Local anesthetic infiltration vs. nervous blocks in face’s skin lesions: what’s new

Skin tumors are the most common type of cancer. They are localized throughout the body, more frequently in those regions chronically exposed to sun, like face, scalp and neck, compromising aesthetic appearance. The optimization of day hospital surgical procedures is mandatory, to avoid erroneous indications, insufficient intra operative comfort and prolonged recovery. New guidelines should be discussed and shared. Patients were divided in two groups: i. Group A of 50 patients, 21 male and 29 female, age 65 ±9, ASA I – III (10/19/21), weight 68±11 kg, height 160±8, with anesthetic Local Infiltration (LI); ii. Group B of 50 patients, 16 male, 34 female, age 68 ±10, ASA I – III (9/22/19), weight 64 ± 9 kg, height 158 ±11, with nerve block (NB). The purpose of our study is to evaluate the analgesia level, compliance and complication rate after LI or selective NB with alkalinised mepivacaine cloridrate 2%, Guardant®. Demographic data, ASA physical stauts, size of lesions, surgery, anesthesia durations and volume of LA injected were analyzed. Fisher’s exact test and Student’s t test were used; P ≤ 0.05 was considered statistically significant. No differences in age (65 ± 9 vs 68 ± 10 years), weight (68 ± 11 vs 64 ± 9), height (160 ± 8 vs 158 ± 11 cm), size of lesion (23 ± 11 vs 25 ± 14 mm), duration of surgery (47 ± 18 vs 51 ± 23 minutes) were detected in two groups (p > 0.05). Both anesthetic techniques ensured good analgesia, but only nerve’s blocks were be able to determine satisfactory intra operative patient’s comfort, a bloodless wound and weak risk for nervous lesions and toxic reaction to local anesthetic

Actinomyces infection after permanent fillers lip augmentation: Diagnosis and treatment

Background: Although dermal filler injections are a widespread and secure practice, early or late complications may nonetheless occur. Objective: In this paper, the authors report an unusual asymptomatic late filler infection caused by Actinomycetes in a patient having received liquid silicone and acrylate filler injections for lip enhancement, seeking treatment for upper lip macrocheilia. Methods: The case report is about a patient who complained of recurrent lip region edema and denied any infective episodes. Preoperative analysis was in the normal range. Sonographic exam showed two fillers in the upper lip, suggestive of silicone and polyacrylamide gel. A conservative macrocheilia reduction was performed; healing was uneventful. Results: Histology report confirmed the preoperative sonographic diagnosis, together with an actinomycetes infection, clinically unsuspected. Many microorganisms have been reported to cause abscesses or granuloma after dermal filler treatments, sterile abscesses were reported as well, suggesting a biofilm infection as causative granuloma origin. Conclusion: This study differs from previous filler complication reports because of the occasional finding of a silent actinomyces infection, a commensal of the oral cavity but responsible for suppurative diseases in the soft tissues. This occasional finding seems to support the biofilm origin of dermal filler granuloma

Effectiveness of Direct Bite Raiser Onlays in Patients Affected By Temporomandibular Disorders: A Retrospective Observational Study

This retrospective observational study aims to assess the effectiveness of direct bite raiser onlays (DBRO) on pain and dysfunctional symptoms in patients affected by pain-related temporomandibular disorders (TMD). Furthermore, it wants to provide descriptive information about the clinical performance of the treatment. We screened the electronic medical records of male and female patients with a diagnosis of pain-related temporomandibular disorders treated with DBRO. A data collection was performed from patients routinely gathered clinical records. A final sample of 43 patients was included in the analysis. At the beginning of treatment all patients (100%) referred having pain and 12 patients (27.9%) complained about both pain and functional limitation. At the end of the treatment, 36 patients (83.7%) were symptom-free. In 5 subjects (11.6%), pain was still present but reduced in intensity. In 2 subjects (16.6%) functional limitations were improved but not completely resolved. During the treatment that lasted on average 8 months a mean of 7 checks have been carried out; the occlusal changes made on the DBRO had been on average 3. In 23 patients (53.5%) initial discomfort occurred after the beginning of treatment. The first beneficial effect was obtained on average on the fifth week of therapy. The results of this retrospective observational study should be treated cautiously because of the limitations of the study design but suggest that patients with a diagnosis of pain-related temporomandibular disorders who are treated with direct bite raiser onlays experience a reduction in pain and dysfunctional symptoms

Motivation, Perception, and Behavior of the Adult Orthodontic Patient: A Survey Analysis

Purpose. The article is aimed at improving the understanding of the sociocultural profile of adult orthodontic patients and their expectations. In particular, it addresses three main aspects: the motivation and needs that underpin the decision to start orthodontic treatment, how it influences the patients’ daily life, and the different oral hygiene demands. Materials and Methods. An online survey was completed by 276 patients undergoing orthodontic treatment with different techniques. The questions asked concerned gender, age, type of appliance, any previous orthodontic treatments, type of any previous retainers, reasons for therapy, satisfaction, pain, problems in eating, daily number of teeth brushings and flossings before and during the treatment, perception of cost, sensation of visibility of the appliance, and if they would recommend orthodontic treatment. Results. A significant role within our sample is played by gender; 87.94% consisted of female patients out of which 72.57% wanted to improve their aesthetics, while only 54.84% of male patients cited the same reason. Invisible aligners were preferred by 67.70% of the patients due to them being considered the least painful, causing the fewest problems with eating, and the least visible. Metal braces were perceived as the less expensive treatment. Over a third of the patients (33.85%) had previously undergone orthodontic treatment, among them 54.05% wore a mobile retainer, 31.08% a fixed one, and 14.86% both. Daily tooth brushing and flossing increased during therapy with clear aligners by 48.94% and 126.39%, respectively. Conclusions. The greatest demand for orthodontic treatments comes from women, as they pay more attention to aesthetics, which makes the clear aligners the most common choice. The relapse after orthodontic treatment seems to cause a higher demand for retreatment, and oral hygiene habits significantly improve during orthodontic treatment, especially with the clear aligners

