Esthetic Surgery of the Chin in Cis- and Transgender Patients-Application of T-Genioplasty vs. Single-Piece Segment Lateralization.

Background and Objectives: Correction of lower face asymmetry still remains challenging in maxillofacial surgery. This report describes techniques for the lateral transposition of the symphyseal segment to restore lower face symmetry while maintaining gender-related features in cis- and transgender patients. Materials and Methods: A retrospective review of medical records of 31 patients who attended for esthetic corrective surgery after orthodontic camouflage or orthognathic treatment, or during facial feminization of the lower face between June 2021 and June 2023 was performed. Result: All patients underwent lateralization genioplasty (with or without advancement or setback), either with or without narrowing T-osteotomy supplemented with necessary procedures in order to obtain proper facial balance and desired esthetical effects, such as bichectomy, liposuction, and face and neck lift. The mean asymmetry of the chin was 5.15 mm and was surgically corrected either by single segment lateralization or T-shape narrowing genioplasty depending on the gender and esthetical requirements. No complications were reported. Conclusions: Lateral shift genioplasty serves as a powerful tool in primary and secondary corrective surgery for lower face asymmetry that maintains gender-specific facial features. It may serve either as an additive to orthodontic camouflage or a way to correct previous orthognathic surgery pitfalls. The surgeon performing esthetic genioplasty associated with gender-specific expectations must be trained in facelift and facial liposculpting techniques in order to provide the best results and properly choose the right procedures for the right patients.

Physicochemical characterization, emulsifying and antioxidant properties of the polysaccharide conjugates from Chin brick tea (Camellia sinensis).

Tea polysaccharide conjugate fractions (TPCs) with different molecular weights (TPC-40, TPC-60, and TPC-80, MW = 1355 to 204 kDa) were prepared from Chin brick tea using graded alcohol precipitation. The physiochemical and functional properties of TPCs were investigated. Results showed that TPC-80 (204 kDa) had the highest antioxidant activity attributed to its higher phenolic and theabrownin contents. Moreover, this fraction had the highest surface pressure (16.2 ± 0.9 mN/m), but the lowest interfacial dilatational modulus (30.3 ± 2.2 mN/m) than TPC-40 (1355 kDa) and TPC-60 (955 kDa). As a result, TPC-80 had the highest emulsifying activity but the lowest emulsion stabilizing properties due to its fastest adsorption kinetics but the relatively thin interfacial coating on the oil droplets. Overall, our results indicate that the chemical compositions and structural characteristics of TPCs significantly impact their functional attributes. TPCs have the potential to be a novel natural antioxidant emulsifier in food industry.

Penctrimertone, a bioactive citrinin dimer from the endophytic fungus Penicillium sp. T2-11.

Penctrimertone (1), a novel citrinin dimer bearing a 6/6/6/6 tetracyclic ring scaffold, along with two known compounds xerucitrinic acid A (2) and citrinin (3) were isolated from the endophytic fungus Penicillium sp. T2-11. Their structures were unequivocally established by a comprehensive interpretation of the spectroscopic data, with the stereochemistry for 1 was defined by a combination of TDDFT-ECD calculations and the DP4+ probability analysis based on NMR chemical shift calculations. Bioassays revealed that compound 1 exhibited noticeable antimicrobial activities and moderate cytotoxicity. A plausible biosynthetic pathway of 1 was also proposed.

[Interpretation of the connotation of the colored drawing of Neijing Tu in the Museum of Chinese Medical History].

Neijing Tu(, Chart of Inner Landscape), collected by the Museum of Chinese Medical History, is a colored drawing which is used to guide Taoist internal alchemy training pattern. It belongs to the inheritance of the immortals in the Tao Yin(physical and breathing exercise) of traditional Chinese medicine in folk. It is the essence for nurturing vitality of the traditional Chinese medicine. Its core tenet is that one practices with both Shen(spirit) and Qi(pneuma) and makes both to fuse in perfect harmony way. The specific practice process includes four phases: refining Jing and converting it into Qi, refining Qi and converting it into Shen, extracting and then restoring Xu(void)from Shen, purifying Xu to fit Dao. This process contains the contents of the Secret Alchemy such as sub-Meridian Circle Vessel, overcoming the roadblock and entering Primary Meridian Circle Vessel, getting Yangshen (highest level spirit) and harmonizing the body and spirit. Its important value lies in being able to treat the disease which has not yet completely developed and the disease developed already.

Effect of photobiomodulation on recovery from neurosensory disturbances after sagittal split ramus osteotomy: a triple-blind randomised controlled trial.

