Simultaneous Rhinoseptoplasty and Orthognathic Surgery: Outcome Analysis of 250 Consecutive Patients Using a Modified Le Fort I Osteotomy.

BACKGROUND: The purpose of the present study was to assess the safety and efficacy of both functional intranasal procedures and cosmetic rhinoplasty combined with bimaxillary surgery. METHODS: The author executed a retrospective cohort study derived from patients who underwent combined rhinoseptoplasty and bimaxillary surgery at a private practice setting (Face Surgery Center, Parma, Italy) between April 2006 and 2015 by a single surgeon. The minimum follow-up was 12 months. Patients underwent bimaxillary orthognathic surgery, functional nasal surgery and cosmetic rhinoplasty. RESULTS: Two-hundred and fifty (250) consecutive, non-randomized patients met the inclusion criteria to enter the study. The overall complication rate was 5%, whereas the revision rate was 9%, showing an overall low rate, comparable to that of primary rhinoplasty (control group). About 94% of the patients polled after this procedure asserted they definitely accepted to have rhinoplasty only because it was included in one single surgical act together with orthognathic surgery. CONCLUSION: Cosmetic rhinoplasty shows great potentials to change our patients' appearance, whereas orthognathic surgery corrects jaw skeletal deformities and builds the right foundation for facial harmony. The combination of both procedures magnifies the single results reciprocally and significantly enhances the final outcomes. The quality of the overall aesthetic results, the scarcity of complications and the low percentage of defects that require revisions lead to the conclusion that when alterations to both the jaws and the nose are detected, a single intervention can grant great benefit to the patients in terms of morbidity and costs. LEVEL OF EVIDENCE IV: 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 .

Closed reduction of the isolated anterior frontal sinus fracture via percutaneous screw placement.

Fractures of the frontal sinus are a common maxillofacial trauma and constitute 5-15% of all maxillofacial fractures. Conventional surgical approaches include the coronal flap, direct cutaneous incision, and endoscopic techniques. Minimally invasive techniques have recently been described for the reduction of the isolated anterior frontal sinus fracture via a closed approach. The medical records and radiological findings of all patients who underwent surgical treatment for anterior frontal sinus fractures from January 2009 to December 2013 at the study hospital in Florence, Italy, were reviewed. The final study sample consisted of 15 patients (13 males and two females) with isolated anterior frontal sinus fractures who were treated with closed reduction using percutaneous screws. The mean age was 32.1 years. The skin incisions healed without any visible scarring, and no depressions of the frontal sinuses were evident in the postoperative period. Computed tomography scans performed at 6 months postoperatively showed adequate reduction of the displaced fragments. This closed technique is a good option for displaced isolated fractures of the anterior frontal sinus. However, the technique is not adequate for complex fractures of the frontal sinus.

[The patient on hemodialysis: psychological and management difficulties]. / Il paziente emodializzato: difficoltà psicologiche e gestionali.

OBJECTIVES: Chronic renal failure is a public health problem of great relevance for significant mortality and high socio-economic impact. This study purposed to assess the psychological status in patients on hemodialysis; moreover other purpose is to investigate the possible differences among the first 3 months of hemodialysis treatment replacement. MATERIALS AND METHODS: The study was carried out on 12 hemodialysis patients, aged 71.6 years (range: 34-87). Mood was measured by using the Profile of Mood States (POMS) developed in 1971 by Douglas M. McNair. RESULTS: The overall score of mood disorders shows a total negative state in the initial phases of dialysis treatment [F (2,22) = 10.17; p <0.01] and a progressive improvement of the same, with a linear trend [F (1,11) = 12.65; p <0.05]. CONCLUSIONS: The model of hemodialysis patients is particularly interesting for several reasons, but especially for the possibility of crosssectional and longitudinal assessments. The aim of future studies will be to characterize and investigate the complex psycho-social variables in this category of patients, to improve their quality of life.

Spindle cell liposarcoma of the face: case report and literature review.

Liposarcoma is a common soft tissue sarcoma accounting for approximately 20% of all mesenchymal tumours across all ages. Recently, collaborative research in the specialties of pathology and genetics has led to the delineation of several tumour variants with different behaviours and prognoses, one of which includes the very rare spindle cell liposarcoma (SCL) subtype. We present the first case of an SCL arising in the subcutaneous tissue of the forehead of a 78-year-old man. In light of the rarity of this tumour, we describe the tumour and its clinical and pathological characteristics and undertake a literature review to clarify the surgical management and prognosis of SCL, and increase awareness to avoid misdiagnosis of a benign soft tissue neoplasm.

Adipofascial anterolateral thigh free flap for hemifacial atrophy.

