Retrospective comparison of one-stage and two-stage orbital reconstruction in patients suffering from combined injuries of the midface.

Reconstruction of the bony orbit in patients with combined midface injuries is frequently discussed in the current literature. Two main concepts can be distinguished: single-stage reconstruction, usually with a hand-bent titanium orbital mesh, and two-stage reconstruction, in which osteosynthesis of the zygomaticomaxillary complex (ZMC) is followed by orbital reconstruction with a virtually-planned, patient-specific titanium implant in a second surgery. This study aimed to compare one-stage and two-stage surgical approaches on combined midface fractures regarding postoperative diplopia. A total of 58 patients treated with one-stage (n = 29) or two-stage (n = 29) reconstruction of the ZMC and orbit were included, and their postoperative course over five months was retrospectively analysed. A descriptive quantitative analysis of the course of occurrence of diplopia was recorded to calculate the success of orbital repair in complex midface fractures including the orbit. The two workflows differed in the prevalence of postoperative clinical diplopia and eyelid complications. Multiple factors affect the decision whether or not to reconstruct the orbit first, and in the same intervention as the associated midface fracture. Thorough evaluation of each individual patient with a patient-specific choice of surgical concept is crucial, and includes multiple factors.

Frequency, Treatment and Outcome of Immune-Related Toxicities in Patients with Immune-Checkpoint Inhibitors for Advanced Melanoma: Results from an Institutional Database Analysis.

Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events (irAEs), which may result in treatment discontinuation. We sought to describe the onset, frequency, and kinetics of irAEs in melanoma patients in a real-life setting and to further investigate the prognostic role of irAEs in treatment outcomes. In this retrospective single-center cohort study, we included 249 melanoma patients. Onset, grade, and resolution of irAEs and their treatment were analyzed. A total of 191 (74.6%) patients in the non-adjuvant and 65 (25.3%) in the adjuvant treatment setting were identified. In the non-adjuvant setting, 29 patients (59.2%) with anti-CTLA4, 43 (58.1%) with anti-PD1, and 54 (79.4%) with anti-PD1/anti-CTLA4 experienced some grade of irAE and these had an improved outcome. In the adjuvant setting, the frequency of irAEs was 84.6% in anti-CTLA4 and 63.5% in anti-PD1, but no correlation with disease relapse was observed. Patients with underlying autoimmune conditions have a risk of disease exacerbation. Immunomodulatory agents had no impact on treatment efficacy. IrAEs are correlated with increased treatment efficacy in the non-adjuvant setting. Application of steroids and immunomodulatory agents, such as anti-TNF-alpha or anti-IL6, did not affect ICI efficacy. These data support irAEs as possible prognostic markers for ICI treatment.