Interventions to Prevent Obesity in Mexican Children and Adolescents: Systematic Review.

The prevalence of overweight and obesity has been rising among Mexican children and adolescents in the last decades. To systematically review obesity prevention interventions delivered to Mexican children and adolescents. Thirteen databases and one search engine were searched for evidence from 1995 to 2021. Searches were done in English and Spanish to capture relevant information. Studies with experimental designs, delivered in any setting (e.g., schools or clinics) or digital domains (e.g., social media campaigns) targeting Mexican children or adolescents (≤ 18 years) and reporting weight outcomes, were included in this review. In addition, the risk of bias was appraised with the Effective Public Health Practice Project Quality Assessment Tool. Twenty-nine studies with 19,136 participants (3-17 years old) were included. The prevalence of overweight and obesity at baseline ranged from 21 to 69%. Most of the studies (89.6%) were delivered in school settings. The duration ranged from 2 days to 3 school years, and the number of sessions also varied from 2 to 200 sessions at different intensities. Overall, anthropometric changes varied across studies. Thus, the efficacy of the included studies is heterogeneous and inconclusive among studies. Current evidence is heterogeneous and inconclusive about the efficacy of interventions to prevent obesity in Mexican children and adolescents. Interventions should not be limited to educational activities and should include different components, such as multi-settings delivery, family inclusion, and longer-term implementations. Mixed-method evaluations (including robust quantitative and qualitative approaches) could provide a deeper understanding of the effectiveness and best practices.

Straightforward Method for Coverage of Major Vessels After Modified Radical Neck Dissection.

A new method for covering the internal jugular vein and carotid artery after exposure of the cervical vascular axis subsequent to neck dissection is presented. To cover the most caudal part of the vascular axis, a platysma coli muscle flap is harvested from its most medial and inferior part of the neck in a caudally based fashion and is slightly rotated posteriorly up to 45°. In addition, a superiorly based sternocleidomastoid muscle flap involving the posterior half of the muscle after detachment of the clavicle head is harvested and rotated 45° anteriorly to cover the upper two thirds of the vascular axis. This technique seems to be a good alternative to the pectoralis major myocutaneous flap for covering cervical major vessels, if no classical radical neck dissection is performed, especially in those oncologic malnourished patients who will undergo adjuvant radiotherapy after surgical treatment.

Closure of the Radial Forearm Free Flap Donor Site Using the Combined Local Triangular Full-Thickness Skin Graft.

PURPOSE: Traditional donor-site closure has been associated with serious esthetic and functional morbidity. The purpose of this study was to assess morbidity in esthetics and function and measure the postoperative complications of the radial forearm free flap (RFFF) donor site after using combined local triangular full-thickness skin grafting. MATERIALS AND METHODS: This prospective study of patients who underwent reconstruction of head and neck defects using an RFFF was conducted from July 2008 through December 2014. The donor site was repaired with a combined local triangular full-thickness skin graft. Quality of the scar, color match, tendon exposure, presence of necrosis, dehiscence of the suture, and presence of dysesthesia were recorded and analyzed using SPSS 21.0 software. RESULTS: One hundred consecutive patients (71 male and 29 female) underwent RFFF harvesting. RFFF donor-site defects ranged from 15 to 70 cm2; partial skin graft loss occurred in 7% of patients. Five patients (5%) had small dehiscences of the forearm skin graft, and 2 cases (2%) presented tendon exposure. In all cases, these sites healed secondarily by conservative management, with no final impairment of function. Esthetic results were considered excellent in 87%, good in 11%, and suboptimal in 2% of the cases. CONCLUSIONS: The combined local triangular full-thickness skin graft is a reliable method for closing RFFF donor-site defects because it obviates a second surgical site, it provides excellent color match and pliability, and it can be used for covering large defects of the donor site.

Enhancing systematic reviews: An in-depth analysis on the impact of active learning parameter combinations for biomedical abstract screening.

Systematic Review (SR) are foundational to influencing policies and decision-making in healthcare and beyond. SRs thoroughly synthesise primary research on a specific topic while maintaining reproducibility and transparency. However, the rigorous nature of SRs introduces two main challenges: significant time involved and the continuously growing literature, resulting in potential data omission, making most SRs become outmoded even before they are published. As a solution, AI techniques have been leveraged to simplify the SR process, especially the abstract screening phase. Active learning (AL) has emerged as a preferred method among these AI techniques, allowing interactive learning through human input. Several AL software have been proposed for abstract screening. Despite its prowess, how the various parameters involved in AL influence the software's efficacy is still unclear. This research seeks to demystify this by exploring how different AL strategies, such as initial training set, query strategies etc. impact SR automation. Experimental evaluations were conducted on five complex medical SR datasets, and the GLM model was used to interpret the findings statistically. Some AL variables, such as the feature extractor, initial training size, and classifiers, showed notable observations and practical conclusions were drawn within the context of SR and beyond where AL is deployed.

