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Purpose The goal of this systematic review is to assess the accuracy and complications (including failure) of dynamic navigation in placing zygomatic implants. Methods PubMed, Cochrane Library (CENTRAL), trial register ( clinicaltrial.gov ), and Google Scholar were searched systematically up to May 2020. In addition, the reference lists of included systematic reviews were hand searched. The New Castle Ottawa and Joanna Briggs Institute Critical Appraisal Checklist for Case Reports were used for quality assessment. Results Ninety-four studies were assessed, and finally, 12 articles were included. According to Joanna Briggs Institute tool, the mean score of case reports (±standard deviation) was 6.4 (range, 5/9 to 8/9) and the mean score of observational studies (±standard deviation) was 5.66 (range, 5/9 to 7/9) as measured by New Castle Ottawa tool. Included materials pointed out that higher accuracy and drastic cut down on the risk of perioperative/postoperative complications were reported by using the dynamic navigation system compared with freehand implant placement. Conclusions Application of dynamic navigation systems is a reliable technology for zygomatic implant placement, especially in difficult cases with a history of maxillary deficiency. Evidence of reliability and accuracy of dynamic navigation technique in multicenter large randomized and prospective controlled studies is still lacking.

Objective post-surgical complications of rhinoplasty such as scars may alter the success rate of the operation. The aim of this study was to investigate the effects of fractional CO2 laser on the scars of alar base region in rhinoplasty patients. Materials and methods Twenty six patients who had subsequent scar in the alar base region after open rhinoplasty were enrolled to this clinical study. Their skin type was recorded using Fitzpatrick scale, and then patients were randomly allocated into the control and the laser groups. Patients in the control group received no treatment, in the laser group, one session of fractional CO2 laser therapy with a 0.05 mm spot diameter, 4 ms pulse duration, 12−14 W power and 48_56 mJ energy in each pulse was completed. The scar score was evaluated using Vancouver Scar Scale before and 6 months after the treatment. The Scar score was calculated in a descriptive manner. Paired t-test and (Wilcoxon test) were employed to compare the results before and after the treatment. Data were analyzed using SPSS software version 22, and the level of significance was P Results No difference was observed regarding the demographic information and the skin type between the two groups. After 6 months, reduction in the scar score was observed in both groups, however, the difference was not statistically significant. Conclusion This study concluded that fractional CO2 laser did not affect the scar of alar base incision after rhinoplasty.

Piezoelectric tools are the novel ultrasonic methods for effective and safe osteoplasty or osteotomy in comparison with traditional soft and hard tissue approaches using rotating instruments due to lack of microvibrations, ease of control and use, and safer cutting, mainly in complex anatomic areas. Piezoelectric indicates favorable and valuable outcomes based on the immediate postoperative morbidities, even though long-term results have not been investigated. It could be indicated that the piezosurgery in rhinoplasty can be considered as a reliable and safe method and should be taken into account as a part of the surgeon's repertoire for rhinoplasty.

Purpose Numerous methods have been developed for blepharoplasty, including carbon dioxide (CO2) laser-assisted blepharoplasty. Although the superiority of CO2 laser compared with the scalpel for blepharoplasty has been proposed, to the best of our knowledge, no study has compared the clinical outcomes of blepharoplasty with the CO2 laser alone versus the combined use of a scalpel and CO2 laser. Patients and Methods In the present randomized clinical trial, 21 healthy patients underwent bilateral upper eyelid blepharoplasty. For each patient, an initial skin incision was made using the CO2 laser (setting, continuous emission; ultrapulse mode; 3 W of power) on 1 side and a scalpel on the other side. The remaining blepharoplasty steps were conducted using the CO2 laser (setting, continuous emission; 9 W of power) in both groups. The patients were evaluated on postoperative days 1, 3, 7, 14, and 30 using the postoperative repair criteria, including edema and ecchymosis. The Manchester scar scale was used to evaluate the results at 60 days after surgery. Results Our comparison of the 2 methods showed no significant differences at 1 month after surgery using the evaluation criteria. The scar index was not significantly different after 60 days, despite lower scores in the scalpel group. Conclusions In upper eyelid blepharoplasty, making an initial incision with a scalpel, followed by use of a laser provides advantages similar to those found by performing the entire procedure with a CO2 laser alone.

