Maxillofacial Reconstruction Using Polyetheretherketone Patient-Specific Implants by "Mirroring” Computational Planning

In the vast majority of cases, precise symmetric reconstruction of maxillofacial defects remains an unsolved problem for craniofacial surgeons. Computer-designed alloplastic implants have contributed considerably to improvement in the accuracy and reliability of facial rehabilitation, rapidly becoming an irreplaceable part of the surgical armamentarium. In recent years, the subsequently developed new generation of computational technologies has allowed planning to be done by preoperative "mirroring” using the healthy side as a template to fabricate an ideal prosthesis for reestablishment of facial symmetry. Two cases of facial defects are reported, one of the midface and another of the lower face reconstructed using a computer-designed polyetheretherketone (PEEK) patient-specific implant (PSI) technique based on "mirroring” computational planning. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/0026

Upper lip swelling caused by a large dentigerous cyst

Swelling of the upper lip can result from various diseases such as salivary tumors, infectious and inflammatory diseases and cysts. Among the latter, dentigerous cysts, typically involving unerupted teeth, are sometimes associated with supernumerary teeth in the maxillary anterior incisors region called the mesiodens. We report an unusual case of a large dentigerous cyst associated with an impacted mesiodens in a 42-year-old male who presented with a slow-growing swelling in the upper li

Removal of unusual, large high-velocity metallic maxillary sinus foreign bodies by a modified free bone flap technique

Metallic foreign bodies are rarely found in the maxillary sinus, and usually they have a dental origin. Potential complications related to foreign bodies include recurrent sinusitis, rhinolith formation, cutaneous fistula, chemical poisoning, facial neuralgic pain and even malignancies. Two main surgical approaches are currently used for the removal of foreign bodies in the maxillary sinus: the bone flap and the endoscopic sinus techniques. We are reporting two unusual cases of large high-velocity foreign bodies removed by a modified maxillary lateral antrotomy, with free bone flap repositioning and fixation with a titanium miniplat

Developing a panarchy model of landscape conservation and management of alpine-mountain grassland in Northern Italy.

This paper explores methods of applying resilience theory to a case study of natural resource management and the cultural landscape of upland and alpine pasture in northern Italy. We identify that the close interaction between alpine pastures and its managers offers a strong fit with the concept of a social-ecological system that maintains the cultural landscape. We first considered a descriptive approach looking historically at socio-economic development in the study area. We explored whether this can be related to resilience phenomena such as regime shifts, thresholds and/or regime stability through adaptive processes. However, we found it difficult at this overarching level to conceptually combine natural and social capital of alpine pastures and their managers in any quantitative way. We also interpreted our data through considering economic, social and ecological information as acting within separate but interacting domains. This led us to construct conceptual models of adaptive cycles to describe the alpine mountain grassland ecosystem of our study site and to conclude that a panarchy model can offer a powerful metaphor for its ecological dynamics. This has practical implications both for the management of Natura 2000 interest and the maintenance of the cultural landscape in which this Alpine interest occurs. We suggest that Resilience theory through its dynamic approach of interacting scales of adaptive cycles offers useful insights into the resource management (of valued cultural and natural attributes) but that care is needed in distinguishing between descriptive metaphor and predictive model or "real" system.natural resource management, natural and social capital

Severe subcutaneous and deep cervicofacial emphysema of unusual etiology

Subcutaneous and deep cervical emphysema (SCE) in the head and neck are found in a wide spectrum of conditions. Most of them are seen in patients with midfacial trauma or oropharyngeal infections. Subcutaneous and deep cervical emphysema can also be a symptom of life-threatening mediastinitis and/or necrotizing fasciitis, both of which need immediate surgery. Rarely however does SCE occur in isolation as a consequence of elevated intraoral pressure in combination with or without visible lacerations of the oral mucosa. As a consequence, air penetrates the mucosal tears and results in subcutaneous emphysema even extending down to the mediastinum in severe cases. This article describes a series of five cases of isolated SCE. It discusses the diagnosis, the pathomechanism, the differential diagnosis and the treatment. It underlines the importance of anamnesis and careful physical and laboratory examinations in order to differentiate isolated SCE from more severe conditions such as necrotizing fasciitis or mediastinitis, which necessitate immediate surger

Multisystem Langerhans' cell histiocytosis (Hand-Schüller-Christian disease) in an adult: a case report and review of the literature