Robust cardiac segmentation corrected with heuristics.

Cardiovascular diseases related to the right side of the heart, such as Pulmonary Hypertension, are some of the leading causes of death among the Mexican (and worldwide) population. To avoid invasive techniques such as catheterizing the heart, improving the segmenting performance of medical echocardiographic systems can be an option to early detect diseases related to the right-side of the heart. While current medical imaging systems perform well segmenting automatically the left side of the heart, they typically struggle segmenting the right-side cavities. This paper presents a robust cardiac segmentation algorithm based on the popular U-NET architecture capable of accurately segmenting the four cavities with a reduced training dataset. Moreover, we propose two additional steps to improve the quality of the results in our machine learning model, 1) a segmentation algorithm capable of accurately detecting cone shapes (as it has been trained and refined with multiple data sources) and 2) a post-processing step which refines the shape and contours of the segmentation based on heuristics provided by the clinicians. Our results demonstrate that the proposed techniques achieve segmentation accuracy comparable to state-of-the-art methods in datasets commonly used for this practice, as well as in datasets compiled by our medical team. Furthermore, we tested the validity of the post-processing correction step within the same sequence of images and demonstrated its consistency with manual segmentations performed by clinicians.

Obesity and its association with mental health among Mexican children and adolescents: systematic review.

CONTEXT: Obesity and mental health issues increasingly affect children and adolescents, but whether obesity is a risk factor for mental health issues is unclear. OBJECTIVE: To systematically review the association between obesity and mental health issues (ie, anxiety and/or depression) among Mexican children and adolescents. DATA SOURCING, EXTRACTION, AND SYNTHESIS: A literature search of 13 databases and 1 search engine was conducted. Population, exposure, comparison, outcomes, and study design data were extracted, analyzed, and narratively synthesized. The JBI critical appraisal tool was used to evaluate evidence quality. RESULTS: A total of 16 studies with 12 103 participants between 8 and 18 years old were included. Four studies focused on anxiety outcomes, 10 on depression, and 2 on both (ie, anxiety and depression). Evidence is unclear about the association of obesity with anxiety. However, most evidence shows that Mexican children and adolescents with overweight or obesity are more likely to have depression or report a higher number of depressive symptoms than normal-weight participants. Such likelihood is greater for females. CONCLUSION: Health promotion interventions to treat or prevent obesity could also consider mental health outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42019154132.

Implementation of NAO Robot Maze Navigation Based on Computer Vision and Collaborative Learning.

Maze navigation using one or more robots has become a recurring challenge in scientific literature and real life practice, with fleets having to find faster and better ways to navigate environments such as a travel hub, airports, or for evacuation of disaster zones. Many methodologies have been explored to solve this issue, including the implementation of a variety of sensors and other signal receiving systems. Most interestingly, camera-based techniques have become more popular in this kind of scenarios, given their robustness and scalability. In this paper, we implement an end-to-end strategy to address this scenario, allowing a robot to solve a maze in an autonomous way, by using computer vision and path planning. In addition, this robot shares the generated knowledge to another by means of communication protocols, having to adapt its mechanical characteristics to be capable of solving the same challenge. The paper presents experimental validation of the four components of this solution, namely camera calibration, maze mapping, path planning and robot communication. Finally, we showcase some initial experimentation in a pair of robots with different mechanical characteristics. Further implementations of this work include communicating the robots for other tasks, such as teaching assistance, remote classes, and other innovations in higher education.

Cultural factors related to childhood and adolescent obesity in Mexico: A systematic review of qualitative studies.