Since the beginning of the era of space travel, there have been mentions of related health effects. Various studies have described the effect of space travel and microgravity on health. Some of these studies involved short and extended follow-ups of the effect of microgravity on the head and neck of astronauts. Therefore, we aimed to analyse the oral and maxillofacial health effects associated with this sophisticated mission. It is essential to identify relevant problems and address microgravity complications. Humans have long dreamed of flying and in recent years, the dream has evolved to exploring space and creating new habitats on other planets such as Mars. This led to an increase in the need for dental treatment of the flight crew members, which led to the creation of aviation dentistry for the screening and treatment of the oral cavity of the flight crew. We are moving towards a more conservative approach than before, such as removing pulpless teeth in aircrew patients or extracting roots that had a fracture or incomplete extraction. With all the advancements in aerospace knowledge, the aviation dentistry has rarely or briefly been discussed in dental textbooks. Dentists must screen each flight crew member thoroughly and impose flight restrictions and ground them if necessary; the reasons will be discussed later within this paper. It is the duty of dentists and surgeons to notify their patients (aircrew members) about the postoperative flight consequences and restrictions.

Background: Malnutrition is generally due to a lack of nutritional information rather than food deficiency. Therefore, the current knowledge, attitudes, and practice (KAP) of the target audience should be evaluated to eliminate malnutrition. However, KAP varies across demographic status and socioeconomic status (SES). Aim: The associations of nutritional KAP with demographic and socioeconomic variables were evaluated among households living in urban and rural areas of southwestern Iran. Methods: A cross-sectional, population-based study was conducted on 842 household heads (492 urban and 350 rural) using a standardized NUTRIKAP Household Questionnaire. The data evaluating nutritional KAP as well as demographic and socioeconomic information were obtained using a multi-stage cluster sampling method. SES score was also computed. Results: Urban households had a higher level of nutritional knowledge ( p < 0.05) but a lower level of nutritional attitude ( p < 0.001) and practice ( p < 0.001) compared with the rural ones. Rural households with the poorest quintiles of SES were 0.4 times less likely to have good nutritional knowledge (adjusted odds ratio = 0.4, confidence interval: 0.2, 0.9; p < 0.05), compared with higher quintiles. Households with an over-60-years-old household head had significantly higher nutritional attitude ( p < 0.05) and practice ( p Conclusions: These results can indicate the role of demographic and socioeconomic determinants in KAP of Iranian households towards the principle of nutrition and can be effective in prioritizing the implementation of nutritional interventions including nutrition education for them.

Objective This study evaluated three different internal rigid fixation patterns’ strength by finite element analysis (FEA) in a Zygomaticomaxillary complex (ZMC) fracture to find the best fixation results. Methods This is a FEA research study of a 30-yearold man’s skull cone-beam computed tomography (CBCT) imaging. The zygomatic complex fracture was simulated by the software on the model. Various fixation types were simulated on the model by Synthes miniplates in seven different methods. The resistance of each group against the average pressure of masseter and pterygoid muscles was analyzed by force importation on the muscle line axis. Results Both the Highest Bone Movement and the Highest Average Bone Movement were related to group 1 (one plate on zygomaticofrontal suture). On the other hand, both the Lowest Bone Movement and the Lowest Average Bone Movement were related to group 6 (two plates on zygomaticomaxillary suture and inferior orbital rim). There were, however, no significant differences between the measurements. Conclusion According to the lack of significant difference between the movements, there is no significant difference between all groups’ strength.

Background As the desire for beauty and youthful appearance has increased in recent years, cosmetic injections are getting more attention. However, patients discomfort during these injections is a challenging issue. Aim This review explores common approaches to reduce pain and discomfort during cosmetic injections through the available literature. Methods The eligible studies through searching in PubMed have been entered to evaluate the common methods of pain reduction for cosmetic injections. Results According to reviewed studies, vibration, local anesthesia, and vapocoolant anesthesia are common methods applied in order to reduce pain and discomfort in patients. All of these methods are able to reduce pain through their affects on neuron fibers. Conclusion It seems that all common approaches can result in some amount of pain reduction. Using a combination of these methods during injections, practitioners can successfully reduce the pain of injection.

