"Black bone": the new backbone in CAD/CAM-assisted craniosynostosis surgery?

BACKGROUND: Computer-assisted design and manufacturing (CAD/CAM) techniques have been implemented in craniosynostosis surgery to facilitate cranial remodeling. However, until now, computed tomography (CT) scans with ionizing radiation were necessary to plan the procedure and create guiding templates. The purpose of this study was to present our series using CAD/CAM techniques in planning and conducting fronto-orbital advancement surgery in patients with trigonocephaly with datasets acquired only by "black bone" magnetic resonance imaging (MRI). METHODS: Six consecutively operated cases from 2019 were included in this study. All patients suffered from non-syndromic trigonocephaly with no primary surgeries. All patients underwent cranial MRI including black bone sequences. Preoperative planning and guides were created based on the DICOM datasets. We analyzed demographic data, clinical data, and outcome measured by Whitaker score. RESULTS: In all cases, precise frontobasal advancement was possible with the CAD/CAM guides created by black bone MRI. The mean operation time and planning time were 222 and 32 min. The time on intensive and intermediate care unit (ICU/IMC) time was 4.5 days, respectively. All but one case were classified as Whitaker I. CONCLUSION: In trigonocephaly treatment by frontobasal advancement, black bone MRI-based CAD/CAM craniosynostosis surgery is safe and feasible. It offers the major advantage of completely avoiding CT scans and ionizing radiation with superior imaging quality of intracranial structures. Thus, it improves intraoperative safety and-at the same time-has the potential to reduce operating room (OR) time.

Impact of COVID-19 on Oral and Maxillofacial Surgery: Preliminary Results After the Curfew.

INTRODUCTION: The COVID-19 pandemic affects basic health care in maxillofacial surgery (MFS) due to the shift in resources and the change in patient disorders treated during the pandemic. This paper aims to elucidate the medical and financial consequences driven by the measures for COVID-19 treatment in a tertiary care centre. MATERIAL AND METHODS: To evaluate the impact of pandemic measures on daily routines of MFS, the surgical schedule during the first 2 weeks after the onset of the curfew (March 2020), and to compare it with the schedule of the same period of time 1 year earlier. Furthermore, postponed surgeries as well as cancelled follow-ups are listed. The loss of earning was calculated as well as the number and kind of postponed procedures. RESULTS: The number of surgeries decreased by 45% (n = 163 in 2019 vs n = 89 in 2020), and the duration of the surgeries decreased from 94.2 minutes to 62.1 minutes. No elective surgeries, such as implantology, aesthetic surgery, or orthognathic surgery, took place. Furthermore, also trauma cases decreased from 9 to 3 cases. Considering all variables, the financial loss can be calculated as approximately 100,256.50 Euros per week. CONCLUSION: The impact of COVID-19 on MFS is certainly of medical and economic importance and is related to the duration of the pandemic.

An analysis of microvessel density in salivary gland tumours: a single centre study.

BACKGROUNDS: Microvessel density (MVD) can be used for determining neoplastic neovascularisation. Tumour angiogenesis correlates with prognosis of cancers in many organs. The aims of this study were to evaluate MVD as demonstrated by CD31 and CD105 in salivary gland tumours (SGTs), and to correlate the MVD results with clinicopathological characteristics of the tumours. MATERIALS AND METHODS: Using a retrospective cohort study design, we enrolled SGTs patients at the Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand, over the 22-year period. The predictor variables included demographic, anatomic and histopathological parameters. The outcome measure was average CD31-MVD and CD105-MVD counted by the "hot spot" method. Descriptive, uni- and bivariate statistics were computed, and P <0.05 was considered statistically significant. RESULTS: The study sample consisted of 43 subjects with a mean age of 39.6 ± 17.8 years (range, 9-82), including 26 females (60.5%), diagnosed with SGTs. In this cohort, 58.1% of the cases were benign, and 83.7% were minor SGTs. There was a significant correlation between CD31-MVD and CD105-MVD (r = 0.8, P < 0.001), but mean CD31-MVD and CD105-MVD were 17.7 ± 9.3 and 12.8 ± 7.4, respectively (P = 0.009). Age, gender and tumour site were not individually associated with significant differences between CD31-MVD and CD105-MVD. Tumours with myoepithelial cells had lower MVD than those without myoepithelial cells (P = 0.04 for CD31; P = 0.03 for CD105). Only CD105-MVD showed statistical difference between benign and malignant SGTs (P = 0.01). CONCLUSIONS: These results suggest that MVD in SGTs can be demonstrated by CD31 and CD105. Despite a strong correlation, CD31-MVD is always higher than CD105-MVD and cannot differentiate between benign and malignant SGTs. The presence of myoepithelial cells within SGTs affects the MVD analysis using either CD31 or CD105, while age, gender and tumour location do not.

