The Influence of Bolus of Methylprednisolone on Postorthognathic Surgery Symptoms: A Controlled Clinical Trial.

OBJECTIVE: Despite improvements in maxillary and mandibular osteotomy, complications still result in around 20%. Post and intraoperative standard therapies, based on the use of betamethasone and tranexamic acid, could help to minimize the onset of side effects. The aim of the study was to compare the role of a supplementary bolus of methylprednisolone rather than the standard therapy in the onset of postoperative symptoms. METHODS: The authors enrolled 10 patients, affected by class 2 and 3 Dentoskeletal, submitted to the institution for maxillomandibular repositioning osteotomy between October 2020 and April 2021. Patients were divided into 2 groups as follows: 5 patients (group A ) received standard therapy consisting of the administration of 4 mg of betamethasone, intraoperatively, and 1 g of tranexamic acid in 2 administrations. The remaining 5 patients (group B ) received a supplementary bolus of 20 mg methylprednisolone before the end of the surgery.All patients received, in the postoperative period, 4 mg of betamethasone every 12 hours, for 3 days. Postoperative outcomes were evaluated with a questionnaire evaluating speaking discomfort, pain when swallowing, feeding discomfort, drinking discomfort, swelling, and ache. Each parameter was associated with a numeric rating scale ranging from 0 to 5. RESULTS: The authors observed that patients treated with a supplementary bolus of methylprednisolone (group B ) had a statistically significant reduction of all postoperative symptoms as compared with patients of group A (* P < 0.05, ** P <0.01 Fig. 1 ). CONCLUSION: The study highlighted that the additional bolus of methylprednisolone improved all of the 6 parameters investigated by the questionnaire submitted to patients, resulting in a faster recovery and improvement of the patient's compliance with surgery. Further studies with a larger population are needed to confirm preliminary results.

Three-dimensional digital planning of class III decompensation with clear aligners: Hard and soft tissue augmentation with concomitant corticotomy to stretch the limits of safe orthodontic treatment.

PURPOSE: Three-dimensional diagnosis has shown that orthodontic therapy could potentially move the roots of the teeth outside the original bone structure. The purpose of these case studies was to test the possibility of obtaining correct three-dimensional tooth positioning with clear aligners, thereby modifying the periodontal structure accordingly, at the same time. METHODS: Regenerative Corticotomy (RC) was performed with clear aligners on ten adult patients (40 anterior teeth) with skeletal Class III malocclusion, for dental decompensation, prior to the orthognathic surgery. The CBCT examinations were performed before treatment (T0) and 1 year after orthognathic surgery (T1). The vertical and the horizontal hard tissue changes, the width of keratinized gingiva, the incisors proclination (IMPA) and the percentage of inclination compared to the planning were analyzed. RESULTS: The distance between the Cemento-Enamel Junction (CEJ) and the Bone Marginal Level (BML) decreased in average from 5.5 â€‹± â€‹3.2 â€‹mm to 1.39 â€‹± â€‹0.53 â€‹mm. The horizontal changes were at the 3 â€‹mm level 1.42 â€‹± â€‹0.5 â€‹mm, at the 5 â€‹mm level 1.98 â€‹± â€‹0.66 â€‹mm and at the 7 â€‹mm level 2.70 â€‹± â€‹0.87 â€‹mm. The width of Keratinized gingiva changes were on average 1.42 â€‹± â€‹0.36 â€‹at T0 and 4.16 â€‹± â€‹2.25 â€‹at T1. All the changes were statistically significant with p â€‹< â€‹0,05. The mean proclination based on IMPA values was +9.16 +-1.19°. The mean difference of the incisor's proclination compared to the digitally planned was -1 +-0.6° (89.87 +- 6.46%). CONCLUSION: Clear Aligners with three-dimensional digital planning seems to be reliable in controlling teeth movements in the pre-orthognathic decompensation phase. Regenerative Corticotomy seems to have the ability to improve the periodontal tissues despite proclination.

Surgery First and Invisalign System: Combined Digital Approach.