Background Reduction in postoperative complications is of vital considerations in impacted third molar teeth surgery. The aim of this study was to compare postoperative complications of impacted third molar surgeries for bone removal using laser, piezoelectric equipment, and conventional rotary instruments. Methods To address the research purpose, the investigator designed the prospective double-blind clinical trial study. The sample size was determined 20 (40 teeth) by sampling formula in any kind of operation. The data of patients were obtained in the different periods in terms of pain, trismus, swelling, ecchymosis, and patient’s satisfaction and then analyzed using SPSS 20 software via paired t test and Wilcoxon and McNemar’s tests. Results The pain immediately after surgery and 2 days and 7 days after surgery was higher in the laser group. The swelling immediately after surgery was more in the laser group but not significant. The amount of mouth opening immediately after surgery and 2 days and 7 days after surgery was significantly lower in the laser group than in the piezosurgery group. The total duration of surgery and duration of osteotomy were significantly longer in the laser group. The patient’s satisfaction from surgery with piezosurgery was more than that with laser, but this difference was not significant. Conclusion Due to the rising demand for impacted wisdom tooth surgery, the present study suggests that hard tissue laser surgery and piezosurgery can clear the future of impacted molar surgery, and these approaches are more efficient in reducing postoperative complications compared to the conventional surgeries.

Background Nasal sill is one of the components of the alar ring, affecting the esthetic outcomes of rhinoplasty; accordingly, we developed a novel technique to adjust defects in this area and compared it with the available techniques. Methods Our technique was based on creating a tunnel access to the nasal sill area through an incision made in the lower third of the columella using the open approach or through a nostril base incision in patients, who underwent alar base reduction, followed by insertion of a cartilaginous graft into the marked defect area. Results A total number of 54 patients with a defect in the nasal sill area were included in this study. Thirty-one patients underwent open rhinoplasty with the sill approach from the lower third of the columella, while 23 patients underwent rhinoplasty with a nostril base approach for nasal sill augmentation procedure. There were no reports of patient dissatisfaction, infection, bleeding, sensory dysfunction, or remaining asymmetry of the sill area. Conclusion Based on the findings of the present study, this technique can be successfully used in reconstructing the nasal sill area with minimal complications and morbidity.

Background Autologous fat has become more frequently used for nasal volume augmentation and nasal correction. Nasal lipofilling refers to the use of injectable autologous fat grafts for nonsurgical aesthetic corrections. Objectives This systematic review aims to assess the satisfaction, complication, and retention rates of fat injection in nasal shape corrections. Methods The authors searched PubMed/Medline and Google Scholar up to and including October 2020 with no time and language restrictions for pertinent materials. Two authors conducted a duplicate searching process independently to determine proper materials based on the inclusion and exclusion criteria. One author retrieved the following data from the finally included studies based on a predefined checklist worksheet. Results The included studies report data from a total of 564 patients undergoing nasal fat injection in 12 studies. The mean score in our included materials was 6.08 with a range of 4 to 7 scores. In most of our included materials, no complication was reported for the peri/postsurgical period. Although some papers reported manageable complications such as an insufficient volume or decreased volume by resorption, tip excess and supratip fillness, and mild displacement, more than half of our included materials reported on patient satisfaction with aesthetic results of fat injection. The satisfaction rates were mostly high and ranged from 63% to 100%. Conclusions Autologous fat injection is an effective and minimally invasive treatment for nasal aesthetic and contour correction with a high satisfaction rate and low complication rate. Clinical expertise is essential to have a safe injection and to minimize the potential complications. Level of Evidence: 4

Orthognathic surgery is not solely a treatment related to functional occlusion. Most patients demanding orthognathic surgery also opt for other aesthetic procedures like genioplasty, rhinoplasty, fat grafting, and cheek augmentation, some of which can be performed in a single procedure. Over 60% of orthognathic surgery patients have been found to have concurrent nasal deformity before surgery. We briefly discussed indications, concerns, and feasibility of performing orthognathic surgery and rhinoplasty simultaneously.

Today, maxillofacial and cosmetic surgeries are experiencing significant development in terms of virtual reality (VR) and augmented reality (AR) applications. Currently, applications of this technology can be classified into three major categories: training and education of students, clinical application for the surgeon, and communication with patients. In this chapter, after discussing the fundamental concepts of VR/AR technology, we will describe each application of these technologies in the areas of oral, maxillofacial, and cosmetic surgery.

The ultimate goal for an oral and maxillofacial surgeon is to recover normal function and reach satisfying aesthetic results. The nature of surgical procedures for the treatment of trauma, malignancy, and congenital defects requires grafts to recover the lost amount of the tissues. Each kind of graft from human or non-human sources may lead to specific complications. These complications can lead to unfavourable results of surgical procedures. Regenerative medicine aims to use the high capability of human tissues to regenerate.

Clinical facial analysis (CFA) is a technique used by the surgeon to examine the appearance of the face, volume, angles, and possible abnormalities and includes direct examination, clinical imaging, and x-ray imaging. In this chapter, we strive to provide a standard approach to face analysis both in terms of hard tissue and soft tissue.

