Intraoral and facial rehabilitation retained with zygomatic implants and magnets after complete resection of the maxilla, lip and nose: A clinical report.

Prosthetic rehabilitation is an option available for patients with extensive maxillofacial defects with the ability to restore esthetics and function. The surgical procedure can result in anatomical and functional sequelae leading to functional, psychological and aesthetic disorders. This clinical case report describes the unique and highly-specialized fabrication method of an oral and facial prosthesis for a patient with a near total maxillectomy, excision of upper lip, rhinectomy and radiotherapy for treatment of an extensive malignant neoplasm. Four carefully placed zygomatic implants were used to retain an oral obturator and an external mid-facial prosthesis. A well-functioning maxillofacial prosthesis is essential for improving quality of life, psychological adjustment to cancer and cancer related disabilities, and a positive coping response. The prosthetic rehabilitation allowed the patient's reintegration into society accompanying the satisfactory restoration of aesthetics, phonetics, mastication, and deglutition. Key words:Maxillectomy, rhinectomy, maxillofacial prosthesis, zygomatic implants, head and neck neoplasm.

Integrated microtia and aural atresia management.

Objectives: To present recommendations for the coordinated evaluation and management of the hearing and reconstructive needs of patients with microtia and aural atresia. Methods: A national working group of 9 experts on microtia and atresia evaluated a working document on the evaluation and treatment of patients. Treatment options for auricular reconstruction and hearing habilitation were reviewed and integrated into a coordinated care timeline. Results: Recommendations were created for children with microtia and atresia, including diagnostic considerations, surgical and non-surgical options for hearing management and auricular reconstruction, and the treatment timeline for each option. These recommendations are based on the collective opinion of the group and are intended for otolaryngologists, audiologists, plastic surgeons, anaplastologists, and any provider caring for a patient with microtia and ear canal atresia. Close communication between atresia/hearing reconstruction surgeon and microtia repair surgeon is strongly recommended.

Prosthetic Facial Reconstruction in a Blast Injury Case.

The management of blast and burn injuries to the facial soft tissue and craniomaxillofacial skeleton has been a challenge since the inception of reconstructive plastic surgery. These injuries continue to present complex reconstructive challenges today. While there have been advancements in free tissue transfer and vascularized composite allotransplantation, prosthetics have been used successfully since antiquity until the present day. Prosthetics may achieve acceptable coverage without complex surgery or as an adjunct to reconstructive surgery. Here, we report a case of devastating blast injury to the face that has been managed successfully with orbital prosthetics anchored with osseointegrated implants.

Osseointegrated Prosthetic Ear Reconstruction in Cases of Skin Malignancy: Technique, Outcomes, and Patient Satisfaction.

BACKGROUND: Ear reconstruction with osseointegrated prosthetic implants is a well-established method of reconstruction after resection of skin malignancies on the external ear. There is limited literature reporting technique, outcomes, and patient satisfaction. METHODS: We evaluated our outcomes over a 5-year period looking at osseointegrated prosthetic reconstruction after auriculectomy for external ear skin malignancies. We report demographics, disease characteristics, technique, and complications. The patients were surveyed looking at 6 domains: satisfaction, stability, comfort, ease of use, level of self-consciousness, and preoperative education. RESULTS: Of the 21 patients included in the study, 14 (67%) were treated for invasive melanoma (Breslow depth, >0.8mm), 4 (19%) for squamous cell carcinoma, 2 (10%) for basal cell carcinoma, and 1 (5%) for an atypical fibroxanthoma. Complications rates were low. There were no cases of infection, hematoma, or bleeding. In 2 patients (9.5%), 1 of the 3 implants failed to osseointegrate and was removed, but the prosthesis was able to be secured with the remaining 2 posts. There were 3 cases (14%) of delayed healing and 1 with excessive granulation tissue growth. Survey results showed high satisfaction in all measured domains. CONCLUSIONS: In cases of skin malignancy requiring total or subtotal auriculectomy, prosthetic ear reconstruction with osseointegrated implants is a good alternative to reconstruction with autologous tissue. Our experience demonstrates good outcomes and with low complication rates and high patient satisfaction.

