Bony Canal Method of Dexamethasone Injections in Aggressive Form of Central Giant Cell Granuloma-Case Series.

Central Giant Cell Granuloma constitutes approximately 7% of benign tumors of the jaws. The aggressive form of CGCG clinically behaves like a classic semi-malignant neoplasm. In the literature, the suggested method of treatment of aggressive forms of CGCG is curettage or resection with the margin of 0.5 cm. Surgical treatment, especially in the developmental age, entails disturbances in the growth and differentiation of tissues and deforms and disturbs the functioning of the stomatognathic system. Alternative treatment methods of the CGCG presented in this article lead to the patient avoiding a mutilating procedure and improve their quality of life. The aim was to present alternative method of treatment of aggressive forms of Central Giant Cell Lesion of the jaws-injections of dexamethasone into the tumor mass through drilled bony canals. Here, we present the three cases of aggressive forms of CGCG of jaws treated with dexamethasone injections into the tumor mass. Two cases resulted in regression of the tumor, which was confirmed in histologic evaluation after remodeling surgery. Those two patients were uneventful and showed no signs of tumor recurrence at 8 and 9 years of thorough follow-up, respectively. The third patient was qualified for the mandible resection due to the enlargement of the lesion and destruction of the cortical bone. According to our observations, if the proper patient discipline, and thorough, careful clinical and radiological examinations are provided, the dexamethasone injections could be a recommended method of treatment of intraosseous giant cell granuloma. The indication is restricted to the cases with preserved bony borders despite deformation. Additionally, leaving vital teeth in the lesion is also possible.

Analysis of the Validity of Perioperative Antibiotic Prophylaxis in Maxillofacial Surgery.

Perioperative antibiotic prophylaxis is the standard in surgical departments. The type of operation, the duration of the procedure, the degree of microbiological purity of the operating field and the current clinical condition of the patient determine its administration. The aim of this study was to validate the antibiotic prophylaxis used in a Maxillofacial Surgery Department for a group of trauma and non-trauma patients. To that end, an observational prospective cohort study was carried out. The study was conducted on a group of 83 patients of the Department of Cranio-Maxillo-Facial Surgery who were divided into a group of trauma patients (n = 43) and one of non-trauma patients (n = 40). In both groups, the classic microbiological tests were carried out, and the results were analyzed in relation to: the study group, age, sex, duration of surgery, type of surgical access. Most bacterial strains were isolated at the initial stage of the operation. Gram (+) cocci were isolated more often in the trauma group and Gram (-) rods in the non-trauma group. Significantly more often, strains of fungi were noted in the initial stage of the procedure in the trauma group. We conclude that the use of perioperative antibiotic prophylaxis in the Maxillofacial Surgery Departments is justified.

The Role of Full-Thickness Skin Grafts in Patient's Rehabilitation after Maxillectomy and Midface Defects.

(1) Background: Nowadays, microvascular grafts are the gold standard in the reconstruction of midface defects after maxillectomy, however, not all patients may qualify for this type of surgery. The purpose of present study is to evaluate the benefits of alternative reconstruction methods such as full-thickness skin grafts for these conditions. (2) Methods: The research group consisted of 37 patients who underwent maxillectomy due to cancer of the mid-face and had full-thickness skin graft reconstruction. The study covered the period from 2011 to 2020. (3) Results: Based on the clinical examination and the subjective assessment of patients, a positive effect of the use of free skin grafts on their convalescence and rehabilitation was found. In particular, they contributed to the reduction in postoperative pain and pain associated with prosthetic stages (VAS Scale). (4) Conclusion: Full-thickness skin grafts in combination with individual prosthetic restorations are a good alternative to rehabilitation in patients who do not qualify for microsurgical treatment.

Operating room environment assessment and biofilm risk for breast implants. A case series.

AIM: Breast implant-associated anaplastic large cell lymphoma, is a rare cancer. Several theories are speculated that may constitute its etiological factors. None of them has been clearly proven. The case report we present is intended to indicate the leading cause of this disease entity. CASE PRESENTATION: Air samples taken in varying conditions at appropriate intervals by the MicroFlow Alfa 90 device in the operating room during five breast implant surgery were analyzed. Samples were taken four times during each operation. After the air was taken and delivered to the laboratory, the plates were immediately incubated under aerobic conditions. The incubation was carried out for up to 7 days. It has been shown that there is a significant difference between the total number of microorganisms during air intake carried out without and with the supply of air to purify the area in a given area by air recirculation of the operating block and cleaning it from bacteria and particles. No air colony-forming units were grown from air samples taken in the supply. However, from air samples taken without blowing, they were raised in various quantities. CONCLUSION: Laminar free airflow used in operating room conditions significantly reduces the risk of infection of the surgical site, and thus may reduce the risk of developing breast implant-associated anaplastic large cell lymphoma. KEY WORDS: BIA-ALCL ethiological factors, Biofilm, Breast implants, Laminar air flow, Surgical site infections.

