Management of maxillofacial hard and soft tissue discrepancy in Möbius sequence: Clinical report and review of the literature

Background

Möbius sequence implies significant maxillofacial hard and soft tissue anomalies which nevertheless have not been addressed thoroughly in the scientific literature.

Objectives

To report a case of complete Möbius sequence and discuss the management of maxillofacial hard and soft tissue anomalies.

Patients and methods

A 15-year-old girl with complete Möbius underwent bimaxillary orthognathic surgery, horizontal sliding genioplasty and mentalis muscles reinsertion. Vestibuloplasty and bilateral canthopexy were performed to address lip deficiency and attenuate hypotonic depression of the lower eyelids, respectively. Cheekbone augmentation was achieved with an autologous fat transfer. The authors review the scientific literature and discuss surgical planning for the correction of maxillofacial discrepancy.

Results

The patient exhibits significant functional and aesthetic improvement, with excellent integration of the transferred fat and adequate bone healing.

Conclusions

Orthognathic bimaxillary surgery combined to soft tissue management can improve aesthetics and orofacial function in Möbius patients, thereby contributing to facilitate social interaction and increase patients’ self-esteem.     

Evaluation of fit of cement-retained implant-supported 3-unit structures fabricated with direct metal laser sintering and vacuum casting techniques

This study evaluated the vertical discrepancy of implant-fixed 3-unit structures. Frameworks were constructed with laser-sintered Co-Cr, and vacuum-cast Co-Cr, Ni-Cr-Ti, and Pd-Au. Samples of each alloy group were randomly luted in standard fashion using resin-modified glass-ionomer, self-adhesive, and acrylic/urethane-based cements (n = 12 each). Discrepancies were SEM analyzed. Three-way ANOVA and Student-Newman-Keuls tests were run (P < 0.05). Laser-sintered structures achieved the best fit per cement tested. Within each alloy group, resin-modified glass-ionomer and acrylic/urethane-based cements produced comparably lower discrepancies than the self-adhesive agent. The abutment position did not yield significant differences. All misfit values could be considered clinically acceptable.     

High-risk cytogenetics and persistent minimal residual disease by multiparameter flow cytometry predict unsustained complete response after autologous stem cell transplantation in multiple myeloma

The achievement of complete response (CR) after high-dose therapy/autologous stem cell transplantation (HDT/ASCT) is a surrogate for prolonged survival in multiple myeloma; however, patients who lose their CR status within 1 year of HDT/ASCT (unsustained CR) have poor prognosis. Thus, the identification of these patients is highly relevant. Here, we investigate which prognostic markers can predict unsustained CR in a series of 241 patients in CR at day +100 after HDT/ASCT who were enrolled in the Spanish GEM2000 (n = 140) and GEM2005 < 65y (n = 101) trials. Twenty-nine (12%) of the 241 patients showed unsustained CR and a dismal outcome (median overall survival 39 months). The presence of baseline high-risk cytogenetics by FISH (hazard ratio 17.3; P = .002) and persistent minimal residual disease by multiparameter flow cytometry at day +100 after HDT/ASCT (hazard ratio 8.0; P = .005) were the only independent factors that predicted unsustained CR. Thus, these 2 parameters may help to identify patients in CR at risk of early progression after HDT/ASCT in whom novel treatments should be investigated.