Aesthetic and Functional Outcomes of Upper Blepharoplasty Combined with Dacryoadenopexy in Lacrimal Gland Prolapse.

INTRODUCTION: Lacrimal gland prolapse (LGP) is a term used to describe a benign, anterior displacement of the lacrimal gland. If this condition is not properly addressed during upper blepharoplasty, the aesthetic and functional results are less than optimal. This study aimed to report the surgical outcomes of upper blepharoplasty combined with dacryoadenopexy in patients with LGP. METHODS: We reported an unusual case of severe LGP in a young patient. In addition, we performed a systematic review of the English literature on surgical cases of LGP published between 1973 and 2023. Eligible articles were analyzed for individual patient data (IPD) and aggregate patient data (APD). The primary predictor variable was the surgical technique used for lacrimal gland repositioning/suspension. The primary outcome variable was relapse rate. RESULTS: The bibliographic search retrieved 488 surgical cases of LGP: 12 in IPD, and 476 in APD datasets. The relapse rates in the IPD and APD cohorts were 8.3% (1/12) and 1.2% (6/476), respectively. Within the APD dataset, no significant difference in the relapse rates between dacryoadenopexy via suture suspension and Whitnall's ligament suspension (5/409 and 1/20, respectively; P > 0.05) was observed. Light cauterization of the lacrimal gland capsule and surrounding soft tissues was performed in mild LGP cases (< 4 mm prolapse), with a relapse rate of 0% (0/47). CONCLUSION: Upper blepharoplasty combined with dacryoadenopexy proved to be a safe surgical procedure with very satisfactory aesthetic outcome and minimal relapse rate. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Detection and Segmentation of Radiolucent Lesions in the Lower Jaw on Panoramic Radiographs Using Deep Neural Networks.

Background and Objectives: The purpose of this study was to develop and evaluate a deep learning model capable of autonomously detecting and segmenting radiolucent lesions in the lower jaw by utilizing You Only Look Once (YOLO) v8. Materials and Methods: This study involved the analysis of 226 lesions present in panoramic radiographs captured between 2013 and 2023 at the Clinical Hospital Dubrava and the School of Dental Medicine, University of Zagreb. Panoramic radiographs included radiolucent lesions such as radicular cysts, ameloblastomas, odontogenic keratocysts (OKC), dentigerous cysts and residual cysts. To enhance the database, we applied techniques such as translation, scaling, rotation, horizontal flipping and mosaic effects. We have employed the deep neural network to tackle our detection and segmentation objectives. Also, to improve our model's generalization capabilities, we conducted five-fold cross-validation. The assessment of the model's performance was carried out through metrics like Intersection over Union (IoU), precision, recall and mean average precision (mAP)@50 and mAP@50-95. Results: In the detection task, the precision, recall, mAP@50 and mAP@50-95 scores without augmentation were recorded at 91.8%, 57.1%, 75.8% and 47.3%, while, with augmentation, were 95.2%, 94.4%, 97.5% and 68.7%, respectively. Similarly, in the segmentation task, the precision, recall, mAP@50 and mAP@50-95 values achieved without augmentation were 76%, 75.5%, 75.1% and 48.3%, respectively. Augmentation techniques led to an improvement of these scores to 100%, 94.5%, 96.6% and 72.2%. Conclusions: Our study confirmed that the model developed using the advanced YOLOv8 has the remarkable capability to automatically detect and segment radiolucent lesions in the mandible. With its continual evolution and integration into various medical fields, the deep learning model holds the potential to revolutionize patient care.

Association among Clopidogrel Cessation, Platelet Function, and Bleeding in Coronary Bypass Surgery: An Observational Trial.

OBJECTIVES: This study sought to determine (1) the association between the length of preoperative clopidogrel discontinuation, blood loss, and transfusion requirements and (2) whether preoperative platelet function testing predicts excessive postoperative bleeding in patients undergoing coronary artery bypass grafting (CABG) surgery. METHODS: In this retrospective analysis, patients undergoing CABG were divided into three groups with regard to the period between preoperative clopidogrel cessation and surgery: group 1 (n = 94, ≤3 days), group 2 (n = 100, 4-5 days), and group 3 (n = 83, 6-7 days), respectively. Impedance aggregometry (Multiplate) with arachidonic acid (ASPI) test assay (used for platelets stimulation) and adenosine diphosphate (ADP) test (used for platelets stimulation) was performed before the surgery. Primary outcome was 24 hours chest tube output (CTO) and transfusion requirements (red blood cell concentrate [RBCC], platelet concentrate [PC], fibrinogen concentrate [FC], and fresh-frozen plasma [FFP]) were considered as secondary outcomes. RESULTS: CTO during 24 hours was significantly higher in group 1 as compared with groups 2 and 3, respectively (p = 0.003). Considering secondary outcomes, RBCC (p = 0.043), PC (p = 0.001), FC (p = 0.003), and FFP (p = 0.010) were more frequently transfused in group 1 as compared with groups 2 and 3, respectively. Multiple electrode aggregometry ASPI and ADP tests were significantly correlated with the 24-hour CTO (ASPI test-rho = -0.258, p < 0.001; ADP test-rho = -0.164, p = 0.007). A significant correlation was observed between clopidogrel-free interval and 24-hour CTO (rho = -0.200, p < 0.001). Receiver-operating characteristics (ROC) curve analysis revealed cutoff values to delineate bleeding tendency (ASPI test ≤ 25 area under the aggregation curve [AUC], ADP test ≤63 AUC, and clopidogrel-free interval ≤3 days). CONCLUSION: Excessive postoperative bleeding occurred less frequently if the period between clopidogrel discontinuation and surgery was longer than 3 days, as compared with shorter waiting time. Inadequate recovery of the platelets function following clopidogrel cessation in preoperative period was associated with increased bleeding risk. Platelet function testing was found to be a useful tool for postoperative bleeding management in our hands.

