Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint.

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

Exploring Binocular Visual Attention by Presenting Rapid Dichoptic and Dioptic Series.

This study addresses an issue in attentional distribution in a binocular visual system using RSVP tasks under Attentional Blink (AB) experimental protocols. In Experiment 1, we employed dichoptic RSVP to verify whether, under interocular competition, attention may be captured by a monocular channel. Experiment 2 was a control experiment, where a monoptic RSVP assessed by both or only one eye determines whether Experiment 1 monocular condition results were due to an allocation of attention to one eye. Experiment 3 was also a control experiment designed to determine whether Experiment 1 results were due to the effect of interocular competition or to a diminished visual contrast. Results from Experiment 1 revealed that dichoptic presentations caused a delay in the type stage of the Wyble's eSTST model, postponing the subsequent tokenization process. The delay in monocular conditions may be further explained by a visual attenuation, due to fusion of target and an empty frame. Experiment 2 evidenced the attentional allocation to monocular channels when forced by eye occlusion. Experiment 3 disclosed that monocular performance in Experiment 1 differs significantly from conditions with interocular competition. While both experiments revealed similar performance in monocular conditions, rivalry conditions exhibit lower detection rates, suggesting that competing stimuli was not responsible for Experiment 1 results. These findings highlight the differences between dichoptic and monoptic presentations of stimuli, particularly on the AB effect, which appears attenuated or absent in dichoptic settings. Furthermore, results suggest that monoptic presentation and binocular fusion stages were a necessary condition for the attentional allocation.

Attentional Bias Modification Training Based on Virtual Reality and Eye Tracking in Anorexia Nervosa Patients.

Anorexia nervosa (AN) patients exhibit attentional bias (AB) related to the body, which is the tendency to pay greater attention to weight-related body areas compared to non-weight-related ones. This phenomenon has been linked to elevated levels of body dissatisfaction (BD) and may potentially reduce the effectiveness of body exposure therapy. The purpose of this pilot study is to assess the efficacy of a single session of a new body-related AB modification task (ABMT) that combines virtual reality with eye tracking in patients with AN. The goals of the ABMT are to reduce body-related AB by balancing attention between weight and non-weight-related body areas and to reduce BD levels. Twenty-three adolescent patients with AN were embodied in a virtual avatar and immersed in a virtual environment where they completed the ABMT. Body-related AB measures and BD levels were assessed before and after the training. A paired samples t-test showed statistically significant differences between pre-assessment and post-assessment; the complete fixation time on weight-related body parts was reduced and BD levels decreased. The initial evidence of the efficacy of this ABMT has important clinical implications, since AB and BD are considered risk factors for developing and maintaining eating disorder symptomatology among patients with AN.

Modification of Body-Related Attentional Bias through Virtual Reality and Eye-Tracking in Healthy Participants: Implications for Anorexia Nervosa Treatments.

Cognitive biases have a significant impact on the etiology and treatment of eating disorders (EDs). These biases, including selective attentional bias (AB) to disliked body parts, may reinforce concerns about body shape, fear of gaining weight and body image disturbances and may contribute to dietary restriction and restraint. Decreasing AB could reduce core symptoms in anorexia nervosa (AN). This study represents a preliminary exploration aiming to assess whether AB towards weight-related (WR) and non-weight-related (NW) body parts could be reduced through an AB modification task in a virtual reality (VR) environment in healthy participants. A total of 54 female participants, aged 22.98 ± 1.89, were recruited. The task consisted of directing the participants' attention towards all body parts equally in a VR setting. Eye-tracking (ET) measurements (complete fixation time [CFT] and number of fixations [NF]) were made before and after the task. The results showed a significant reduction of the AB in the two groups with an initial AB towards WR body parts or towards NW body parts. Participants showed a tendency to more balanced (non-biased) attention after the intervention. This study provides evidence of the usefulness of AB modification tasks in a non-clinical sample.

An Attentional Bias Modification Task, through Virtual Reality and Eye-Tracking Technologies, to Enhance the Treatment of Anorexia Nervosa.