We have investigated the effect of photobiomodulation on the recovery of neurosensory function of the lip and chin after bilateral sagittal split osteotomy (BSSO). Laser irradiation was applied with a GaAs diode laser (continuous wave 980nm wavelength, power 100mW, and energy density 12J/cm2). It was maintained within a 0.5cm2 area in a total of 12 points for 60seconds at each visit on each point. Unilateral extraoral contact photobiomodulation treatment was applied the day before operation and then on days 1, 3, 7, 14, 21, and 28 postoperatively. One side of the mandible was the intervention side and the other the control side. On the control side, the laser probe was turned off and placed on the chosen area. Neurosensory evaluations were made before and immediately after operation, and 30 days and 60 days postoperatively. Twenty-five patients were screened, and 18 who met the inclusion criteria were included in the study; 14 were women and the mean (SD) age was 23 (5) years. Analysis of the visual analogue scales for general sensibility, pain discrimination, directional discrimination, and 2-point discrimination showed a significant difference between the intervention and control sides after 30 days (p=0.0011, 0.0034, 0.0023, and 0.0160, respectively). The difference was also significant after 60 days (p=0.0001, 0.0002, 0.0003, and 0.0010, respectively). The thermal discrimination rate was significantly higher in the laser group than the control group 30 days after surgery (p=0.002), but after 60 days the difference was not significant (p=1.000). We found no side effects from the laser radiation during the two-month follow up. The results suggest that photobiomodulation accelerated the patients' improvement from neurosensory disturbance after BSSO.

Changes in Event-Related Potentials Underlying Coma Recovery in Patients with Large Left Hemispheric Infarction.

BACKGROUND The aim of this study was to investigate changes in event-related potentials (ERPs) between coma and awakening in patients with large left hemispheric infarction (left LHI). MATERIAL AND METHODS Ten patients with left LHI who suffered coma and survived to awaken were enrolled in this study. The eye-opening subscore of the Glasgow Coma Scale (GCS) was used to assess the extent of patients' arousal. ERPs elicited by the passive oddball paradigm were collected during coma and awakening states, respectively. Peak latencies, peak amplitudes, topography, and time-frequency information of P1, N1, P2, and mismatch negativity (MMN) were compared between the 2 sessions. RESULTS No significant differences in the peak amplitudes and peak latencies of P1 and N1, but significantly greater P2 amplitude with shorter latency in left hemisphere and midline was shown in the awakening state compared with that in coma. A marked shift of P2 topography in response to deviant tones was also seen, from the right centro-parieto-frontal areas during coma to left frontal-midline areas during awakening. MMN waveforms were not detected in 6/10 patients during the coma state, but these 6 patients all recovered to awakening. Evoked oscillations in bilateral hemisphere were profoundly inhibited during the coma state, with poor inter-trial phase synchronization, while obvious activities with broader frequency ranges and consistent inter-trial phase synchronization were observed during awakening state, and different frequency activities were distributed in distinct brain regions. CONCLUSIONS P2 may be a central index of coma recovery and a component of the arousal system. Changes in time-frequency information could provide more information during coma recovery, perhaps including some cognitive processing of the sensory stimulus.

Is Low-Level Laser Therapy Effective on Sensorineural Recovery After Bilateral Sagittal Split Osteotomy? Randomized Trial.

PURPOSE: When performing a sagittal osteotomy of the mandibular ramus, one must consider the risk of long-term postsurgical sensory abnormalities from lesions to the inferior alveolar nerve. One treatment for these changes is low-level laser therapy (LLLT). Thus, the aim of this research was to evaluate the effectiveness of LLLT on sensorineural recovery after split ramus osteotomy of the mandible. MATERIALS AND METHODS: This randomized, double-blinded, split-mouth design trial included patients who underwent advanced surgery of the mandible and then received LLLT on 1 side of the mandible (experimental) and a random placebo (control) treatment on the opposite site. Patients were divided into 2 groups: group 1 was treated during the short postoperative period (within 30 days) and group 2 was treated for persistent sensory abnormalities during the late postoperative period (6 months to 1 yr). Each patient received 5 LLLT and control sessions with intervals of 3 to 4 weeks between sessions. The experimental side in each patient received LLLT in the extraoral area (mandibular ramus and entire length of the inferior alveolar nerve to the mental region) and the intraoral area (mental foramen region). The control side received simultaneous placebo treatments. The sensorineural response was analyzed before the onset of treatment and after each LLLT and control session using the Semmes-Weinstein monofilament test. RESULTS: Twenty adult patients (mean age, 35.6 years; 70.0% women) showed improvement in the experimental and control sides during the follow-up period. However, the experimental side in groups 1 and 2 exhibited a marked improvement in sensorineural recovery over the course of the sessions, and group 1 had the best results. CONCLUSION: LLLT was effective in the recovery from sensorineural disorders after orthognathic surgery during the short postoperative period, particularly in the fifth session.