Since rhinoplasty surgery was first introduced, notable developments have been obtained in this field. In the last decades, surgeons aimed at improving the surgical procedure to achieve the long-term constant outcomes, avoiding postoperative complications, preventing nasal airway deficiency, making the operation less invasive and consequently lowering the possible damages to adjacent tissues, and finally proper management of the procedure to enhance the esthetic appearance of the nose. On the other hand, there is a significant change in people’s way of thinking toward having a nose with a natural appearance. Meanwhile, the emergence of grafting methods has led to disappearing of older invasive techniques. The present chapter attempts to have an overview of the novel techniques in rhinoplasty. The latest techniques in nasal tip surgery, lateral osteotomy, dorsal surgery, nasal base surgery, Asian rhinoplasty, and preservation rhinoplasty are discussed.

Background Orthognathic surgery such as bilateral sagittal split ramus osteotomy (BSSRO) for the treatment of mandibular deformities is one of the most common procedures in maxillofacial operations that may lead to neurosensory disturbance. In this study, we aimed to evaluate the effectiveness of low-level laser therapy (LLLT) on augmenting recovery of neurosensory disturbance of inferior alveolar nerve (IAN) in patients who underwent BSSRO surgery. Methods A comprehensive literature search was conducted by two independent authors in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Embase, and Google Scholar electronic databases. Besides, a manual search of all textbooks and relevant articles were conducted. Searches took place in August 2020 and were limited to published and peer-reviewed articles from 2000 to 2020. All analysis was performed using the comprehensive meta-analysis (CMA) and the STATA MP (version:16) software. The weighted mean difference (WMD) using the inverse variance method and the standard mean difference (SMD) was considered for continuous variables. Results Seventy-four papers were retrieved after removing duplicate studies and finally, eight studies were assessed for qualitative synthesis and five for meta-analysis. Totally, 94 patients were included in the meta-analysis. Based on the meta-analysis, it was shown that LLLT was not effective in a short interval (0 to 48 h) after surgery, but in a period of more than 1 month after surgery, the positive results of treatment can be observed strikingly. Also, LLLT side/group showed no significant difference in some aspects of neurosensory recovery such as thermal sensation compared to the placebo side/group. Conclusions The meta-analysis of randomized controlled trials revealed that LLLT generally improves IAN sensory disturbance caused by BSSRO. Further high-quality clinical trials with longer follow-up periods and larger sample sizes are recommended.

Background Different genioplasty techniques are applied for the adjustment of chin area deformities such as chin deviation. Results Thirty patients with simple facial asymmetry due to chin deviation underwent computer-assisted horizontal translational osseous genioplasty. In this technique, a surgical guide was used to cut a bone strip from the side where the chin should be transferred to; then, the same bone strip was used for the filling of the gap that was formed on the opposite side. Conclusion According to the experience gained from this study, the authors believe that computer-assisted horizontal translational osseous genioplasty is a simple and reliable technique for patients with facial asymmetry due to chin deviation.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes serious acute respiratory diseases including pneumonia and bronchitis with approximately 2.3% fatality occurrence.Main bodyThis study argues the main concepts that need to be considered for the gradual reopening of dental offices include treatment planning approaches, fundamental elements needed to prevent transmission of SARS-CoV-2 virus in dental healthcare settings, personal protection equipment (PPE) for dental health care providers, environmental measures, adjunctive measures, and rapid point of care tests in dental offices.ConclusionThis article seeks to provide an overview of existing scientific evidence to suggest a guideline for reopening dental offices.

