Surgical management of dysthyroid optic neuropathy: A systematic review.

OBJECTIVE: There is currently no recommendation on the optimal surgical management for dysthyroid optic neuropathy (DON). The aim of this study is to systematically review the surgical management of DON and its outcome on visual acuity (VA). DATA SOURCES: MEDLINE, Cochrane Library, and clinicaltrials.gov REVIEW METHODS: A systematic review of studies about the surgical management of DON was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were included if preoperative and postoperative VA in logMAR (Logarithm of the Minimum Angle of Resolution) were available. RESULTS: Fifteen articles were included in the study accounting for 669 orbits. The mean VA improvement was of 0.44 logMAR overall, 0.41 logMAR for 1-wall, 0.41 logMAR for 2-wall, and 0.55 logMAR for 3-wall decompressions. The mean reduction in exophthalmos was 4.9 mm overall, 4.3 mm for 1-wall, 4.54 mm for 2-wall, and 6.02 for 3-wall decompressions. The mean new onset diplopia (NOD) rate was 19.84% overall, 19,12% for 1-wall, 20.75% for 2-wall, and 19.83% for 3-wall decompressions. CONCLUSION: The results are limited due to the high number of biases in the included studies. It seems that 3-wall decompression offers the best VA improvement and proptosis reduction although also the highest NOD and complications rate. Two-wall balanced decompression or 1-wall inferomedial decompression seems to be effective with less morbidity.

Bilateral double site (calvarial and mandibular) critical-size bone defect model in rabbits for evaluation of a craniofacial tissue engineering constructs.

Most existing preclinical models for evaluating the biosafety and bone-regeneration efficacy of innovative bone substitute materials (BSMs) or tissue engineering (TE) constructs only consisted of a single-site defect and the anatomical locations of defect varied drastically. While the compelling evidence showed that the bone healing pattern is location-dependent, owing to developmental, structural, and functional differences of anatomical locations, this is particularly true for the craniofacial region. Taking this into account, the bone healing efficiency of a BSM shown at one anatomical defect location cannot ensure the same impact at another. This prompted us to develop, for the first time, a model of bilateral critical-sized defect (CSD) at two distinctly different locations (non-load-bearing parietal calvaria and load-bearing mandibular body) co-existing in one rabbit to reduce the number of animals needed and avoid the influence of interindividual variability and evaluation bias on comparisons. 24 healthy adult male New Zealand White rabbits were randomly assigned to a group, either control, autograft (considered the "gold standard") or a clinically relevant BSM (biphasic calcium phosphate granules) (BCPg, Mastergraft®, Medronics). The full-thickness cylindrical calvarial defect (ø10 mm) on frontoparietal region and mandibular composite defect (ø11 mm) on the body of the mandible were created bilaterally using low-speed drilling with saline irrigation. The defect on one side was filled with autograft debris or BCPg, and the other side was no graft (empty). Following the euthanasia of animals at the predetermined intervals (4w and 12w), the defect zones were examined macroscopically and then sampled and processed for microcomputed tomography (microCT) and histological analysis. All surgeries went uneventfully, and all rabbits recovered slowly but steadily. No symptoms of infection or inflammation associated with the defect were observed during the experiment. At 4w and 12w, macroscopic views of all defect sites were clean without any signs of necrosis or abscess, and no intraoral communication was found. The analysis of microCT and histological findings showed the non-healing nature of the empty defect, thereby both calvaria and mandible CSDs can be validated. The study of the application of BCPg in this defect model highlighted good osteointegration and excellent osteoconductive properties but compromised the osteoinductive properties of this material (compared with autograft). To conclude, this novel double-site CSD model holds great promise in the application for preclinical evaluation of BSMs, TE construct, etc. With a reduced number of animals in use, and lower interindividual variability and evaluation bias for comparisons.

Management of sinus graft infection-a systematic review.

Sinus graft infections are rare but serious complications, as they are associated with significant morbidity and sinus graft loss. The aim of this study was to systematically review the management of sinus graft infection in order to define which protocols should be implemented. The terms searched in each database were "sinus graft infection management", "maxillary sinus lift infection", "maxillary sinus graft infection", "maxillary sinus elevation infection", and "maxillary sinus augmentation infection". The management of the sinus graft infection was assessed. The outcomes evaluated were maxillary sinus health and dental implantation results. The initial search yielded 1190 results. Eighteen articles were included, reporting a total of 3319 patients and 217 sinus graft infections. Drainage was performed with an intraoral approach in 13 studies, an endoscopic approach in two studies, and a combined approach in three studies. In every study, a disease-free sinus was finally obtained in all patients, but the outcomes of the graft and the dental implant were more varied. It is not possible to define the best treatment protocol for sinus graft infections based on the published data, since the level of evidence is poor. Management is very heterogeneous. This review highlights the necessity of surgical treatment associated with antibiotic therapy.