Restoration of a harmonious and pleasant appearance is a crucial aspect of surgical treatment for many congenital and acquired deformities of the face. A 38-year-old female patient with residual scarring on the right hemiface following evacuation of a odontogenic phlegmon underwent microsurgical reconstruction with a free adipofascial anterolateral thigh free flap. A stable result was achieved 7 years later. Thanks to adipofascial anterolateral thigh free flap fixation onto the periosteum a very good long-lasting aesthetic and dynamic result was obtained; this approach can be used in patients both with severe and mild abnormalities. Whereas many methods of facial contour restoration are described in the literature, in Authors' opinion, microsurgical techniques are the gold standard unless contraindications; fasciocutaneous flaps, in particular, have shown the best aesthetic results since they can be sculptured to match the defect and stable anchoring is possible thanks to the thick fascia of the anterolateral thigh free flap.

Further experience with adipofascial ALT flap for oral cavity reconstruction.

BACKGROUND: The restoration of the buccal mucosa is the main challenge for the plastic surgeon. In the past 15 years the free radial forearm flap has been widely used, due to its thickness and pliability. More recently, the anterolateral thigh free flap has become the customary flap in oral cavity reconstruction. METHODS: Six patients affected by oral cavity tumours underwent microsurgical reconstruction with the adipofascial anterolateral thigh free flap between December 2005 and December 2006. RESULTS: One flap was lost due to venous thrombosis. In the other five flaps the postoperative period was uneventful. The patients are still free from disease. Multiple biopsies were performed to compare the neo-mucosa with the native. No relevant differences have emerged. CONCLUSIONS: Replacing tissue with like tissue should be the surgeon's aim. In the authors' opinion, the adipofascial variation of the anterolateral thigh free flap is the ideal replacement for oral cavity mucosa, allowing good fixation and mobility, and optimum aesthetic and functional results. It can be thinned to fit the defect with low risk. The patching condition resulting from fasciocutaneous flaps reconstruction is avoided. The remucosalisation of the flap occurs in about 1 month for the neo-mucosal functions as it does in the native tissue. It is non-hair bearing and is not influenced by postoperative radiotherapy.

Submandibular cellulitis (Ludwig's angina) associated to a complex odontoma erupted into the oral cavity. Case report and literature review.

The clinical presentation of Ludwig's angina consists in a severe expanding cellulitis causing swelling of the floor of the mouth, tongue and submandibular region, thus resulting in a possible obstruction of the airway and in a rapid progress in deep neck soft tissue infection and mediastinitis with potentially fatal consequences. Frequently, submandibular cellulitis develops from an acute infection spreading from the lower molar teeth. Mandibular fractures, traumatic laceration of the floor of the mouth, and peritonsillar abscesses are other concomitant clinical features. A case of Ludwig's angina associated with a large erupted odontoma and with a deeply impacted third molar displaced to the border of the mandible is described. The patient was affected by enlargement of submandibular space, marked face swelling causing an evident face deformity, tenderness and redness of the neck and limited movement of the neck and mouth. In the past, Ludwig's angina was frequently fatal, however aggressive surgical and medical therapy have significantly reduced the mortality rate. The reported case can be considered as important, not only because of the rarity of the odontoma eruption in the oral cavity, but mainly for the extent of the clinical manifestation of a lesion usually described in literature as asymptomatic.

Acute thyroiditis of odontogenic origin.

If an abscess is not able to establish drainage through the skin surface or into the oral cavity, it may spread diffusely through fascial planes of the neck's soft tissue. Once the infection descends into the submandibular space, it may extend to the lateral pharyngeal space, and then to the retro-pharyngeal space. From here, it may reach the thyroid gland. The authors here describe a case of submandibular phlegmon derived from a periapical abscess of inferior premolar, which has reached the thyroid gland. The damage caused to the gland resulted in the release of a conspicuous quantity of thyroid hormones, thus causing a thyrotoxic pattern: temperature, cutaneous pallor, excessive perspiration, tremor, tiredness, weight loss, increased appetite, and tachycardia. Additionally, the gland's edema caused dysphagia and dysphonia commonly seen with thyroid gland enlargement. After dental drainage and appropriate anti-inflammatory and antibiotic therapy, administration of oral beta-blockers and corticosteroid therapy were performed to counteract thyrotoxicosis in order to prevent recurrences. Finally, a root canal was performed once the thyrotoxicosis had been resolved.

Simultaneous determination of B-group vitamins in enriched Brazilian dairy products.

