Efficacy and safety of dupilumab in atopic dermatitis in elderly patients: a retrospective study.

Atopic dermatitis (AD) is a common inflammatory skin disease with high prevalence in both children (15-30%) and adults (2-10%), but limited data are available for older people. Elderly patients form a challenging group, as multiple comorbidities, associated polypharmacy and failures with previous treatments are common. We performed a retrospective observational study on elderly (≥ 65 years) patients treated with dupilumab, monoclonal antibody to the shared alpha subunit of the interleukin-4 and -13 receptor approved for the treatment of moderate-to-severe AD in adults.

Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?

Maxillo-mandibular advancement MMA is considered an efficacious treatment for patients affected by severe obstructive sleep apnoea syndrome (OSAS). Even though OSAS improvement is the main goal of MMA, excessive maxillo-mandibular protrusion should be avoided to guarantee pleasant postoperative facial aesthetics. In order to attain such a result, the amount of MMA should be planned preoperatively by both aesthetic and cephalometric analyses. Steiner and Delaire cephalometric analyses are commonly used in the preoperative planning of orthognatic surgery for dentofacial deformities, however controversies still exist about the basis and postoperative aesthetic results of such cephalometric analyses in OSAS patients candidate for MMA. Forty-eight patients affected by severe OSAS were submitted to MMA. Pre- and post-operative Steiner and Delaire cephalometric tracings were assessed in each subject. For Steiner analysis, the variation in the SNA and SNB angles was measured, while for Delaire tracings the variation in the C3/FM-CPA and C3/FM-Me angles was assessed. Mean MMA was 6.9 + 3.8 mm for the maxilla and 13.6 + 5 mm for the mandible. After surgery, an improvement of the apnoea-hypopnoea index was recorded (40.47 + 7.64 preoperative vs. 12.56 + 5.78 postoperative). In all patients, both cephalometric analyses showed presurgical bimaxillary retrusion. After surgery, the mean value of Steiner's SNA angle increased from 78.18° to 85.58° (p < 0.001), while mean Delaire's C3/FM-CPA angle increased from 81.19° to 89.71° (p < 0.001). The mean value of Steiner's SNB angle increased from 74.33° to 80.73° (p < 0.001), while Delaire's C3/FM-Me angle increased from 80.10° to 87.29° (p < 0.001). Postoperatively, both the maxilla and mandible were in a more protrusive position (p < 0.001) according to Steiner analysis compared with Delaire tracing. Basing MMA on Delaire cephalometric analysis leads to an increased advancement of the maxillo-mandibular complex than Steiner tracing. The consequences of this aspect on facial aesthetics should be considered during surgical planning and preoperative informed consent in OSAS patients candidate for MMA.

Temporomandibular joint dysfunction in Moebius syndrome.

AIM: Moebius syndrome is a rare condition characterised by bilateral facial and abducens nerve paralysis. In the present study, it was investigated the effect of the long term facial muscles hypoactivity on temporomandibular joint movements development. METHODS: Accordingly with Terzis classification (Terzis, 2003), a wide sample of A type and B type Moebius patients was investigated for mandibular range of movements. Moebius patients were compared with a sample of healthy subjects. RESULTS: Both type A and type B Moebius patients develop a severe articular movement reduction, especially during mouth opening. A highly significant difference was found between Moebius patients and the healthy group. No difference was found between A and B Moebius sub-samples. CONCLUSION: The authors stress the importance of an early adequate rehabilitation of Moebius patients, in order to avoid the limitation of TMJ movement range.

Orthognathic surgery for the complete rehabilitation of Moebius patients: principles, timing and our experience.

Moebius syndrome is a rare disorder found in approximately 1/100,000 neonates and the treatment of facial palsy is now well established worldwide and consists of free-muscle transplants reinnervated with motor nerves. Dentofacial deformities are often detected in Moebius patients, and different degrees of micrognathia are often present, particularly in patients with complete expressions of Moebius syndrome. However only two published reports have described the surgical treatment of such anomalies in these patients; in both cases, the suggested approach consisted of orthognathic surgery followed by soft-tissue management. In this paper we discuss the indications and correct timing of orthognathic surgery and suggest to perform facial animation at an early age and then to wait for the completion of maxillofacial skeletal growth before performing orthognathic surgery. Finally, facial animation should precede orthognathic surgery in adult patients to prevent lower lip deformities and to ensure more predictable and satisfactory results.