Culture and culturally specific beliefs or practices may influence perceptions and decisions, potentially contributing to childhood obesity. The objective of this study is to identify the cultural factors (expressed through decisions, behaviors, individual experiences, perceptions, attitudes, or views) related to childhood and adolescent obesity in Mexico. Ten databases and one search engine were searched from 1995 onwards for qualitative studies. The Sunrise Enabler Model, described within the Cultural Care Theory, guided this review. Sample, the phenomenon of interest, study design, and evaluation data were extracted, and the Critical Appraisals Skills Programme tool was used to assess the quality of the included studies. Twenty-four studies were included. Of these, 12 studies included children or adolescents, 12 included parents, eight included schoolteachers, four included school staff (other than teachers), four included food vendors, and one included policymakers. Cultural values, beliefs, lifeways (especially food and food costumes), kinship, and social factors (particularly immediate and extended family) strongly influenced childhood and adolescent obesity-related lifestyles in Mexico. Most cultural factors related to childhood obesity in Mexico identified in this review may be modifiable and amenable to practical interventions.

Obesity and oral health in Mexican children and adolescents: systematic review and meta-analysis.

CONTEXT: A relationship between obesity and poor oral health has been reported. OBJECTIVE: To investigate the association between overweight/obesity and oral health in Mexican children and adolescents. DATA SOURCES: A literature search was conducted of 13 databases and 1 search engine for articles published from 1995 onward. DATA ANALYSIS: A total of 18 publications were included. Evidence was inconclusive and varied according to sociodemographic factors or outcome measuring tools. The Decayed, Missing, and Filled Teeth and Filled Teeth Surfaces indices and the decayed extracted filled teeth index outcomes were included in a random effects model meta-analysis. Pooled estimates showed no statistically significant oral health differences (measured via the decayed extracted filled teeth or the Decayed, Missing, and Filled Teeth Surfaces indexes) among body mass index (BMI) categories. However, pooled estimates of 6 studies showed that children with higher BMI had worse oral health in permanent teeth (measured via the Decayed Missing Filled Teeth Index) than children with lower BMI (overall mean difference, -0.42; 95%CI, -0.74, -0.11). CONCLUSION: Whether there is an association between poor oral health and high BMI is inconclusive; however, both co-exist among Mexican children. Therefore, health promotion and prevention efforts should address common risk factors and broader risk social determinants shared between noncommunicable diseases.

Interventions to Treat Obesity in Mexican Children and Adolescents: Systematic Review and Meta-Analysis.

CONTEXT: Prevalence of overweight and obesity has been rising in the past 3 decades among Mexican children and adolescents. OBJECTIVE: To systematically review experimental studies evaluating interventions to treat obesity in Mexican children and adolescents (≤18 years old). DATA SOURCES: For this study, 13 databases and 1 search engine were searched. DATA ANALYSIS: A total of 29 studies met the inclusion criteria. Overall, 2302 participants (age range, 8-16 years) from 11 states in Mexico were included. Most of the studies (n = 17 of 29) were provided in a clinical setting. A random-effect meta-analysis of 4 randomized controlled trials was conducted and a significant effect was found on body mass index reduction that favored the intervention group (-1.52; 95%CI, -2.15 to -0.89) for short-term (≤6 mo) interventions. CONCLUSIONS: A multicomponent, multidisciplinary, and individualized intervention that includes dietary modifications, physical activity practice, behavioral strategies, and active parental involvement might help treat childhood obesity in Mexico. However, long-term results need to be produced to identify effectiveness pointers that might help establish an integrated, long-lasting care model to treat obesity.

Using artificial intelligence methods for systematic review in health sciences: A systematic review.

The exponential increase in published articles makes a thorough and expedient review of literature increasingly challenging. This review delineated automated tools and platforms that employ artificial intelligence (AI) approaches and evaluated the reported benefits and challenges in using such methods. A search was conducted in 4 databases (Medline, Embase, CDSR, and Epistemonikos) up to April 2021 for systematic reviews and other related reviews implementing AI methods. To be included, the review must use any form of AI method, including machine learning, deep learning, neural network, or any other applications used to enable the full or semi-autonomous performance of one or more stages in the development of evidence synthesis. Twelve reviews were included, using nine different tools to implement 15 different AI methods. Eleven methods were used in the screening stages of the review (73%). The rest were divided: two in data extraction (13%) and two in risk of bias assessment (13%). The ambiguous benefits of the data extractions, combined with the reported advantages from 10 reviews, indicating that AI platforms have taken hold with varying success in evidence synthesis. However, the results are qualified by the reliance on the self-reporting of the review authors. Extensive human validation still appears required at this stage in implementing AI methods, though further evaluation is required to define the overall contribution of such platforms in enhancing efficiency and quality in evidence synthesis.

Costochondral graft with green-stick fracture used in reconstruction of the mandibular condyle: experience in 13 clinical cases.