A randomized controlled trial comparing computer-aided learning with versus without tuition/lecture in promoting English proficiency.

AIM: To compare test scores in English-error detection between Thai high school students undergoing self-learning by an online tool (computer-assisted learning: CAL) with versus without tuition/lecture. METHODS: This prospective, randomized, controlled study enrolled a sample of grade-12 high school students from a Thai secondary school. The predictor variable was the use of error-detection exercises in 9 separate 50-min tuition sessions during a 3-week period. Each subject was randomly assigned to receive a CAL program with or without tuition/lecture during the study interval: June-September 2009. The main outcome variable was the test scores of English-error identification. To measure the outcomes, the students were evaluated twice using the 25-question test within a 1-month interval (pre-test/post-test). Appropriate sample size estimates, descriptive, uni-, and bivariate statistics were calculated, and the level of statistical significance was set at P < 0.05. RESULTS: The sample included 69 students, 36 of whom (52.2%) were in the intervention group (CAL plus teaching). Within-group comparisons showed statistically significant improvements in post-test scores, regardless of learning methods (P < 0.05). Tuition/lecture was significantly associated with the improved post-test scores (P = 0.0012) and with a higher number of students showing improved post-test scores (P = 0.0007). CONCLUSIONS: The results of this study suggest that tuition/lecture facilitates self-learning with CAL. In this sample, tuition/lecture still seems to be necessary for nonnative-English-speaking high school students to improve their English proficiency. CAL alone should not be used to replace conventional teaching.

Female and older adult patients (age ≥ 21 Years) had slower recovery after third-molar surgery compared with males and younger adults in a US study.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Recovery after third-molar surgery: the effects of age and sex. Phillips C, Gelesko S, Proffit WR, White RP Jr. Am J Orthod Dentofacial Orthop 2010;138(6):700.e1-8 REVIEWERS: Poramate Pitak-Arnnop, DDS, PGDipClinSc (OMS), MSc, PhD, DSc Niels Christian Pausch, MD, DMD, PhD. PURPOSE/QUESTION: To assess the effects of age and gender on quality-of-life recovery after third-molar surgery in patients treated in either community practices or academic centers. SOURCE OF FUNDING: The Oral and Maxillofacial Surgery Foundation, the American Association of Oral and Maxillofacial Surgeons, and the Dental Foundation of North America. TYPE OF STUDY/DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE: Not applicable.

The ideal auricular protrusion - An interactive perceptual pilot study.

PURPOSE: Excessive ear protrusion (prominauris) can negatively affect facial appearance. Because the concept of an ideal auriculocephalic angle is controversial, however, it is difficult to define when an obtrusive auricle requires surgical intervention. It is often assumed that angles exceeding 30° require corrective surgery. However, little is known about public perception of ear protrusion. This study aimed to assess perceptions of different degrees of auricular protrusion. MATERIALS AND METHODS: We conducted an interactive panel survey. Male and female evaluators assessed digitally processed cloned images of a male and female model that depicted various ear protrusions ranging from 0° to 90°. Predictor variables were the sex of the evaluator, the sex of the clone and the extent of auricular protrusion. The outcome variable was the overall attractiveness of auricular appearance. RESULTS: Forty-four evaluators (students of dental medicine, mean age 25.43 years) participated in the study: 22 women and 22 men. The study results revealed sexual dimorphism, with the attractiveness of corresponding male and female clones rated differently. Male evaluators favoured female ear positions that fitted closer to the head; preferred alignments for female clones were: 18° (Mean) ± 9.38° (SD), p = 0.006; for male clones: 30° ± 7.94°, p = 0.003. Ear protrusion starts to negatively affect aesthetic appearance for male evaluators at positions of 42° ± 4.87° (female clone) and 54° ± 8.22° (male clone), p = 0.001. The panel of evaluators agreed to perceive angles of 21-24° ± 8.10° (female clones), ± 8.33° (male clones), as the ideal degree of protrusion in both sexes (p = 0.158). CONCLUSION: In this study, perception of ear appearance depended on the sex of both the evaluator and the clone being assessed. Obtrusive ears were more readily accepted in male faces than in female ones. Nevertheless, the overall panel perception shows a preference for rather close fitting, unobtrusive ear alignments. For planning of corrective ear surgery, a target angle of approximately 22° can be considered as a desirable result.

Donor-site morbidity after harvesting of radial forearm free flaps-comparison of vacuum-assisted closure with conventional wound care: A randomized controlled trial.