In addition to serving as good natural sources of vitamin B(2), milk and milk products are currently being enriched with the vitamins B(1), B(2), B(6), and nicotinamide in Brazil. The objective of this research was to evaluate the levels of enrichment of these products according to their availability in supermarkets in the Campinas (SP, Brazil) region. The separation of the vitamins was carried out on a C 18 column with gradient elution with acetonitrile and aqueous phase. Detection of vitamins was effected in the ultraviolet region and quantification by an external standard. The levels of vitamin B(2) determined in powdered whole milk, skimmed milk powder, and one brand of flavored lactic beverage, were practically double those stated on the packages. The same occurred with vitamins B(6) and PP (nicotinic acid + nicotinamide), when determined in the same lactic beverage and with vitamin B(6), determined in acidified milk. The high levels of vitamin B(2), naturally present in whole milk, and the predominance of the free form, allowed for the determination of this vitamin in non-enriched milk.

Treatment of human immunodeficiency virus-associated facial lipoatrophy with lipofilling and submalar silicone implants.

In the absence of a current therapy to prevent facial lipoatrophy in HIV+ patients treated with HAART, surgical correction of the defect still remains the best option. We evaluate two different surgical techniques for facial contour enhancing and suggest the right choice related to the lipodystrophy severity. Twelve HIV+ patients underwent surgical submalar correction: eight were treated with lipofilling following Coleman's technique and four had bilateral malar silicone implants inserted after determining their positioning with the aid of a new software. Both techniques gave long lasting results in facial contour reshaping ranging from good to very good. No complication was observed. In the mean follow-up period of 2 years no patient felt uncomfortable with his/her image. Both techniques, lipofilling and silicone implant positioning, for managing facial lipoatrophy in HIV+ patients treated with HAART had good results, but the right choice has to be related to the severity of the lipodystrophy in the patient.

Adipofascial anterolateral thigh free flap for tongue repair.

With the advent of microsurgery fasciocutaneous free flaps have become a well known and accepted option for the repair of tongue defects. Many authors have tried to recover tongue function by modifying this approach. An innovative method for the repair of tongue defects using an adipofascial anterolateral thigh free flap is presented in this paper. The results are compared with those of tongue reconstructions implementing traditional fasciocutaneous free flaps performed at our institution. The histological features of the flaps were investigated postoperatively. Although this preliminary report has to be confirmed by further experience, it seems to solve many tongue-reconstruction related problems.

Spatial articulation affects lightness.

In a recent paper, Agostini and Bruno (1996) showed that the size of simultaneous lightness contrast increases under Gelb lighting. To extend Agostini and Bruno's work, we applied their methodology to a set of more spatially articulated displays. In four experiments, we investigated the role of spatial articulation on the size of the simultaneous lightness contrast effect. In the first experiment, we found a decrease of the simultaneous lightness contrast effect as the spatial articulation increased. In the second experiment (the control experiment), performed under homogeneous illumination, we found that the effect of spatial articulation is not detectable, even though the data seem to show the same trend as that in the previous experiment. In the third experiment, we found that spatial articulation affects not only the middle reflectance region, but also the lowest one. As the spatial articulation increases, the effect on the lightnesses of both regions decreases. In the last experiment, performed with a reduced range of reflectances, we found a lightening effect for all the reflectances and, again, an effect of spatial articulation. The results of these experiments are interpreted according to the model proposed by Gilchrist et al. (in press).

An anchoring theory of lightness perception.

A review of the field of lightness perception from Helmholtz to the present shows the most adequate theories of lightness perception to be the intrinsic image models. Nevertheless, these models fail on 2 important counts: They contain no anchoring rule, and they fail to account for the pattern of errors in surface lightness. Recent work on both the anchoring problem and the problem of errors has produced a new model of lightness perception, one that is qualitatively different from the intrinsic image models. The new model, which is based on a combination of local and global anchoring of lightness values, appears to provide an unprecedented account of a wide range of empirical results, both classical and recent, especially the pattern of errors. It provides a unified account of both illumination-dependent failures of constancy and background-dependent failures of constancy, resolving a number of long-standing puzzles.

The trajectory of a dot crossing a pattern of tilted lines is misperceived.

The straight trajectory of a dot crossing a pattern of tilted lines is perceived as being sinusoidal. Manipulation of the size of the angle between the trajectory and the tilted lines, the velocity of the dot, and the distance between the tilted lines shows that the magnitude of the illusion is inversely proportional to the size of the incidence angle, to velocity, and to the distance between the lines. The illusion is interpreted as being the result of an integration process of local distortions occurring at the intersections with the tilted lines.

The sensitivity of allele-specific polymerase chain reaction can obviate concern of maternal contamination when fetal samples are genotyped for immune cytopenic disorders.

