Postoperative Management of Zygomatic Arch Fractures: In-House Rapid Prototyping System for the Manufacture of Protective Facial Shields

Zygomatic fractures account for 10% to 15% of all facial fractures. The surgical management of isolated zygomatic arch fractures usually requires open reduction treatment without fixation through an intraoral access. Therefore, the main problem in the non-fixed treatment of zygomatic arch fractures is related to the difficulty in obtaining a stable reduction for a period long enough to guarantee the physiological bone healing process. We propose an innovative "in-house" rapid prototyping (RP) protocol for the 3D-zygoma mask manufacture of a patient-specific protective device to apply after zygomatic arch fracture reduction. Our study includes 16 consecutive patients who underwent surgical open reduction for an isolated zygoma fracture without fixation between January 2017 and February 2018. The patients received regular postoperative checks at weeks 1 and 2. Before the device was removed, a multiple choice questionnaire was administered to measure the degree of wearability of the mask. The estimated cost of the production is around &OV0556;5 per case and the construction time is around 90 minutes. Based on the encouraging results, obtained in our experience, we hope that other studies can be conducted to confirm our procedure and improve its functionality in the field of facial trauma

Perisylvian white matter connectivity in the human right hemisphere

Background By using diffusion tensor magnetic resonance imaging (DTI) and subsequent tractography, a perisylvian language network in the human left hemisphere recently has been identified connecting Brocas's and Wernicke's areas directly (arcuate fasciculus) and indirectly by a pathway through the inferior parietal cortex. Results Applying DTI tractography in the present study, we found a similar three-way pathway in the right hemisphere of 12 healthy individuals: a direct connection between the superior temporal and lateral frontal cortex running in parallel with an indirect connection. The latter composed of a posterior segment connecting the superior temporal with the inferior parietal cortex and an anterior segment running from the inferior parietal to the lateral frontal cortex. Conclusion The present DTI findings suggest that the perisylvian inferior parietal, superior temporal, and lateral frontal corticies are tightly connected not only in the human left but also in the human right hemisphere

The effects of visual control and distance in modulating peripersonal spatial representation

In the presence of vision, finalized motor acts can trigger spatial remapping, i.e., reference frames transformations to allow for a better interaction with targets. However, it is yet unclear how the peripersonal space is encoded and remapped depending on the availability of visual feedback and on the target position within the individual’s reachable space, and which cerebral areas subserve such processes. Here, functional magnetic resonance imaging (fMRI) was used to examine neural activity while healthy young participants performed reach-to-grasp movements with and without visual feedback and at different distances of the target from the effector (near to the hand–about 15 cm from the starting position–vs. far from the hand–about 30 cm from the starting position). Brain response in the superior parietal lobule bilaterally, in the right dorsal premotor cortex, and in the anterior part of the right inferior parietal lobule was significantly greater during visually-guided grasping of targets located at the far distance compared to grasping of targets located near to the hand. In the absence of visual feedback, the inferior parietal lobule exhibited a greater activity during grasping of targets at the near compared to the far distance. Results suggest that in the presence of visual feedback, a visuo-motor circuit integrates visuo-motor information when targets are located farther away. Conversely in the absence of visual feedback, encoding of space may demand multisensory remapping processes, even in the case of more proximal targets

Hemispheric Asymmetry in White Matter Connectivity of the Temporoparietal Junction with the Insula and Prefrontal Cortex

The temporoparietal junction (TPJ) is a key node in the brain's ventral attention network (VAN) that is involved in spatial awareness and detection of salient sensory stimuli, including pain. The anatomical basis of this network's right-lateralized organization is poorly understood. Here we used diffusion-weighted MRI and probabilistic tractography to compare the strength of white matter connections emanating from the right versus left TPJ to target regions in both hemispheres. Symmetry of structural connectivity was evaluated for connections between TPJ and target regions that are key cortical nodes in the right VAN (insula and inferior frontal gyrus) as well as target regions that are involved in salience and/or pain (putamen, cingulate cortex, thalamus). We found a rightward asymmetry in connectivity strength between the TPJ and insula in healthy human subjects who were scanned with two different sets of diffusion-weighted MRI acquisition parameters. This rightward asymmetry in TPJ-insula connectivity was stronger in females than in males. There was also a leftward asymmetry in connectivity strength between the TPJ and inferior frontal gyrus, consistent with previously described lateralization of language pathways. The rightward lateralization of the pathway between the TPJ and insula supports previous findings on the roles of these regions in stimulus-driven attention, sensory awareness, interoception and pain. The findings also have implications for our understanding of acute and chronic pains and stroke-induced spatial hemineglect

Syngnathia: A rare case of maxillo-mandibular fusion in an adult patient

Syngnathia is a congenital bony fusion of the mandible to maxilla involving the pediatric age. it is a rare condition that may comprise soft tissue or hard tissues. according to the literature, to our knowledge, 29 cases have been reported during childhood. This clinical condition is usually discovered immediately after birth, since the child is not able to open the mouth, and is unable to feed himself adequately. generally the surgical treatment consists of multiple procedures to release bony fusion, or debride adhesions during the first few days of life. When the lock involves only the soft tissue, the treatment consists in removal the mucosal synechia, by performing an intraoral approach. To our knowledge, herein we describe the first case of unilateral syngnathia in adulthood. A 27-year-old African male was referred to our Department of Maxillo-Facial Surgery of the Federico ii university of Naples in January 2008. The patient reported to have been victim of a direct trauma to the face as a result of an assault when he was child, during the second civil war in Sudan. he was hit with a blunt instrument on the right maxillo-zygomatic region. in conclusion, as far as we know, this is the older patient affected by syngnathia with a suspicion of traumatic etiology, and none of the patients reported in the literature had a traumatic etiology