Langerhans' cell histiocytosis (LCH) is a rare and enigmatic clonal disorder that affects mainly children. It is characterized by single or multiple granulomatous mass lesions composed of cells with the Langerhans' cell phenotype. Clinical presentation and behavior are heterogeneous and can range from a solitary lytic bone lesion (i.e., eosinophilic granuloma) with a favorable course to a fatal disseminated leukaemia-like form, with a wide spectrum of intermediate clinical presentations between these two extremes. Although LCH typically involves the bone, lesions can be found in almost all organs. We are reporting the case of a multisystem LCH in a 47-year-old patient who presented with a panhypopituitarism and diabetes insipidus, and who, 5years later, developed mandibular, mastoid and femoral lesions. The final diagnosis of LCH was made on mandibular biops

Unilateral widening of the inferior alveolar nerve canal: a rare anatomic variant mimicking disease

We report a case of an asymptomatic healthy 49-year-old male patient with an incidental finding of enlargement of the right inferior alveolar nerve (IAN) canal (9 vs. 4mm). After 2years, follow-up magnetic resonance imaging (MRI) revealed no change in the findings. In addition, MR-based diffusion tensor imaging with tractography of the right and left mandibular nerves showed that the difference in size between the right and left nerves was caused by an increased number of nerve fibers in the right IAN. During the entire follow-up period of 4years, the patient remained symptom-free. Therefore, we suggest that the enlargement in our patient was a pure anatomic variant. However, a multitude of conditions are known to produce the identical radiological appearance in conventional radiology, including benign and malignant tumors, vascular malformations, and inflammatory disorders. We describe these pathologies in more detail as well as the possibilities for examinations with different MRI sequence

Morphometric analysis of fat globules in ewe's milk and correlation with qualitative parameters

In this study the morphometric characteristics of fat globules from ewe’s milk have been correlated with the chemicaland technological parameters of the milk.Milk samples were taken from twenty-five Massese ewes, subdivided according to the parity; the animals were homogeneousfor lactation phase and diet. The morphometric analysis of fat globules (n./ml, diameter, surface area/volume),the standard chemical analysis, SCC and determination of the rheological parameters were performed on milk samplesobtained during the morning milking.The mean number of fat globules/ml was 3.09 x 109, with a mean diameter of 3.93 μm, ranging from 1.20 μm to 12.30μm. For all parities, a fat globule diameter ranging from 3.21 to 4.20 μm was found most frequently. Animals in the firstlambing order showed a significantly lower percentage (5.26%) of large globules (>5.21μm), while animals in the fifthlambing order showed a higher percentage (20.75%). The number of globules/ml was negatively correlated to milk production(P≤0.01) and curd firmness at 45 min (P≤0.05); whereas it was positively correlated to protein content, non-fatdry matter, and curd firming time (P≤0.05). Fat globule dimensions varied according to the parity of the animals andinfluenced various qualitative parameters of the milk

Cheese making aptitude and the chemical and nutritional characteristics of milk from Massese ewes

The purpose of this study was to determine the effects of season, locality and the different altitudes at which farms are located, on the physico-chemical composition, morphometric characteristics of fat globules, fatty acid composition and cheese making aptitude of milk of Massese ewe's raised in 11 flocks from two provinces of north-west Tuscany (Massa Carrara and Lucca). The winter lactation shows higher percentages of casein, lactose and not fat dry matter (P≤0.01); curd firming time (k20) is significantly lower and there is a greater curd firmness (a30) (P≤0.01); while in the summer there is a higher percentage of lipids (P≤0.01). The effect of the season significantly influences (P≤0.01) the size of the fat globules and impacted significantly on the fatty acids composition of the milk. In the hills the milk has a higher percentage of dry matter, protein, casein, fat, phosphorous and not fat dry matter (P≤0.01), whereas it has a lower percentage of lactose and calcium (P≤0.05). The Somatic Cell Count (SCC) and the Total Bacterial Count (TBC) are statistically greater on the plains (P≤0.01), while milk produced in the hills shows higher quantity of α-linolenic acid and lower saturated fatty acids (P≤0.05). In the two typical rearing areas for Massese ewes we found differences amongst dry matter, fat, phosphorous and SCC, higher (P≤0.01) in the province of Massa Carrara that also had the best rheological parameters, but we found the highest cheese yield (P≤0.05) in the province of Lucca where there are also the greatest weight loss (P≤0.01). The milks produced in the winter season and in hilly areas present the best physico-chemical and nutritional characteristics. However, we found that the technological side should be improved by diversifying cheese-making techniques in relation to the characteristics of milk. In fact, currently these techniques do not fully exploit the potential to transform those milks with the best qualitative characteristics