Mirror exposure therapies (METs) have been shown to be effective in reducing body image disturbances through the habituation process. Virtual reality (VR) combined with eye-tracking techniques can provide innovative solutions to some of METs' limitations reported with patients with anorexia nervosa (AN), especially the negative influence of body-related attentional bias (AB). This pilot study aimed to assess the preliminary efficacy of a new VR-based AB modification task (ABMT) among healthy women and the procedure's user experience. AB levels towards weight- and non-weight-related body parts, using complete fixation time (CFT) and number of fixations (NF), were assessed throughout the ABMT procedure (300 trials). The user experience was evaluated at the end of the procedure. The results showed that VR-based ABMT was effective in reducing AB significantly after 150 trials for both CFT- and NF-based measures, although 225 trials were necessary to get the same result for women with an NF initially more oriented towards weight-related body parts. Overall, the software received a "C-rating" on a scale from "A" (most usable) to "F" (least usable). These results provide evidence of the opportunity to use a VR-based ABMT procedure to reduce AB and improve existing treatments for AN.

Food is special by itself: Neither valence, arousal, food appeal, nor caloric content modulate the attentional bias induced by food images.

When food cues appear in a visual context, such information is likely to influence eating behavior by enhancing attention for food cues. We investigated whether active but task-irrelevant information could modulate the attentional bias for food stimuli using a novel paradigm in which participants were purposely deceived by being enrolled in a memory experiment. A set of images were first held in working memory and then used as task-irrelevant distractors in a subsequent single target rapid serial visual presentation (RSVP) task, allowing us to investigate the attentional blink (AB) effect elicited by those images. In Experiment 1, the results revealed that food images elicited a larger AB effect than nonfood images. In three follow-up experiments, we investigated whether valence or arousal (Experiment 2), food preparation (Experiment 3), or food caloric content (Experiment 4) were factors related to the attentional bias for food. Overall, our results demonstrated that when held in working memory, food images can easily capture attention, even in circumstances in which the information retained in memory is irrelevant to solve the task, as indicated by the strong correlation found between items that were recognized in the RSVP task and the AB effect. Nonetheless, none of the food-related properties we examined were found to be associated with this attentional bias for food.

The Emotional Attentional Blink as a Measure of Patriotism.

This study aims to explore whether the implicit processing of emotional symbols related to patriotic feeling may exert some effects on attention. Here, we have conducted an experiment using two interrelated tasks. First, we use flags with different meanings to participants for measuring the strength of the emotional attentional blink (EAB) within a rapid serial visual presentation (RSVP) paradigm. Then, we use a "congruency judgments" subjective test, where we confront participants to judge the affinity between pairs of politician leaders and flags of different sign for community participants, while recording two physiological measures (Heart Rate Variance and Galvanic Skin Response) to evaluate the variations elicited by that confrontation. Results on the EAB task show a significant emotion induced blindness for emotional stimuli representing Catalan and Spanish patriotism (α = .05), while the effect does not appear for the stimulus representing neutral patriotism. The interaction "Flags x Patriotism" was significant, F(1, 51) = 4.62; p = .036; ηp2 = .083. Results on the second task show that measures derived from electrophysiological records are sensitive to patriotic feeling, both being complementary. In addition, by using measures of congruence, the "Leaders x Flags" interaction was significant, F(3.682, 125.204) = 53.55; p < .001; ηp2 = .612. Finally, a multiple linear regression model for each emotional inductor was verified for the Catalan case, using the EAB effect as criteria, R2Adjusted = .79; p < .001. Some theoretical and methodological aspects derived of this exploratory study are discussed.

The emotional attentional blink as a measure of patriotism

This study aims to explore whether the implicit processing of emotional symbols related to patriotic feeling may exert some effects on attention. Here, we have conducted an experiment using two interrelated tasks. First, we use flags with different meanings to participants for measuring the strength of the emotional attentional blink (EAB) within a rapid serial visual presentation (RSVP) paradigm. Then, we use a "congruency judgments" subjective test, where we confront participants to judge the affinity between pairs of politician leaders and flags of different sign for community participants, while recording two physiological measures (Heart Rate Variance and Galvanic Skin Response) to evaluate the variations elicited by that confrontation. Results on the EAB task show a significant emotion induced blindness for emotional stimuli representing Catalan and Spanish patriotism (alfa = .05), while the effect does not appear for the stimulus representing neutral patriotism. The interaction "Flags X Patriotism" was significant, F(1, 51) = 4.62; p = .036; ηp2 = .083. Results on the second task show that measures derived from electrophysiological records are sensitive to patriotic feeling, both being complementary. In addition, by using measures of congruence, the "Leaders X Flags" interaction was significant, F(3.682, 125.204) = 53.55; p < .001; ηp2 = .612. Finally, a multiple linear regression model for each emotional inductor was verified for the Catalan case, using the EAB effect as criteria, R2Adjusted = .79; p < .001. Some theoretical and methodological aspects derived of this exploratory study are discussed

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Attention to Monocular Images Bias Binocular Rivalry.