Since its publication in 1920 by Gillies, costochondral grafts have been used by surgeons to replace and injured mandibular condyle and to reconstruct the temporomandibular joint. This procedure is currently applied in cases of congenital dysplasia, developmental defects, temporomandibular ankylosis, neoplastic disease, osteoarthritis and post-traumatic dysfunction. Over the years, various procedures for the reconstruction with this type of graft have been described. In 1989, Mosby and Hiatt described a technique for setting the graft securely, reducing the space between the graft and the mandibular area. In 1998, Monje and Martín-Granizo developed a variation of this method, enabling a precise adaptation of the costochondral graft to the remaining mandibular ramus. The aim of this study is to evaluate the functional and anatomic results of the costochondral graft treatment by green-stick fracture for reconstruction of the TMJ in the 10 years following the description of this technique. We carry out a retrospective study of thirteen cases of temporomandibular pathology (tumors, ankylosis and hypoplasia) treated during a period of ten years from 1998 to 2008. In all these cases, the technique described by Monje and Martín-Granizo was used: removal of the sixth rib, fixation to a titanium mini-plate using screws, making an internal corticotomy in order to obtain a green-stick fracture of the outer cortex, providing adequate adaptation of the graft to the mandibular ramus. The graft was then set in place, attaching it with titanium screws. This technique was successful in achieving optimal ossification, a good interincisal opening and satisfactory cosmetic results. In conclusion, according to our experience, the green-stick fracture for the adaptation of costochondral grafts to the remaining mandibular ramus has presented outstanding results in the surgical treatment of temporomandibular pathology.

Metastasis of renal clear-cell carcinoma to the oral mucosa, an atypical location.

The majority of cases of metastatic tumors involve the mandible and some the maxilla but they are considerably less common in intraoral soft tissues. In addition, the primary tumor is known in the majority of cases; although in one-third of such cases, metastasis is the first clinical manifestation. The most common primary tumors metastasizing to the mouth are lung carcinoma in men and breast carcinoma in women. An oral metastasis implies a serious prognosis, as in the majority of patients there is multiple organ involvement at the time of diagnosis. We present the case of a 52-year old patient with renal pathology who came to the emergency room due to a rapidly increasing gingival tumor. With the provisional clinical diagnosis of a pyogenic granuloma,the tumor was excised. Subsequent anatomopathological analysis revealed a tumor metastasis compatible with clear-cell carcinoma, and its renal origin was confirmed by means of immunohistochemical techniques.

Arthroscopy of the Inferior Compartment of the Temporomandibular Joint: A New Perspective.

OBJECTIVE: Arthroscopy of the temporomandibular joint (TMJ) has become a well-standardized non-invasive procedure for the treatment of TMJ internal derangement (ID). Since the last 1980s, no clinical application for arthroscopy of the inferior compartment has been established because of the intrinsic difficulty of the technique and the believing of the absence of clinical relevance for treatment of ID. METHODS: We report on a particular case in which arthroscopy of the inferior joint compartment together with the examination of the upper joint space was performed in a patient with ID of the TMJ. A 1.9 mm scope was used, while the technique for entering the inferior compartment is presented. RESULTS: The presence of intense synovitis, fibrous adhesion, and pseudowall were observed in the inferior joint compartment, thus leading to the hypothesis of the more than likely influence of the status of the synovial lining within this space in the persistence of symptoms in recalcitrant patients with ID. CONCLUSION: We believe that this new insight could lead surgeons to a more complete use of this non-invasive procedure for the treatment of this entity. LEVEL OF EVIDENCE: 4/5.

Endoscopically-Assisted Zygomatic Implant Placement: A Novel Approach.

BACKGROUND: Zygomatic implants (ZIs) have been proposed as a valid alternative to advance bone-grafting procedures in the rehabilitation of the severe atrophied upper maxilla, with a reported overall success rate of more than 95 %. Otherwise, the use of the endoscope has been described for the treatment of maxillofacial trauma, orthognatic surgical procedures, sinonasal pathology, salivary gland disease, and TMJ internal derangement. A careful identification of anatomical landmarks is of utmost importance while trying to avoid potential complications during the insertion of ZIs. Several approaches for ZI insertion have been reported, such as the classical approach; the sinus slot technique; and the exteriorized approach. MATERIALS AND METHODS: The authors first introduce in the literature the endoscopically-assisted approach for the insertion of ZIs in the extremely severe atrophic maxilla. RESULTS: Optimal results in terms of ZIs positioning with no damage to surrounding structures were obtained. CONCLUSIONS: By means of this new technique the surgeon may minimize the risk of complications related to the damage of neighbouring anatomic structures, such as orbital disruption or infraorbitary nerve damage, while ensuring an adequate drill positioning and angulation for the placement of one or two implants into the zygomatic bone.

