Soft tissue facial volumes and shape in skeletal Class III patients before and after orthognathic surgery treatment.

BACKGROUND: To obtain the best surgical results in orthognathic surgery, treatment planning and the evaluation of results should be performed on measurable three-dimensional reproductions of the face of the patients, and compared to reference subjects. METHODS: Seven women aged 18-35 years, all with a skeletal Class III and mandibular asymmetry, were assessed both before (on average, 2 months) and after (on average, 10.7 months) surgical intervention (mandibular reduction by sagittal split osteotomy and LeFort I maxillary advancement). The three-dimensional coordinates of 50 soft tissue facial landmarks (face, eyes, nose, mouth and lips, ears) were collected with a noninvasive, electromagnetic digitizer; facial volumes were estimated, and compared to reference values collected in 87 healthy women of the same age and ethnic group. Inter-individual modifications in facial shape were also assessed. RESULTS: Before surgery the patients had smaller faces than the reference women, with larger lower lips and noses. A large within-group variability was found. Surgical treatment significantly reduced total facial volume and mandibular volume, increased total and upper lip volumes (Student's t test, p<0.05), and made all values more homogenous within the group. Shape differences were significantly larger before than after surgery. On average, right side gonion was the landmark that moved the most, closely followed by menton, while the tragi and ala nasi moved the least. The three-dimensional approach used in this study enabled quantitative evaluation of the final soft tissue results of surgery, without submitting the patients to invasive procedures.     

Relevance of intraoperative D wave in spine and spinal cord surgeries

Purpose

The combined recordings of epidural-(D wave) and muscle motor evoked potentials (m-MEPs) have been proposed in many studies in intramedullary spinal cord tumour (IMSCT) surgery, although not all agree. Furthermore, the usefulness of the intraoperative monitoring of motor systems using these methods in other types of spine surgery has not yet been clearly confirmed. The aim of this study is to test the impact of intraoperative D wave on the monitorability and motor outcome in spine surgery.

Methods

Intraoperative recording of posterior tibial nerve somatosensory potentials, lower limb m-MEPs (LLm-MEPs) and epidurally recorded D wave caudally to the surgical level was attempted in a total of 103 spine and spinal cord surgeries (23 IMSCT, 55 extramedullary spinal cord tumours and 25 myelopathies).

Results

There was a 97.1 %, overall monitorability where at least 1 of the 3 modalities was applicable in 100 surgical procedures. Baseline LLm-MEPs were recorded bilaterally in 85 cases and unilaterally in 11. A caudal D wave was recorded in 97 cases. Transient, or persistent intraoperative modifications occurred in 14/23 IMSCT, 5/55 extramedullary spinal cord tumours and in 2/25 myelopathies. The presence of a persistent stable caudal D wave was predictive of a good motor outcome even when the LL-MEPs were absent and/or when lost during surgery.

Conclusions

Not only is intraoperative D wave recording to be considered mandatory in IMSCT surgery but it should also be attempted in other types of spine/spinal cord surgeries.     

Jaw clenching effects in relation to two extreme occlusal features: patterns of diagnoses in a TMD patient population

Objective:

The aim of this investigation was to compare the pattern of temporomandibular disorder (TMD) diagnoses in clenching patients with different occlusal features, the null hypothesis being that no between-group differences exist.

Materials and methods:

Two groups of subjects receiving a jaw clenching diagnosis and having large overjet or anterior open bite (Group A; N?=?45, 75·5% females, mean age: 38·1±15·9 years) or normal occlusion (Group B; N?=?69, 71% females, mean age: 34·6±13·8 years) were recruited among a TMD patient population and were given Research Diagnostic Criteria for TMD (RDC/TMD) axis I diagnoses, namely, group I muscle disorders, group II disc displacements, and group III arthralgia/osteoarthritis/osteoarthrosis.