PURPOSE: The aim of the present paper is to verify the long-term results in dental and skeletal stability in terms of symmetry, occlusion and functional balance by the association between the IS and the SF technique. METHODS: In this paper, the authors described 12 cases of severe class III malocclusion treated by the association between the IS and the SF technique. RESULTS: At 1 year of post-orthodontic follow up, the patients present an Angle class I occlusal relationship, no deep bite, no scissor or cross-bite and no open bite. No one patient referred TMJ discomfort nor severe post-surgical complications and no surgical-orthodontic relapse occurred. The surgical and occlusal results are stable in terms of stability in all patients. CONCLUSION: The results of this study suggest the validity of our protocol in management of class III malocclusion patients.

Morphological Eyelids Changing After Orthognathic Surgery in Long-Face Syndrome.

PURPOSE: The aim of the authors study is to demonstrate the soft tissues changes in the eyelid-brow area (ELBA) in patients with long-face syndrome after LeFort I osteotomy and impaction movements. MATERIALS AND METHODS: To perform this study the authors have analyzed retrospectively orthognathic patients with at least 1 years of completely follow-up. The inclusion criteria were: long-face syndrome according to Farkas' studies and vertical maxillary shortening movement without considering whether movements have been made in the other 2 planes of space (sagittal and horizontal).Orthognathic patients in which the maxillary impaction movement did not correlate to the long-face syndrome represented the control group. In this group too the authors did not consider if other movements were performed.Size and shape of the eyelid and the eyebrow was assessed on the frontal patients photos calibrated on the three-dimensional soft tissue volume imported from cone beam computed tomography.Two reference lines were taken: a horizontal line from the nasal point passing through both medial canthal angles and a perpendicular line through the pupil centre bilaterally. Then the measures were taken.The same operator (A.C.) took all of the measurements.In both groups, the preoperative measures were then compared with the postoperative ones. Then the soft tissue changes in both groups were compared. RESULTS: The results demonstrate different reaction of the ELBA after orthognathic surgery. The ELBA's position changes in long-face patients in a higher position after maxillary impaction. The authors did not obtain the same results in patients who do not have long-face syndrome. CONCLUSIONS: Repositioning skeletal bases in patients with long face causes a change in the ELBA's morphology.

Temporomandibular Disorders Clinical and Anatomical Outcomes After Fat-Derived Stem Cells Injection.

Temporomandibular disorders (TMD) are common disorders that usually involve temporomandibular joint (TMJ), masticatory muscles, and other relevant structures. The symptoms may vary limiting the patients' quality of life. Many treatment options were proposed during the last years with the aim to treat the pathology. In this article, we analyze the effect of the injection of the fat-derived stem cell in the joint as a new treatment option.

Mucosal Dehiscence After Alveolar Bone Graft in Cleft.

Cleft lip and palate patient represent a challenging experience for the surgeon. This kind of patients had to be followed by a multidisciplinary team from the beginning to the end to avoid the deformation sequelae. During the several surgical procedures, the bone graft represents a possible procedure that, through the new procedure, could be avoided. Unfortunately, patient treated following the previous procedure must be submitted to alveolar bone graft to coordinate the arch, to restore the maxillary integrity, to allow the correct dentition.

Nasal Valve Collapse: Our Treatment Protocol.

The nasal valve area is the functional area that allows airflow regulation. It could be divided in an internal area and an external one, basing on the anatomical landmarks. Many conditions can damage these areas with a consequently nasal obstruction, more often in particular extended rhinoplasty and sequels of facial trauma. To restore this area many techniques were advocated during the last decades.In this article the authors investigate on valve areas deficiency in sequel of rhinoplasty proposing a structural approach through alar batten grafts to correct internal-external nasal valves collapse.

Nasal Dorsum Reconstruction With Alloplastic Material.