INTRODUCTION: Radial forearm free flaps (RFFF) are often used to replace tissue removed in head and neck surgery. In recent years, many attempts have been made to reduce donor-site morbidity and to prevent common complications such as infection, skin-graft necrosis, tendon exposure and subsequent impairment of hand function. One promising option is the use of vacuum-assisted-closure wound therapy (VAC). The objective of this study was to evaluate the effectiveness of VAC compared with a conventional bolster dressing (CBD). MATERIAL AND METHODS: A randomized controlled trial was enrolled. Our study was prospective in design and included patients with a skin-grafted forearm defect after harvesting of RFFF. Patients who met the inclusion criteria were randomly assigned into two study arms. The predictor variable was the type of wound therapy (VAC therapy compared with CBD) and the outcome variables were (1) the size of the wound area, (2) wrist movement and (3) grip strength. Outcome variables were assessed 12 days, three weeks and eight weeks after surgery. RESULTS: Fifty patients (33 males, mean age 61.7 years [SD 15.5]; 17 females, mean age 54.7 years [SD 10.5]) were included consecutively in the study. Patients in the VAC group experienced a faster postsurgical reduction of wound area and had better wrist movement; nonetheless, the differences between the VAC group and CBD group did not reach statistical significance. In contrast, the recovery of postsurgical grip strength was significantly faster in the VAC group. CONCLUSIONS: Our study failed to prove that VAC therapy is significantly superior to CBD for all the variable studied. Because VAC therapy has some positive effects, however, we recommend further development of this negative-pressure wound treatment, rather than the termination of its use.

Upper-eyelid weight implants for patients with lagophthalmos-comparison of rigid and flexible implants.

INTRODUCTION: For treatment of lagophthalmos, metallic weight implants can be inserted in the upper eyelid to aid eyelid closure. Rigid and flexible implants are available. The objective of this study was to investigate the effect of implant type and patient variables on the survival of lid load implants. MATERIALS AND METHODS: Forty-four patients with lagophthalmos were recruited to undergo upper-eyelid weight implantation. The predictor variable was type of implant inserted (rigid or flexible). The outcome variable was survival of the inserted implant (survival or extrusion). Other study variables were demographic data (age, gender), implant features (material, weight), and other conditions, such as history of radiation. An NMLE test was used to compare implant survival, depending on implant type (flexible versus rigid). Other variables were analysed by use of a χ2 test. RESULTS: Forty-four participants were recruited, 29 female (65.9%) and 15 male (34.1%). Forty-six implants (23 rigid implants, 50.0%; 23 flexible implants, 50.0%) were inserted (bilateral implantation in two patients). The average weight of implants used was 1.76 g (range 1.4-2.2 g). One to two years after surgery, average vertical aperture (eyelid gap) for the closed eye was 0.65 mm (range 0-4 mm). Incidence of extrusion was 15.2% (one in the rigid implant group, 2.2%; six in the flexible implant group, 13.0%). Incidence of extrusion was significantly higher for flexible implants than for rigid implants (p = 0.0273). CONCLUSIONS: The study results suggest that flexible implants are more likely to perforate the skin. The assumed advantages of the expensive chain lid weight must, therefore, be re-evaluated.

Gender-specific evaluation of variation of maxillary exposure when smiling.

INTRODUCTION: Excessive exposure of maxillary teeth when smiling can have a negative effect on the aesthetics and attractiveness of the face. The presented study was aimed to evaluate the effect of different amounts of gingival exposure on the perception of such human characteristics and qualities as age, attractiveness, gender specificity, and felt sympathy in the context of the whole face. MATERIALS AND METHODS: Forty-two participants (21 female and 21 male students of Dental Medicine) were recruited as evaluators for the study. Two average-looking subjects (one female, one male) were photographed. The images were processed to create a series of eight clones with different gingival exposure (shift A-H; A = full over-exposure, H = invisibility of the crown surfaces of the teeth). The panellists evaluated characteristics as attractiveness, gender specificity, age, and felt sympathy. RESULTS: 42 participants joined the study (21 female, 21 male). Shift H was assessed as worst for sympathy and attractiveness, and resulted in the highest estimated age. Best attractiveness was observed for shifts C and D. Gender dimorphism was noticed, with own gender being rated as less attractive and opposite gender as more attractive. CONCLUSIONS: Female and male evaluators assess excessive gingival and maxillary incisor display differently for female and male probands. Excessive over- or underexposure of the maxillary gingiva and teeth when smiling is perceived as unattractive and results in less observer sympathy.

A new approach to treat bone gaps after midfacial and zygomatic fractures with a collagen membrane.

PURPOSE: The aim of the study was to analyze the eligibility of resorbable collagen membrane in the treatment of midfacial fractures to prevent gap formation and subsequent cheek tissue retraction. MATERIAL AND METHODS: We included nine patients (six males, three females; mean age 51; range 20-73 years; mean bone gap size 8.03 × 13.12 mm) in a retrospective study design. The defect size was assessed by ultrasound. RESULTS: After a healing period of 4 to 55 weeks, treatment resulted in a significant reduction of gap size (residual mean bone gap size 6.14 × 7.32 mm). CONCLUSIONS: Native resorbable collagen membrane is a promising tool to reduce the size of bony gap in midfacial defects.