Temporomandibular Joint Prostheses: Optimal Materials for the Optimal Stomatognathic System Performance-Preliminary Study.

The aim of this study was to quantitatively evaluate alloplastic Temporomandibular Joint (TMJ) Prostheses against other treatment modalities regarding the jaw kinematics. Six patients with Temporomandibular Joint Prostheses, four with mandibular ramus Patient-Specific Implant (PSI) with condylar head preservation, and four after mandibular condylectomy were evaluated by the means of axiography (Cadiax Compact 2), which is the noninvasive three-dimensional study of condylar movements. The patients were also evaluated clinically for the mandibular movements. The study revealed that the significant movement limitations occurred bilaterally in patients fitted with TMJ prosthesis. For the protrusion movement, the vector length of the movement (L) for the TMJ prosthesis was 0.31 vs. 3.01 mm for the PSI (Kruskal-Wallis chi-squared = 9.1667, df = 2, p-value = 0.01022, post hoc Dunn p-value = 0.015) and for the laterotrusion to the operated side, the length of the vector (L) was 0.66 vs. 3.35 mm, respectively. Statistically significant differences between groups were most frequent for the laterotrusion to the unoperated side. The study shows that a further development on TMJ Prostheses geometry and materials is needed.

Pancreatic-pleural fistula presenting as epigastric pain.

We are reporting a case of a pancreatic-pleural fistula causing epigastric pain. Chest radiograph revealed pleural effusion reaching the seventh rib. Thoracocentesis was performed and 1600 mL of brownish fluid was removed, which showed an elevated amylase level. Ultimately, the diagnosis was confirmed by computed tomography. Due to the failure of medical and endoscopic treatment, the decision was made to perform surgery. It resulted in total pancreatectomy.

The role of chitin and chitosan in peripheral nerve reconstruction.

Chitin is a natural polysaccharide commonly found in nature and chitosan is its partially deacetylated derivative. The properties of both biopolymers allow their wide use in medicine and various industries. This paper presents the possibilities offered by chitin and chitosan for the creation of neurotubes utilized in peripheral nerve repair procedures. In the initial part of this manuscript, experimental studies on both polysaccharides carried out by numerous authors have been presented and their results have been discussed. Further, basic information on Reaxon® Nerve Guide, being the first chitosan tube approved for clinical use, is provided. Finally, existing limitations in the optimal use of chitosan tubes in peripheral nerve reconstruction have been pointed out. It is expected that modification of the properties of chitosan itself as well as enriching neurotubes with components of extracellular matrix, cells, growth factors and filaments will further improve the results of nerve regeneration obtained with chitosan-based nerve conduits.

Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up.

BACKGROUND: Injury to the infraclavicular brachial plexus is an uncommon but serious complication of shoulder dislocation. This work aims to determine the effectiveness of operative treatment in patients with this type of injury. METHODS: Thirty-three patients (26 men and 7 women; mean age, 45 years and 3 months) treated operatively for brachial plexus injury resulting from shoulder dislocation between the years 2000 and 2013 were included in this retrospective case series. Motor function of affected limbs was assessed pre- and postoperatively with the use of the British Medical Research Council (BMRC) scale. Sensory function in the areas innervated by ulnar and median nerves was evaluated with the BMRC scale modified by Omer and Dellon and in the remaining areas with the Highet classification. Follow-up lasted 2-10 years (mean, 5.1 years). RESULTS: Good postoperative recovery of nerve function was observed in 100% of musculocutaneous, 93.3% of radial, 66.7% of median, 64% of axillary, and 50% of ulnar nerve injuries. No recovery was observed in 5.6% of median, 6.7% of radial, 10% of ulnar, and 20% of axillary nerve injuries. Injury to a single nerve was associated with worse treatment outcome than multiple nerve injury. CONCLUSIONS: Obtaining improvement in peripheral nerve function after injury resulting from shoulder dislocation may require operative intervention. The type of surgical procedure depends on intraoperative findings: sural nerve grafting in cases of neural elements' disruption, internal neurolysis when intraneural fibrosis is observed, and external neurolysis in the remaining cases. The outcomes of surgical treatment are good, and the risk of intra- and postoperative complications is low.

Disentangling functions of online aggression: The Cyber-Aggression Typology Questionnaire (CATQ).

