Unexpected massive bleeding during the modified LeFort III advancement surgery for Crouzon syndrome: A case report.

Key Clinical Message: Vigilant monitoring for postoperative complications, including bleeding and dysrhythmia, is crucial in patients with craniosynostosis syndromes like Crouzon syndrome undergoing craniofacial surgery, with a thorough evaluation, including coagulation tests, assisting in diagnosing underlying conditions such as von Willebrand disease subtype 1 to inform appropriate management strategies. Abstract: Crouzon syndrome is a rare genetic disorder affecting craniofacial structures. Its etiology is the premature fusion of cranial sutures. The LeFort III advancement surgery is a commonly used approach to correct malformations related to midface hypoplasia. Complications following surgical treatment of craniosynostosis and craniofacial syndromes can include both intracranial and extracranial problems. Reporting of this syndrome and the surgery complications, in addition to consideration of other differential diagnoses, can help improve the treatment plan and surgery outcomes. The aim of the article is to report a 14-year-old female with Crouzon syndrome who underwent the modified LeFort III osteotomy and developed unexpected massive bleeding during the surgery. Post-surgery, she experienced complications including dysrhythmia, hypothermia, and cyanosis. Treatment included fluid therapy, blood transfusions, and antibiotic therapy for suspected septic shock. Differential diagnosis was disseminated intravascular coagulation but was ruled out. Post-discharge, coagulation tests suggested von Willebrand disease subtype 1 as the diagnosis. Excessive bleeding during surgery for craniosynostosis syndromes is a significant and concerning issue in the surgical management of Crouzon syndrome. For patients with von Willebrand disease who are candidates for elective surgeries, von Willebrand factor concentrates or recombinant von Willebrand factor can be used.

3D-printed MgO nanoparticle loaded polycaprolactone ß-tricalcium phosphate composite scaffold for bone tissue engineering applications: In-vitro and in-vivo evaluation.

Magnesium (Mg) plays an important role in controlling bone apatite structure and density and is a potential bioactive material in repairing critical-sized bone defects. In this study, we aimed to evaluate the effect of adding NanoMgO to polycaprolactone/beta-tricalcium phosphate (PCL/ß-TCP) scaffolds on bone regeneration. Novel 3D-printed porous PCL/ß-TCP composite scaffolds containing 10% nanoMgO were fabricated by fused deposition modeling (FDM) and compared with PCL/ß-TCP (1:1) scaffolds (control). The morphology and physicochemical properties of the scaffolds were characterized by ATR-FTIR, XRD, scanning electron microscope-energy dispersive X-ray analysis (SEM-EDX), transmission-electron-microscopy (TEM), water contact angle, and compressive strength tests and correlated to its cytocompatibility and osteogenic capacity in-vitro. To evaluate in-vivo osteogenic capacity, bone-marrow-derived stem cell (BMSC)-loaded scaffolds were implanted into 8 mm rat critical-sized calvarial defects for 12 weeks. The hydrophilic scaffolds showed 50% porosity (pore size = 504 µm). MgO nanoparticles (91.5 ± 27.6 nm) were homogenously dispersed and did not adversely affect BMSCs' viability and differentiation. Magnesium significantly increased elastic modulus, pH, and degradation. New bone formation (NBF) in Micro-CT was 30.16 ± 0.31% and 23.56 ± 1.76% in PCL/ß-TCP/nanoMgO scaffolds with and without BMSCs respectively, and 19.38 ± 2.15% and 15.75 ± 2.24% in PCL/ß-TCP scaffolds with and without BMSCs respectively. Angiogenesis was least remarkable in PCL/ß-TCP compared with other groups (p < .05). Our results suggest that the PCL/ß-TCP/nanoMgO scaffold is a more suitable bone substitute compared to PCL/ß-TCP in critical-sized calvarial defects.

Validity and reliability of tooth color selection by smartphone photography and software applications.

Aim: This study assessed the validity and reliability of color selection by smartphone photography using two smartphone applications and Adobe Photoshop software. Settings and Design: In vitro comparative study. Materials and Methods: The validity and reliability of dental tooth shade recognition (DTSR), Chromatcher, and Adobe Photoshop were evaluated for color selection of shade tabs. The iPhone 7 camera in automatic mode was used for photography. Images were captured using Smile Lite with/without polarized filter and with camera flash. To assess the reliability, nine Vita Lumin Vacuum shade tabs were chosen and each was photographed for 10 times using Smile Lite. The reliability of DTSR, Chromatcher, and Photoshop in shade-taking was calculated. To assess their validity, 16 shade tabs of Vita Lumin Vacuum and 26 shade tabs of Vita 3D Master were photographed using the aforementioned lighting conditions. The color of photographs was calibrated and shade-taking was performed and compared with the shade suggested by SpectroShade as reference. Statistical Analysis Used: Data were analyzed using Two-way analysis of variance and Bonferroni post hoc test. Results: The reliability of Photoshop, DTSR, and Chromatcher was 98.88%, 63.3%, and 100%, respectively. The validity of Photoshop was significantly higher than other software programs (P < 0.05). Chromatcher had higher validity than DTSR (P < 0.05). Conclusion: Shade-taking by calibrated smartphone pictures and Adobe Photoshop has high validity and reliability.