Mother and Daughter Carrying of the Same Pathogenic Variant in FGFR2 with Discordant Phenotype

Craniosynostosis are a heterogeneous group of genetic conditions characterized by the premature fusion of the skull bones. The most common forms of craniosynostosis are Crouzon, Apert and Pfeiffer syndromes. They differ from each other in various additional clinical manifestations, e.g., syndactyly is typical of Apert and rare in Pfeiffer syndrome. Their inheritance is autosomal dominant with incomplete penetrance and one of the main genes responsible for these syndromes is FGFR2, mapped on chromosome 10, encoding fibroblast growth factor receptor 2. We report an FGFR2 gene variant in a mother and daughter who present with different clinical features of Crouzon syndrome. The daughter is more severely affected than her mother, as also verified by a careful study of the face and oral cavity. The c.1032G>A transition in exon 8, already reported as a synonymous p.Ala344 = variant in Crouzon patients, also activates a new donor splice site leading to the loss of 51 nucleotides and the in-frame removal of 17 amino acids. We observed lower FGFR2 transcriptional and translational levels in the daughter compared to the mother and healthy controls. A preliminary functional assay and a molecular modeling added further details to explain the discordant phenotype of the two patients

Filler e Complicanze

Filler e Complicanze F. Grippaudo Negli ultimi anni al fine di ottenere un riempimento dei tessuti molli per motivazioni esclusivamente estetiche, sono stati introdotti nei mercati molti nuovi dermal filler. Questi dispositivi promettono un risultato permanente o di lunga durata, un’ottima biocompatibilità con il paziente, l’assenza di fenomeni di migrazione e in ogni modo una facile e completa rimozione nella rara eventualità di complicanza. La composizione dei filler è quanto mai varia e comprende collagene, acido ialuronico, associazioni di polimetilmetacrilato con o senza collagene; idrossimetilmetacrilato o etilmetacrilato con acido ialuronico; idrogel di poliacrilamide; polialchilimmide; alcool polivinilico; idrossiapatite di calcio; DEAE sephadex ed acido ialuronico. In letteratura medica, sono frequentemente descritte le complicanze causate dai filler, ed in particolare l’insorgenza di infezioni tardive ricorrenti, l’edema recidivo dei tessuti molli, la migrazione del prodotto impiantato, i granulomi, l’insorgenza di tumefazioni, le discromie cutanee e la necrosi tissutale. Materiali e metodi: 36 pazienti si sono rivolti al chirurgo plastico con una o più complicanze in seguito a trattamento con dermal fillers. Le aree del trattamento erano le labbra (17), le guance (8), i solchi naso genieni (10), gli zigomi (3), la regione periorbitaria (5), il naso (1) ed i glutei (1). I filler impiegati riconoscevano una diversa composizione: polimetilmetacrilato con collagene (3); idrossietilmetacrilato ed etilmetacrilato con acido ialuronico (2), idrogel di poliacrilamide (14), polialchilimide (10), Alcol polivinilico (3), idrossiapatite sintetica (1), DEAE Sephadex ed acido ialuronico (1), silicone (2). Le complicanze insorte a breve distanza erano l’infezione nella sede d’inoculazione oppure un edema prolungato (10); mentre le complicanze a distanza consistevano nell’edema ricorrente del volto (20), nell’infezione frequente con drenaggio spontaneo (15), nei granulomi (10), la migrazione del filler (7), la formazione di tumefazioni (5), la necrosi tissutale (1), l’insorgenza di discromie cutanee (2). Trenta pazienti sono stati trattati con terapia medica (corticosteroidi ed antibiotici locali e/o sistemici). Quindici pazienti hanno richiesto il drenaggio chirurgico degli ascessi cutanei. La rimozione del filler, secondo la procedura indicate dal produttore, è stata tentata in 21 pazienti. In dieci pazienti è stata necessaria la rimozione chirurgica delle tumefazioni. Quattro pazienti hanno richiesto procedure chirurgiche più invasive ( face lift, ecc). Risultati: la rimozione complete del filler è stata possibile solo in 7 pazienti, con guarigione completa dalla patologia cutanea. La terapia medica ha esposto le pazienti a numerose recidive del processo infiammatorio, che può progredire con comparsa di atrofia dei tessuti molli, fibrosi o ulcerazioni. La sede del trattamento non ha alcuna influenza sulla comparsa di complicanze e sull’evoluzione delle stesse. Alcuni filler hanno condotto all’insorgenza di più complicanze, non correlate tra loro. Nella maggior parte dei pazienti è stato impossibile rimuovere completamente il filler, in seguito ad estesi processi di fibrosi