Aggression in online contexts has received much attention over the last decade, yet there is a need for measures identifying the proximal psychological drivers of cyber-aggressive behavior. The purpose of this study was to present data on the newly developed Cyber-Aggression Typology Questionnaire (CATQ) designed to distinguish between four distinct types of cyber-aggression on dimensions of motivational valence and self-control. A sample 314 undergraduate students participated in the study. The results confirmed the predicted four-factor structure providing evidence for distinct and independent impulsive-aversive, controlled-aversive, impulsive-appetitive, and controlled-appetitive cyber-aggression types. Further analyses with the Berlin Cyberbullying Questionnaire, Reactive Proactive Aggression Questionnaire, and the Behavior Inhibition and Activation Systems Scale provide support for convergent and divergent validity. Understanding the motivations facilitating cyber-aggressive behavior could aid researchers in the development of new prevention and intervention strategies that focus on individual differences in maladaptive proximal drivers of aggression. Aggr. Behav. 43:74-84, 2017. © 2016 Wiley Periodicals, Inc.

Schwannoma of the medial cutaneous nerve of the arm: a rare location with concomitant compression neuropathy of the ulnar nerve.

The objective of this paper is to present a case of rare location of schwannoma in the medial cutaneous nerve of the arm at the level of the axilla. Preliminary diagnostic examination of the tumour was carried out in another hospital by means of open biopsy. In the preoperative period symptoms of ulnar nerve dysfunction (paraesthesias, positive Hoffmann-Tinel sign) dominated the clinical picture. After having performed imaging studies and electromyographic (EMG) examination, the patient was scheduled for an operation. The tumour, measuring 3.5 × 3.0 × 1.5 cm, was resected without damage to the fascicular structure. Presence of paraesthesias in the distribution of the medial cutaneous nerve of the arm, which was first noted in the postoperative period, persists in moderate severity until now. As a result of the performed operative treatment, such symptoms as palpable tumour mass, pain, paraesthesias in the ulnar nerve distribution and positive Hoffmann-Tinel sign resolved. On the basis of histopathological examination results the final diagnosis of classical schwannoma was established.

Benign nerve tumours of the hand (excluding wrist).

INTRODUCTION: Hand tumours of neural origin are rare in clinical practice. The aim of this work is to present our experience in operative treatment of benign nerve tumours located in the hand. Special emphasis has been put on determining the occurrence rates of particular tumour types characterized by their unique histopathological patterns and describing detailed location of the lesions. The obtained results of treatment were assessed. MATERIALS AND METHODS: The study comprised of 26 patients, both female (19) and male (7). The mean age and age range of the female and male patients were 44.8 years (range, 21-73 years) and 39.6 years (range, 21-74 years), respectively. The patients underwent operative treatment for tumours of neurogenic origin located in the hand between the years 1990 and 2013. In total, 31 tumours in 26 patients were removed. The most common site of tumour origin was small cutaneous branches and only exceptionally the tumours arose from common digital nerves (2 patients). No patient was lost to postoperative follow-up. The shortest period of postoperative follow-up covered 1 year. RESULTS: No tumour recurrence was detected during postoperative follow-up examinations. The patients reported neither pain nor presence of paraesthesias. Neurofibromas (17 tumours) predominated in the gathered clinical material, while the second most common group of tumours were schwannomas (12 tumours). CONCLUSIONS: (1) Benign nerve tumours of the hand are rare. Neurofibromas and schwannomas predominate among them. Tumours having other histopathological patterns are extremely uncommon. (2) The prognosis after resection of benign nerve tumours located in the hand is good and the risk of postoperative complications and recurrence is low.

Online Moral Disengagement, Cyberbullying, and Cyber-Aggression.

The study of moral disengagement has greatly informed research on aggression and bullying. There has been some debate on whether cyberbullies and other cyber-aggressors show more or less of a tendency for moral disengagement than traditional aggressors and bullies. However, according to the triadic model of reciprocal determinism, an individual's behavior influences and is influenced by both personal factors and his/her social environment. This article reviews the literature to propose a new conceptual framework addressing how features of the online context may enable specific mechanisms that facilitate moral disengagement. Specific affordances for moral disengagement proposed here include the paucity of social-emotional cues, the ease of disseminating communication via social networks, and the media attention on cyberbullying, which may elicit moral justification, euphemistic labeling, palliative comparison, diffusion and displacement of responsibility, minimizing and disregarding the consequences for others, dehumanization, and attribution of blame. These ideas suggest that by providing affordances for these mechanisms of moral disengagement, online settings may facilitate cyber-aggression and cyberbullying.