A retrospective analysis of the management and surgical treatment of orbital lesions: Outcomes and rationale.

The orbital cavity is a subject of interest for various specialists, and achieving optimal outcomes requires comprehensive, multidisciplinary management. This study aims to report 10 years of experience in the preoperative, surgical, and postoperative care of patients with orbital lesions, examining their clinical, radiological, and anatomopathological features and outcomes. A retrospective review of 125 patients who underwent surgical treatment for intraorbital masses between January 2012 and December 2021 was performed. Outcome measures included postoperative diplopia, exophthalmos, decimal visual acuity, eyeball position, ocular motility, operative time, complications, and aesthetic results. A total of 107 patients were included. All cases were discussed with a neuroradiologist to determine the best therapeutic approach based on preoperative imaging. Preoperative diplopia was linked to extraconal (p = 0.03) and anterior (p = 0.001) lesions, and exophthalmos and visual acuity deterioration were associated with intraconal (p = 0.02; p = 0.03) and retrobulbar (p = 0.001; p = 0.02) lesions. Complications (11.2%) included diplopia, worsened visual acuity, postoperative blepharoptosis, and postoperative ectropion. Of the patients, 80.4% reported an "excellent" aesthetic outcome. This study underscores the importance of a multidisciplinary approach based on a thorough analysis of preoperative imaging. Periorbital approaches tailored to the lesion's three-dimensional location enables safe access to most intraorbital lesions, resulting in minimal complications and good aesthetic results.

Postoperative infections associated with microvascular free flaps in head and neck reconstruction: Analysis of risk factors and results with a standardized prophylaxis protocol.

Currently, large defects of the head and neck regions are mainly reconstructed using microvascular free flap. Postoperative infections, including surgical site infections (SSIs) and medical postoperative infections (MPI), are important causes of morbidity and worsening of surgical outcomes. The authors aimed to analyze the results obtained using a standardized prophylaxis protocol in a series of 100 consecutive patients who underwent microvascular reconstruction surgery between 2016 and 2021 at a single institution, to identify the risk factors, which could be overcome, to minimize the incidence of infectious complications. In this study, 24 patients developed infectious complications. Higher American Society of Anesthesiologists (ASA) score was statistically associated with higher risk of infectious complications (p = 0.01), need for postoperative transfusions (p = 0.01), and higher T and N stage (p = 0.03 and p = 0.02, respectively) in patients with cancer. We also found a correlation between the increase in surgery duration, hospitalization, and intensive care unit (ICU) stay with higher risk of infection (p = 0.03, p = 0.01, and p = 0.001, respectively). Nine patients reported partial or total flap necrosis and in this group of patients, a higher incidence of infectious complication was recorded (p = 0.001). Our experience shows that SSIs and MPIs affect the global and surgical outcomes of patients and both their incidences can be reduced by correcting potential risk factors preoperatively (e.g., anemia), intraoperatively (amount of blood loss and duration of surgery), and postoperatively (duration of hospitalization and ICU stay and early elimination of potential sources of infection).

Impact of COVID-19 epidemic on maxillofacial surgery in Italy.

Maxillofacial departments in 23 surgical units in Italy have been increasingly involved in facing the COVID-19 emergency. Elective surgeries have been progressively postponed to free up beds and offer human and material resources to those infected. We compiled an inventory of 32 questions to evaluate the impact of the SARS-COV2 epidemic on maxillofacial surgery in 23 selected Italian maxillofacial departments. The questionnaire focused on three different aspects: the variation of the workload, showing both a reduction of the number of team members (-16% among specialists, -11% among residents) due to reallocation or contamination and a consistent reduction of elective activities (the number of outpatient visits cancelled during the first month of the COVID-19 epidemic was about 10 000 all over Italy), while only tumour surgery and trauma surgery has been widely guaranteed; the screening procedures on patients and physicians (22% of maxillofacial units found infected surgeons, which is 4% of all maxillofacial surgeons); and the availability of Personal Protective Equipment, is only considered to be partial in 48% of Maxillofacial departments. This emergency has forced those of us in the Italian health system to change the way we work, but only time will prove if these changes have been effective.

Parameters and outcomes in 525 patients operated on for oral squamous cell carcinoma.

