Trans-nasal endoscopic marsupialization of a voluminous radicular cyst involving maxillary sinus and nasal cavity: A case report and a literature review on this surgical approach

The treatment of a huge cystic lesion in the upper jaw involving the respiratory cavities may result challenging. A traditional oral approach entails patient discomfort and may have negative aesthetic implications. This treatment, particularly in case of enucleation not preceded by marsupialization for volumetric reduction of the lesion, may cause irreversible damage to important anatomical structures and the collapse of the bone architecture. The purpose of this case report is to show the benefits of an endoscopic trans-nasal approach for the definitive treatment of such a clinical situation. The surgical technique aimed to remove part of the cystic wall and to open the inner compartment of the lesion to the nasal cavity after the resection of the anterior edge of the inferior turbinate and the lateral wall of the inferior nasal meatus. After a follow-up period of 18 months, without any problem or discomfort for the patient, the cyst appeared radiologically healed without the loss of any lesion-associated tooth. The bone nasal cavity, the maxillary sinus and the anterior alveolar process architecture, noticeably modified by the expansive enlargement of the cyst, resulted completely restored with a complete recover of the respiratory and oral functions

Analysis of Marsupialization of Mandibular Cysts in Improving the Healing of Related Bone Defects

Purpose: Marsupialization, designed to reduce the mandibular cyst volume, has continued to debated regarding its influence on the healing of the related bone cavity. The aim of the present study was to evaluate the 3-dimensional radiographic variation over time in mandibular odontogenic cystic lesions after marsupialization and assess the correlations between these variations and variables that can affect the procedure. Materials and Methods: We planned a retrospective cohort study. The predictor variables were the treatment duration, preoperative volume, patient age, histologic type, and number of preoperative residual bony walls. The outcomes variables were the postoperative volume reduction and the daily reduction rate calculated using computed tomography (CT) from before to after marsupialization using software designed for volumetric reconstruction and measurement of cyst-related bone defects. The descriptive and bivariate statistics were computerized, and the significance level was set at P =.05. Results: The sample included 15 patients (12 men and 3 women; mean age, 51.6; range, 27 to 85 years) affected by keratocysts (n = 6), dentigerous cysts (n = 6), and radicular cysts (n = 3) who had undergone marsupialization. The median duration of marsupialization was 406 days (25th to 75th percentile, 276 to 519). The mean ± standard deviation (SD) pre- and postdecompression volumes were 6,908.27 ± 2,669.058 and 2,468.13 ± 1,343.517 mm3, respectively (P < 0.001), and the mean ± SD percentage of reduction was 63.90 ± 13.12%. The volume decrease in the bone defects correlated positively with the treatment duration (P =.009) and preoperative volume (P <.001). However, no correlation was found with the other variables (P >.05) nor between the daily reduction rate and other variables (P >.05). Conclusions: Marsupialization appears useful in improving the healing of cyst-related bone defects in mandibles, especially larger defects. Further studies with a wider sample size would add more knowledge to this topic

Guided bone regeneration using titanium mesh to augment 3-dimensional alveolar defects prior to implant placement. A pilot study

Objectives: To evaluate the outcomes of bone regeneration using a customized titanium mesh scaffold to cover a bone graft for reconstruction of complex defects of the jaws. Materials and Methods: 19 large defects were digitally reconstructed using CT scans according to the prosthetic requirements. A titanium mesh scaffold was designed to cover the bone (autologous/bovine bone particulate) graft. At least 6 months after surgery, a new cone-beam CT was taken. The pre- and postoperative CT datasets were then converted into three-dimensional models and digitally aligned. The actual mesh position was compared to the virtual position to assess the reliability of the digital project. The reconstructed bone volumes (RBVs) were calculated according to the planned bone volumes (PBVs), outlining the areas under the mesh. These values were then correlated with the number of exposures, locations of atrophy, and virtually planned bone volume. Results: The mean matching value between the planned position of the mesh and the actual one was 82 ± 13.4%. 52.3% (40% early and 60% late) exposures were observed, with 15.8% exhibiting infection. 26.3% resulted as failures. The amount of reconstructed bone volume (RBV) in respect to PBV was 65 ± 40.5%, including failures, and 88.2 ± 8.32% without considering the failures. The results of the exposure event were statistically significant (p =.006) in conditioning the bone volume regenerated. Conclusions: This study obtained up to 88% of bone regeneration in 74% of the cases. The failures encountered (26%) should underline the operator's expertise relevance in conditioning the final result