When monocular images cannot be fused, perception alternates between the two (or more) possible images. This phenomenon, binocular rivalry (BR), is driven by the physical properties of the stimuli (size, contrast, spatial frequency, etc.) but it can also be modulated by attention to features of one of the rival stimuli (Chong et al., 2005; Dieter et al., 2016) and by attentional demands independent of the BR assessment (Paffen et al., 2008). Instead of the perceptually demanding tasks previously used to bias BR, we designed a simple counting task. We monocularly presented a number of trials (around 10 min) with a set of symbols and asked participants to count them. We found that after this task, dominance durations decreased for the unattended channel, and did not change for the attended channel. The results parallel those of Paffen et al. (2008) and square nicely with Levelt's second proposition, suggesting that the counting task effectively increased the sensibility of one channel which led to increased strength of the images presented to that channel. Alternatively, the results could be explained assuming that the non-attended channel was inhibited during the counting task, and the inhibition was carried over to the BR task.

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.

What is the role of elective neck dissection in patients with squamous cell carcinoma of the upper jaw? / ¿Cual es el papel de la disección cervical electiva en el carcinoma escamoso del maxilar superior?

Background. Surgical treatment of clinically negative neck in maxillary squamous cell carcinoma (SCC) of the upper jaw is controversial. The purpose of this study was to define the incidence of cervical metastasis and to assess if elective neck dissection is justified when the neck is not primarily affected. Methods. We retrospectively reviewed 20 patients treated of SCC of the maxillary alveolus and hard palate between 2005 and 2012. Results. Six (30%) patients presented with cervical lymph metastasis at initial diagnosis. Two of the14 patients who initially had no signs of metastasis in the neck developed cervical metastasis during follow-up and another patient with cervical metastasis at diagnosis developed contralateral cervical metastasis. All the patients with cervical metastasis (45%) were pT3/T4 SCC. Cervical metastasis developed at a mean of 11.6 months. Conclusions. Despite this study being limited by its retrospective nature and the sample size, based on our findings and on an extensive review of the literature, we may conclude that cervical metastasis from maxillary alveolus and hard palate SCC appears most frequently in pT3/T4 tumors. Therefore, we find elective neck dissection appropriate for patients with pT3/T4 SCC of the upper jaw (AU)

Introducción. El tratamiento quirúrgico del cuello clínicamente negativo en el carcinoma de células escamosas (CCE) del maxilar superior es controvertido. El objetivo de este estudio es mostrar la incidencia de metástasis cervical y analizar si la disección cervical electiva está justificada cuando el cuello no está afectado de inicio. Métodos. Revisamos retrospectivamente 20 pacientes tratados por CCE de paladar duro y reborde alveolar superior entre 2005 y 2012. Resultados. Seis (30%) pacientes presentaron metástasis cervical de inicio. Dos de los 14 pacientes que inicialmente no tuvieron signos de metástasis cervical la desarrollaron durante el seguimiento, y otro paciente con metástasis cervical al inicio desarrolló una metástasis cervical contralateral. Todos los pacientes con metástasis cervical (45%) fueron pT3/T4 CCE. El tiempo medio de aparición de metástasis cervical fue de 11,6 meses. Conclusiones. A pesar de las limitaciones de este estudio (naturaleza retrospectiva, limitado número de pacientes), y tras analizar los resultados obtenidos y revisar la literatura, podemos concluir que la metástasis cervical de CCE de maxilar superior aparece con mayor incidencia en tumores pT3/T4. Por lo tanto, creemos conveniente realizar disección cervical electiva en pacientes con CCE T3/T4 de maxilar superior (AU)

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.

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.