Management of Peri-Implant Hypertrophic Scarring for an Ear Prosthesis.

The clinical report describes a case of a 14-year-old patient with a traumatic amputation of the left auricle and severe hypertrophic scarring. The management of peri-implant soft tissue was challenging, but successful in the rehabilitation of a patient with auricular prosthesis retained by implants. The prosthesis restored the patient's facial aesthetics and contributed not only to function, but also to psychosocial well-being.

Relevance of UV filter/sunscreen product photostability to human safety.

Photostability or photo-instability of sunscreen products is most often discussed in undesirable terms with respect to human safety. The health risks, specifically associated with sunscreens, photostable or photo-unstable, include phototoxic/photoirritation or photoallergic responses and, longer-term, an increased risk of skin cancers or photoageing. The aims of this paper are to define photostability/photo-instability and objectively assess the acute and chronic toxicological consequences from the human exposure to UV filter/sunscreens and any probable photo-degradation products. The reported prevalence of photoirritation and photoallergic responses to sunscreens is rare compared with adverse events, for example, skin irritation or sensitization, produced by cosmetics or topically applied drugs and do not directly implicate potential photo-degradation products of UV filters. Moreover, for at least one photo-unstable combination, octyl methoxycinnamate and avobenzone, the long-term benefits to humans, i.e., reduction in skin cancers, seem to outweigh any potential adverse consequences attributed to photo-degradation. Sunscreen products are formulated to achieve maximum efficacy which, by necessity and design, incorporate measures to support and promote photostability since all organic UV filters have the potential to photo-degrade. Current performance measures, in vivo SPF and in vitro UVA, conducted under standardized conditions, in part account for photostability. The concerns expressed when considering human exposure to potential photo-unstable UV filters or sunscreen products may not manifest as health risks under conditions of use. Still, improvement in sunscreen product photostability continues to be a key strategic objective for manufacturers.

Depigmented skin and phantom color measurements for realistic prostheses.

PURPOSE: The purpose of this study was to test the hypothesis that regardless of human skin phototype, areas of depigmented skin, as seen in vitiligo, are optically indistinguishable among skin phototypes. The average of the depigmented skin measurements can be used to develop the base color of realistic prostheses. METHODS AND MATERIALS: Data was analyzed from 20 of 32 recruited vitiligo study participants. Diffuse reflectance spectroscopy measurements were made from depigmented skin and adjacent pigmented skin, then compared with 66 pigmented polydimethylsiloxane phantoms to determine pigment concentrations in turbid media for making realistic facial prostheses. RESULTS: The Area Under spectral intensity Curve (AUC) was calculated for average spectroscopy measurements of pigmented sites in relation to skin phototype (P = 0.0505) and depigmented skin in relation to skin phototype (P = 0.59). No significant relationship exists between skin phototypes and depigmented skin spectroscopy measurements. The average of the depigmented skin measurements (AUC 19,129) was the closest match to phantom 6.4 (AUC 19,162). CONCLUSION: Areas of depigmented skin are visibly indistinguishable per skin phototype, yet spectrometry shows that depigmented skin measurements varied and were unrelated to skin phototype. Possible sources of optical variation of depigmented skin include age, body site, blood flow, quantity/quality of collagen, and other chromophores. The average of all depigmented skin measurements can be used to derive the pigment composition and concentration for realistic facial prostheses.

The evolution of sunscreen products in the United States--a 12-year cross sectional study.

Excessive exposure from ultraviolet (UV) radiation contributes to the development of skin cancers and photoaging. Topical sunscreen products remain one of the most widely used forms of protection for the majority of the public. The objective of this analysis was to examine photoprotection trends (e.g., SPF value) and the degree of UVA I protection from 1997 to 2009 in the United States. Sunscreen products purchased and evaluated in 1997 (N = 59), 2003 (N = 188) and again in 2009 (N = 330), totaling 577, were included in this analysis. Information regarding (1) the SPF value, (2) name and concentration of the active ingredients, (3) type of products (i.e., daily vs. recreational/beach), and (4) claims of UVA protection was recorded and analyzed. In addition, the critical wavelength (CW) of 330 products from 2009 was determined. The results showed an increase in the SPF values of products from 1997 to 2009. The percentage of low SPF products (SPF 4-14) decreased from 27% in 1997 to 6% in 2009. The number of products containing a known UVA-I filter (i.e., avobenzone or zinc oxide) increased from 5% in 1997 to 70% in 2009. Lastly, approximately, 225 (68%) of the products tested in 2009 attained CW > 370 nm. In the past decade, sunscreen products have undergone fundamental improvements, the most significant of which is the breadth of protection against UVA I.