Digital approach for the rehabilitation of the edentulous maxilla with pterygoid and standard implants: The static and dynamic computer-aided protocols

A full-arch rehabilitation of the edentulous upper jaw without grafting procedures exploits the residual alveolar or the basal bone, with the necessity of long implants placed with a particular orientation. The precision in planning and placing the fixtures is fundamental to avoid clinical problems and to allow an acceptable connection with the prosthesis. The computer-aided implantology resulted in more accuracy than the traditional one, with a high standard of correspondence between the virtual project and the real outcome. This paper reports about the two different digital protocols, static and dynamic, as support to implant-borne prosthetic rehabilitation of edentulous maxillae. Two pterygoid and two/four anterior standard implants were seated in both cases by two different operators, without flap raising, and immediately loaded. This approach avoided the posterior cantilever by-passing the maxillary sinus and was adequately planned and realized without any surgical or prosthetic error. The two digital flow-charts were described step by step, underlining each other’s advantages and drawbacks compared to a free-hand approach

Relevance of the Operator’s Experience in Conditioning the Static Computer-Assisted Implantology: A Comparative In Vitro Study with Three Different Evaluation Methods

The present study aimed to evaluate the influence of manual expertise on static computer-aided implantology (s-CAI) in terms of accuracy and operative timings. After the cone-beam CT (CBCT) scanning of eleven mandibular models, a full-arch rehabilitation was planned, and two different skilled operators performed s-CAI. The distances between the virtual and actual implant positions were calculated considering the three spatial vectorial axes and the three-dimensional Euclidean value for the entry (E) and apical (A) points, along with the axis orientation differences (Ax). These values emerged from the overlapping of the pre-op CBCT to post-op CBCT data (method 1), from scanning the data from the laboratory scanner (method 2), and from the intra-oral scanner (method 3) and were correlated with the operators’ expertise and operative timings. The mean values for accuracy from the three methods were: E = 0.57 (0.8, 0.45, 0.47) mm, A = 0.6 (0.8, 0.48, 0.49) mm, and Ax 1.04 (1.05,1.03,1.05) ° for the expert operator; and E = 0.8 (0.9, 0.87, 0.77), A = 0.95 (1.02, 0.95, 0.89), and Ax =1.64 (1.78, 1.58, 1.58) for the novice. The mean value of the operative timings was statistically inferior for the expert operator (p < 0.05), with an improved accuracy over time for both operators. A significant difference (p < 0.05) emerged between method 1 and methods 2 and 3 for seven of the nine variables, without differences between the evaluations from the two scanners. The support from digital surgical guides does not eliminate the importance of manual expertise for the reliability and the shortening of the surgical procedure, and it requires a learning pathway over time

The horizontal root fractures. Diagnosis, clinical management and three-year follow-up

Objective: The aim of this retrospective analysis is to describe and to evaluate the middle third horizontal root fractures, long term clinical management results and to estimate the effect of treatments factors upon healing and survival rate. Methods: Our clinical study included 42 patients presenting a middle third horizontal root fracture in permanent dentition. For each patient at t the parameters recorded were: diastasis, mobility, sensibility, periodontal inflammation, pulpal pathology, associated fracture and dislocation of the coronal fragment. The follow-up was performed after 6 (t1), 12 (t2) and 36 (t3) months after the trauma, both clinically and radiologically. Clinical examination, vitality tests and a radiological evaluation (periapical x-ray) were performed. Results: At t0 it was observed: diastasis (14, 3%), mobility (28, 6%), thermal sensibility (61, 9%), periodontal inflammation (4, 8%), pulpal pathology (38, 1%) and dislocation of the coronal fragment (47, 6%) of the patients. The treatment plan started with the coronal fragment repositioning and the blockage (splint) with the adjacent teeth in 47, 6% of cases. A root canal treatment was performed at t in 52,4% of the fractured teeth. Statistical analysis showed the highest level of significance between pulpal lesions (t) and associated fractures. The mobility, sensibility and pulpar lesions parameters, showed a reduction in relation to the follow up timing, with a main variation remarkably evident between t and t1. The ratio between observation time and the presence of diastasis was statistically significant. Conclusion: The analysis of the clinical results exhibits the high success rate of a conservative approach in the treatment of teeth fractured in the middle third of the root

Football players do not show "neural efficiency" in cortical activity related to visuospatial information processing during football scenes: an EEG mapping study