Major findings:

The distribution of RDC/TMD single and combined group diagnoses was significantly different between the two groups (P<0·05), with Group A subjects showing a higher prevalence of multiple diagnoses (60% versus 43·3%), as well as a higher prevalence of combined RDC/TMD axis I group II and III diagnoses (37·8% versus 20·2%). All TMD signs and symptoms were more frequent in the patients with large overjet or anterior open bite with respect to the patients with normal occlusion.

Conclusion:

In a TMD patient population, jaw clenching may have different consequences in subjects with large overjet or anterior open bite with respect to subjects featuring normal occlusion.     

A patient with early puberty associated with Chiari 1 malformation

A boy is described with early puberty and Chiari 1 malformation. It is not known whether there was an etiological relationship between these two conditions, or whether they were coincidental. This report emphasizes the utility of MRI when early puberty is diagnosed, particularly in males.     

Immunohistochemical and proteomic profile of melanotic medulloblastoma

We present the case of a 6‐year‐old male affected by an infratentorial tumor. Histological diagnosis was melanotic medulloblastoma. Immunohistochemistry showed in the melanin rich areas positive cells for HMB45. We performed a proteomic study to compare protein profiles in melanotic versus non‐melanotic areas. Protein profiles of different areas of the tumor displayed similarity, with the exception of seven proteins. In accordance with the hypothesis that melanotic medulloblastomas produce oculo‐cutaneous melanin, proteomic analysis showed melanocytic‐associated antigens and epidermal autoantigen 450K in the pigmented nodule; both these proteins have a significant role as markers of melanotic elements. Pediatr Blood Cancer 2009;52:875–877. © 2008 Wiley‐Liss, Inc.     

Influence of psychological symptoms on home-recorded sleep-time masticatory muscle activity in healthy subjects

The present investigation attempts to describe the correlation between sleep-time masticatory muscle activity (MMA) and psychological symptoms by the use of a four-channel electromyography (EMG) home-recording device in a group of 15 healthy volunteers completing a battery of psychometric questionnaires for the assessment of anxiety, depression and anger. The integrated EMG signal was adopted to quantify the work (μV × s) produced by each of the four muscles (bilateral masseter and temporal) during the 5-h recording span and per each 1-h increment. The duration of MMA events and the muscle work during the first hour of sleep was related to trait anxiety scores for both masseter (P = 0·007) and temporalis muscles (P = 0·022). Trait anxiety was also significantly correlated to the total amount of MMA duration (in seconds) of the temporalis muscles (r = 0·558; P = 0·031). The present investigation provides support to the hypothesis that the duration of sleep-time masticatory muscle activity, especially during the early phases of a night's sleep, may be related to anxiety trait and not to anxiety state, depression or anger. These findings may support the view that features related to the individual management of anxiety, viz. trait, are likely to be more important than acute episodes of anxiety, viz. state, in the aetiology of sleep-time masticatory muscle activity. The role of other psychological symptoms is likely to be less important.     

The use of acrylic spacers in orthognathic model surgery

A technique has been presented for use in conjunction with model surgery that provides both a permanent record and a stabilization device for study models prior to and after their surgical repositioning. It is extremely useful during the planning of the surgery and as a permanent source of reference, postoperatively.     

Statistical comparison of surgical results with or without laser in neurosurgery]

In the literature, no significant statistical studies have been published on the effectiveness of laser compared with traditional procedures in neurosurgery; we have decided to study a series of 198 gliomas and 220 meningiomas operated upon either with a laser or with conventional techniques. We considered the post-operative morbidity, the duration and the quality of survival. These data have been clearly influenced by the type of surgery. On the contrary, no significative difference was observed concerning the survival rate of gliomas whatever their grading. In the laser-group, morbidity and quality of life are improved (36 months follow-up); but the mortality rate (3 years) is equal in both groups. Concerning meningiomas, patients of both groups (with and without laser) were clinically improved during the post-operative period. A significative difference appears only for meningiomas located in functional areas and operated with a laser.