PURPOSE: This report analyzed the outcomes of patients undergoing surgery for oral squamous cell carcinoma (OSCC) to identify the value of prognostic factors. MATERIAL AND METHODS: A total of 525 patients were studied who had undergone surgery for oral squamous cell carcinoma (OSCC) between 2000 and 2011, of whom 222 had received postoperative radiation-therapy (PORT) and or chemoradiation-therapy (PORTC). For each patient, personal data, histological findings, treatment and outcome were recorded and analyzed statistically. Survival curves were calculated using the Kaplan-Meier algorithm, and the difference in survival among subgroups was examined. RESULTS: The overall survival (OS) and disease-specific survival (DSS) 5-year survival rate in the 525 patients were respectively 71.38% and 73.18%. The differences in the overall survival and disease-specific 5-year survival were significant (p < 0.05) for age < 40 years, site of origin, N status, staging, grading, osseous medullar infiltration, and perineural invasion. In patients undergoing radiation therapy, only perineural invasion negatively influenced the survival prognosis. In 150 pT1 cases of tongue and floor-of-mouth cancer, an infiltration depth (ID) > 4 mm was statistically correlated with poorer prognosis. CONCLUSIONS: The results demonstrate an improvement in the 5-year OS and DSS rates during the past decade compared with the previous decade. Univariate analysis revealed that age, tumor staging, and lymph node involvement, extracapsular spread, grading, perineurial invasion, infiltration depth, and osseus medullary invasion were associated significantly with overall survival and disease-specific survival.

Morphofunctional compensation of masseter muscles in unilateral posterior crossbite patients.

Unilateral posterior crossbite is a widespread, asymmetric malocclusion characterized by an inverse relationship of the upper and lower buccal dental cusps, in the molar and premolar regions, on one side only of the dental arch. Patients with unilateral posterior crossbite exhibit an altered chewing cycles and the crossbite side masseter results to be less active with respect to the contralateral one. Few studies about morphological features of masticatory muscle in malocclusion disorders exist and most of these have been performed on animal models. The aim of the present study was to evaluate morphological and protein expression characteristics of masseter muscles in patients affected by unilateral posterior crossbite, by histological and immunofluorescence techniques. We have used antibody against PAX-7, marker of satellite cells, and against α-, ß-, γ-, δ-, ε- and ζ-sarcoglycans which are transmembrane glycoproteins involved in sarcolemma stabilization. By statistical analysis we have evaluated differences in amount of myonucley between contralateral and ipsilateral side. Results have shown: i) altered fibers morphology and atrophy of ipsilateral muscle if compared to the contralateral one; ii) higher number of myonuclei and PAX-7 positive cells in contralateral side than ipsilateral one; iii) higher pattern of fluorescence for all tested sarcoglycans in contralateral side than ipsilateral one. Results show that in unilateral posterior crossbite hypertrophic response of contralateral masseter and atrophic events in ipsilateral masseter take place; by that, in unilateral posterior crossbite malocclusion masticatory muscles modify their morphology depending on the function. That could be relevant in understanding and healing of malocclusion disorders; in fact, the altered balance about structure and function between ipsilateral and contralateral muscles could, long-term, lead and/ or worsen skeletal asymmetries.

Facial soft tissue changes after transverse palatal distraction in adult patients.

This longitudinal study investigated the 3-D facial soft-tissue response to transverse palatal bone-anchored osteodistraction in 18 adult patients. Laser-scanned facial surface data were obtained for all patients before (T(0)), 6 months (T(1)) and 1 year (T(2)) after transverse palatal distraction. The averaged facial morphologies at T(0), T(1) and T(2) were calculated and compared. Sagittal and vertical measurements were obtained from lateral cephalograms to evaluate skeletal and dental movements. Pre- and immediate post-distraction dental casts were used to investigate transverse maxillary movements. Cutaneous changes were mainly observed in the paranasal regions and cheeks, in the range 1-3 mm, reflecting the underlying increase in the maxillary width. A significant enlargement of the nasal base was also demonstrated. The absolute magnitude of these facial changes was limited but clinically relevant. Variable skeletal movements were observed. These were of low magnitude and no systematic tendency could be demonstrated statistically. Significant changes were documented only with regard to orthodontic repositioning of the upper and lower incisors. The mean transverse increases in the maxillary dental arch were 6.7 mm at the intercanine, 6.8 mm at the interpremolar, and 6.1 mm at the intermolar levels.

Reconstruction of facial morphology from laser scanned data. Part I: reliability of the technique.