Utilizing Deep Learning for Diagnosing Radicular Cysts.

OBJECTIVES: The purpose of this study was to develop a deep learning algorithm capable of diagnosing radicular cysts in the lower jaw on panoramic radiographs. MATERIALS AND METHODS: In this study, we conducted a comprehensive analysis of 138 radicular cysts and 100 normal panoramic radiographs collected from 2013 to 2023 at Clinical Hospital Dubrava. The images were annotated by a team comprising a radiologist and a maxillofacial surgeon, utilizing the GNU Image Manipulation Program. Furthermore, the dataset was enriched through the application of various augmentation techniques to improve its robustness. The evaluation of the algorithm's performance and a deep dive into its mechanics were achieved using performance metrics and EigenCAM maps. RESULTS: In the task of diagnosing radicular cysts, the initial algorithm performance-without the use of augmentation techniques-yielded the following scores: precision at 85.8%, recall at 66.7%, mean average precision (mAP)@50 threshold at 70.9%, and mAP@50-95 thresholds at 60.2%. The introduction of image augmentation techniques led to the precision of 74%, recall of 77.8%, mAP@50 threshold to 89.6%, and mAP@50-95 thresholds of 71.7, respectively. Also, the precision and recall were transformed into F1 scores to provide a balanced evaluation of model performance. The weighted function of these metrics determined the overall efficacy of our models. In our evaluation, non-augmented data achieved F1 scores of 0.750, while augmented data achieved slightly higher scores of 0.758. CONCLUSION: Our study underscores the pivotal role that deep learning is poised to play in the future of oral and maxillofacial radiology. Furthermore, the algorithm developed through this research demonstrates a capability to diagnose radicular cysts accurately, heralding a significant advancement in the field.

Intranasal supernumerary tooth: two case reports and review of the literature.

The presence of supernumerary tooth (SNT) in the nasal cavity is a rare condition with limited literature data. We report two cases with a history of nasal obstruction and difficulty breathing. In both cases, clinical and radiological examination confirmed intranasal SNT. Extractions were executed in general anesthesia using Rochester-Pean instruments transnasally. In addition, a literature review of intranasal SNT was performed. The database search retrieved a total number of 50 cases in time period from 1970 to 2020. Mean age of patients was 22.5 years. Most common symptoms were unilateral obstruction of breathing and headache. Surgical extraction of intranasal SNT is recommended to eliminate the symptoms.

Prognostic significance of cystic nodal metastasis in HPV-positive oropharyngeal cancer.

This is a brief communication stressing some critical points associated with cystic nodal metastasis (CNM) in human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC) and its implication on treatment protocols and outcomes.

Embryo-derived teratoma in vitro biological system reveals antitumor and embryotoxic activity of valproate.

Antiepileptic/teratogen valproate (VPA) is a histone deacetylase inhibitor/epigenetic drug proposed for the antitumor therapy where it is generally crucial to target poorly or undifferentiated cells to prevent a recurrence. Transplanted rodent gastrulating embryos-proper (primitive streak and three germ layers) are the source of teratoma/teratocarcinoma tumors. Human primitive-streak remnants develop sacrococcygeal teratomas that may recur even when benign (well differentiated). To screen for unknown VPA impact on teratoma-type tumors, we used original 2-week embryo-derived teratoma in vitro biological system completed by a spent media metabolome analysis. Gastrulating 9.5-day-old rat embryos-proper were cultivated in Eagle's minimal essential medium (MEM) with 50% rat serum (controls) or with the addition of 2 mmVPA. Spent media metabolomes were analyzed by FTIR. Compared to controls, VPA acetylated histones; significantly diminished overall teratoma growth, impaired survival, increased the apoptotic index, and decreased proliferation index and incidence of differentiated tissues (e.g., neural tissue). Control teratomas continued to grow and differentiate for 14 days in isotransplants in vivo, but in vitro VPA-treated teratomas resorbed. Principal component analysis of FTIR results showed that spent media metabolomes formed well-separated clusters reflecting the treatment and day of cultivation. In metabolomes of VPA-treated teratomas, we found elevation of previously described histone acetylation biomarkers [amide I α-helix and A(CH3 )/A(CH2 )]) with apoptotic biomarkers within the amide I region for ß-sheets, and unordered and CH2 vibrations of lipids. VPA may be proposed for therapy of the undifferentiated component of teratoma tumors and this biological system completed by metabolome analysis, for a faster dual screening of antitumor/embryotoxic agents.