Temporomandibular disorders in head and neck cancers: Overview of specific mechanisms and management.

Diagnosis classification system of Temporomandibular disorders (TMD) is based on the biopsychosocial model of pain. The pathogenesis is poorly understood, leading to difficulties in treating these multifactorial conditions. The predisposing factors are pathophysiological, psychological or structural processes that alter the masticatory system and lead to an increase in the risk of development of TMD. The purpose of this integrative review was then to point out the specific mechanisms of TMD in the oral oncologic context to optimize the TMJ functional results in the management of patients with oral oncologic conditions. We explored in this paper the role of Axis II assessment of the biopsychosocial model of pain, the involvement of mechanical concepts such as dental occlusion, mandibular condyle positioning and related-structures reconstruction, and the stomatognathic changes induced by radiation.

Extracorporeal septorhinoplasty: Technical note.

Severe nasal septal deformities can be responsible for functional and aesthetic impairments. Correction of these deformities can be difficult and restoring perfect nasal shape and function is still challenging. Classical techniques can, sometimes, lead to disappointing results or relapse. In this article, the aim was to describe the different techniques of extracorporeal septorhinoplasty and fixation of the neoseptum. Three techniques are mainly used: "crisscross" suture, "U-shaped" suture and anterior septal reconstruction to fix the neoseptum after extracorporeal remodeling. All these techniques are technically demanding, especially concerning keystone area management; but, if well performed, could give satisfactory functional and aesthetic outcomes. We therefore think that extracorporeal septorhinoplasty should really improve our results concerning functional and aesthetic aspects in case of severe anterior or caudal septum deviation.

Temporomandibular Joint Ankylosis Following Mandibular Distraction Osteogenesis: A Dreadful Complication.

INTRODUCTION: Mandibular distraction osteogenesis (MDO) is an effective treatment for severe micrognathia, as it helps to avoid tracheostomy but has some adverse effects on the temporomandibular joint (TMJ). TMJ ankylosis is a serious condition leading to feeding difficulties and growth impairment, and could result in worse consequences in cases with micrognathia who already have limited growth potential. Here, we aimed to report on cases with TMJ ankylosis-a rare but devastating complication of MDO. In total, we described 3 syndromic cases with TMJ ankylosis that developed after MDO and reviewed the associated literature. MATERIAL AND METHODS: We retrospectively enrolled 3 patients who presented with TMJ ankylosis following MDO at the Oral and Maxillofacial Surgery Department of the University Hospital of Lille, France. RESULTS: All 3 patients had craniofacial syndrome with micrognathia. MDO was performed at least twice in each case, and the 3 patients developed subsequent TMJ ankylosis. They all presented with TMJ ankylosis and micrognathia in our Department. DISCUSSION: MDO leads to a certain amount of stress on the TMJ, and in cases with congenital TMJ deformation, such stress could lead to TMJ ankylosis. To our knowledge, 12 cases of TMJ ankylosis after MDO have been described in studies involving 309 patients while it is not reported in other publications. They were all syndromic patients. Thus, TMJ health should be carefully monitored during and after MDO to avoid TMJ ankylosis, and alternative treatments such as costochondral grafts should be considered.

Twenty-four years of experience in management of complex mandibular fractures with low cost, custom-made mandibular external fixation: A 65-patient series.

INTRODUCTION: Ginestet introduced the first external device used to fix the mandible in 1936. In 1949, Morris introduced a biphasic fixation device. This "Joe Hall Morris fixation" design led to use of a self-crafted external fixator based on pins connected by a breathing tube filled with dental resin. The objective of this study was to present our surgical results with this device through a 65-patient series. METHODS: This retrospective study included all the patients who benefited from the self-crafted mandibular external fixator at our Oral and Maxillofacial department from 1995 to 2019. Sixty-five patients were allocated into two groups. There were 39 patients in the temporary stabilisation (TS) group and 26 in the bone healing (BH) group. Functional criteria were investigated, including mouth opening limitations and occlusal abnormalities. Aesthetic evaluation focused on skin healing, evaluated by both surgeon and patient. RESULTS: Twenty-three patients exhibited spontaneous bone healing during their immobilisation period and two patients developed a pseudoarthrosis in the BH group. Most TS group patients benefited from secondary management by bone graft, bone free flap, or distraction osteogenesis. Few complications were noted with our technique during the study period. CONCLUSION: Our self-crafted external fixation with Joe Hall Morris fixation style is a valuable option for external stabilisation of the lower third of the face.

