarian stimulation with letrozole plus fixed dose human menopausal gonadotropin prior to IVF/ICSI for infertile non-obese women with polycystic ovarian syndrome being pre-treated with metformin: a pilot study.

BACKGROUND: Letrozole is widely employed as ovulation induction agent in women with PCOS, but its use in mild stimulation (MS) protocols for IVF is limited. Aim of the present study was to evaluate the feasibility of a MS protocol with letrozole plus hMG in non-obese PCOS women undergoing IVF after a metformin pre-treatment. METHODS: We retrospectively evaluated the data of 125 non-obese PCOS undergoing MS with letrozole plus hMG, 150 IU as starting dose, (group 1, N = 80) compared to those undergoing a conventional IVF stimulation protocols (CS) (group 2, N = 45) prior to IVF. All patients had received metformin extended release 1200-2000 mg daily for three to six months before IVF. GnRH antagonist was administered in both groups when the leading follicles reached 14 mm. RESULTS: Both groups were comparable for age, BMI and ovarian reserve markers. Both groups showed lower than expected AFC and AMH values as a consequence of metformin pre-treatment. Letrozole-treated patients required a significantly lower amount of gonadotropins units (p < 0.0001), and showed significantly lower day 5, day 8 and hCG day E2 levels compared to patients undergoing the CS protocol (p < 0.0001, p < 0.0001 and p = 0.001 respectively). The oocyte yield, in terms of total (6, IQR 3, vs 6, IQR 4 respectively,) and MII oocytes (5, IQR 3, vs 5, IQR 3, respectively) number, did not differ among groups; the number of total (3, IQR 2, vs 3, IQR 1 respectively) and good quality embryos (2, IQR1 vs 2, IQR 1,5 respectively) obtained was comparable as well in the two groups. The number of fresh transfers was significantly higher in group 1 compared to group 2 (80% vs 60%, p = 0.016). A trend for higher cumulative clinical pregnancy rate was found in women undergoing MS compared to CS (42.5%vs 24,4%, p = 0.044), but the study was not powered to detect this difference. CONCLUSIONS: The present study suggests that the use of letrozole as adjuvant treatment to MS protocols for IVF may be an effective alternative to CS protocols for non-obese PCOS patients pre-treated with metformin, as it provides comparable IVF outcome without requiring high FSH dose, and avoiding supraphysiological estradiol levels.

Alveolar ridge augmentation with maxillary sinus elevation and split crest: Comparison of 2 surgical procedures.

The purpose of this study was to evaluate the clinical and radiological outcomes of 2 piezosurgical split techniques performed in conjunction with the sinus lift.The present retrospective study included 20 patients with edentulism of the posterior maxilla who had undergone the sinus lift and alveolar ridge split treatment separately or the sinus lift combined with the monoblock alveolar ridge split. Differences between these 2 techniques were analyzed.All the surrounding areas successfully produced an adequate bone volume for the insertion of implants. A clinical evaluation showed a mean vertical augmentation of 3.6 ±â€Š0.4 mm in Group A and 3.2 ±â€Š0.7 mm in Group B. With regards to the lateral augmentation, the clinical evaluation gives a mean gain of 5.2 ±â€Š0.3 mm in Group A and 4.9 ±â€Š0.5 mm in Group B. The mean vertical and horizontal bone augmentation recorded for both types of surgical procedures were comparable.The proposed surgical procedures enabled the tridimensional volume of the alveolar ridge to be recreated. This resulted in the creation of a natural contour of hard and soft tissues which enabled a functional and aesthetic rehabilitation of the edentulous posterior maxilla to be obtained.

Phosphaturic mesenchymal tumor, an unusual localization in head and neck.

Phosphaturic mesenchymal tumor (PMT) is a rare mesenchymal neoplasm associated with tumor-induced osteomalacia involving bone and soft tissue that produces paraneoplastic hypophosphatemic osteomalacia. The common physiologic defect in this conditions involves an impairment in renal tubular phosphate reabsorption with a downregulation of renal 1α-hydroxylase activity, while calcium metabolism remains essentially unaffected. Microscopic features consist of spindle cells, multinucleated giant cells and calcifications embedded in a chondromyxoid matrix with variable cellularity and prominent vascularity. Approximately 95% of PMTs involve the extremities and appendicular skeleton, with only 5% occurring in the head and neck region. Localization in the head and neck is pretty uncommon, nose and paranasal sinuses are preferentially affected. Due to its rarity, the purpose of the study was to report a new case of PMT whose locations in temporomandibular joint was never reported in literature.

Orbital Desmoid-Type Fibromatosis: A Case Report and Literature Review.

