Periangular transmasseteric infraparotid approach in the treatment of condylar-base and low condylar­neck fractures.

AIM: Mandibular condylar fractures account for 25 to 52 % of all mandibular fractures. Though current literature favors open reduction and internal fixation (ORIF) of condylar­base and low condylar­neck fractures, extraoral approaches are usually considered to be complicated by the risk of facial nerve injury and other possible complications. This study was undertaken to demonstrate that the periangular transmasseteric infraparotid surgical approach (TMIP) to condylar­base and low condylar­neck fractures provides excellent access to the bony fragments with minimal risk of complications such as facial nerve and parotid gland injury. PATIENTS: In the period from January 2010 to December 2018, 81patients (96 fractures) with condylar­base and low condylar­neck fractures underwent ORIF via periangular transmasseteric infraparotid surgical approach. RESULTS: The results of this retrospective study showed minimal postoperative complications. The periangular transmasseteric infraparotid surgical approach allowed precise anatomic repositioning and fixation of the bony fragments in almost all cases except for two juvenile cases with noticeable scars and one case with plate fracture. There were no transient or permanent facial nerve palsies, parotid gland or salivary fistulae complications during a 12­month follow­up period. CONCLUSION: The periangular infraparotid transmasseteric approach to ORIF of condylar­base and low condylar­neck fractures is an effective and safe approach allowing accurate anatomic reposition and fixation of the fragments with minimum surgical complications (Tab. 1, Fig. 12, Ref. 21).

3D navigation in surgery of Eagle syndrome.

NTRODUCTION: Eagle's syndrome is a rare condition caused by the elongation of the styloid process (> 4 cm) or calcification of the stylohyoid ligament. Patients with Eagle's syndrome typically present various clinical symptoms, such as headache, facial pain, neck pain, pulsating pain, sore throat, foreign body sensation, dysphagia, dysphonia, cough, voice changes, otalgia or vertigo. 3D printing refers to processes in which successive layers of material are formed from 3D computer tomography data to synthesize a three-dimensional object. This new diagnostic technique of rapid prototyping technology led to innovative new applications in biomedicine. OBJECTIVE: The primary goal for this case study was to find out, whether the nowadays so popular 3D technology aids in the treatment of the Eagle syndrome or other similar craniofacial abnormalities during the surgical procedure. CASE PRESENTATION: We report a case of a patient who initially presented a combination of symptoms like headache, sore throat, neck pain, which exacerbated with the movement of the head. This case report provides a brief review of the diagnosis and surgical management of the Eagle's syndrome with the help of 3D model navigation. CONCLUSION: Eagle's syndrome is difficult to diagnose due to its wide variability in symptoms. The inherent accuracy and other properties of 3D printing have allowed it to have exciting applications in anatomy education and surgery, with great benefit to the maxillofacial surgery. With the assistance of 3D technology, it is much easier for the surgeon to plan the surgical approach and the surgery, and significantly reduce the operation time (Fig. 3, Ref. 22).

Dopaminergic-opioidergic interaction is reflected by changes in pituitary hormone secretion in patients with essential hypertension.

In a randomized, double-blind crossover study 13 untreated patients with mild essential hypertension were exposed to submaximal bicycle exercise. Sixty minutes before ergometry 10 mg metoclopramide or placebo, and 10 min before exercise 0.4 mg naloxone or placebo, were given intravenously. Plasma adrenocorticotrophic hormone, beta-endorphin and cortisol levels increased significantly after ergometry, whether performed after placebo, naloxone, metoclopramide or metoclopramide + naloxone treatment. However, only naloxone administration potentiated plasma adrenocorticotrophic hormone, beta-endorphin and cortisol responses to workload. Plasma levels of adrenocorticotrophic hormone, beta-endorphin and cortisol were 45 +/- 14 pg/ml, 6.2 +/- 1.2 pmol/l and 141 +/- ng/ml, respectively, after ergometry, when performed after placebo, but these values were increased to 61 +/- 10 pg/ml, 11.4 +/- 2.8 pmol/l and 207 +/- 22 ng/ml, respectively, after naloxone treatment. This naloxone-induced potentiation of hormonal release was blocked by metoclopramide pretreatment, suggesting a close interaction between dopaminergic and opioidergic mechanisms, regulating hormonal responses to physical exercise.

Adrenergic and dopaminergic regulation of circulating beta-endorphin-like immunoreactivity in hypertension.

The central alpha-2-adrenergic receptor agonist, clonidine (300 micrograms daily) significantly increased the plasma beta-endorphin-like immunoreactivity (beta ELI) in 12 patients with mild to moderate essential hypertension in a randomized, crossover study. A significant linear correlation between the increase in plasma beta ELI and the decrease in blood pressure (both systolic and diastolic) was found after clonidine administration. The role of the reduced central sympathetic tone, induced by alpha-2-adrenoceptor stimulation, in the elevation of circulating beta ELI can be suggested. The plasma beta ELI increased also significantly after the dopaminergic D-2 receptor agonist, bromocryptine treatment, (5 mg, daily) in 13 patients with borderline and mild essential hypertension in a randomized, crossover study. A significant drop in circulating noradrenaline and in arterial blood pressure and a significant linear correlation between the changes of plasma noradrenaline level and blood pressure was found after bromocryptine administration. There was no correlation between the rise in plasma beta ELI and the decrease in blood pressure after bromocryptine. The importance of the central sympathetic activity and not only a direct pituitary dopaminergic agonist effect on the beta-endorphin secretion can be stressed in the effect of bromocryptine on the immunoreactive beta-endorphin level.

Clinical studies with captopril treatment of hypertensive patients.

Haemodynamic and humoral effects of captopril were studied in patients with essential and renovascular hypertension. Captopril decreased significantly both systolic and diastolic blood pressure and moderately, it reduced also the heart rate. On the basis of the haemodynamic effects our patients could be divided into two groups: in patients where the total peripheral resistance (TPR) exceeded 2000 dyn x sec x cm-5 during rest, captopril exerted its hypotensive effect by decreasing TPR. In patients in whom TPR was lower, the hypotensive action could be attributed to the reduction of cardiac output (CO). Captopril increased plasma renin activity, and decreased the activity of angiotensin converting enzyme (ACE) in the plasma. In acute study captopril did not influence plasma noradrenaline level but increased it during long-term administration. It did not affect dopamine or adrenaline levels. Captopril had no effect on plasma beta-endorphin concentration, moreover, the opiate antagonist, naloxone, failed to antagonize its antihypertensive effect. Comparing the acute effects of Capoten (Squibb, USA) and Tensiomin (EGIS, HUNGARY) no significant differences were found.