Coronaviruses are known as enveloped viruses with apositive-sense single-stranded RNA genome that theirhelical symmetry nucleocapsid is about 26–32 kilobasesin size, making it the largest investigated genome amongRNA viruses The disease caused by 2019 new coronavirus(2019-nCoV) was named coronavirus disease-19(COVID-19) by the World Health Organization in February2020 The 2019-nCoV is phylogenetically relatedto severe acute respiratory syndrome-coronavirus(SARS-CoV) [1] It has been shown that 2019-nCov entersthe cell through the ACE2 cell receptor in the sameway as the severe acute respiratory syndrome (SARS)coronavirus [2] 2019-nCoV effectively uses angiotensinconvertingenzyme 2 receptor (ACE2) as a receptor forcell invasion [3] Primary non-specific reported symptomsof 2019-nCoV infection at the prodromal phaseare malaise, fever, and dry cough The most commonlyreported signs and symptoms are fever (98%), cough(76%), dyspnea (55%), and myalgia or fatigue (44%) [4] Our information on the probability and effect of 2019-nCoV on the peripheral and central nervous system is stillscarce and therefore unreliable There have been variousstudies evaluating coronavirus’s effects on the central nervoussystem These studies suggest that the human centralnervous system (CNS)may be susceptible to coronavirus infection[5] Routes intended for central nervous system infectionwith coronaviruses are peripheral trigeminal or olfactorynerves following intranasal inoculation [6, 7] The findings ofstudies on rodents show that these viruses cause demyelinationand stimulate T cell-mediated autoimmune reactionsagainst CNS antigens producing the question about the relationbetween coronaviruses especially the 2019-nCoV andneurologic disorder in humans Given that the peripheral trigeminalor olfactory nerves are pathways of penetration ofthe coronaviruses into the central nervous system, and basedon animal studies, it may be hypothesized that complicationssuch as demyelination and stimulation of T cell-mediatedautoimmune reactions may occur in the path of the infectionspreading, so the occurrence of dysosmia and dysgeusia canbe considered potential consequences of these nerve injuries Numerous reports of loss of sense of smell and tastehave been received from Iranian people as one of themost heavily involved countries with COVID-19 duringthe outbreak of the disease [8, 9] Significant numbers ofpeople with confirmed COVID-19 also reported acomplete or partial loss of their sense of smell and tastein the early stages Initial investigations also indicate thatin some cases, if one member of a family has experiencedsuch symptoms, other family members have experiencedsimilar symptoms over a short period of time Another primary point that needs further investigationis that in confirmed COVID-19 patients with reporteddysosmia and dysgeusia, often, other manifestations wereless severe and the patients frequently recovered morequickly In addition to what has been said that requirefurther investigations to establish their validity, the timelinessor permanence of these complications, as well ashow they are likely to be managed and treated, are ofparticular importance and require thoughtful scrutiny Although there is not sufficient evidence to make a definitivejudgment and need more comprehensive investigations,two scenarios are more likely to be suggested asthe cause of such an incident The appearance of dysosmiaand dysgeusia whether can be attributed to olfactorynerve and trigeminal nerve damage caused by the 2019-nCoV infection or excessive exposure to chemicals anddisinfectants that are more commonly used by peopledue to the viral epidemic Designing a study to assess the validity of such a hypothesis is important in that itcan be considered a relatively acceptable diagnostic criterionfor both the individual and the physicians Sincethe existence of such a relationship is likely, it alsoseems likely that during the COVID-2019 outbreak,those who experience complications such as dysosmiaand dysgeusia should be considered potential carriers o

Purpose The periorbital area undergoes a series of postoperative sequelae after rhinoplasty. Patients and Methods Between January 2015 and January 2016, 50 patients aged between 19 and 46 years who underwent rhinoplasty qualified for the study. Of these patients, 25 were chosen for each group: One group underwent a low-to-low lateral nasal osteotomy, and the other group underwent a low-to-high lateral nasal osteotomy. Six specific periocular findings were designated and recorded to measure differences in the outcomes of the 2 osteotomy techniques. Specific periocular findings included the amount of scleral show as measured through the marginal reflex distance; lateral and medial scleral surface area; and palpebral fissure height, width, and inclination. Results There were no significant differences in any of the outcome variables at different intervals between the 2 groups (P > .05) except for palpebral fissure inclination after 3 months (P = .02). Conclusions According to the results and considering the inherent limitations of the study, it can be concluded that both low-to-low and low-to-high techniques are similar and have no considerable permanent effects on the periorbital region.

Purpose To evaluate the effectiveness of micro-osteoperforation technique for rapid canine retraction. Methods and Materials Twenty adult patients with a mean average age of 28 years (12 men and 8 women) having Class I dental malocclusion who required extraction of the four first premolars were included in this single-blinded prospective split-mouth clinical trial. Each side of the patients' jaws were randomly divided into interventional and control groups. The interventional group of maxilla and mandible received micro-osteoperforations with two holes using a bone screw and a handheld screwdriver. The primary predictor variable was the micro-osteoperforations. The outcome variable was the rate of canine movement, which was estimated by comparing pre- and posttreatment location of canine and second premolars through digital models in Ortho Analyzer software, after 28 days. The statistical evaluation of the findings was performed using SPSS software. Parametric tests (t test) were used to compare the treatment efficacy. Results Micro-osteoperforations significantly increased the rate of tooth movement by more than 2-fold (P = 0.000). However, comparing the differences in the rate of tooth movement when maxillary and mandibular canine retraction, in both interventional and control side yielded insignificant results (P > 0.05). Conclusions Micro-osteoperforations with two holes by application of the simple and less costly method presented in this study is an effective and time-preserving treatment modality.