This study tested the hypothesis of cortical neural efficiency (i.e., reduced brain activation in experts) in the visuospatial information processing related to football (soccer) scenes in football players. Electroencephalographic data were recorded from 56 scalp electrodes in 13 football players and eight matched non-players during the observation of 70 videos with football actions lasting 2.5 s each. During these videos, the central fixation target changed color from red to blue or vice versa. The videos were watched two times. One time, the subjects were asked to estimate the distance between players during each action (FOOTBALL condition, visuospatial). Another time, they had to estimate if the fixation target was colored for a longer time in red or blue color (CONTROL condition, non-visuospatial). The order of the two conditions was pseudo-randomized across the subjects. Cortical activity was estimated as the percent reduction in power of scalp alpha rhythms (about 8-12 Hz) during the videos compared with a pre-video baseline (event-related desynchronization, ERD). In the FOOTBALL condition, a prominent and bilateral parietal alpha ERD (i.e., cortical activation) was greater in the football players than non-players (p < 0.05) in contrast with the neural efficiency hypothesis. In the CONTROL condition, no significant alpha ERD difference was observed. No difference in behavioral response time and accuracy was found between the two groups in any condition. In conclusion, a prominent parietal cortical activity related to visuospatial processes during football scenes was greater in the football players over controls in contrast with the neural efficiency hypothesis

Sleep deprivation and Modafinil affect cortical sources of resting state electroencephalographic rhythms in healthy young adults

Objective: It has been reported that sleep deprivation affects the neurophysiological mechanisms underpinning the vigilance. Here, we tested the following hypotheses in the PharmaCog project (www.pharmacog.org): (i) sleep deprivation may alter posterior cortical delta and alpha sources of resting state eyes-closed electroencephalographic (rsEEG) rhythms in healthy young adults; (ii) after the sleep deprivation, a vigilance enhancer may recover those rsEEG source markers. Methods: rsEEG data were recorded in 36 healthy young adults before (Pre-sleep deprivation) and after (Post-sleep deprivation) one night of sleep deprivation. In the Post-sleep deprivation, these data were collected after a single dose of PLACEBO or MODAFINIL. rsEEG cortical sources were estimated by eLORETA freeware. Results: In the PLACEBO condition, the sleep deprivation induced an increase and a decrease in posterior delta (2–4 Hz) and alpha (8–13 Hz) source activities, respectively. In the MODAFINIL condition, the vigilance enhancer partially recovered those source activities. Conclusions: The present results suggest that posterior delta and alpha source activities may be both related to the regulation of human brain arousal and vigilance in quiet wakefulness. Significance: Future research in healthy young adults may use this methodology to preselect new symptomatic drug candidates designed to normalize brain arousal and vigilance in seniors with dementia

Effects of tiredness on visuo-spatial attention processes in elite karate athletes and non-athletes

"Attentional" adaptations are fundamental effects for sport performance. We tested the hypothesis that tiredness and muscular fatigue poorly affect visuo-spatial attentional processes in \ue9lite karate athletes. To this aim, 14 \ue9lite karate athletes and 11 non-athletes were involved in an isometric contraction exercise protocol up to muscular fatigue. Blood lactate and attention measurements were taken. Posner's test probed "endogenous" (i.e. internally planned allocation of spatial attention) and "reflexive" (i.e. brisk variation of endogenous spatial attention due to unexpected external stimuli) attention. Lactate and attentional measurements were performed before (Block 1, B1) and after the fatiguing exercise (B2) and at the end of a recovery period (B3). Compared to the non-athletes, the athletes showed a better performance in the fatigue protocol, confirmed by the higher absolute lactate values in B2. The correct responses in the "valid trials" probing "endogenous" attention were 92.4% (B1), 93.9% (B2), and 95.8% (B3) in the non-athletes, and 98.5%, 96.4%, 95.5% in the \ue9lite karate athletes. The correct responses in the "invalid trials" probing "reflexive" attention were 95.4%, 89.7%, 93.2% in the non-athletes, and 96.4%, 97.3%, 98.5% in the \ue9lite karate athletes. The percentage of correct responses in the "invalid" trials significantly decreased from B1 to B2 in the non-athletes but not in the \ue9lite karate athletes. In conclusion, tiredness and muscular fatigue do not affect "reflexive" attentional processes of \ue9lite karate athletes, which is crucial to contrast attacks coming from an unexpected spatial region