A rare case of blindness due to an odontogenic abscess

Orbital cellulitis can be caused by distant infective foci, local spread and surgical procedures. Typical symptoms and signs are conjunctival chemosis, pain, extraocular muscles dysfunction, proptosis and visual impairment; systemic symptoms are fever and general discomfort. Nowadays death is uncommon, due to prompt antimicrobial and surgical management, but loss of vision remains an important cause of morbidity. This article shows the case of a 50-years-old woman referred to the Department of Orbital Pathology of the hospital Polyclinic Federico ii (Naples) with a severe case of odontogenic orbital cellulitis. The orbital infection caused bulbar perforation and endophthalmitis. an evisceration surgery was indicated to avoid a risky sympathetic endophthalmitis. Surgical and medical prompt therapy lead to clinical improvement. Odontogenic orbital cellulitis is a rare, serious infection which can lead to endophthalmitis and visual loss. unfortunately, the dental origin of infection can be missed during the examination. For these reasons, it’s important for the practitioner to consider this source or infection. The management consists of prompt medical therapy, intensive monitoring, cultural exams, serial imaging and proper surgical intervention, if needed. Therefore, early hospitalization and multidisciplinary approach are mandatory

A comparison of a SARS-CoV-2 rapid-test and serological-test in a Public Health Hospital

Introduction: Nowadays, with the start of the vaccination campaign is very important to assess the extent of exposure of the population and identifying rapid, sensitive and accurate test to quickly identify new cases of SARS-CoV-2. The rapid test, cheap and easy to perform, is therefore very useful in developing countries, where the vaccination campaign has not yet reached adequate coverage. Methodology: We compared the VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with the Roche Elecsys Anti-SARSCoV-2 (Roche Diagnostics, Rotkreuz, Switzerland) to recognize past infections and to compare VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with Abbott Real Time PCR SARS-CoV-2 assay to recognize infection during its acute phase so that it’s possible to evaluate the use of commercially available assays in clinical practice. Results: Of the 1,100 patients tested with serological and rapid test, 1,085 were negative both to serological and rapid test, 4 patients were positive at rapid (2 for IgM and 2 for IgG) but negative serological test, 11 patients were positive at serological test but negative to rapid. Of the 300 tested with oropharyngeal swab and rapid test, 294 were negative both to swab and rapid test, 2 positives both to swab and rapid test, 3 positives at swab but negative at rapid test, 1 negative at swab but positive at rapid test. Conclusions: the combined use of these tests according to the specific needs of users, allows a reliable identification of infected patients in the acute phase, distinguishing them from subjects with an antibody response from a previous infection

Postoperative complications after removal of pleomorphic adenoma from the parotid gland: A long-term follow up of 297 patients from 2002 to 2016 and a review of publications

Pleomorphic adenomas are rounded, lumpy, capsulated lesions that are more common in women. They are typically benign, but can be associated with malignancy in a minority of cases (such as carcinoma ex pleomorphic adenoma), between 3% - 12% of the time, according to available data. The purpose of our study was to evaluate clinical outcomes in patients with benign parotid gland tumours after extracapsular dissection (ECD) or superficial parotidectomy (SP). We made a retrospective study of 297 patients who had had benign tumours of the parotid gland, and had been referred to our department from 2002 – 2016 to have either procedure. We measured the statistical differences between the two techniques (evaluated recurrence rate and complications) with the chi squared test. The chosen level of statistical significance was p < 0.05. Median (range) follow-up time was 43 months (25–168) months. Haematoma and hypoaesthesia were significantly more common after SP than after ECD (8.9% compared with 7.7%, and 16.8% compared with 5.6%, respectively). Transient facial nerve injury, Frey syndrome, and facial paralysis were significantly more common after SP than after ECD (23.6% compared with 1.5%, 6.7% compared with 1% and 6,7% compared with 0%, respectively). ECD had the advantage of reduced operating time, lower morbidity and lower recurrence rate, and could be considered the treatment of choice for pleomorphic adenoma of the parotid gland up (to 3 cm) which are mobile and sited in the superficial lobe of the parotid gland

Surgical Approaches in Odontogenic Orbital Cellulitis (OOC): Our Experience and Review of Literature

Aims Odontogenic orbital cellulitis represents a complication of root infections of upper pre-molars and molars. The severity depends on the orbital structure involved. The treatment is based on antibiotic therapy associated or not to surgery. Through the presentation of three cases and a review of literature, we purpose as aim of our study to underline the necessity of a timely diagnosis and to provide the correct surgical approach in each different types and stages of orbital infections. Methods We present three patients that were affected by dental infection evolved in orbital cellulitis. In two cases the disease was solved with the extraction of infected tooth and a surgical endoscopic drainage of the abscess through antrostomy of maxillary sinus. In the third patient the disease had already induced a bulbar perforation and endophthalmitis, so an orbit evisceration was necessary. Results Review of literature showed that the standard treatment of orbital cellulitis is the transnasal approach associated or not by a transoral and/or transcutaneous procedure depending on the stage of the disease and on the causes. In our 3 cases these indications were followed without relapses of the disease. Conclusion An early diagnosis is mandatory in odontogenic orbital cellulitis specially to avoid serious complications. Surgical treatment can be simple and effective mostly in early-stage infection: it is based on extraction of infected tooth and on the drainage of abscess. Surgical approach consists in transnasal procedure flanked or not by transoral and transcutaneous procedures based on the stage of the infection considering involved structures