Hybrid mandibular Bologna midline distractor in combination with surgically assisted rapid maxillary expansion for transverse facial expansion: clinical and cephalometric results

Transverse maxillomandibular hypoplasia can be treated with surgically assisted rapid maxillary expansion (SARME) in association with mandibular symphyseal distraction (MSD). This paper introduces a hybrid mandibular Bologna midline distractor (BMD); the effectiveness of the distractor in combination with SARME for the treatment of transverse skeletal deficiency was evaluated. This two-centre study included 10 patients with a transverse arch width deficit>7 mm and dental crowding, in both the maxilla and mandible, treated with SARME and MSD. The study design was partly retrospective (seven patients) and partly prospective (three patients). Frontal and lateral cephalometric analyses, as well as measurements on dental models, were performed at three different times: before treatment, after the distraction, and 6 months after postoperative orthodontic treatment. The cephalometric analyses and measurements on dental impressions confirmed a balanced and stable skeletal and dental mandibular expansion. An average symphyseal expansion of 7.8 mm was obtained, resolving dental crowding without dental extractions. In conclusion, mandibular expansion performed with the BMD in combination with SARME appears to be a viable surgical approach to transverse maxillomandibular hypoplasia. This technique allows the surgeon to obtain a balanced skeletal and dental expansion, with a low level of relapse.

Malignant tumours of the parotid gland: management of the neck (including the clinically negative neck) and a literature review

Major salivary gland malignancies are rare, constituting 1%-3% of head-neck tumours. The surgical management of the clinically negative neck (cN0) does not have a univocal consensus yet. We have carried out a retrospective study on 119 cases of malignant parotid tumours that were surgically treated between January 1999 and January 2014. Our aim was to analyse preoperative findings (cytotype, cTNM) and to correlate these with postoperative results (grading, histotype, occult neck metastasis) in patients with parotid tumours to obtain an appropriate indication for neck management. In cN0 patients with a T1, T2 low-grade cancer a wait-and-see approach is preferred. Instead, in cNO patients with high-grade or low-grade T3, T4 tumours an elective neck dissection (END) is always planned. Levels II, III and IV, at least, must be dissected. The decision to dissect level V or I depends on the location of the primary tumour. In the cN0 group 19 of 58 (32.7%) patients who underwent an END had occult metastases. In clinically positive neck (cN+) patients a Modified Radical Neck Dissection (MRND), at least, must be performed. The criteria to add adjuvant radiotherapy (PORT) include deep lobe parotid tumours, advanced lesions (T3-T4), microscopic (R2) or macroscopic (R1) residual disease after surgery, high grade tumours, perineural diffusion, lymph node metastasis, capsular rupture, and local recurrence after previous surgery. Kaplan-Meier analyses have shown a reduction in the overall survival (OS) from 100% to 91% and in disease-free survival (DFS) from 100% to 95.5% for the NO-PORT and PORT group, respectively. In our study, the cN0 pN+ patients had a higher degree of DFS compared to the cN+.

Evaluation of gingival microcirculation in patients undergoing fixed orthodontic treatment: a pilot study

AIM

Among the many biological effects which occur during orthodontic movement, we decided to investigate gingival microcirculation. The aim of the study was to evaluate the biological microvascular response to the application of orthodontic force in vivo.

MATERIALS AND METHODS

Forty patients (case group) between 9-22 years of age (average± DS 12±3.01) were selected for the study (M/F ratio: 20/20). They needed fixed orthodontic treatment due to several types of malocclusion. Forty healthy subjects (control group) were also recruited (M/F ratio 20/20; average age 12 years ± 4.01; Mean±SD =10.04±1.7). A videocapillaroscopic examination was performed on each patient on the buccal alveolar mucosa at the pre- treatment time (t0), 1 month after the beginning of the treatment (t1), after 2 months (t2), after 6 months (t3), and after 12 months (t4).

