Sinus lift access in partial maxillectomies

Maxillectomies often result in anatomical defects that need to be reconstructed. In partial maxillectomies, the most significant defect is the formation of an oronasal or oral-antral fistula. This creates discomfort and needs to be addressed secondarily with local or regional flaps. Here, we describe a technique adopted in 8 patients in which limited maxillectomies are carried out in a way that preserves the nasal and sinus mucosa, preventing the formation of fistulas and allowing the use of flaps that would normally carry a high risk of fistula formation. Contemporary bone reconstruction with grafts was used in 2 patients. Sparing the sinus and nasal mucosa during maxillectomies is an easy, safe procedure that can prevent a number of complications and can be recommended in selected cases.

High levels of women's satisfaction and compliance with transdermal contraception: results from a European multinational, 6-month study

OBJECTIVE

To investigate compliance, satisfaction, and preference in women using a transdermal contraceptive patch.

METHODS

Women (18-46 years) from eight European countries used contraceptive patches (norelgestromin 6 mg, ethinylestradiol 600 μg) for six, 4-week treatment cycles. Compliance, satisfaction, and preference were assessed after 3 and 6 cycles and study completion using self-report methods.

RESULTS

Of the 778 participants, 36.8% (n = 287) used no contraception at baseline. The most common methods were oral contraceptives (67.9%, n = 334) and barrier methods (21.5%, n = 106). Of oral contraception users, 63.5% (n = 212) were satisfied or very satisfied with their previous method, but compliance was poor with 77.8% (n = 260) reporting missed doses. After 3 and 6 cycles, >80% of all included women were satisfied or very satisfied with the patch. At study completion, most participants (73.7%) reported a preference for the patch compared to their previous method. Of 4107 cycles, 3718 (90.5%) were completed with perfect compliance. Two pregnancies occurred during this study, representing a Pearl Index of 0.63. No new safety issues were identified and the patch was well tolerated.

CONCLUSION

Women were highly satisfied with transdermal contraception and preferred this form of family planning over their previous method. Transdermal contraception represents a valuable addition to contraceptive options with potential to offer high compliance and efficacy.

HIF-1α mRNA levels in Eurasian perch (Perca fluviatilis) exposed to acute and chronic hypoxia

The big advantage of using molecular biomarkers to monitor oxygen levels in aquatic systems is that responses at the molecular level tend to be more sensitive, and usually occur earlier than those at higher levels of biological organization Aquatic hypoxia is a frequent event, which can occur naturally in a variety of marine, estuarine and freshwater habitats. More often, however, hypoxia arises as a result of euthrophication of aquatic ecosystem and can lead to changes in community structure by eliminating hypoxia-sensitive species. Consequently fish have develop various physiological and biochemical mechanisms to cope with this environmental stress. Many of these adjustments depend to changes in expression of a wide range of genes. The transcriptional responses to hypoxia are primarily mediated by hypoxia-inducible factor-1 (HIF-1), a heterodimer composed of an α and β subunit. This study investigated if HIF-1α mRNA levels were regulated by hypoxia in Eurasian perch (Perca fluviatilis), a hypoxia-sensitive fresh water species. The real-time PCR was utilized to monitor dynamic changes in levels of HIF-1α mRNA in response to acute (DO 0.4 ± 0.1 mg/l for 1 h) and chronic (DO 2.8 ± 0.3 mg/l for 15 days) hypoxia. Our results indicated an up-regulation of HIF-1α in brain and liver, but not in muscle tissue after acute hypoxic treatment, whereas significant changes of HIF-1α mRNA levels were detected in muscle, but not in brain and liver after chronic hypoxia exposure. This study suggests that HIF-1α mRNA level in selected perch tissues could be an useful indicator of acute exposure to hypoxia.

Lingual nerve lesion during ranula surgical treatment: case report

Iatrogenic lingual nerve (LN) injuries are quite common in oral surgery both in maxillo-facial surgery and in oral surgery. LN runs superficially into the lateral mouth floor just beneath the mucous layer and this position enhances damage frequency. This article lists the different aetiologies of iatrogenic LN injuries and it almost focuses on lesions due to surgical treatment of ranulas. In the case report a LN lesion due to oral ranula excision is discussed; the patient experienced anaesthesia and hyperpatia in the corrisponded tongue side. It was treated with a microneurosugical anastomosis of LN, after amputation neuroma excision. The partial and definitive recovery of perception happened in six months and was deemed satisfying with 70% of functionality restored (results compared with the functionality of the contralateral side). An algorithm for diagnosis and therapy indication for iatrogenic injuries to nerves is also proposed. In case of surgical treatment, funcitonal recovery manifests after 4-6 month; a functional recovery of 70% of total nerve function is possible. The variable that most affects nerve functional recovery is surgical treatment timing; it must be performed as soon as possible.

Reconstruction of the anterior floor of the mouth using a peroneal perforator free flap. A case report

Personal experience is presented concerning a case in which reconstruction of the anterior floor of the mouth was carried out using a fascio-cutaneous free flap harvested from the lateral part of the leg; the flap pedicle is represented by perforating vessels originating from the peroneal vascular axis.