PURPOSE: Desmoid-type fibromatosis is a benign fibrous neoplasia originating from connective tissue, fascial planes, and musculoaponeurotic structures of the muscles. Currently, there is no evidence-based treatment approach available for desmoid fibromatosis. In this article, a case of a patient in the pediatric age affected by desmoid fibromatosis localized in the orbit is presented. The aim of the article is to describe this unusual and rare location for the desmoid fibromatosis and outline the principle phases in the decision-making process and the therapeutic alternatives for a patient affected by desmoid fibromatosis. METHODS: The protocol of this review included study objectives, search strategy, and selection criteria. The primary end point of this study was to analyze the head and neck desmoid fibromatosis. The secondary end point was to identify the available therapies and assess their specific indications. RESULTS: The mean age of patients was 18.9 years ranging from 0 to 66, and 52% were female. A bimodal age distribution was observed, and two age peaks were identified: 0-14 years (57%) and 28-42 years (18%). The most common involved areas were the mandible (25%) followed by the neck (21%). In 86% of the cases, the treatment was the surgical resection of the disease, and only in 5% of the cases, the surgical resection was followed by adjuvant radiotherapy. CONCLUSION: The orbital location is extremely rare, especially in the pediatric population. The management of desmoid fibromatosis is based on the function preservation and the maintenance of a good quality of life, but in case of symptomatic patients or aggressive course of the disease or risk of functional damages, the surgical approach may be considered. Therapeutic alternatives to surgical resection are radiotherapy and systemic therapy.

The Arterialized Facial Artery Musculo-Mucosal Island Flap for Post-Oncological Tongue Reconstruction.

BACKGROUND: In 1992, Pribaz described the facial artery musculomucosal flap (FAMM), an axial musculomucosal flap based on the facial artery. The FAMM flap, a modification of the nasolabial and buccal mucosal flaps, is widely used in the reconstruction of defects in the oral cavity. Many modifications of this flap have been described in the literature. Here we aimed to explore the use of an arterialized tunnelized FAMM island flap (a-FAMMIF) for the reconstruction tongue defects after tumor resection. METHOD: From January 2015 to December 2016, five cases of tongue cancer were selected for the use of arterialized FAMMIF flap to reconstruct defects after tumor resection. RESULTS: Reconstruction was successful in all cases, except one case of total flap necrosis; partial necrosis of the flap occurred in two patients, which were solved with medications. CONCLUSION: The authors consider the a-FAMMIF an unreliable flap in the reconstruction of tongue defects.The authors recommend avoiding tunneling and island modification when the vein is not included in the pedicle.

Evaluation of the cervix tissue homogeneity by ultrasound elastography in infertile women for the prediction of embryo transfer ease: a diagnostic accuracy study.

BACKGROUND: Ultrasound elastography is a non-invasive medical imaging technique able to quantitatively characterize the stiffness of a given tissue. It has been shown to predict the risk for cervical insufficiency and preterm delivery, and to allow differentiation of malignancy from normal tissue. The present study sought to evaluate whether cervical tissue dishomogeneity, as assessed by cervical ultrasound elastography, may predict the embryo transfer (ET) ease in infertile women undergoing IVF/ICSI. METHODS: We evaluated 154 infertile patients with no history of previous ET or intrauterine insemination. Cervical stiffness was evaluated in six regions of interest (ROI), compared two by two to obtain strain ratio (SR) values. Since a SR value of 1 was suggestive of tissue homogeneity, we computed 1-SR/SR-1 values to obtain a measure of the degree of cervical tissue dishomogeneity that we named "dishomogeneity index" (DI). Ultrasound-guided ET was performed by an expert operator blinded to the results of cervical elastography. The prediction ability of elastography on ET ease was evaluated by binary logistic regression, and the predictive accuracy of the independent variables was quantified with area under the curve (AUC) estimates derived from receiver operating characteristic (ROC) curve. RESULTS: ET resulted to be easy in 99 out of 154 patients (64,2%), difficult in 54 patients (35%), and impossible in one. DI values in cervical medial lips region correctly classified 86.9% of patients, according to binary logistic regression, with a sensitivity of 81.4% and a specificity of 89,9%, positive likelihood ratio (LR) 8.07 and negative LR of 0.21. A DI cut-off value of 0.29 predicted a difficulty of ET with a sensitivity of 88,9% and a specificity of 85%. CONCLUSIONS: Cervical ultrasound elastography, by allowing the identification of cervical tissue dishomogeneity, may be of help in predicting the ET ease in infertile women candidates to IVF/ICSI.

Surgery-first orthognathic approach vs traditional orthognathic approach: Oral health-related quality of life assessed with 2 questionnaires.