A case of hypoglossal nerve stimulator-resistant obstructive sleep apnea cured with the addition of a chin strap.

A population of appropriately selected patients does not respond, or does not achieve cure, with hypoglossal nerve stimulation (HGNS). We describe the case of nonresponder whose obstructive sleep apnea (OSA) resolved with the addition of chin strap. After initial placement and titration of HGNS implant, follow-up sleep study demonstrated persistent moderate OSA. Drug-induced sleep endoscopy demonstrated supraglottic collapse with activate neurostimulation. With mouth closure and change of stimulation settings to unipolar from bipolar, the airway collapse and desaturations improved. The follow-up polysomnogram with (HGNS) therapy and chin strap demonstrated resolution of sleep apnea. Laryngoscope, 128:1727-1729, 2018.

Effects of Superpulsed, Low-Level Laser Therapy on Neurosensory Recovery of the Inferior Alveolar Nerve.

OBJECTIVE: The purpose of this investigation was to evaluate the therapeutic efficacy of superpulsed, low-level laser therapy (SLLLT) on neurosensory recovery of the inferior alveolar nerve (IAN) after oral surgical injury. BACKGROUND DATA: A survey of the literature reveals the uncertainty of outcomes for the surgical management of IAN injury and the efficacy of low-level laser therapy in the treatment of IAN injury. METHODS: In this study, the authors report the results for SLLLT in 57 patients affected by paresthesia of the lip, chin, gingival, and buccal regions. Each patient was subjected to 10 laser treatments, once a week, with a GaAs diode laser. Clinical neurosensory tests (soft touch, 2-point discrimination, pin prick, thermal test) and the visual analogue scale were used before every treatment to evaluate the extent of neurosensory recovery. RESULTS: The authors' results demonstrate that 83.3% of the patients had a significant neurosensory recovery, as evident in the objective and subjective tests. CONCLUSION: The results reported in this study indicate that SLLLT has the potential to improve neurosensory recovery in patients with IAN paresthesia.

Effect of submental sensitive transcutaneous electrical stimulation on virtual lesions of the oropharyngeal cortex.

OBJECTIVE: The aim of this study was to assess the effect of submental sensitive transcutaneous electrical stimulation (SSTES) on pharyngeal cortical representation after the creation of an oropharyngeal cortical virtual lesion in healthy subjects. METHODS: Motor-evoked potential amplitude of the mylohyoid muscles was measured with transcranial magnetic stimulation (TMS), the oropharyngeal cortex was mapped by cartography, and videofluoroscopic parameters of swallowing function were measured before and after SSTES (at the end of SSTES [0 min] and at 30 and 60 min), after the creation of a cortical virtual lesion (repetitive TMS, 1 Hz, 20 min on the dominant swallowing hemisphere). RESULTS: Nine subjects completed the study. After 20 min of SSTES, motor-evoked potential amplitude increased (P<0.05), as did swallow reaction time after repetitive TMS, as seen on videofluoroscopy, which was reversed after electrical stimulation. On cortical mapping, the number of points with a cortical response increased in the dominant lesioned hemisphere (P<0.05), remaining constant at 60 min (P<0.05). CONCLUSION: SSTES may be effective for producing cortical plasticity for mylohyoid muscles and reverses oropharyngeal cortical inhibition in healthy subjects. It could be a simple non-invasive way to treat post-stroke dysphagia.

Physiological correction of lingual dysfunction with the "Tongue Right Positioner": Beneficial effects on the upper airways.

Several studies have demonstrated the beneficial role of functional tongue therapy in stabilizing treatments for dental malocclusion and treating sleep-disordered breathing (SDB). The aim of this retrospective study was to evaluate the effect on the upper airways of the Tongue Right Positioner device (TRP) used for the correction of atypical swallowing. We analyzed lateral headfilms of 94 orthodontic patients aged between 11 and 17, before the start of treatment and after establishment of mature swallowing, treated with the TRP (TRP group) or by reeducation exercises (control group). In the TRP group, the establishment of mature swallowing occurs twice as fast as in the control group. This led to thinning of the floor of the mouth (-8.38%, P<0.001) linked to anteroposterior enlargement of the pharynx (+10.48%, P<0.01), both probably due to an increase in genioglossal and styloglossal muscle tone and correction of cranio-cervical posture (+2.52%, P<0.01). These results are not dependent on the type of orthodontic treatment. They suggest that the TRP could be used in the treatment of SDB.