The secondary nasal surgery represents a challenging surgical procedure. The difficulties in fact are several: the surgeon must make an effort to achieve the functional and aesthetic consequences of the previous surgical procedure, has to correct the aesthetic and functional imperfections, and has to work on a fibrotic and altered framework.The goal of the secondary nasal surgery is then to restore the normal nasal proportions correcting any functional inability unresolved by the previous surgery or determined by it.The aim of our study is to present our experience in dorsum reconstruction using Medpor. It became necessary as a result of previous surgery procedures responsible for an important sagittal projection deficiency.In the past the autologous grafts were used to restore the correct anatomical relationships.With the improvement in the surgical procedure, the alloplastic implants become of a wider use. Among these, Medpor represents the first choice because of its own intrinsic characteristics.Between 2004 and 2014, 18 patients underwent nasal dorsum reconstruction procedure using Medpor. Medpor was used to reconstruct the nasal dorsum and to augment the columella, supporting the nasal tip.The 18 patients treated by Medpor reported an aesthetic and functional improvement.Medpor represents a safe method in the secondary rhinoplasty to restore the nose anatomy and functionality and to achieve good aesthetic results.

Development and validation of the quality-of-life adolescent cleft questionnaire in patients with cleft lip and palate.

Only a few reports in the literature have described the use of specific instruments for assessing the quality of life in adolescents and young adults with cleft lip and palate (CLP). This condition markedly affects their lifestyle, even after surgical treatment. In the present study, we aimed to develop a quality-of-life assessment tool specifically designed for such patients with CLP. Our multidisciplinary team created a questionnaire focused on the physical, psychological, and social satisfaction of adolescents and young adults with CLP, which was adapted from 3 dimensions of the 36-item Short-Form Health Survey. The questionnaire was administered to a randomized sample of 40 adolescents and young adults (aged 16-24 years) with CLP who had completed treatment protocols and 40 (aged 16-24 years) who were not affected by CLP. The statistical results stated that the questionnaire had good reliability and validity; the Cronbach α coefficient was found to be 0.944. Moreover, factorial analysis confirmed the presence of 3 subscales that were the fundamental components of this questionnaire, which is consistent with the areas theoretically proposed and from which the items were designed and selected. Thus, we validated our novel questionnaire that was administered in the present study and proved its consistency. However, further investigations on a larger population would be useful to confirm these findings.

Simultaneous options for cleft secondary deformities.

INTRODUCTION: So much has been written by so many about secondary procedures in cleft surgery that testify not only the complexity and variable expression of cleft deformity itself but also the need to find methods of primary surgery that will reduce, if not avoid, adverse effects on all the structures and functions involved and affected. It must be the principal aim of cleft surgeon to restore the deformed and displaced regional anatomy to as close to normality as possible, whether or not true hypoplasia exists. The pathogenesis of secondary deformities is related to specific features as: the presence of scar tissues into the cleft basal bone area, that inhibits alveolar growth; scarring of palatal soft tissue, that inhibits growth and causes palatal orientation of dentoalveolar elements; and the exceeding lip tension, that may inhibits maxillary growth along dentoalveolar structures. MATERIALS AND METHODS: From 2008 to 2011 at the Department of Cranio-Maxillo-Facial Surgery, Santo Spirito Hospital, Rome 25 patients (21 males and 4 females) who had undergone previous surgery for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) were enrolled in our study. Diagnosis of deformity was made by means of a cephalometric and photographic analysis (Arnett), gipsometry and a radiological assessment (orthopantomography, lateral and frontal cephalometric X-rays). Moreover, every patient was studied with a temporomandibular joint (TMJ) tomography, TMJ magnetic resonance imaging (MRI) and a computerized gnatography to better evaluate potential TMJ dysfunctions. The surgical procedures adopted simultaneously were: Total or segmental maxillomandibular osteotomies, genioplasty, rhinoplasty, labioplasty, and application of facial prosthesis. Every patient received a postoperative questionnaire to evaluate his/her satisfaction with the surgery performed. RESULTS: The surgical procedures adopted were Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) in 16 patients (65%) and only Le Fort I osteotomy in 9 patients (35%). A relapse of malformation occurred in 4.5% of cases. Concerning the patient questionnaire, 96% of patients were satisfied with the jaw surgery and favorable for combined surgery, 88% were satisfied with lip-nose surgery, and finally 76% would advise to a friend. CONCLUSIONS: Simultaneous correction of the deformities is indicated as to avoid several surgical distresses for the patient, to improve facial aesthetic and function in one surgical step, and to reduce risk of psychological consequences.