A modified method for a customized harvest of fibula free flap in maxillofacial reconstruction.

Mandibular reconstruction using computer-aided design/computer-aided manufacturing cutting guides is currently a common procedure. However, inaccurate positioning of the cutting guide onto the fibular bone may result in osteosynthesis difficulties or imprecision in the reconstruction. A novel way to improve the stability of the cutting guides may be to add pillars in order for them to be suspended from the fibula, avoiding soft tissues interactions. We present the case of a 39-year-old male who needed mandibular reconstruction after a self-inflicted ballistic injury. We designed a customized cutting guide which included a set of 8 pillars allowing a suspension of the cutting guide 8 millimeters above the bone level. The pillars were perpendicular to one another, and allowed the operator to screw the cutting guide to the bone. The orthogonal position of the pillars enabled real stability during the osteotomies. In the operator experience, the length of the pillars was too important, and led to incomplete osteotomies, and the whole device was too bulky. However, with adaptations in the size of the pillars and the size of the whole device, this solution could be useful in cutting guide design to avoid impairments due to the soft tissues surrounding the fibula.

Spasmodic torticollis after orthognathic surgery.

The treatment of malocclusions can involve orthognathic surgery. Although orthognathic surgery is a safe surgical procedure, low incidences of many complications have been reported such as infections, hemorrhage, nerve injuries, temporomandibular disorders (TMDs), and psychological problems. There are no reports in the literature of orthognathic surgery being associated with postural disorders although the link between dental occlusion and postural disorders is highlighted in numerous recent publications. This report describes the case of a young, healthy patient who presented with sustained spasmodic torticollis following orthognathic surgery. In addition, the physiopathological aspects of this atypical condition are discussed.

Influence of preoperative imaging on fibula free flap harvesting.

INTRODUCTION: The fibula free flap (FFF) is the gold standard for the reconstruction of large maxillofacial defects. Magnetic resonance angiography (MRA) seems to supersede digital subtraction angiography (DSA) as the reference in preoperative evaluation, being non-invasive and having equivalent diagnostic results. The aim of this study was to assess the impact of preoperative MRA versus DSA on the viability of FFF and its success rate. MATERIAL AND METHODS: A total of 216 patients, who underwent mandibular or maxillary FFF reconstruction from January 1995 to January 2011, were retrospectively included in the study. Of them, 101 patients underwent preoperative DSA and 115 underwent MRA. Recorded criteria were as follows: age, sex, tobacco consumption, defect etiology, preoperative vascular assessment, donor-site choice and flap failure. The DSA group was compared to the MRA group. RESULTS: The harvested side was switched in 15.7% of cases with preoperative MRA versus 4% with DSA. Our success rate was higher (96.1%) with MRA than with DSA (88.1%) (P<0.05). More atherosclerotic patients (P=0.004) were diagnosed through MRA. MRA and DSA showed similar results in anatomical variation detection. CONCLUSION: MRA is less invasive and more effective in atherosclerosis detection than DSA. Therefore, donor-site switching was more frequent in the MRA group, which led to a better success rate. MRA should replace DSA as the reference in preoperative assessment.

Le Fort 1 osteotomy and calvarial bone grafting for severely resorbed maxillae.

INTRODUCTION: Long standing maxillary edentulism leads to alveolar ridge resorption which prevent implant placement and causes prosthetic malocclusion. The aim of the study was to assess vertical and transversal bone increase following Le Fort 1 osteotomy associated with calvarial bone grafting. MATERIALS AND METHODS: 66 patients who presented severely atrophic maxillae were treated with Le Fort 1 osteotomy with bone grafting from 2003 to 2014. Vertical and transversal bone level was measured preoperatively and 6 months post-operatively to calculate the alveolar ridge augmentation. Follow up ranged from 10 months to 11 years. RESULTS: The mean increase of bone height was 9.3 mm and the mean increase of bone width was 6 mm 417 endosseous implants were placed in the grafted maxilla. Mean endosseous implant length was of 10.7 mm at the first molar site (range: 8-16 mm). A total of 25 implants failed, the overall implant survival rate is of 94%. The definitive prosthetis was fixed in 65% of the patients and removable in 35% of the patients. DISCUSSION: Le Fort 1 osteotomy associated with calvarial bone grafting is the main treatment option able to offer fixed bridge and perfect class 1 occlusion in cases of severe maxillary atrophy.