Use of porous polyethylene for correcting defects of temporal region following transposition of temporalis myofascial flap

Transposition of the temporalis myofascial flap results in permanent aesthetic stigma in the donor site. Reconstruction of this deformity is desirable. The Authors present personal experience in the use of a porous polyethylene prosthesis to camouflage the temporal defects following transposition of the temporalis myofascial flap. From 2002 to 2005, 12 patients (5 male, 7 female, age range 36-84 years, mean 60), following the transposition of the temporalis myofascial flap, underwent reconstruction of the temporal region defect using porous high-density polyethylene temporal implants. The majority of the neoplasms removed proved to be squamous cell carcinomas of the alveolar crest or of the sinusal antrum. The standard surgical technique was used, namely, hemicoronal access and placement of 12 porous high-density polyethylene prostheses (5 left, 7 right). The size of the implants to be used (small, medium, large) was decided during the surgical operation. Of the 12 patients, 2 underwent post-operative radiotherapy, 6 weeks after the implantation of the prosthesis, without adopting any particular precautions to protect the area directly involved in the prosthesis implant. All patients are alive and free from disease, and implant placement appears to be free from post-operative complications. During the period of radiotherapy no complications. directly or indirectly related to the prosthetic implant, arose. Placement of the high-density polyethylene prosthesis fulfilled its filling effect on the deficit with a cosmetic success rate of 90%, as it was well integrated with no evident discontinuity between the edges of the prosthesis and the surrounding tissue or any alteration in the physiological convexity of the treated region. There were no incidents of pain or dysaesthesia of the skin covering the prosthesis. In conclusion, reconstruction of the temporal defect after temporalis myofascial flap transposition with the use of high-density polyethylene implants is an easy and safe method, with excellent functional and aesthetic results.

Management of a case of arhinia

Arhinia is a rare condition characterised by the congenital absence of nasal structures, with different patterns of presentation, and often associated with other craniofacial or somatic anomalies. To date, about 30 surviving cases have been reported. We report the case of a female patient aged 6 years, who underwent internal and external nose reconstruction using a staged procedure: a nasal airway was obtained through maxillary osteotomy and ostectomy, and lined with a local skin flap and split-thickness skin grafts; then the external nose was reconstructed with an expanded frontal flap, armed with an autogenous rib framework.

A single question for the rapid screening of restless legs syndrome in the neurological clinical practice

The purposes of this study were to validate the use of a single standard question for the rapid screening of restless legs syndrome (RLS) and to analyze the eventual effects of the presence of RLS on self-assessed daytime sleepiness, global clinical severity and cognitive functioning. We evaluated a group of 521 consecutive patients who accessed our neurology clinic for different reasons. Beside the answer to the single question and age, sex, and clinical diagnosis, the following items were collected from all patients and normal controls: the four criteria for RLS, the Epworth Sleepiness Scale (ESS), the Clinical Global Impression of Severity (CGI-S), and the Mini-Mental State evaluation. RLS was found in 112 patients (70 idiopathic). The single question had 100% sensitivity and 96.8% specificity for the diagnosis of RLS. ESS and CGI-S were significantly higher in both RLS patient groups than in normal controls. RLS severity was significantly higher in idiopathic than in associated/symptomatic RLS patients. RLS can be screened with high sensitivity and good reliability in large patient groups by means of the single question; however, the final diagnosis should always be confirmed by the diagnostic features of RLS and accompanied by a careful search for comorbid conditions.

REM sleep behaviour disorder

REM sleep behaviour disorder (RBD) is a parasomnia characterised by nocturnal complex motor activity associated with dream mentation. RBD, which affects mainly older men, may be idiopathic or associated with other neurological disorders. A strong association between RBD and alpha-synucleinopathies has been recently observed, with the parasomnia often heralding the clinical onset of the neurodegenerative disease. The idiopathic form accounts for up to 60% of the cases reported in the three largest series of RBD patients. Follow-up studies in small samples revealed that a proportion of RBD patients will eventually develop Parkinson's disease and/or a dementia of Lewy bodies type in the years following the RBD diagnosis. Recently, neurophysiological and neuropsychological studies in idiopathic RBD have found evidence of central nervous system dysfunction. An impairment of cortical activity, specific neuropsychological deficits, signs of autonomic dysfunction and olfactory impairment have been observed in these patients, challenging the concept of idiopathic RBD. The detection of early markers of neurodegenerative disorders in idiopathic RBD, and the evaluation of their value by the combined application in prospective studies may be crucial for developing early intervention strategies.

Impaired movement control in Alzheimer's disease

Movement accuracy in normal subjects depends on feedforward commands based on representation in memory of spatial and biomechanical features. Here we ask whether memory deficits in Alzheimer's disease (AD) interfere with movement planning and execution. Nine AD patients and nine age-matched controls moved a cursor to targets without seeing their limb. Starting and target positions were always visible on a screen, while, during movement, cursor position was either visible or blanked. Patients' paths showed discontinuous segments and prolonged movement time; movement inaccuracy, which increased without visual feedback, correlated significantly with scores of disease severity, working memory and attention.