RESULTS

Capillary density increases significantly from t0 to t1. Between t1 to t2, t2 to t3 the density underwent another increase. Between t3 and t4 (69.22 ± 3.63) the density showed no increase. In the control group no statistical differences were observed.

CONCLUSION

Videocapillaroscopy allows the in vivo evaluation and quantification of the microcirculatory changes consequent to the application of orthodontic force, managing to detect subclinical changes in angiogenesis. In fact, the study revealed an increase in the density of the capillaries which is directly proportionate to the application time of the orthodontic device, i.e. the exogenous mechanical force. This research offers new perspectives for the future of monitoring fixed orthodontic therapy.

Diagnosis of glycogenosis type II

The diagnosis of glycogenosis type II is often complicated by the rarity of the condition and the heterogeneity of the clinical manifestations of the disease. It is a progressive, debilitating, and often fatal neuromuscular disorder that manifests as a continuum of clinical phenotypes, which vary with respect to organ involvement, age at onset, and severity. Early diagnosis requires both increased awareness among physicians regarding the clinical characteristics of the disease and fast and reliable acid alpha-glucosidase (GAA) enzyme activity assays to confirm the GAA deficiency. The clinical diagnosis of glycogenosis type II is confirmed by virtual absence (found in infants) and marked reduced activity (found in juveniles and adults) of GAA enzyme in blood samples, cultured fibroblasts, and muscle biopsies. This article specifically highlights the need for early recognition of the clinical manifestation of the disease in infants, juveniles, and adults. Descriptions of the main clinical features of the condition, as well as differential diagnosis are included. In addition, the tests required for a confirmed diagnosis are described, and use of muscle imaging to evaluate muscle pathology is reviewed.

Fructose, prostatic acid phosphatase and zinc levels in the seminal plasma of varicoceles

The function of sex accessory glands in 95 varicocele patients was investigated by determining the fructose, prostatic acid phosphatase (PAP), and zinc levels in the seminal plasma. These biochemical substances are, in fact, markers of the seminal vesicles and prostate, respectively. It was observed that both the PAP and zinc levels were significantly lower (P less than .002) in varicoceles than in the control group, while both fructose and PAP levels were particularly low in a small subgroup of the older patients. The authors suggest that the impaired sex accessory gland functions could arise from decreased venous drainage in the vesico-prostatic plexus. The fructose/zinc ratio appears to be negatively related to sperm motility (r = .31, P = .01); this suggests that in varicocele the impaired sex accessory gland secretions could themselves influence the motility of ejaculated spermatozoa.

[Long-term development of chronic hepatitis caused by virus B in childhood]

Ten children with chronic hepatitis B have been followed for at least 3 years. All patients received 2 liver biopsies, the first after 1 year of continuous liver disfunction and HBsAg positivity, and the second 2 years after, that showed a mild improvement of the histologic lesions in 4 cases of chronic persistent hepatitis (CPH) and in 1 case of chronic lobular hepatitis (CLH). Three children out of 5 with chronic active hepatitis (CAN) changed to CPH and the other 2 remained unchanged without any evidence of cirrhosis. No patient received any drug for the treatment of hepatitis.

[Intra-familial transmission of HBV infection]

We investigated 63 household contacts of 29 children positive for serologic markers of hepatitis B virus, in order to assess the intrafamiliar spread of HBV infection. 40 relatives of 15 children affected by chronic hepatitis B (Group I) and 23 relatives of 14 patients affected by hemophilia (Group II) were studied. HBV markers (HBsAg, anti-HBs, anti-HBc, HBeAg, anti-HBe) were tested in all the subjects by RIA. Positive markers were found in 39 (62%) of the subjects; the combined prevalence for all HBV markers was 75% in the Group I, and 39% in the Group II. The higher prevalence rate in Group I can be explained by the possible previous infection of another member of the family, whereas in Group II the child is almost surely the first infected subject. Besides, subjects of Group I have probably been in contact with HBV infected children a longer time, compared to subjects in Group II. Our data suggest that household contacts of children with HBV infection are at high risk and should therefore be immunized against HBV.