OBJECTIVES: The aim of this study was to evaluate the effects of scanning parameters on the precision of the data acquired using a facial laser scanner and to assess the reliability of automatic model recording in humans. METHODS: Data were acquired using a laser scanner (Cyberware 3030RGB); analysis and measurements were performed with Rapid Form 2004 software. A mannequin and six volunteers were scanned to investigate the effects of environmental conditions, positioning, head orientation, and software procedures. Precision and accuracy of the data were evaluated comparing six linear measures calculated on scanned data with those obtained directly. Two sessions with different head inclination were performed. The reliability of repeated scans was also assessed measuring the distance between the surfaces reconstructed from two separate scans of the same subject, at 12 anatomical points, in 5 subjects, during two sessions using a different head inclination. Differences were analysed using paired t-tests or analysis of variance (ANOVA). RESULTS: The accuracy of scanning was +/-0.65 mm. The development of a specific protocol resulted in a mean scanning error of 1-1.2 mm and a recording error of 0.3-0.4 mm on repeated scans of human subjects. CONCLUSIONS: This study indicates that scanning of the human face may be hampered by errors and artefacts, mainly due to movements. While the effect of trembling and involuntary movements during the exam may be minimized using faster scanning devices, comparative observation over time may be affected by unreal differences due to the uncertainty of facial expression. The overall error is, however, in the range useful for most clinical studies.

Transverse maxillary distraction with a bone-anchored appliance: dento-periodontal effects and clinical and radiological results.

In 29 adult patients presenting with maxillary deficiency, a bone-anchored palatal distractor (Surgi-Tec NV, Brugge, Belgium) was applied after osteotomy of the anterolateral walls of the maxillary sinuses, midpalatal suture, and, eventually, separation of the pterygomaxillary sutures. Expansion proceeded at a rate of 0.33-0.66 mm per day and the device was retained for 4-6 months for consolidation. Active orthodontic therapy was started after 8-10 weeks. The increment of arch width and the perimeter were evaluated using dental casts. Tooth thermal sensitivity and the periodontal side effects of treatment were monitored clinically after distraction, at device removal, and after 1 year. Bone healing was also investigated during the procedure using conventional radiological techniques. This experience confirms that transverse maxillary distraction is an effective technique in adult patients, leading to the formation of new bone. There were no noticeable intraoperative complications, but postsurgical periodontal side effects were documented. The procedure offers advantages over traditional teeth-borne appliances in terms of rapidity of treatment and the absence of mechanical forces acting on the teeth. Further evaluation is required to assess the long-term stability and periodontal consequences of this technique.

Diagnosis and treatment of retrobulbar haematomas following blunt orbital trauma: a description of eight cases.

Retrobulbar haematoma following blunt orbital trauma is a rare, but potentially serious, complication, since it can evolve rapidly from visual impairment to permanent loss of vision. This sight-threatening situation most commonly arises from orbital bleeding accompanying undisplaced fractures of the orbital walls, an event that increases the pressure inside the orbit and results in vascular damage to the optic nerve. The clinical presentation includes pain, exophthalmos with proptosis, and internal ophthalmoplegia, with impairment or loss of the pupillary reflex. A thin-layer orbital CT scan is an essential diagnostic aid. Any delay between the onset of symptoms and treatment can have a significant effect on functional recovery. Therapy is based on orbital decompression, via different surgical approaches, with the intention of reducing the pressure on the nerve and vascular structures inside the orbit. This paper presents eight cases of retrobulbar haematoma and their follow-up, in detail.

Expression of neuropeptides and growth-associated protein 43 (GAP-43) in cutaneous and mucosal nerve structures of the adult rat lower lip after mental nerve section.

The reinnervation of the adult rat lower lip has been investigated after unilateral section of the mental nerve. Rats were sacrificed at 4, 7, 9, 14, 30, and 90 days after the operation. A further group of animals with section of the mental nerve and block of the alveolar nerve regeneration, was sacrificed at 14 days. Specimens were processed for immunocytochemistry with antibodies against PGP 9.5, GAP-43 or neuropeptides (CGRP, SP and VIP). Four days after nerve section, axonal degeneration seems evident in the mental nerve branches and inside skin and mucosa. GAP-43 immunoreactivity is intense in the mental nerve 7 days after nerve section and it reaches its maximal expression and distribution in peripheral nerve fibres at 14 days. At 30 days, the decline in its expression is associated with the increase of PGP9.5-, SP-, and CGRP immunopositivity. VIP is observed only in perivascular fibres at all times observed. Present results suggest that, after sensory denervation of the rat lip, nerve fibres in skin and mucosa remain at lower density than normal. The different time courses in the expression of neuropeptides and GAP-43 suggest a possible early involvement of GAP-43 in peripheral nerve regeneration.