[Preliminarily analysis on traditional Chinese medicine advices in Treatise on Febrile Diseases].

To make a systematic analysis on literatures concerning traditional Chinese medicine (TCM) advices in Treatise on Febrile Diseases, and summarize the main connotations of traditional Chinese medicine advices, relevant TCM advices in Treatise on Febrile Diseases were collected, screened, compared, summarized and analyzed according to TCM dosage form preparation methods, TCM administration methods, medication contraindications and nursing after TCM administration. The literatures concerning medications in Treatise on Febrile Diseases were consulted, summarized and compared to standardize medicine advices and facilitate rational clinical application of TCMs. The standard medicine advices were as follows. The boiling water for TCMs shall be tap water and well water. The decoctions that have effects in promoting blood and meridians can be boiled with wine. The decoctions containing toxic components can be boiled with honey. Some TCMs shall be boiled with special methods, e. g. Herba Ephedra that could be boiled before other medicine and skimmed. Japonica rice could be added in decoctions to measure the duration of decoctions. Different dosages were required for different forms (litre, pill, medicine spoon). Administration times, temperature and frequency shall be adjusted according to target positions, functions and stage of illness. As for dietary contraindications during medication, thick porridges are recommended, where foods impacting medicine efficacy are prohibited. Regarding nursing after medication is important to recover physical functions, particularly warm porridges can go with diaphoretic recipes, while thick porridges can go with purgative recipes. And drug efficacies shall be defined by observing urine and excrements, and blood form. In conclusion, Treatise on Febrile Diseases is the first book that discusses TCM advices and records them in details. In this study, new standard medicine advices were proposed to provide important basis for improving clinical advices of TCMs and supports for developing the TCM dispensing technology.

The human brain response to dental pain relief.

Local anesthesia has made dental treatment more comfortable since 1884, but little is known about associated brain mechanisms. Functional magnetic resonance imaging is a modern neuroimaging tool widely used for investigating human brain activity related to sensory perceptions, including pain. Most brain regions that respond to experimental noxious stimuli have recently been found to react not only to nociception alone, but also to visual, auditory, and other stimuli. Thus, presumed functional attributions have come under scrutiny regarding selective pain processing in the brain. Evidently, innovative approaches are warranted to identify cerebral regions that are nociceptive specific. In this study, we aimed at circumventing known methodological confounders by applying a novel paradigm in 14 volunteers: rather than varying the intensity and thus the salience of painful stimuli, we applied repetitive noxious dental stimuli at constant intensity to the left mandibular canine. During the functional magnetic resonance imaging paradigm, we suppressed the nociceptive barrage by a mental nerve block. Brain activity before and after injection of 4% articaine was compared intraindividually on a group level. Dental pain extinction was observed to correspond to activity reduction in a discrete region of the left posterior insular cortex. These results confirm previous reports demonstrating that direct electrical stimulation of this brain region-but not of others-evokes bodily pain sensations. Hence, our investigation adds further evidence to the notion that the posterior insula plays a unique role in nociceptive processing.

Preliminarily analysis on traditional Chinese medicine advices in Treatise on Febrile Diseases / 中国中药杂志

To make a systematic analysis on literatures concerning traditional Chinese medicine (TCM) advices in Treatise on Febrile Diseases, and summarize the main connotations of traditional Chinese medicine advices, relevant TCM advices in Treatise on Febrile Diseases were collected, screened, compared, summarized and analyzed according to TCM dosage form preparation methods, TCM administration methods, medication contraindications and nursing after TCM administration. The literatures concerning medications in Treatise on Febrile Diseases were consulted, summarized and compared to standardize medicine advices and facilitate rational clinical application of TCMs. The standard medicine advices were as follows. The boiling water for TCMs shall be tap water and well water. The decoctions that have effects in promoting blood and meridians can be boiled with wine. The decoctions containing toxic components can be boiled with honey. Some TCMs shall be boiled with special methods, e. g. Herba Ephedra that could be boiled before other medicine and skimmed. Japonica rice could be added in decoctions to measure the duration of decoctions. Different dosages were required for different forms (litre, pill, medicine spoon). Administration times, temperature and frequency shall be adjusted according to target positions, functions and stage of illness. As for dietary contraindications during medication, thick porridges are recommended, where foods impacting medicine efficacy are prohibited. Regarding nursing after medication is important to recover physical functions, particularly warm porridges can go with diaphoretic recipes, while thick porridges can go with purgative recipes. And drug efficacies shall be defined by observing urine and excrements, and blood form. In conclusion, Treatise on Febrile Diseases is the first book that discusses TCM advices and records them in details. In this study, new standard medicine advices were proposed to provide important basis for improving clinical advices of TCMs and supports for developing the TCM dispensing technology.