Experience-dependent changes in human brain activation during contingency learning.

Successful adaption requires learning to respond appropriately to cues associated with response-reinforcer contingencies. In this investigation, we used functional magnetic resonance imaging to characterize changes in frontal and limbic activation associated with learning under a positive reinforcement contingency. Imaging analyses identified linear and nonlinear changes in brain activation across nine reinforcement trials when response accuracy and reaction times were stable. The development of contingency control was generally associated with linear increases or inverted-U shaped changes in activation in superior, medial and orbitofrontal (OFC) regions, amygdala, insula and the medial temporal lobe. Linear decreases and U-shaped changes in activation were generally observed in parietal, occipital and cerebellar regions. Results highlighting linear increases in activation in superior, medial and OFC regions suggest involvement in the development of contingency control, even when behavior is stable. Results also highlighted a positive correlation between changes in OFC activation and amygdala activation. However, inspection of the correspondence between group changes and individual subject changes in OFC, amygdala and insula activation revealed that approximately half of subjects exhibited changes resembling group changes and the strength of the OFC-amygdala relationship varied markedly between subjects. Such disparities highlight a unique opportunity for exploring individual differences in regional sensitivity to contingency as well as improving experimental preparations to better highlight and control the effects of extraneous variables.

Experience-dependent plasticity: differential changes in activation associated with repeated reinforcement.

Experience-dependent change in blood-oxygen-level-dependent (BOLD) signal is increasingly being employed in neuroimaging research to examine questions about function and plasticity. In this investigation, plasticity was examined during consecutive visual cue presentations that preceded correct button presses and subsequent reinforcer deliveries. Using functional neuroimaging and a modified repeated acquisition methodology, 10 adult subjects learned, through trial and error, a series of novel cue-response-reinforcer relations. Separate BOLD responses were obtained to consecutive cues and reinforcers. Repeated measures analysis of variance highlighted differential BOLD response changes. Consecutive visual cue presentations elicited rapid bilateral increases in activation in the anterior cingulate and medial frontal gyrus and moderate increases in medial temporal lobe structures and the striatum. Consecutive reinforcer presentations elicited rapid increases in activation in the left precuneus, lingual and fusiform gyri and moderate increases in medial temporal lobe structures and striatum. Within the medial temporal lobe, cues elicited a gradual increase then an abrupt decrease in activation and rewards elicited abrupt and then sustained activation. Consideration of experience-dependent BOLD response change and variability provides basic research a new perspective from which to examine regional plasticity and further explore dynamic experience-dependent shifts among cognitive processes. Furthermore, BOLD change and variability offer many clinical research areas novel supplemental indices of neuropathology.

Relations between decision-making deficits and discriminating contingencies following brain injury.

Deficits in decision-making characterized by failures to respond adaptively to consequences that follow responding are common following brain injury. To examine decision-making about consequences, individuals with and without acquired brain injury responded under different response-reinforcer contingencies. In two control conditions, reinforcement was contingent on responding and response repetition. Results showed responding (pressing four computer keys) by both groups produced similar amounts of reinforcement (money) and highlight equal sensitivity to money as a reinforcer. In subsequent experimental conditions, reinforcement was contingent upon varying responses. Results showed both groups produced variable response patterns, but injured subjects earned less reinforcement than controls. With instructions to vary responding across trials, injured subjects earned similar amounts of reinforcement as controls. Collectively, the results suggest reductions in sensitivity to contingencies may be present following injury and function as one behavioural mechanism of maladaptive decision-making.

When instructions fail. The effects of stimulus control training on brain injury survivors' attending and reporting during hearing screenings.

Bedside hearing screenings are routinely conducted by speech and language pathologists for brain injury survivors during rehabilitation. Cognitive deficits resulting from brain injury, however, may interfere with obtaining estimates of auditory thresholds. Poor comprehension or attention deficits often compromise patient abilities to follow procedural instructions. This article describes the effects of jointly applying behavioral methods and psychophysical methods to improve two severely brain-injured survivors' attending and reporting on auditory test stimuli presentation. Treatment consisted of stimulus control training that involved differentially reinforcing responding in the presence and absence of an auditory test tone. Subsequent hearing screenings were conducted with novel auditory test tones and a common titration procedure. Results showed that prior stimulus control training improved attending and reporting such that hearing screenings were conducted and estimates of auditory thresholds were obtained.