Purpose The purpose of the study is to compare the effects of Aloe vera mouthwash on postoperative complications after impacted third molar surgery. Patients and methods The randomized double blind clinical trial was conducted on 20 healthy adults with bilateral symmetrical impacted third molar teeth. Participants in the study received Aloe vera and normal saline (as placebo) mouthwash after each side surgery. Evaluation was made by assessing cheek swelling, trismus, incidence of dry socket and VAS (for pain scoring) over a time period of 1, 3, 5 and 7 days after operation. Results The group using Aloe vera presented less swelling than the normal saline group over the following days, but data was significant only on day 3 ( P P P Conclusion The results of this study suggest that Aloe vera mouthwash is effective in the management of postoperative complications, especially pain and swelling.

Purpose In the present report, we have introduced a novel technique for concomitant Le Fort I surgery and dorsal preservation rhinoplasty and reviewed the reported data. Patients and Methods Concurrent surgery could be considered a suitable option for patients requiring both upper jaw orthognathic surgery and rhinoplasty or those who are willing to undergo single-stage concomitant rhinoplasty and orthognathic surgery. In the present technical note, we have introduced a dorsal preservation rhinoplasty technique combined with Le Fort I surgery through an intraoral approach. The advantages of this technique include its conservative design, avoidance of a second surgery and anesthetic, the ability to correct possible nasal defects caused by the Le Fort I osteotomy, keeping the keystone area intact, and, most importantly, the possibility of concomitant surgery. However, recurrence of the hump and nasal pyramid lateralization are among the problems that could be associated with this technique. These disadvantages might necessitate revision surgery. Results A total of 48 patients (23 females and 15 males) had undergone concomitant rhinoplasty and Le Fort I surgery using a modified dorsal preservation technique. No patient reported dissatisfaction with the results of surgery regarding the nasal and facial esthetics. No evidence of severe complications, such as saddle nose, severe deviation, airway compromise, or severe asymmetry, was observed postoperatively. Conclusions Based on our experience with patients and after at least 1 year of follow-up, the results of the present study suggest that this technique is straightforward and produces excellent results.

Rhinoplasty is one of the most challenging cosmetic surgical procedures. Although different techniques have been introduced for grafting the osteocartilaginous part of the nose, the alar rim remains vastly unexamined. The form and strength of the alar rim are crucial in nasal tip esthetics and function. External valve collapse may occur owing to trauma, congenital weakness, or malposition of the lower lateral cartilage (LLC). Alar pinching and collapse are possible outcomes if there is any over-resection of the cephalic portion of the LLC. Traditionally, the closed technique creates a tunnel, dissected along an incision made in the soft triangle lining near the most anterior portion of the nostril rim. Alar rim grafts also can run through the marginal incision. The main goal of this study was to introduce a straightforward and effective technique for alar rim grafting, which can help surgeons with more precise placement. A total of 84 patients (61 female and 13 male patients) underwent transcutaneous alar rim grafting. After the alar base resection, a 2-mm stab incision was made in the bulk of the incised alar, using a No. 11 blade. Thereafter, a pocket was created through the alar fibrofatty tissue, which crossed the ala up to near the dome, and a cartilage graft was inserted in the tunnel. Transcutaneous alar rim grafting is a simple and effective approach to provide support for the external nasal valve and increase alar harmony. If the nasal tip analysis shows malpositioned LLC, alar flaring, an over-projected nasal tip, mild retraction, or contour asymmetries, this type of grafting may prove effective in primary or secondary rhinoplasty.

Background To introduce a novel technique for advancement genioplasty helping surgeons to avoid soft tissue difficulties especially in short-faced patients with deep mentolabial fold and everted lower lip. Case presentation In a trapezius-shaped, osteotomy was performed in the chin region. The mobilized segment was advanced, and the existing gap was grafted using interpositional allograft materials. Each side had been fixated by three-hole plates and two screws. The outcomes revealed no change in lower anterior teeth vitality. The patients did not report any changes of sensation in lower lip and chin either. The measurements indicated no increase in depth of mentolabial fold in patients undergoing this surgical technique. The postoperative evaluation showed a successful esthetic outcome for the patient and the surgeon concurrently. Conclusion Based on our experience, the authors concluded that the Balcony technique is a simple and reliable procedure for patients with a deep mentolabial fold.