OBJECTIVE: Fetuses at risk for immune cytopenic disorders can be identified by molecular genotyping assays. To better understand the impact of maternal contamination on genotyping results, the levels of contamination that are routinely encountered during prenatal testing of fetal samples and the sensitivity of allele-specific polymerase chain reaction in detecting paternal alloalleles were examined. STUDY DESIGN: Reconstitution experiments were performed to define the sensitivity of allele-specific polymerase chain reaction assays. The sensitivities of allele-specific polymerase chain reactions and polymerase chain reaction-restriction fragment length polymorphism were compared for detection of the factor V Leiden mutation. RESULTS: A quantitative analysis of variable-number tandem repeat loci revealed maternal contamination in 4 of 56 fetal samples. Contaminating deoxyribonucleic acid compromised genotyping results when it comprised between 94% and 99% of the total deoxyribonucleic acid. Allele-specific polymerase chain reaction was found to be the more sensitive technique (0.8% sensitivity vs 13% sensitivity). CONCLUSION: These results illustrate that allele-specific polymerase chain reaction is well suited for reliable prenatal identification of fetuses at risk of immune cytopenic disorders.

One-tube method for complete HPA-1 genotyping by PCR using sequence-specific primers.

Human platelet antigens (HPA) can be targets for antibody responses that cause life-threatening thrombocytopenia following platelet transfusions or pregnancy. As an aid to diagnosis and prevention, serologic and DNA-based methods have been developed to type HPA. Of the DNA-based strategies, those using the polymerase chain reaction (PCR) are very sensitive, but often require processing of amplification products. Sequence-specific primers (SSP) in the PCR eliminate the need for extensive handling of reaction products beyond gel electrophoresis. However, current methods require a separate reaction for each allele being typed. In this report we describe a method to simultaneously and completely genotype both alleles of HPA-1 in a single PCR. In addition, because the absence of an amplification product might also show the failure of a SSP, we introduced a recombinant template that can only be amplified by the SSP, thus ensuring primer performance and the identified genotype.

Lightness contrast in CRT and paper-and-illuminant displays.

The increased use of CRT monitors for displaying and controlling stimuli in studies of surface color poses problems of comparability with data obtained with traditional paper-and-illuminant methods. A review of comparable studies using the two methodologies revealed that CRT studies tend to report larger contrast effects. To investigate factors that may be responsible for this difference, simultaneous lightness contrast was measured using both CRT and paper-and-illuminant presentations. The spatial distribution of luminance in the whole field of view and the visual angles subtended by the displays were controlled. The CRT presentation yielded contrast effects twice as big as those measured for a paper surface in a homogeneously illuminated room. However, a paper display under Gelb lighting yielded almost exactly the same effect size as that measured in the CRT presentation. These results demonstrate that contrast effects in both modes of presentation are affected by the spatial distribution of luminance beyond the basic experimental stimuli.

[Chemical characteristics of the pulp and oil of the annona tree (Annona coriaceae)]. / Caracterizaçáo química da polpa e do óleo do marolo (Annona coriaceae).

Belonging to the Annonaceae family, marolo (Annona coriaceae) is a native species of the Brazilian "cerrado" región (Minas Gerais, Goiás and Distrito Federal) and can be found in South American tropical zones. Its fruits are highly consumed by local people and commercialized in markets or street stalls. There is, however, a tendency for the extinction of marolo due to deforestation and the large scale plantation of monocultures instead of native plants. The literature still offers no data on the chemical composition of the proximate composition and vitamin C, A and tannin contents were carried out on the yellow marolo pulp as well as the determination of the physico-chemical characteristics of the seed oil. Five batches of fruit from the Alfenas region--south of Minas Gerais State--were analysed in this work and their average composition were: humidity 77%, total sugar 15%, reducing sugar 11%, crude protein 1%, lipids 3%, fiber 5% and fixed mineral residue 1%. The contents of vitamin C and A were 8.2 mg/100g and 117.5 RE/100g, respectively, and the tannin content was 245 mg/100g. The results showed high fiber and lipid contents of marolo pulp in comparison with many other tropical fruit pulps. The vitamin C contents were equivalent to those found in avocado, pineapple and watermelon, while the vitamin A contents were equivalent to papaya, peach, guava and several other tropical fruits. Marolo seed contains 45% of oil on a dry basis. Its composition and physico-chemical characteristics showed the possibility of producing a good quality oil, with great potential for the fine oil market. However the presence of alkaloids in the oil needs to be further studied. Their elimination could be done by refining or extraction in a continuous press. The results exalt the high quality of marolo pulp, showing that the preservation of native species should be stimulated.