A surgical guide for craniofacial implant placement for an implant-retained auricular prosthesis.

Craniofacial implants provide excellent stability and retention for auricular prosthetic rehabilitation. Accurate location of implants is important to achieve optimal prosthetic results. This article describes an alternative procedure for fabricating an acrylic resin surgical template for craniofacial implant placement with the assistance of a 6-inch contour duplication gauge.

Many-body ionization in a frozen Rydberg gas.

In a dense gas of 300 microK 85Rb atoms of n approximately 50 ionization occurs on a 100 ns time scale, far too fast to be explained by the motion of the atoms or photoionization by 300 K blackbody radiation. Rapid ionization is accompanied by spectral broadening, with the spectrum becoming continuous at n=88 at a density of 5x10(10)cm(-3). The atomic transitions broaden both smoothly and by the emergence of new features, which we attribute to multiple atom absorptions. We attribute the rapid ionization to a sequence of near resonant dipole-dipole transitions through virtual states in this intrinsically many-body system, culminating in the ionization of some of the atoms.

External auricular and facial prosthetics: a collaborative effort of the reconstructive surgeon and anaplastologist.

Surgeons who communicate on a regular basis with an anaplastologist will benefit from having a more comprehensive practice and will be able to provide a broader depth of information to their patients contemplating facial reconstruction. When a prosthesis is chosen as the best option, it is important for the surgeon to understand that early communication with the anaplastologist can lead to improved appearance and function of the prosthesis. When the surgeon and anaplastologist work closely, their efforts complement one another in creating a final reconstructive plan that will ultimately improve the patient's quality of life.

Sunscreen product formulation.

On the surface, sunscreen products are pretty simple. They consist of a delivery vehicle containing one or more sunscreen active ingredients. When applied to the skin, these sunscreen actives intercept solar ultraviolet (UV) rays before they can damage the underlying skin. However, while conceptually simple, a detailed analysis reveals that sunscreen formulations are quite complex, requiring careful selection of sunscreen active and vehicle components to control multiple performance and in-use parameters.Thus, to enable a better understanding and appreciation of sunscreen products, the typical steps in formulating a sunscreen product are described. Throughout this process, the key is to apply scientific principles together with a bit of formulation art to holistically create the best sunscreen product that meets the design targets--a sunscreen product that people will use regularly and properly.

Ultraviolet A radiation: testing and labeling for sunscreen products.

Conceptually, sunscreen products are quite simple. The ultraviolet (UV) filters in these products reduce the "dose" of solar energy to which the skin is exposed. Underlying this empirical notion are many complexities including measures of product efficacy and how to communicate this to consumers. The sun protection factor (SPF) test is and should remain the singular in vivo method for evaluating sunscreens. Additionally, substrate spectrophotometric measure of absorbance/transmittance and the calculation of the summary statistic, such as the critical wavelength (ie, lambda(c)), should be used as a means of evaluating broad-spectrum (ie, UVA) protection. Ideally, the photoprotective efficacy of sunscreen products will be communicated to consumers as an SPF no greater than 50 and a single designation of "broad-spectrum" to indicate long-wavelength UVA protection.

Dipole-dipole excitation and ionization in an ultracold gas of Rydberg atoms.

In cold dense Rydberg atom samples, the dipole-dipole interaction strength is effectively resonant at the typical interatomic spacing in the sample, and the interaction has a 1/R3 dependence on interatomic spacing R. The dipole-dipole attraction leads to ionizing collisions of initially stationary atoms, which produces hot atoms and ions and initiates the evolution of initially cold samples of neutral Rydberg atoms into plasmas. More generally, the strong dipole-dipole forces lead to motion, which must be considered in proposed applications.