Effectiveness of social marketing strategies to reduce youth obesity in European school-based interventions: a systematic review and meta-analysis.

CONTEXT: The use of social marketing to modify lifestyle choices could be helpful in reducing youth obesity. Some or all of the 8 domains of the National Social Marketing Centre's social marketing benchmark criteria (SMBC) are often used but not always defined in intervention studies. OBJECTIVE: The aim of this review is to assess the effectiveness of European school-based interventions to prevent obesity relative to the inclusion of SMBC domains in the intervention. DATA SOURCES: The PubMed, Cochrane, and ERIC databases were used. STUDY SELECTION: Nonrandomized and randomized controlled trials conducted from 1990 to April 2014 in participants aged 5 to 17 years were included. DATA EXTRACTION: After the study selection, the 8 domains of the SMBC were assessed in each included study. RESULTS: Thirty-eight publications were included in the systematic review. For the meta-analysis, randomized controlled trials (RCTs) reporting body mass index or prevalence of overweight and obesity were considered. Eighteen RCTs with a total of 8681 participants included at least 5 SMBC. The meta-analysis showed a small standardized mean difference in body mass index of -0.25 (95%CI, -0.45 to -0.04) and a prevalence of overweight and obesity odds ratio of 0.72 (95%CI, 0.5-0.97). CONCLUSION: Current evidence indicates that the inclusion of at least 5 SMBC domains in school-based interventions could benefit efforts to prevent obesity in young people. PROSPERO registration number: CRD42014007297.

A Modified Single-Step Method to Repair a Central Defect of the Upper Lip.

INTRODUCTION: Defects in the central region of the upper lip are difficult to repair. DISCUSSION: Several techniques have been described, many of them requiring a second surgical procedure to obtain acceptable aesthetic results. CASE REPORT: A patient with a soft defect in the central region of the upper lip following aggression by human bite is presented. To repair the defect, the principles described by Goldstein for lateral lip defects were used (Goldstein in Plast Reconstr Surg 85(3):446-452, 1990; Robotti et al. in J Plast Reconstr Aesthet Surg 63:431-439, 2010). CONCLUSION: In this particular case, two full-thickness advancing miomucosal flaps from the vermilion of the upper lip were used with predictable aesthetic results.

Vagus Nerve Paraganglioma: Radiological Features We Should Be Aware of.

INTRODUCTION: A rare case of vagal paraganglioma is reported. MATERIAL AND METHODS: The specific radiological features of this tumor are presented to the clinician in order to make presumptive diagnosis. CONCLUSION: By CT-scan and/or MRI it must be suspected when a hypervascular tumor in relation to the major cervical vessels displaces the internal and external carotid arteries forward, does not open the carotid bifurcation, and displaces the internal jugular vein backwards.

¿Es el desplazamiento discal sinónimo de patología articular temporomandibular? Correlación clínico-radiológica y prevalencia de trastornos internos en sujetos voluntarios asintomáticos / Is disc displacement synonymous with temporomandibular joint pathology? Clinical-radiological correlation and prevalence of internal disorders in asymptomatic volunteers subjects