A rare case of ectopic laterocervical thymoma.

The ectopic cervical thymoma is a rare site for a thymus neoplasm. It is frequently confused with cyst or with later neck mass of uncertain diagnosis until a histological diagnosis is made. Thymic neoplasms normally arise in the mediastinum, causing signs and symptoms of compression of the adjacent structures. Although rare, malignant thymomas may develop from an ectopic thymus, situated in the thyroid gland (Miyauchi et al., 1985; Matsuura et al., 2004), the neck (Yan et al., 2010; Yao et al., 2010; Jung et al., 1999), the lungs (Myers et al., 2007), and the heart (Miller et al., 2005). It is thought to be caused by the persistence of embryological organ portions along its route of physiological descent from the neck into the mediastinum during embryological development. The incidence of ectopic thymoma is around 4%. The thymus is a lympho-epithelial organ that is the centre of the development and maturation of the T lymphocytes. It develops from the ventral portion of the third and fourth pharyngeal pouches and by the sixth week of gestation it descends into the anterior mediastinum. It has a lobular structure with an external or cortical portion, richly populated by immature T cells, thymocyte and an internal medullary part.

Bone autografting of the calvaria and craniofacial skeleton: historical background, surgical results in a series of 15 patients, and review of the literature.

BACKGROUND: Although the use of autologous bone for reconstruction of the cranial and facial skeleton underwent a partial reappraisal following the introduction of a vast range of alloplastic materials for this purpose, it has demonstrated definite advantages over the last century and, particularly, during the last decade. METHODS: Fifteen patients underwent cranial and/or cranio-facial reconstruction using autologous bone grafting in the Department of Neurologic Sciences-Neurosurgery and the Division of Maxillo-Facial Surgery of the Rome "La Sapienza" University between 1987 and 1995. This group of patients consisted of 8 females and 7 males whose average age was 29.5 years (range 7.5 to 59 years, mean age 30). In all these patients cranioplasty and/or cranio-facial reconstruction had been performed to repair bone defects secondary to benign tumors or tumor-like lesions (12 cases), trauma (2 cases), or, in the remaining case, to wound infection after craniotomy for a neurosurgical operation. RESULTS: The results obtained in a series of 15 patients treated using this method are described with reference to the abundant data published on this topic. CONCLUSION: The mechanical, immunologic, and technical-grafting properties of autologous bone, together with its superior esthetic and psychological effects, probably make it the best material for cranioplasty.

Six novel missense mutations in the LDL receptor-related protein 5 (LRP5) gene in different conditions with an increased bone density.

Bone is a dynamic tissue that is subject to the balanced processes of bone formation and bone resorption. Imbalance can give rise to skeletal pathologies with increased bone density. In recent years, several genes underlying such sclerosing bone disorders have been identified. The LDL receptor-related protein 5 (LRP5) gene has been shown to be involved in both osteoporosis-pseudoglioma syndrome and the high-bone-mass phenotype and turned out to be an important regulator of peak bone mass in vertebrates. We performed mutation analysis of the LRP5 gene in 10 families or isolated patients with different conditions with an increased bone density, including endosteal hyperostosis, Van Buchem disease, autosomal dominant osteosclerosis, and osteopetrosis type I. Direct sequencing of the LRP5 gene revealed 19 sequence variants. Thirteen of these were confirmed as polymorphisms, but six novel missense mutations (D111Y, G171R, A214T, A214V, A242T, and T253I) are most likely disease causing. Like the previously reported mutation (G171V) that causes the high-bone-mass phenotype, all mutations are located in the aminoterminal part of the gene, before the first epidermal growth factor-like domain. These results indicate that, despite the different diagnoses that can be made, conditions with an increased bone density affecting mainly the cortices of the long bones and the skull are often caused by mutations in the LRP5 gene. Functional analysis of the effects of the various mutations will be of interest, to evaluate whether all the mutations give rise to the same pathogenic mechanism.