Background This study was aimed to compare the efficacy of customized patient-specific titanium mesh based on 3D printed model with intra-operative bending of titanium mesh for reconstructing of orbital floor fracture. Methods This study was prospectively conducted on 10 patients with unilateral orbital floor fractures caused by accident or falls. In intervention group (n=5), the CT-scan slices were used for generating 3D reconstruction of both affected and unaffected orbits. Then, a 3D printed template of mirrored unaffected orbit was produced to mold the titanium mesh. The titanium mesh in conventional group (n=5) was bended only manually and intraoperatively by surgeon and positioned over the bony defect. All patients were followed-up within 1 week, 1 month and 4 months after surgery for assessing enophthalmos, diplopia and other complications. Results Of 10 patients of the study only two patients in intervention group had preoperative vertical dystopia or diplopia which had been resolved after intervention. The mean enophthalmos at baseline and 1 week, 1 month and 4 months after surgery in control group were 3.8±0.7, 2.4±0.8, 2.4±0.8, and 2.4±0.8 mm, respectively, and in intervention group were 2.6±0.8, 0.35 ± 0.4, 0.35 ± 0.4 and 0.35 ± 0.4 mm, respectively. The mean enophthalmos did not differ significantly at baseline between two groups, while two groups showed significant difference after surgery. Conclusion Finally, we concluded that the placement of patient-specific titanium implant for reconstructing of orbital bone fracture led to better outcomes when compared to manual bending in terms of enophthalmos and other complications.

Introduction: Our primary intention is to review the literature that has been published in this field and to report some cases of surgical correction of facial and skeletal deformities in patients with thalassemia. Thalassemia is widespread, and about 5% of the world population is affected. Management of facial and skeletal deformity is a major concern in patients with thalassemia, and numerous surgical approaches have been advocated to correct facial deformities, although the type of treatment remains in dispute. Materials and Methods: We report the cases of 3 specific patients who were treated with uncommon surgical procedures after the hematologic condition was corrected. Results: No signs of relapse or maxillary bony overgrowth have occurred in these patients. No massive bleeding occurred during the procedures, and the patients tolerated the surgical approach very well. Complicated surgical procedures, such as bimaxillary segmental osteotomies with 2 or more pieces have been done in patients who had proper systemic conditions without any complications. Conclusions: Maintaining a hemoglobin level of approximately 10 g/dL decreases the risk of preoperative hemorrhage and complications of anesthesia. A complicated surgical approach and more instability during surgery is expected in patients with higher degree of systemic problems. We found that preoperative facial analysis was important in guiding our surgical planning and would benefit the cosmetic outcome as well. Attention to cardiac dysfunction, osteoporosis, vitamin D deficiency, and type of hemoglobin deficiency must be kept in mind, though more surgical cases must be treated before reaching a definitive conclusion.

Non-steroidal anti-inflammatory drugs like Ibupro- fen alleviate mild to moderate postoperative pain caused by the third molar extractions. Moreover, Acetaminophen is a non-opioid analgesic with anti-pyretic properties, effective in relieving mild to moderate pain. On the other hand, recent studies have demonstrated that Caffeine also acts as an analgesic adjuvant when combined with Acetaminophen, Aspirin, or their mixture. The objective of study is to compare the efficacy of a combination of Ibuprofen 200 mg and Acetaminophen 325 mg plus Caffeine 40 mg with Ibuprofen 400 mg alone for relieving the pain after surgical removal of impacted mandibular third molar. 80 adult patients (56 females, 24 males) were randomly placed into two groups. Preoperative pain recorded prior to the surgery and compare with patients’ pain after the operation. According to findings, there was no significant relationship between preoperative and postoperative pain (P value > 0.05) and also between surgical trauma and postoperative pain (P value > 0.05). The mean pain showed a slight numerical superiority for the group which used Ibu-profen plus Acetaminophen plus Caffeine especially 3hours after surgery, but there was no significant difference between the two groups (P value = 0.073). In conclusion, combination of Ibuprofen plus aceta-minophen plus caffeine does not offer any clinical advantages compared with Ibuprofen for alleviating acute postoperative pain after third molar surgeries.

Botulinum toxin A has a wide variety of clinical applications in medical and dermatologic sciences. Nowadays, researchers introduce some other indications for botulinum toxin in cosmetic and especially noncosmetic aspects of dermatology such as medical rhinoplasty, hypertrophic scar, chemical brow lift, supraciliary wrinkles, pompholix, eccrine angiomatosis, Hailey-Hailey, dermatochalasis, lichen simplex, nosthalgia parestetica, and granulosis rubra nasi. In this general overview of the use of botulinum toxin in dermatology, an extensive literature search was carried out to updates of all dermatology-oriented experiments and clinical trials on the mentioned aspect of botulinum toxin.