[Facial anthropometry and aesthetic perception in young italian subjects: their use for orthognatic surgery]. / Antropometria e percezione estetica del volto in un campione di popolazione italiana. Considerazioni ai fini della chirurgia ortognatica.

BACKGROUND: Aesthetic requests of patients undergoing orthognatic surgery have increased over time and represent nowadays the leading subjective motivation for the patient and a major aim of the treatment for the surgeon. In this regard, anthropometric evaluation has considerably improved the diagnostic capacity of the orthodontist and of the surgeon. Aim of the study is to provide the orthognatic surgeon with anthropometric normal values based on a sample of aesthetically pleasant Italian subjects and to discuss the use of a simplified aesthetical analysis in the set-up of the surgical plan and in the evaluation of treatment outcome. METHODS: The present study analyses 94 Italian subjects, by means of anthropometric measurements on photographic images, considering 28 facial proportions and 33 angular values. These figures were compared with the aesthetic judgement provided by 3 common observers and 3 orthodontists. The aesthetic score was attributed on a subjective discrete scale (common observer: above average/average/below average; orthodontist: eumorphic/ dismorphic). Data were also compared with similar evaluations on North-American and African subjects reported in the international literature. RESULTS: This study confirms the sexual dismorphism and the ethnic variability already reported by other Authors and documents specific morphological characters in the Italian population. CONCLUSIONS: The described method appears acceptably simple and consistent for clinical application. Its use in orthognatic surgery may provide objective and reproducible data for evaluating the aesthetic outcome of treatment.

Dimensions and volumes of the orbit and orbital fat in posttraumatic enophthalmos.

OBJECTIVES: To estimate from 2D and 3D-CT the anatomical defects that are most likely to be responsible for posttraumatic enophthalmos. MATERIALS AND METHODS: The morphology and dimensions of the orbit and of fat content were investigated in 25 patients 6-12 months after treatment for complex orbital fractures by image analysis and volumetric estimation from 2D and 3D-CT. RESULTS: The shape of orbit was very often changed from conical to more rounded due to enlargement of the posterior segment. The retrobulbar fat appeared fragmented and dislocated posteriorly. No changes were observed in the structural appearance or radiodensity of either the orbital fat or muscles. There was reduced sagittal eye projection, increased width of the orbital rim, downward dislocation of the posteromedial orbital floor, and increased volume in the posttraumatic orbits which was significantly different (P < 0.05). Enophthalmos was correlated with orbital volume and height of the retrobulbar portion of the orbit. The volume of fat did not correlate with enophthalmos. CONCLUSIONS: Posttraumatic enophthalmos appears to be more commonly related to failure in correcting the orbital volume and in reducing the outward dislocation of the posterior orbital floor and not to changes in the fat content.

Immunocytochemical evidence of plasticity in the nervous structures of the rat lower lip.

In this immunocytochemical study we investigated the distribution of nervous structures in the lower lip of adult rats. The region is characterized by a rich cutaneous and mucosal sensory innervation originating from terminal branches of the trigeminal system. Lower lip innervation was investigated by detection of the general neuronal marker protein gene product 9.5 (PGP 9.5) and the growth-associated protein 43 (GAP-43), a neurochemical marker of neuronal plasticity. The entire neural network of both cutaneous and mucosal aspects was stained by the antibody to PGP 9.5. In particular, nerve fibers were observed in the submucosal and the subepithelial plexuses. Thin immunoreactive fibers were observed within the epithelial layers ending as free fibers or as fibers associated with immunopositive Merkel cells. Well-identified anatomical structures receiving sensory or autonomic innervation were also surrounded by PGP 9.5-ir nerve fibers, in particular, hair follicles, vibrissae, glands, and blood vessels. GAP-43-immunostained nerve fibers were observed in all these structures; however, they were generally less numerous than the PGP 9.5-immunoreactive elements. An equal amount of PGP 9.5 and GAP-43 immunoreactivity occurred, in contrast, in the subepidermal and the submucosal plexuses, or in the epidermis and the mucosal epithelium. The present results show that GAP-43 is normally expressed in the mature trigeminal sensory system of the rat. Skin and oral mucosa are characterized by continuous remodeling that may also involve the sensory nervous apparatus. Continuous neural remodeling, regeneration and sprouting may be the reason for the observed expression of GAP-43.

The use of replicate resin models in the treatment of maxillary sinus augmentation patients.

