New technologies in rhinoplasty : a comprehensive workflow for computer-assisted planning and execution

Rhinoplasty in facial cleft patients is among the most challenging types of reconstructive facial surgery due to its variability Advances in 3-dimensional imaging enable improved preoperative assessment in rhinoplasty. In complex cases with bony support irregularities and asymmetry, it is rational to initiate planning with reconstruction of the aberrant substructure (ie, "bottom-up" planning) rather than starting the surgical design with soft-tissue morphing. We present a new comprehensive workflow in which novel advanced technologies are implemented to perform "bottom-up" computer-assisted planning and execution in complex rhinoplasty cases. This workflow enables meticulous planning, use of grafting templates, and 3-dimensional-guided osteotomies with integration of piezotome and intraoperative navigation. Previous reports separately discuss some of these innovations. However, greater benefit lies in the combination of these techniques, with emphasis on preoperative computer analysis, virtual planning, and transfer to the operation theater. Surgeons are seeking new ways to enhance minimally invasive approaches and to obtain predictable and favorable clinical results. The presently introduced workflow allows clinicians to plan complex cases in a simple, effective, and safe manner, with the combination of different techniques to produce consistent results

The Anatomy of a Banking Crisis. The Case of the Catholic Banks of the Veneto Region in the Late 1920s

This essay deals with a little known episode of Italian financial history: the crisis of Catholic banks during the twenties. Taking into account the significant number of banks involved (about fifty), the field of investigation is limited to the Catholic banks of Veneto region. The study is conducted on documents consulted at the Bank of Italy\u2019s Historical Archives and the Intesa-Sanpaolo Historical Archive. Even considering the plausible thesis on the existence of a strategy of the fascist regime aimed at weakinig the system of Catholic banks, the causes of the crisis must be sought elsewhere. Though the macroeconomic and institutional context certainly played an important role, the consulted documents bring out the responsability of the men that managed the banks. First of all, to improve their business, flattered by easy earnings, they understimated the risks to be involved in industrial investments, not only as borrowers but also as shareholders. Then, they were hiding the real financial situation of the banks through accounting manipulation and through equity crossings between banks. The latter contributed to complicate the actions of the authorities, whose late decisions undoubtedly damaged the depositors rights

A History of Wine in Europe, 19th to 20th Centuries, a cura di S.A. Conca Messina, S. Le Bras, P. Tedeschi e M. Vaquero Piñeiro

Viene recensita un'opera in 2 volumi con 20 contributi in inglese, pubblicata da Palgrave. i due volumi dedicati alla storia del vino in Europa meritano l’attenzione della comunità scientifica nazionale e internazionale in quanto gettano luce su cruciali aspetti di un importante comparto agroindustriale in forte crescita a livello mondiale. Al riguardo non è superfluo notare che la qualità dei singoli contributi è avvalorata dalla ricca messe di fonti e dall’ampia bibliografia sui cui poggiano e che ne fanno un utile strumento per gli studiosi che intendono avvicinarsi al profumato mondo del vino

Extended Complex Temporomandibular Joint Reconstructions Exploiting Virtual Surgical Planning, Navigation Assistance, and Custom-Made Prosthesis: A Comprehensive Protocol and Workflow

Background: Alloplastic temporomandibular joint (TMJ) replacement is a well-established procedure in maxillo-facial surgery. However, the surgical management of large excision in this area requires complex reconstruction beyond the standard TMJ prosthesis. Objective: This study aims to describe the design and the consequential application of a protocol which involves the use of computer-assisted surgery tools to best face complex TMJ reconstruction (TMJR). Preoperative accurate study of every single case and intraoperative check of the surgical act are nowadays essential to perform such delicate surgical procedures. Materials and Methods: The study is a retrospective and single institution case series. The various processes of the management and planning of extended TMJ reconstruction (eTMJR) are extensively described, from the preoperative clinical evaluation, imaging acquisition protocols and virtual surgical planning (VSP), focusing also on the intraoperative transfer of VSP using navigation and surgical guides. Results: We included nine patients with different pathologies which were candidates for eTMJR. Overall, the application of our protocol and workflow permitted the reduction of complications and pain, and the improvement of the maximum interincisal opening (MIO) of the patients, restoring patients’ masticatory function and esthetics. Conclusions: The eTMJR should be considered as a safe and reliable surgical management modality in selected patients with large temporomandibular joint and skull base (TMJ-SB) lesions. An accurate preoperative protocol and workflow is essential to perform such insidious and complex reconstruction. However, more extensive studies on this type of device have to be conducted in order to validate its real usefulness and indications

Double osseous flaps for simultaneous midfacial and mandible reconstruction: Automation in surgical complexity within an entirely computerized workflow

Introduction: Broad maxillofacial surgical resections involving both the midface and the mandible represent a challenge in terms of reconstruction. Although several papers have explored the possibility of simultaneously using two microsurgical flaps, reports on the implementation of a dual osseous flap strategy are limited, and mainly addressed to static anatomical reconstruction, regardless of functional implications. In particular, there is a lack in the literature of a unifying protocol which illustrates how technology including virtual planning, statistical shape modeling, virtual occlusion, 3D-printing and patient-specific implants can address the functional and accuracy needs required for an optimal reconstruction. Materials and methods: In this paper, the Authors present their preliminary experience in a two-center study, showing how broad maxillofacial defects, requiring a simultaneous reconstruction in both the mandible and the midface, can be successfully reconstructed using the combination of two osseous flaps in an automated sequence in which all steps are anticipately defined in a virtual plan, accounting for the optimal alignment of temporomandibular joint, predicting the final occlusion and defining a mandibular shape according to a statistical shape model. Results: Average RMSE for the iliac bone crest flap was of 3.2 ± 0.36 mm; for the fibula flap, RMSE value was of 2.3 ± 0.65 mm, for patient-specific implants, for mandibular prostheses the average RMSE was 2.46 mm with 0.76 mm standard deviation. Temporomandibular joint function increased when a TMJ prosthesis was placed. Conclusions: Double bone free flap is a valuable resource to reconstruct wide defects that simultaneously involve two thirds of the cranio-maxillo-facial skeleton, but a careful virtual planning study should be always performed before approaching this surgical option