Monobenzylether of hydroquinone (MBEH) has long been utilized for the depigmentation therapy of patients with extensive vitiligo. In this approach, the normally pigmented areas surrounding vitiligo lesions are depigmented to achieve a uniform skin tone. One of the important disadvantages of MBEH therapy, however, is the resistance of a considerable number of vitiligo patients against the depigmenting effect of this agent. We have previously proposed that the glutathione-dependent cytoprotection of melanocytes can be impaired through the inhibition of the enzyme glutathione S-transferase by retinoic acid (RA). The combination of RA with melanocytotoxic agents could thus lead to increased susceptibility of melanocytes to such compounds. In this study we have shown, for the first time, that the melanocytotoxic and depigmenting effects of MBEH are synergistically enhanced when it is combined with RA. The treatment of black guinea pig skin with RA (0.025%) alone induced no significant changes in the number of epidermal melanocytes and no skin depigmentation. On the other hand, MBEH (10%) produced mild to moderate skin depigmentation and reduced the average number of melanocytes from 76 (+/-5)/field (magnification: x 40) in control sites, to 42 (+/-6)/field in the depigmented skin. The RA (0.025%)-MBEH (10%) combination, however, produced a complete degree of depigmentation in the majority of treated sites after 10 days of application and reduced the average number of melanocytes to only 6 (+/-6)/field. RA-MBEH combination serves as a very potent skin depigmenting formula and now awaits future assessments of its potential use for the treatment of extensive vitiligo.

Genioplasty is a common operation to enhance function and appearance of the chin, the most prominent part of the lower third of the face, which has major impact on character impressions and facial beauty. However, since transference of preconfigured accurate treatment plans to patients during operation is difficult, sometimes it can be challenging, especially for inexperienced surgeons. This article represents a simplified technique to perform reduction genioplasty by utilizing a customized genioplasty guide manufactured with three-dimensional printing technology. This approach is helpful to achieve more precise and safer outcomes with fewer complications.

Purpose: To report two patients with different presentations of orbital echinococcosis, namely hydatid and alveolar cysts and to compare their clinical, imaging and histopathologic findings and treatment.Methods: This retrospective study includes two young rural children who were referred because of progressive proptosis.Results: Orbital imaging in both cases revealed cystic intraorbital lesions. With a clinical suspicion of hydatid and alveolar cysts, both patients underwent intact surgical excision. Histopathologic evaluation confirmed the diagnoses.Conclusions: Clinical findings and imaging can help in the preoperative diagnosis of patients with orbital echinococcosis. Knowledge of the nature of cystic orbital lesions is important in preventing complications. Alveolar cysts are more invasive than hydatid cysts and their treatment is more complicated.

Congenital maxillomandibular fusion (syngnathia) is rare. The first case was reported in 1936. By 2004, only 25 cases of syngnathia had been reported including 6 cases with fusion of the ascending rami of the mandible with the maxilla and zygomatic complex. This report concerns a 6-month-old girl with a type of congenital fusion of the ascending rami of the mandible with the upper alveolar arch and zygomatic complex that leads to restriction of mouth opening. The clinical features of this anomaly and a brief review of literature are presented.

We have previously shown that the peroxidase inhibitor methimazole (1-methyl-2-mercapto imidazole; MMI) is a noncytotoxic inhibitor of melanin production in cultured B16 melanocytes. It was further demonstrated that the topical application of 5% MMI on brown guinea pig skin for 6 weeks causes a significant reduction in the amount of epidermal melanin, resulting in visually recognizable cutaneous depigmentation. Herein, we report a 27-year-old male with postinflammatory hyperpigmentation (due to acid burn), successfully treated with topical MMI as a new skin depigmenting agent. Topical 5% MMI caused a moderate to marked improvement of the hyperpigmented lesions within 6 weeks of once-daily application. Topical MMI was well tolerated by the patient and did not affect the level of serum thyroid hormones (free thyroxin, free triiodothyronine and the thyroid-stimulating hormone). Unlike most known depigmenting agents, such as hydroquinone and kojic acid, MMI is a noncytotoxic, nonmutagenic compound, and it is possible that MMI could serve as a novel agent for the treatment of hyperpigmentary disorders in human.