The elevation of the floor of the maxillary sinus is becoming a routine surgical procedure to develop the site for dental implants. This delicate procedure is best performed with diagnostics of the highest magnitude. To this point, computer tomographic scans provide valuable information, especially when defining the location and extension of septae transversing the sinus. Additional useful information is provided by a replicate resin model that is constructed from a magneto-optical disk compatible with a personal computer. The image data is then converted to a DOS format. Bone structures of interest are thresholded in each slice based on single-pixel gray levels. Object profiles with linear interpolation and their elaboration generate the three-dimensional surface of the object. Finally, the physical resin model is fabricated.

[The validation of stereolithographic anatomical replicas: the authors' own experience and a review of the literature]. / Convalida delle repliche anatomiche stereolitografiche: esperienza personale e revisione della letteratura.

The visual three-dimensional (3D) reconstruction of CT findings has been used since the Seventies to design and plan complex surgical procedures. The availability of such models and the development of computer science have permitted, since the mid-Eighties, the medical use of rapid prototyping for anatomical modelling. We studied the technical steps of CT data processing for rapid prototyping and the dimensional and structural accuracy of replicas of skeletal components relative to the originals. A dried mandible and an arthrotic hip joint were compared with their stereolithographic replicas using the measurements made on CT images. The 3D graphic models were processed with a commercially available software and replicated with an SLA 250 stereolithographer (3D System Inc, Valencia CA, USA). Satisfactory morphologic agreement was found between the original and its replica. The mandibular replica exhibited dimensional errors ranging 0 to 4.03%, z-axis shortening and an increase in gonial angle, but with a reliable reproduction of details. The hip replica exhibited dimensional errors ranging .2% to 8.53%; it appeared to be less affected than the mandibular replica by geometrical distortion but it was less accurate in the reproduction of cancellous bone and arthrosis. The accuracy of the solid replicas depends, in the different manufacturing steps, on several factors, namely: during data acquisition, the accuracy and suitability of original data, depending in turn on equipment and examination parameters--especially the algorithm, acquisition time, gantry tilt and slice thickness; image thresholding and manipulation procedures during graphic model creation; data transfer, creation of the necessary supports and replica finishing during manufacturing; residual polymerization affected by environmental agents and preservation conditions during maintenance.

Changes in the density of protein gene product 9.5-immunoreactive nerve fibres in human oral mucosa under implant-retained overdentures.

Reduced oral sensitivity and impaired masticatory cycles have been demonstrated in edentulous humans wearing removable dentures, and there is some evidence that these patients have a decreased innervation of the oral mucosa. Clinical and electrophysiological evidence shows that sensory performance improves after oral rehabilitation with implant-retained overdentures. The aim of this study was to compare the density of mucosal innervation in edentulous patients with that in dentate controls and to evaluate changes in the number or type of sensory receptors following placement of endosseous implants in these edentulous individuals. The mucosal innervation was evaluated by immunohistochemical assays for the neurospecific marker protein gene product 9.5, and the innervation pattern was compared with that of dentate controls. Morphometric analysis of the immunohistochemical material demonstrated a decrease in numbers of sensory receptors in the mucosa of edentulous patients and a significant increase in the number of nerve fibres in the mucosa covering the distal edentulous mandibular ridges supporting the prostheses after implant-retained rehabilitation. In contrast, there were only minor increases in the number of nerves in the peri-implant mucosa. These changes in innervation appear to be related either to the new biomechanical situation created by implant support, which favours more physiological tissue conditions, or to an adaptive mechanism in the peripheral processing of sensory stimuli. These changes may explain, at least partially, the clinically observed differences in sensory skills before and after implant placement.

Development of nerve fibres in the temporomandibular joint of the human fetus.

The development of nerve fibres in the temporomandibular joint (TMJ) in relation to the development of bone, muscle and fibre components was investigated in human fetuses ranging from 9 weeks of gestation to birth. Immunohistochemistry for the glia-associated protein S-100 and for the neuro-specific marker protein gene product 9.5 (PGP 9.5) were used; specimens were compared to specimens of adult TMJ capsule and disc. At 9-10 weeks, a small number of neural elements are already present in the connective tissue around the joint and in the mesenchyme between the two articular blastemas from which the disc will differentiate. By 19 weeks many nerve fibres are clearly visible. Immunohistochemical results suggest diffuse disc innervation extending along the entire disc but not in the thin central area. More complex structures, i.e. encapsulated corpuscles, were also seen. The fetal disc appears highly innervated compared to adult tissue; already at this developmental stage morphology and distribution of nerves and corpuscles in the joint capsule are comparable to those in the adult joint. It may be concluded that the innervation of the TMJ is detectable from the end of the second month and that it develops fully between the third and the fifth month of gestation. Nerve endings in the disc are most numerous at 20 weeks, after which a progressive reduction, possibly secondary to the growth of articular tissues, is observed throughout the last trimester of fetal life and into adult life. The innervation of the lateral pterygoid muscle, on the contrary, is much less than that seen in adult muscles, even at full-term.

