An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy

INTRODUCTION

The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons' expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes.

METHODS

Patients (stage I-III) underwent surgery post-NACT (breast-conserving surgery (BCS), oncoplastic surgery (OPS), and conservative mastectomy (CMR) were included. Data selected were BRCA mutation, ptosis, breast volume, radiological response, MRI, and mammography pre- and post-NACT prediction of excised breast area. pNESSy was created using the association between these data and surgery. Area under the curve (AUC) was assessed. Patients were divided into groups according to correspondence (G1) or discrepancy (G2) between score and surgery; oncological and aesthetic outcomes were analyzed.

RESULTS

A total of 255 patients were included (118 BCS, 49 OPS, 88 CMR). pNESSy between 6.896-8.724 was predictive for BCS, 8.725-9.375 for OPS, and 9.376-14.245 for CMR; AUC was, respectively, 0.835, 0.766, and 0.825. G1 presented a lower incidence of involved margins (5-14.7%; p = 0.010), a better locoregional disease-free survival (98.8-88.9%; p < 0.001) and a better overall survival (96.1-86.5%; p = 0.017), and a better satisfaction with breasts (39.8-27.5%; p = 0.017) and physical wellbeing (93.5-73.6%; p = 0.001).

CONCLUSION

A score system based on clinical and radiological features was created to select the optimal surgery post-NACT and improve oncological and aesthetic outcomes.

Ultra-Translucent Zirconia Laminate Veneers: The Influence of Restoration Thickness and Stump Tooth-Shade

This in vitro study aimed to evaluate the final shade of translucent zirconia laminate veneers with varying thicknesses over teeth with different shades. Seventy-five chairside computer-aided design/computer-aided manufacturing (CAD/CAM) shade A1 third-generation zirconia dental veneers, with thicknesses of 0.50 mm, 0.75 mm, and 1.00 mm, were placed on resin composite teeth with shades ranging from A1 to A4. The laminate veneers were divided into groups based on thickness and background shade. All restorations were evaluated with a color imaging spectrophotometer, to map the veneer surface from A1 to D4. Regardless of the thickness or background shade, all dental veneers showed color alteration from the original shade. Veneers with 0.5 mm thickness tended to display the B1 shade, while veneers with 0.75 mm and 1.0 mm thickness primarily exhibited the B2 shade. The thickness of the laminate veneer and background shade significantly modified the original shade of the zirconia veneer. One-way analysis of variance was performed and a Kruskal-Wallis test was used to determine the significance between the three veneer thicknesses groups. The results indicated that the thinner restorations showed higher values with the color imaging spectrophotometer, suggesting that thinner veneers may result in more consistent color matching. This study underscores the importance of carefully considering thickness and background shade when selecting zirconia laminate veneers, to ensure optimal color matching and overall aesthetic outcomes.

Five-year outcomes of a randomized controlled clinical trial comparing single-tooth implant-supported restoration with either zirconia or titanium abutments

AIM

To evaluate the influence of the abutment material (zirconia vs. titanium) on the long-term aesthetic and clinical outcomes of implant-supported restorations.

MATERIALS AND METHODS

In 30 patients, a single implant-supported restoration with either a zirconia or a titanium abutment was placed in the anterior maxilla (incisors, canines, and bicuspids). Aesthetic (Implant Crown Aesthetic Index or ICAI), clinical, radiographic, and patient-centred outcomes were recorded at baseline (1 month after final restoration), 1 year, and 5 years of follow-up. This study was registered in ClinicalTrials.gov (NCT02315794).

RESULTS

Twenty-five subjects completed the follow-up visits at 1 and 5 years. ICAI values showed statistically significant better aesthetic outcomes when zirconia abutments were used compared to titanium abutments. Between 1 and 5 years, the aesthetic sub-analysis of the crown component worsened but the mucosal sub-analysis improved. There were no significant changes in bone levels, but the plaque index, bleeding on probing, and probing depths worsened in both groups.

CONCLUSIONS

At 5 years, standard zirconia abutments achieved better aesthetic outcomes, although with similar clinical behaviour.

The influence of thin as compared to thick peri-implant soft tissues on aesthetic outcomes: A systematic review and meta-analysis

Objectives

In systematically healthy patients with an implant‐supported fixed restoration (P), what is the influence of thin (E) as compared to thick (C) peri‐implant soft tissues on aesthetic outcomes (O)?

Methods

Following an a priori protocol, a literature search of six databases was conducted up to August 2020 to identify prospective/retrospective clinical studies on healthy patients with an implant‐supported fixed reconstruction. Measurement of the buccal soft tissue thickness and an aesthetic outcome was a prerequisite, and sites presenting with a buccal soft tissue thickness of <2 mm or shimmering of a periodontal probe were categorized as a thin phenotype. After study selection, data extraction, and risk of bias assessment, random‐effects meta‐analysis of Mean Differences (MD) or Odds Ratios (OR) with their corresponding 95% Confidence Intervals (CI) were conducted, followed by sensitivity analyses and assessment of the quality of evidence.