INTRODUCTION: The purposes of the study were to investigate and evaluate the differences detected by the patients between the traditional orthognathic approach and the surgery-first one in terms of level of satisfaction and quality of life. METHODS: A total of 30 patients who underwent orthognathic surgery for correction of malocclusions were selected and included in this study. Fifteen patients were treated with the conventional orthognathic surgery approach, and 15 patients with the surgery-first approach. Variables were assessed through the Orthognathic Quality of Life Questionnaire and the Oral Health Impact Profile questionnaire and analyzed with 2-way repeated-measures analysis of variance. RESULTS: The results showed significant differences in terms of the Orthognathic Quality of Life Questionnaire (P <0.001) and the Oral Health Impact Profile (P <0.001) scores within groups between the first and last administrations of both questionnaires. Differences in the control group between first and second administrations were also significant. Questionnaire scores showed an immediate increase of quality of life after surgery in the surgery-first group and an initial worsening during orthodontic treatment in the traditional approach group followed by postoperative improvement. CONCLUSIONS: This study showed that the worsening of the facial profile during the traditional orthognathic surgery approach decompensation phase has a negative impact on the perception of patients' quality of life. Surgeons should consider the possibility of a surgery-first approach to prevent this occurrence.

Alveolar Ridge Split Technique Using Piezosurgery with Specially Designed Tips.

The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral and maxillofacial surgery. Among the various techniques introduced for the expansion of alveolar ridges with a horizontal bone deficit is the alveolar ridge split technique. The aim of this article is to give a description of some new tips that have been specifically designed for the treatment of atrophic ridges with transversal bone deficit. A two-step piezosurgical split technique is also described, based on specific osteotomies of the vestibular cortex and the use of a mandibular ramus graft as interpositional graft. A total of 15 patients were treated with the proposed new tips by our department. All the expanded areas were successful in providing an adequate width and height to insert implants according to the prosthetic plan and the proposed tips allowed obtaining the most from the alveolar ridge split technique and piezosurgery. These tips have made alveolar ridge split technique simple, safe, and effective for the treatment of horizontal and vertical bone defects. Furthermore the proposed piezosurgical split technique allows obtaining horizontal and vertical bone augmentation.

Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study.

PURPOSE: The present study sought to determine the diagnostic accuracy of FSH level, testicular volume, and testicular histology in predicting the successful sperm retrieval (SSR) in a large cohort of patients with non-obstructive azoospermia undergoing conventional testicular sperm extraction (TESE). METHODS: We retrospectively evaluated 356 patients with non-obstructive azoospermia between June 2004 and July 2009. Binary logistic regression was used to evaluate the diagnostic accuracy of our predicting model, identifying sperm retrieval rate as binary dependent variable. The predictive accuracy of all variables individually evaluated was quantified with area under curve (AUC) estimates derived from receiver operating characteristic (ROC) curve. RESULTS: The mean patients' age was 36.8 years. Testicular sperm were retrieved in 158 out of 356 patients (44.3 %). Histological diagnosis of Sertoli cell only syndrome (SCO) was obtained in 216 patients (60.6 %), while 55 patients (15.4 %) had maturation arrest (MA) and 85 (23.8 %) had hypospermatogenesis (HYPO). The binary logistic regression model was statistically significant (χ 2 = 96.792, p < 0.0001) and correctly classified 72.8 % of cases with 46.8 % sensitivity and 93.4 % specificity, positive predictive value (PPV) 85.06 %, negative predictive value (NPV) 68.7 %, +likelihood ratio (LR) 7.13, and -LR 0.57. Only testicular histology was significant to the model, while FSH and testicular volume were not. Sperm retrieval rate (SRR) was significantly higher in patients with HYPO compared to patients with SCO or MA (88.2 vs 30.5 and 30.9 %, respectively, p < 0.0001) CONCLUSIONS: This study demonstrates that including testicular histology in a model for predicting sperm retrieval increases its diagnostic accuracy. As histology is not available prior to TESE, this model applies only to patients with previous testicular surgery.

Improvement of gamete quality by stimulating and feeding the endogenous antioxidant system: mechanisms, clinical results, insights on gene-environment interactions and the role of diet.

Oxidative damage triggers extensive repair in gametes and thereafter in the zygote but it results in clinically relevant damage when affecting the maturation of the gametes chromatin, i.e. padlocking and epigenetic marking. It associates with defective DNA methylation and/or with oxidation of the methyl marks leading to derangement of gamete epigenetics, defects of chromatin condensation and aneuploidy. A proper feed to the one carbon cycle has the potential to stimulate the endogenous antioxidant defences, i.e. gluthatione synthesis, and to activate compensative homeostatic mechanisms restoring both the oxy-redox balance and DNA methylation, which are indeed strictly cross-regulated. This has been shown to produce measurable clinical improvements of male reproductive potential in pilot studies herein summarised. However, the effects of dietary habits and of supplementations are variable according to the individual genetic substrate, as genetic variants of several of the concerned enzymes occur with high frequency. Individual risk assessments and personalised interventions are still difficult to implement, in the meantime, a very varied diet may facilitate metabolic compensation in the majority of the cases. This review aims to report on the mechanisms of damage, on the opportunities to modulate the physiologic oxy-redox homeostasis by means of a varied diet or dietary supplements and on the open issues related to the genetic variability of the population.