INTRODUCCIÓN: Los trastornos internos (TI) de la articulación temporomandibular (ATM) constituyen la condición clínica articular más frecuente en pacientes con trastornos temporomandibulares (TTM). Presentes hasta en un 80-90 % de los casos sintomáticos, no se sabe por qué, su presencia en sujetos asintomáticos no causa dolor ni disfunción. En contraposición, una posición normal del disco ha sido descrita en un 16-23 % de pacientes sintomáticos. OBJETIVOS: Analizar la prevalencia de TI de la ATM en sujetos voluntarios asintomáticos y qué características clínico-radiológicas podrían favorecer su presencia o desarrollo. MATERIAL Y MÉTODO: Se diseñó un estudio descriptivo, observacional, transversal. Se seleccionaron 43 sujetos de una población de 253 residentes que realizaban su formación médica especializada. El estudio fue desarrollado en varias fases. Fase I: Anamnesis y examen clínico. Empleo del índice craneomandibular de Fricton (ICM); Fase II: Adquisición y evaluación de imágenes de Resonancia Magnética (RMN). Las imágenes fueron procesadas a formato DICOM 4.0 y evaluadas por dos examinadores externos. Fase III: Análisis morfoestructural de las ATM. Las imágenes de RMN fueron analizadas empleando el programa informático Osirix® V 3.5.1. RESULTADOS: Setenta y dos articulaciones (pertenecientes a 36 sujetos) fueron finalmente analizadas. La edad media fue de 28,39 ± 3,70 años con una distribución por sexos de 47,2 % hombres y de 52,8 % mujeres. El análisis inferencial mostró resultados estadísticamente significativos en relación con las variables sexo (p = 0,021), chasquido articular (p = 0,007), valor del ICM (p = 0,000296), morfología discal (p = 1,032 X 10-8), morfología condilar (p = 2,116 X 10-8), posición condilar en el interior de la ATM (longitudes posterior y superior, p = 5,385 X 10-9; p = 0,000245, respectivamente) y morfología de la fosa articular (p = 0,024). CONCLUSIONES: Existe una elevada prevalencia de TI de la ATM en los sujetos asintomáticos analizados. Ciertos criterios clínicos (chasquido articular) y radiológicos (morfología discal alargada/doblada, cóndilo y fosa aplanados y posición más posterior y craneal del cóndilo mandibular) podrían ser considerados como predictores o relacionados con la presencia de desplazamiento discal. El ICM podría constituir una herramienta útil en el diagnóstico de patología articular de la ATM

INTRODUCTION: Internal derangements (IDs) of the temporomandibular joint (TMJ) constitute the most common clinical joint condition in patients with temporomandibular disorders (TMDs). Present in up to 80-90 % of symptomatic cases, it is not known why, its presence in asymptomatic subjects does not cause pain or dysfunction. In contrast, a normal position of the disc has been described in 16-23 % of symptomatic patients. OBJECTIVES: To analyze the prevalence of IDs of the TMJ in asymptomatic voluntary subjects and what clinical-radiological characteristics could favor their presence or development. MATERIAL AND METHODS: A descriptive, observational, cross-sectional study was designed. Fortythree subjects from a population of 253 residents who performed their training program were selected. The study was carried out in several phases. Phase I: Anamnesis and clinical examination. Use of the Fricton Cranio-mandibular Index (CMI); Phase II: Acquisition and evaluation of Magnetic Resonance Imaging (MRI). The images were processed in DICOM 4.0 format and evaluated by two external examiners. Phase III: Morpho-structural analysis of the TMJs. The MRI were analyzed using the Osirix® V 3.5.1 Software. RESULTS: Seventy-two joints (belonging to 36 subjects) were finally analyzed. The mean age was 28.39 ± 3.70 years with a distribution by sex of 47.2% men and 52.8 % women. The inferential analysis showed statistically significant results in relation to the variables sex (p = 0.021), joint click (p = 0.007), CMI value (p = 0.000296), disc morphology (p = 1.032x10-8), condylar morphology (p = 2.116x10-8) and condylar position inside the TMJ ((posterior and superior lengths, p = 5.385x10-9; p = 0.000245, respectively) and morphology of the joint fossa (p = 0.024). CONCLUSIONS: A high prevalence of IDs in asymptomatic subjects is present in our study. Certain clinical (joint clicking) and radiological criteria (an elongated or bent disc morphology, a flattened condyle and fossa and a more posterior and cranial position of the mandibular condyle) could be considered as predictors or be related to the presence of disc displacement. The CMI could be a useful tool in the diagnosis of joint pathology of the TMJ

Massive glosso-cervical arteriovenous malformation: The rationale for a challenging surgical resection.

Massive arterivenous malformations (AVM) in the cervico-facial area are rare but potentially life-threatening. Treatment protocols are not well-established. A 41-year old man presented large painless rubber-like mass within the entire neck, which also extended intraorally through the floor of the mouth, showing a slow growing pattern for 5 years. Angiography diagnosed it as cervicofacial AVM. Treatment approach consisted on the embolization of the right upper thyroid, lingual and facial arteries under intravenous sedation. Three days later, bilateral radical neck dissection and subtotal glossectomy was performed. A musculo-cutaneous pectoralis major pedicled flap was harvested to reconstruct the floor of the mouth. Treatment of massive AVMs in the cervico-facial area is challenging due to the associated disfigurement and frequent recurrence rate due to incomplete resection. Also, massive bleeding may be present despite pre-operative super-selective embolization. A new case is presented with focus on surgical treatment considerations. Key words:Arteriovenous malformation, high-flow vascular malformation, cervical region, tongue, surgical resection.