Bifosfonatos e implantes dentales, ¿son incompatibles? Revisión de la literatura / Are bisphosphonates and dental implants compatible? A review of the literature

Introducción. La osteonecrosis de los maxilares ha sido descrita en pacientes que toman bifosfonatos y han sido sometidos a cirugía dentoalveolar. Actualmente, la terapia con bifosfonatos e implantes dentales es un tratamiento muy común en adultos. Objetivos. Evaluar, a través de una revisión de la literatura, si la osteointegración del implante dental podría disminuir en pacientes que toman bifosfonatos orales o intravenosos. Además, se analiza el riesgo que tienen estos pacientes de desarrollar osteonecrosis de los maxilares. Material y métodos. Se realizó una búsqueda a través de la base de datos Medline (PubMed) de los artículos publicados en inglés en los últimos 15 años que incluyeran las palabras clave «bisphosphonates and dental implants», «bisphosphonates and orthopaedic implants» y «osteonecrosis of the jaws and dental implants». Conclusiones. El tratamiento con bifosfonatos no disminuye la osteointegración del implante dental, aunque estos resultados se han obtenido en base a estudios retrospectivos en humanos. Se han descrito casos de osteonecrosis de los maxilares relacionada con bifosfonatos en estos pacientes, sobre todo tras tratamiento prolongado (AU)

Introduction. At present, treatment with bisphosphonates and dental implant therapy are frequently used in adults. Bisphosphonate-related osteonecrosis of the jaws has been described in patients with bisphosphonate medication who underwent dentoalveolar surgery. Objectives. The aim of this study was to evaluate, through a literature review, whether osseointegration of dental implants could decrease in patients on intravenous or oral bisphosphonates. The risk of developing bisphosphonate-related osteonecrosis of the jaws in these patients was also analysed. Material and methods. A search was performed to find the most recent scientific literature (the last 15 years) using PubMed database, with the keywords «bisphosphonates and dental implants», «bisphosphonates and orthopaedic implants» and «osteonecrosis of the jaws and dental implants». Conclusions. Based on the current literature, it is concluded that bisphosphonate treatment does not decrease osseointegration of dental implants. Nevertheless, these results have been obtained in a retrospective in humans. Bisphosphonate-related osteonecrosis of the jaws has been described in patients on prolonged treatment (AU)

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.

Melanoma mucoso en una localización extremadamente infrecuente: la base de lengua. A propósito de un caso y revisión de la literatura / Mucosal melanoma in an extremely rare location: base of the tongue. A case presentation and literature review

El melanoma primario en la cavidad oral es una neoplasia rara, especialmente en la lengua. Presentamos un caso de melanoma mucoso en la base de la lengua, una localización extremadamente infrecuente (en la literatura médica tan solo se han aportado unos 30 casos). El estudio de extensión no reveló lesiones metastásicas a distancia. El paciente fue tratado mediante glosectomía subtotal y vaciamiento cervical funcional bilateral. La lengua es una de las estructuras más difíciles de reconstruir, debido a su papel central en la fonación, la deglución y la protección de las vías respiratorias El defecto fue reconstruido con colgajo libre microvascularizado anterolateral de muslo. El tratamiento quirúrgico se complementó con radioterapia e inmunoterapia adyuvantes. El postoperatorio se desarrolló sin complicaciones. En la actualidad, 13 meses después de la cirugía, el paciente se encuentra asintomático, no hay evidencia de recidiva de la enfermedad y no tiene ninguna dificultad en la deglución ni fonación (AU)

Primary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in the literature). The extension study did not reveal any distant metastatic lesions. The patient was treated by sub-total glossectomy and bilateral functional neck dissection. The tongue is one of the most difficult structures to reconstruct, because of its central role in phonation, swallowing, and airway protection. The defect was reconstructed with an anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant radiotherapy and immunotherapy. The post-operative period was uneventful. At present, 13 months after surgery, patient is asymptomatic, with no evidence of recurrence of melanoma and has no difficulty in swallowing or phonation (AU)

Assessing Attention Deficit by Binocular Rivalry.

OBJECTIVE: To determine whether the frequency and duration of the periods of suppression of a percept in a binocular rivalry (BR) task can be used to distinguish between participants with ADHD and controls. METHOD: A total of 122 participants (6-15 years) were assigned to three groups: ADHD-Combined (ADHD-C), ADHD-Predominantly Inattentive (ADHD-I), and controls. They each performed a BR task and two measures were recorded: alternation rate and duration of exclusive dominance periods. RESULTS: ADHD-C group presented fewer alternations and showed greater variability than did the control group; results for the ADHD-I group being intermediate between the two. The duration of dominance periods showed a differential profile: In control group, it remained stable over time, whereas in the clinical groups, it decreased logarithmically as the task progressed. CONCLUSION: The differences between groups in relation to the BR indicators can be attributed to the activity of involuntary inhibition.