A case report of chondrocalcinosis of the temporomandibular joint: Surgical management and literature review

Background: Chondrocalcinosis is a metabolic disorder characterized by non-infectious joint inflammation with intra- or periarticular calcification. Temporomandibular (TMJ) chondrocalcinosis is rare and not usually included in the differential diagnosis of TMJ and facial pain disorders. Case report: A 67-year-old woman presented with a calcified mass in the right TMJ between the condyle and glenoid fossa, eroding into the floor of the middle cranial fossa due to calcium pyrophosphate deposition in the TMJ. She underwent surgical excision of the mass with immediate econstruction with a custom-made prosthesis. On follow-up, there was complete clinical resolution, with no evidence of recurrence. Literature related to surgical treatment of chondrocalcinosis of TMJ and its treatment was reviewed. Surgery is the most commonly used treatment. A custom-made device allowed us to bridge the defect caused by the destructive disease process. Conclusion: Custom-made prostheses can be considered a safe and effective solution in erosive forms of chondrocalcinosis, replacing the TMJ to restore functionality and correct the anatomical defect

External osteotomy in rhinoplasty: Piezosurgery vs osteotome

Purpose: To achieve the desired outcome in rhinoplasty depends on many factors. Osteotomy and surgical reshaping of nasal bones are important steps that require careful planning and execution. The availability of different tools raises the question of which one provides significant advantages for both technique and surgical outcome. Our prospective randomized pilot study compared the outcome of post-traumatic rhinoplasty performed with two different external techniques: ultrasound osteotomic cut using the Piezosurgery Medical Device (Mectron, Carasco, Italy) and traditional external osteotomy. Material and methods: Forty-four lateral osteotomies of the nasal wall were performed in twenty-two patients. In twelve patients the osteotomies were conducted with a 2-mm traditional osteotome (control group), while in the remaining ten patients these were done with the Piezosurgery Medical Device (experimental group). Results: At the postoperative evaluation, significantly lower pain, edema and ecchymosis were noticed in the experimental group (p < 0.05). Moreover, the endoscopic evaluation showed fewer mucosal injuries in the experimental group (p < 0.05), whereas bleeding, symmetry of the pyramid and presence of external scars, were similar in the two groups. Conclusions: In the present study, Piezosurgery Medical Device allowed for safe lateral osteotomies in rhinoplasty preliminarily demonstrating the potential to reduce some of the most frequent complications of rhinoplasty

Restless legs syndrome: differential diagnosis and management with rotigotine

RLS is a common sleep disorder with distinctive clinical features. The prevalence of RLS in Caucasians and North Americans ranges from 5% to 10%. However, only some of these subjects (almost the 3% of the general population) report being affected by a frequent and severe form of the sleep disorder. RLS is diagnosed clinically by means of four internationally recognized criteria that summarize the main characteristics of the sleep disorder. Besides the essential criteria, supportive and associated features of RLS have been established by experts in order to help physicians treat patients with doubtful symptoms. Several clinical conditions may mimic this sleep disorder. In order to increase the sensibility and specificity of RLS diagnosis, doctors should perform a meticulous patient history and then an accurate physical and neurological examination. Dopamine agonists are recognized as the preferred first-line treatment for RLS. Rotigotine is a non-ergoline dopamine agonist with selectivity for D1, D2 and D3 receptors. The drug is administered via transdermal patches which release rotigotine for 24 hours. Four clinical trials demonstrated that this compound is able to improve RLS symptomatology with few and moderate adverse events. Head to head trials are required to compare the efficacy and tolerability of rotigotine with other dopamine agonists administered via oral intake. Rotigotine has been approved by the FDA and EMEA for Parkinson’s disease. For the treatment of moderate to severe idiopathic RLS, rotigotine has been recommended for approval by the EMEA and is under review by the FDA

Redesigning the paradigms of clinical practice for oral and maxillofacial surgery in the era of lockdown for covid-19: From tradition to telesemeiology

The rise of the COVID-19 pandemic has posed new challenges for health care institutions. Restrictions imposed by local governments worldwide have compromised the mobility of patients and decreased the number of physicians in hospitals. Additional requirements in terms of medical staff security further limited the physical contact of doctors with their patients, thereby questioning the traditional methods of clinical examination. Our institution has developed an organization model to translate the essential clinical services into virtual consultation rooms using a telemedicine interface which is commonly available to patients. We provide examples of clinical activity for a maxillofacial surgery department based on teleconsultation. Our experience is summarized and an organization model is drafted in which outpatient consultation offices are translated into virtual room environments. Clinical examples are provided, demonstrating how each subspecialty of oral and maxillofacial surgery can benefit from virtual examinations. The concept of \u201ctelesemeiology\u201d is introduced and a checklist is presented to guide clinicians to perform teleconsultations. This paper is intended to provide an organization model based on telemedicine for maxillofacial surgeons and aims to represent an aid for colleagues who are facing the pandemic in areas where lockdown limits the possibility of a physical examination