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This study aims to explore the prevalence of Iatrogenic retroposition of the lips sequel (IRLS) after bicuspid extraction, associated dentofacial characteristics and the effectiveness of surgical treatment.and methods: Patients with bicuspid extraction as part of an orthodontic treatment plan were retrospectively included. IRLS was identified by clinical evaluation and cephalometric Legan and Burstone analysis. Association of demographic and cephalometric variables were assessed. The effectiveness of combined orthodontic-orthognathic correction of the retroposition of the lips was evaluated.Out of 144 patients with extracted bicuspids, eight Class I patients, nine Class II patients and five Class III patients were seeking treatment because their lips had retruded as a consequence of compensating orthodontic treatment. Lower jaw bicuspid extraction and a decreased vertical facial height in Class II patients correlated significantly more with IRLS development. Postoperative cephalometric analysis of orthodontic-orthognathic treated patients reported improvement in lip projection and naso-labial angle. Only two Class I patients reported postoperative normalization of the lip position according to Legan and Burstone.The consequence of bicuspid extractions on soft tissue profile differs according to skeletal jaw relation. The impact of orthognathic surgery on IRLS is beneficial, although insufficient to completely correct the facial profile when judged on cephalometric standards.

Three-dimensional midfacial deficiency in cleft patients is common and is frequently connected to impairment of the aesthetic facial appearance. Different approaches to augment relevant facial regions are available. Alloplastic facial implants have been established as a viable alternative to autologous tissue augmentation in various circumstances. However, in cleft patients, the application of facial implants has rarely been reported. This retrospective study aimed to evaluate the use of Medpor implants for midfacial contouring in cleft patients. Fifty-one patients with orofacial clefts were assessed with regard to defined parameters. A range of Paranasal, Malar and Nasal Dorsum Medpor implants had been used. Unilateral cleft lip and palate (UCLP) represented the most common indication, followed by bilateral cleft lip and palate (BCLP). Bilateral implant insertion was performed as a general rule with few exceptions. Insertion of implants was frequently combined with other cleft-related surgical procedures. Even after orthognathic surgery, midfacial augmentation was implemented to specifically address residual volume deficiency, particularly in the malar region. The complication rate amounted to 4.9% (6/122 implants). Based on our findings, Medpor implants are reliable and long-term stable materials to successfully augment paranasal, subnasal and malar areas as well as a solid nasal dorsum material with few complications in cleft patients.

Introduction : Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal. Both conservative and invasive treatment options are diverse and guidance to their implementation is lacking. Methods : A Delphi consensus process was used to review current literature and draft relevant statements. These were reconciliated until sufficient agreement was reached. The grade of evidence was determined. These guidelines were based on the published literature up to June 2020. Results : Hemorrhoids are normal structures within the anorectal region. When they become engorged or slide down the anal canal, symptoms can arise. Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations. For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids. Conclusions : The current guidelines for the management of hemorrhoidal disease include recommendations for the clinical evaluation of hemorrhoidal disorders, and their conservative, instrumental and surgical management.

The aims of this study were to assess the accuracy of measurements recorded by 3D stereophotogrammetry and to compare three methods of facial measurement: manual anthropometry, 3D stereophotogrammetry and 2D photography. Measurements were taken from 14 landmarks on each of six volunteers and compared. In addition, the variability of the methods was assessed. Three-dimensional measurements were shown to compare well with manual measurements on volunteers as well as test objects for which the mean difference was 0.23 mm (shortest distance) and 0.13 mm (surface). All the three methods of measurement were found to have good levels of repeatability. Two-dimensional measurements were more variable than manual measurements (P=0.021). Three-dimensional stereophotogrammetric measurements were shown to compare well with manual measurements although the values obtained were mostly slightly larger. Stereophotogrammetry allows images to be taken in a Medical Photography Department, facilitating the accurate measurement of facial morphology from digitized data, including changes associated with treatment or growth. There are clear potential benefits of using 3D measurements in the assessment of facial deformity.

Malar and paranasal implants offer a way to augment and reconstruct midfacial deformities, and can be used across a broad spectrum of craniofacial deformities. Three patients aged between 13 and 15 years underwent such a procedure. Access was achieved via a labial mucosal approach; 'super petite' and 'petite' malar and paranasal Medpor implants were inserted in a subperiosteal plane and secured with titanium screws. All patients underwent an uneventful postoperative recovery and have remained pleased with their reconstruction at follow-up. In carefully selected patients, Medpor implants may have a role in teenage cleft patients with subtle midfacial hypoplasia, where formal osteotomies are not felt to be required, or where the lengthy preparation period might not be tolerated. In the cases described, they were used as a bridging or temporizing measure as there was not yet the skeletal maturity for definitive osteotomies. These patients may otherwise face a lengthy wait during their teenage years, in which they may struggle to manage what they may perceive as a significant facial deformity.

A case of a patient with a pure squamous cell carcinoma of the stomach is presented. Surgery, the treatment of choice for this rare gastroenterological tumour, gives no guarantee for cure. Prognosis, as is demonstrated by our case, is poor with few exceptions. Different theories of histopathogenesis are discussed in the literature but no definitive statement can be made.

Introduction Obstructive sleep apnoea (OSA) is a clinical condition in which there is intermittent and repeated upper airway collapse during sleep. Maxillomandibular advancement (MMA) has been shown to enlarge the pharyngeal and hypopharyngeal airway by physically expanding the facial skeletal framework. It has also been shown that advancement of the maxillomandibular complex increases tissue tension, and is a valid surgical treatment option for those patients unable or unwilling to tolerate long term continuous positive pressure ventilation (CPAP). Method We present a series of 10 patients who underwent MMA and genioplasty surgery for OSA, operated by one surgeon, with an average age of 47 years and an average BMI of 27. The minimum advancement of the mandible was 15mm with the maxilla advancing between 12–15 mm. Diagnosis of OSA was based on: clinical history, Epworth Sleepiness Scale (ESS) questionnaire, and formal sleep study parameters via ambulatory sleep study. Lateral cepalometric radiographs were taken pre- and post-operatively to assess widening of the posterior airway space (PAS). The patients were reassessed using the same criteria 6 months post surgery, with annual follow up. Results All 10 patients reported an improved ESS with the average reduction of 70.3%. The PAS increased by 48.4% (5.11mm), on average, with the biggest increase recorded as 11.8mm. The average apnoea hypopnoea index and oxygen desaturation events decreased by 74% and 69% respectively. Conclusion The outcome of MMA advancement has previously been reported, with success rates in the literature varying from 57% to 100%. There are no long term studies indicating success. The outcomes of our series of patients support MMA advancement as an effective surgical treatment for OSA and show sustained improvement up to 5 years postoperatively. Careful patient selection and a multidisciplinary approach to management are key to achieving success. Although CPAP remains the standard treatment for most patients with OSA, MMA provides an alternative for selected OSA patients who cannot use CPAP or who wish a curative treatment without life-long dependency on these devices.