Background Reconstruction of the maxillary defects following tumor ablation remains to be a challenge for surgeons. Virtual surgical planning (VSP), intraoperative cutting guides and stereolithographic models provides the head and neck reconstructive surgeon with powerful tools for complex reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular free flap has not been as widely reported. The aim of this study was to compare aesthetic results and operation time of free scapular flap, with and without computer-aided design and computer-aided manufacturing (CAD/CAM) customized osteotomy guide, for reconstruction of maxillary defects. Methods In this prospective randomized controlled clinical trial study, we randomly assigned 22 patients with maxillary defects who were scheduled to undergo maxillary reconstruction with either free scapular flap with CAD/CAM customized osteotomy guide; study group (n = 11) or free scapular flap without CAD/CAM customized osteotomy guide; control group (n = 11). All patients were followed up for 3 months. The aesthetic outcome, operation and ischemic times were evaluated and compared. Results Aesthetic outcomes were evaluated objectively by means of differential surface area (sagittal and axial) measurement, which showed improved aesthetic outcome (contour symmetry) in the study group with a mean of (241.39 ± 113.74 mm2), compared to patients in control group with a mean of (358.70 ± 143.99 mm2). There were significant differences between the two groups (P < 0.05). Aesthetic outcomes were also evaluated subjectively by means of visual analogue scale (VAS) and patient’s satisfaction score (PSS). The postoperative aesthetic appearance was better in the study group with more patients satisfied than that in control group and there were statistically significant differences (P = 0.039). The mean total operative time was 678.81 min and 777.18 min in the study group and control group respectively (P < 0.05) and the mean ischemia time was 133.18 min and 195.72 min for study group and control group respectively (P < 0.05). The ischemia time and total operative time were shorter in the study group compared to those in the control group and there were no flap losses in both groups. Conclusion The use of CAD/CAM prefabricated cutting guides facilitates scapular flap molding and placement, minimizes ischemic time and operating time as well as improves aesthetic outcomes. Trialregistration This trial was registered at ClinicalTrials.gov. Registration number: NCT03757286. Registration date: 28/11/2018
Objectives: The present work aimed to examine the early and late histopathological changes occurring in the lower lips of rats, as a result of hyaluronic acid injection, and to determine whether it could really bring us closer to the ideal soft tissue filler material. This research highlights the importance of experimental studies on this subject since adverse reactions have been observed routinely in dental practice. Material and Methods: The present study was carried out on 36 adult male albino rats with age ranging from 2 to 3 months and weight ranging from 150 to 200g. Rats were divided into two equal groups, each consisting of 18 rats; group I (control group) and group II (experimental group). Rats in the experimental group were injected with hyaluronic acid (0.07 ml), whereas rats in the control group were injected with 0.9% sodium chloride. Each group was further subdivided into 3 subgroups: A, B and C according to the time of sacrifice at one week, one and a half months and three months respectively. Results: The results showed inflammation triggered by the injection of hyaluronic acid. On examining the specimens histologically using Hematoxylin and Eosin stains, Toluidine Blue stain and immunohistochemistry with anti-CD68 antibody, there was a significantly greater inflammatory response in the groups at early intervals with hyaluronic acid compared with the control (P<0.0001). Higher collagen formation was also observed with Masson’s Trichrome staining. Conclusions: Based on the histopathological, histochemical and immunohistochemical results of this study, undesirable effects of hyaluronic acid filler injection can be detected at early intervals following its injection. Fortunately, all the undesirable effects are transient and decrease by time, reaching levels comparable to normal. Overall, HA was well-tolerated by tissues, reflecting how this filler material possesses a biocompatible property. Clinical Relevance: This study introduces hyaluronic acid as a favorable dermal filling material to improve skin contour, and lip augmentation, reduce depression in the skin, and treatment of facial wrinkles with minimal side effects and reasonable cost.
Hyaluronic acid (HA) is a naturally occurring biodegradable polymer with a variety of applications in medicine including scaffolding for tissue engineering, dermatological fillers and viscosupplementation for osteoarthritis treatment. HA is present in most connective tissues as well as, in body fluids such as synovial fluid and in the vitreous humor of the eye. Due to its versatility, hyaluronic acid has been a major component of biomedical research and has seen application in several fields such as tissue engineering and cancer treatments. This review aims to outline hyaluronic acid’s effect and applications in the biomedical world.
Background: A customized plate design is an appropriate plate structure for mandibular angle fracture using the minimum output values for stress of plate. Methods: To evaluate the effect of customized plate fixation versus a conventional superior-inferior miniplates fixation of mandibular angle fracture on patient satisfaction. Results: Most patients were males (92%) while (8%) were females. (69 %) of patients’ age ranged from 17-35 years old, and (31%) patients were aged between 35.1-45 years old. There was a statistical difference (p=0.000) in the postoperative sensory dysfunction in both groups. Conclusion: Customized plate is a proper plate structure for mandibular angle fracture, it ensured a proper alignment of the fracture with good fixation without any post-operative sensory dysfunction.
Background: Extera skeletal (Extraosseous) Ewing sarcoma is a rare primary tumor of the soft tissue, with an extremely high mortality rate and a bad prognosis which primarily affects young individuals. It occurs without particular clinical signs and can impact several different areas, which may delay diagnosis. Histopathological examination and immunohistochemistry are crucial for making a definite diagnosis. Besides this, early diagnosis is necessary for succeeding of the management. Case report: The objective of the present case report was to document a rare case of EES which originated from the floor of the mouth. A 37-year-old male patient came to our clinic with sublingual rapidly growing swelling. He was suffering from difficulty in opening his mouth and a feeling of dysphagia. The patient revealed during a history-taking procedure that he had undergone one surgery to remove the mass that had previously developed in the same area, knowing that he had been diagnosed in the first as a non-specific inflammatory reaction. Clinical examinations revealed a dome shape soft tissue mass. The biopsy specimen underwent histopathological and immunohistochemical analysis, which demonstrated poorly differentiated small blue round cells with positive immuno-expression of CD-99, NKX2-2, FLI-1, and Vimentin. The final diagnosis was EES based on the clinical presentation, histopathological pattern, and findings of the immunohistochemistry investigations. Radiotherapy and chemotherapy were chosen as treatment modalities for the case. Unfortunately, the patient died after three months due to the occurrence of multiple distant metastasis areas. Conclusion: Regardless of the relative rarity of Extraosseous Ewing sarcoma, it should be taken into account as a possible differential diagnosis for intraoral soft tissue masses, and accurate diagnosis with precise histopathological and immunohistochemical evaluations should be done as soon as possible. Moreover, improvement of management procedures of such cases generally provides the best chances for patient survival.
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