Cervical necrotizing fasciitis resulting in acupuncture and herbal injection for submental lipoplasty.

Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. Necrotizing fasciitis is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of serious cervical necrotizing fasciitis that developed after acupuncture and herbal injection treatment of fat accumulation of the submental area in a 32-year-old healthy woman. She presented with discharging wound over the submental area. The initial diagnosis was based on clinical information, in which localized necrosis areas in the cervical and chin regions were observed. Wide antibiotic therapy was applied, followed by surgical drainage, debridement, and negative pressure wound therapy. Culture was positive for Serratia liquefaciens and Staphylococcus intermedius. She made a good recovery.

Lower-level laser therapy improves neurosensory disorders resulting from bilateral mandibular sagittal split osteotomy: a randomized crossover clinical trial.

Bilateral sagittal split osteotomy (BSSO) is a technique commonly used to correct mandibular disproportion but many patients experience hypoaesthesia of the inferior alveolar nerve (IAN). The purpose of this study was to verify the effectiveness of using a low-level laser therapy protocol after BSSO. The 10 patients in our study, who underwent BSSO with Le Fort I osteotomy and had low-level laser therapy on one side of the jaw, were evaluated over a period of 60 days. The data for the treated and non-treated sides were compared post-operatively. At 15, 30 and 60 days after surgery, when sensitivity was recovered on both sides. On the treated side, recovery was faster and was almost complete at the time of the last evaluation. We suggest that this lower-level laser therapy protocol can improve tissue response and accelerate the recovery of neurosensory disorders following BSSO. (NCT01530100).

Fibrin Glue Fixation for Suction Blister Epidermal Grafting in Two Patients with Stable Vitiligo

Vitiligo is a chronic disorder characterized by depigmented macules which can slowly enlarge with the concurrent development of new lesions. Although autologous suction blister epidermal grafting is an established technique for the treatment of recalcitrant, stable vitiligo, the donor tissue graft is not easy to fix at the recipient site, especially in areas such as the joints, face, cutaneous folds, hands, feet, and hair-bearing areas. Therefore, various methods of donor tissue fixation have been attempted. We report two cases of vitiligo treated with suction blister epidermal grafting, with fibrin tissue adhesion. The first case is that of 16-year-old female patient presented with hypopigmented patches on the forehead and frontal scalp area. The other case is that of 32-year-old female patient presented with hypopigmented patches on the chin. We treated them with phototherapy for 1~4 years; however, the lesions were recalcitrant. Therefore, we tried treatment with a suction blister epidermal graft. Because graft fixation is difficult at the recipient sites, fibrin glue was sprayed on the grafts. Thereafter, we applied a porous silicone wound contact layer over the graft area and applied sterile gauze dressing that was left for a week. One week after the procedure, firm fixation of the donor tissue was observed in both cases. Fibrin glue seemed to improve the graft fixation, providng protection against infection and an optimal environment for wound healing. This report suggests that the application of an epidermal graft with fibrin glufixation, can provide the best result in the surgical treatment of stable vitiligo.

Effect of infrared laser in the prevention and treatment of paresthesia in orthognathic surgery.

Orthognathic surgery is the surgical procedure that makes correcting deformities of the bones in the region of the maxilla and mandible a reality in the Brazilian dentistry. However, this type of surgery usually involves paresthesia in the postoperative period, concerning the surgeons who perform them and generating discomfort to patients. This study aimed at evaluating the effect of infrared laser (830 nm) in the prevention and treatment of paresthesias after orthognathic surgery. Six patients underwent orthognathic surgery: the experimental group composed of 4 patients and the control group that did not receive laser therapy composed of 2 patients. The experimental group received laser applications during the transoperative and 12 postoperative sessions. Tests for mechanical (deep and shallow) and thermal (cold) sensitivity were performed in the preoperative and postoperative period (during 12 sessions) in the lip and chin areas by the same operator. The paresthesia was classified into 1, strong; 2, moderate; 3, mild; and 4, absent, through the patient's response to stimuli. The results showed that all patients had no disturbance of sensitivity in the preoperative period, but paresthesia was presented at various levels in the postoperative period. Both groups showed recovery of deep mechanical sensitivity within a shorter time interval compared with the superficial mechanical and thermal sensitivity. However, at the 12th assessment, patients who underwent the laser therapy showed better reduction in the level of paresthesia or even complete regression of this. The laser, therefore, brought benefits to the treatment of paresthesia, accelerating the return of neurosensorial sensitivity.