Results

Thirty‐four unique studies reporting on 1508 patients with 1606 sites were included (9 randomized controlled trials, one controlled trial, 10 prospective cohort studies, 8 cross‐sectional studies, and 6 retrospective cohort studies). The mean difference of the pink aesthetic score (PES) after the follow‐up was not significantly different between thin (<2.0 mm) or thick soft tissues (≥2.0 mm) or phenotypes (12 studies; MD = 0.15; [95% CI = −0.24, 0.53]; p = .46). PES changes during the follow‐up, however, were significantly in favour of thick soft tissues (≥2.0 mm) or phenotypes (p = .05). An increased mean mucosal thickness was associated with an increased papilla index (5 studies; MD = 0.5; [95% CI = 0.1, 0.3]; p = .002) and an increase in papilla presence (5 studies; OR = 1.6; [95% CI = 1.0, 2.3]; p = .03). Thin soft tissues were associated with more recession, −0.62 mm (4 studies; [95% CI = −1.06, −0.18]; p = .006). Patient‐reported outcome measures (patient satisfaction) were in favour of thick soft tissues −2.33 (6 studies; [95% CI = −4.70, 0.04]; p = .05). However, the quality of evidence was very low in all instances due to the inclusion of non‐randomized studies, high risk of bias and residual confounding.

Conclusion

Within the limitations of the present study (weak study designs and various soft tissue measurements or time‐points), it can be concluded that increased soft tissue thickness at implant sites was associated with more favourable aesthetic outcomes.

Comparison of aesthetic outcomes between open and endoscopically treated sagittal craniosynostosis

OBJECTIVE

In the last several decades, there has been much debate regarding the ideal treatment for sagittal synostosis. The purpose of this study was to compare perioperative, anthropometric, and subjective assessments of cosmetic outcomes between open and endoscopic management of isolated sagittal synostosis.

METHODS

At their routine postoperative follow-up, pediatric patients with sagittal craniosynostosis were recruited to undergo digital cranial measurement and standardized photography for objective and subjective assessments of perioperative outcomes. Age-normalized z-scores for cephalic index, head circumference, euryon-euryon diameter (Eu-Eu), and glabella-opisthocranion diameter (G-Op) were calculated for each patient. Faculty surgeons, surgical trainees, nurses, and laypersons were asked to rate the normalcy of craniofacial appearances using a 5-point Likert scale. Outcomes were compared between patients treated with endoscopic correction and those treated with open repair.

RESULTS

A total of 50 patients were included in the study. Thirty-one had undergone open surgical correction, and 19 had undergone endoscopic treatment. Endoscopic repair involved significantly lower operative time, blood loss, transfusion rate, and hospital length of stay than those with open repair (p < 0.001). There was no significant difference between groups in terms of z-scores for head circumference (p = 0.22), cephalic index (p = 0.25), or Eu-Eu (p = 0.38). Endoscopic treatment was associated with a significantly lower G-Op (p = 0.009). Additionally, the average subjective rating of head shape was higher for endoscopic treatment when corrected for age, gender, and ethnicity (p = 0.02).

CONCLUSIONS

The study findings suggest that patients who are treated endoscopically may have an overall more normal appearance in skull morphology and cosmesis, although these results are limited by poor reliability.

Current Protocol for Aesthetic Scar Management in Thyroid Surgery

OBJECTIVES/HYPOTHESIS

We compared the scar quality when different protocols were applied, and eventually aim to find the optimal scar management protocol.

STUDY DESIGN

We conducted a prospective, randomized, and blinded comparison of different scar management protocols in a single center.

METHODS

We allocated 126 patients who underwent thyroidectomy via collar neck incision randomly into three groups. Patients in group A were treated with tissue adhesive only. Patients in group B were treated by means of subcuticular suturing and early scar management with a non-ablative fractional laser (NAFL) and intralesional triamcinolone injection (ILI). Patients in group C had skin closure with tissue adhesive and early scar management. At 6 months after the operation, the Patient and Observer Scar Assessment Scale (POSAS) and the width of the final scar were compared.

RESULTS

Comparing the sum of PSAS, groups B and C showed significant higher satisfaction than did group A (22.81 ± 11.66 in group A, 10.9 ± 5.14 in group B, and 15.19 ± 9.98 in group C). In the sum of OSAS, group B also showed a significant difference than did groups A and C (17.74 ± 6.75 in group A, 10.26 ± 3.60 in group B, and 14.52 ± 6.48 in group C). Also, group B showed a narrower scar width than did groups A and C.

CONCLUSIONS

Our finding suggests that subcuticular suturing using barbed suture material and early treatment with a combination therapy using NAFL and ILI showed a favorable aesthetic outcome for both patients and operators. Based on our algorithmic approach for thyroidectomy scar, we anticipate an optimal aesthetic outcome.

LEVEL OF EVIDENCE

II Laryngoscope, 131:E2188-E2195, 2021.

Comparison of the Basal View and a Previously Standardized Cleft Lip Rating Scale

OBJECTIVES

Numerous scales assessing the aesthetics of cleft lip repair exist. Most, including the Asher-McDade scale, use frontal and lateral views, while neglecting a basal view. We believe this view is important for properly assessing the aesthetics of repair. In this study, we evaluate the basal view in comparison to the Asher-McDade scale.

METHODS

This scale was based on progressive columellar shortening and alar flaring/slumping. A panel of 4 plastic surgeons applied the basal and Asher-McDade scales to pictures of patients with repaired unilateral cleft lip in 56 multiethnic participants aged 5 years to 18 years; images were scored from 1 to 5 (best). Statistical analysis was done via Spearman correlation.

RESULTS

Scores from plastic surgeons correlated strongly for each view. There was moderate correlation for the basal view with both nasal form and deviation scores ( P < .05). As expected, there were no strong correlations between the basal view and vermillion border or profile.

DISCUSSION

The Asher-McDade scale has been used to evaluate cleft lift repairs but is limited due to its subjective nature. The basal view scale grades these repairs by using a scale of progressive columellar shortening and alar flaring/slumping, which provides an opportunity for quantification and standardization. Our results show that the basal view correlates with the Asher-McDade scale among raters, thus providing an objective and validated measure of cleft lip repair.