[The prototype of an expert system for the diagnosis of pseudotumorous lesions and tumors of the jaws: ADAPT-M. Archiviazione e Diagnosi Automatica di Pseudotumori e Tumori delle ossa Mascellari]. / Prototipo di un sistema esperto per la diagnosi delle lesioni pseudotumorali e tumorali dei mascellari: ADAPT-M.

Many different tumors and pseudotumors may affect the jaw bones. The number and the rarity of most of these lesions, however, make both classification and differential diagnosis quite difficult. Computer software for statistical calculations and logical-deductive reasoning on vast amounts of data can improve diagnostic skills. These applications are defined as computer-assisted decision-making, medical decision support, or expert systems. This study was aimed at developing a prototype probabilistic expert system, based upon knowledge from an "ad hoc"computerized data base, as an aid in the radiologic diagnosis of jaw tumors and pseudotumors. This program has been called ADAPT-M. The study considered 92 patients with benign space-occupying and fully documented lesions of the jaw bones. For each case, a list of parameters concerning different radiologic exams was considered. From all these pieces of information a data base was built, to calculate both the prevalence of each type of lesion and the frequency of many variables in the single conditions. For each kind of lesion 44 variables were considered. ADAPT-M used a formula based on Bayes' theorem to calculate the "a posteriori" probability of a diagnosis in the presence of a symptom. Overall diagnostic probability rate was high when the highest score hypothesis was matched with pathologic findings (80%) and even higher (96.1%) when the two most probable diagnoses were considered together. As expected, ADAPT-M had higher sensitivity when used with lesions with typical semiology. This results in an unquestionable limitation, especially in the patients in whom a predictive diagnosis would be most desirable. The creation of a larger data base of known cases and software development may help increase the diagnostic accuracy of the ADAPT-M system.

An immunohistochemical study on cutaneous sensory receptors after chronic median nerve compression in man.

Carpal tunnel syndrome represents the most frequent chronic compressive neuropathy in man and hence may be investigated as a spontaneous model of peripheral nerve damage and repair. In the present report the fate of nerve fibers in the digital skin after long-lasting median nerve compression has been investigated immunohistochemically in comparison to normal digital skin, with special consideration to sensory endings and encapsulated receptors. The presence has been documented of the neurospecific marker PGP 9.5, the glia-associated protein S-100, and the neuropeptides CGRP and CPON which are mainly associated with the sensory and sympathetic nerve fibers respectively. The morphology and distribution of nerve fibers and corpuscles appeared comparable to that of normal digital skin; a reduction in the density of sensory receptors has, however, been observed, although not to the degree that was expected to explain the clinical deficits. It has been also demonstrated that at least part of the CGRP-containing sensory and CPON-containing sympathetic axons may survive unaltered even in patients with a long clinical history of profound sensorial impairment. An apparent discrepancy between the maintenance of nerve fibers and the sensory disturbances and the frequent observation of prompt postoperative recovery even after years of compression results from this investigation. The correlation of immunohistochemical observations and functional scores may not be considered conclusive. It must, however, be discussed if the sensorial impairment in this syndrome might have, at least in some cases, not only an anatomical but also an electrophysiological basis.

Sensory endings in skin grafts and scars after extensive burns.

Fifteen patients who underwent a split thickness skin graft operation for full thickness burns and six patients with postburn scars were biopsied after a standard aesthesiological examination completed with Weber and Dellon tests. A semiquantitative evaluation was performed on immunohistochemically stained sections to determine the presence or absence of PGP 9.5 immunoreactive intraepithelial fibres, complex sensory receptors, nerve fibres in the dermal papillae, vessel-innervating fibres, gland-innervating fibres, and nerve trunks in the deep dermis. The reinnervation pattern was similar in grafts and scars. With regard to sensory receptors, free nerve endings and Merkel-neurite complexes were observed. Statistical analysis suggested a significant correlation between sensibility and the amount of regenerated nerve structures (particularly in the epidermis and dermal papillae).