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Objective To determine the predictive value of preoperative clinical factors for postoperative temporomandibular disorders (TMDs) in patients receiving combined surgical–orthodontic treatment. Study Design TMDs were classified according to Research Diagnostic Criteria for TMD in 219 patients. The severity of the TMD was scored according to the Helkimo anamnestic index (Ai) and clinical dysfunction index (Di). Results Anamnestic TMJ clicking was the only significant predictor of TMD (odds ratio [OR] = 3.61, P = .006). The mean difference between clinical dysfunction index points was significant for pain on masticatory muscle palpation. Conclusion This study demonstrated that in orthognathic patients, the following factors had high predictive value: (1) anamnestic TMJ clicking for TMD, (2) TMJ clicking, TMJ pain on palpation and bimaxillary surgery for Ai worsening, (3) maxillary retrusion and mandibular excess for Ai improvement, and (4) pain on masticatory muscle palpation for Di worsening. [ABSTRACT FROM AUTHOR]

There is a growing need to integrate ecosystem services into management strategies of protected areas, and only a comprehensive ecosystem services assessment allows effective strategies for biodiversity conservation to be defined. Beneficiaries are largely disregarded or only mentioned in ecosystem services assessments related to protected areas. Thus, we propose indicators for identifying potential beneficiaries on the local and regional level, focusing on 16 relevant ecosystem services of Natura 2000 sites. For a case study in northern Italy, we used spatially-explicit modelling approaches to map and quantify the potential beneficiaries of multiple ecosystem services, including distance decay functions and basin catchment modelling. The resulting maps indicate that for provisioning and cultural services, the majority of the beneficiaries are located outside the protected area, whereas the beneficiaries of regulating services are mostly situated within or very close to it. The indicators and the beneficiary maps offer an important basis for an exhaustive assessment of ecosystem services flows from Natura 2000 sites and support the implementation of conservation policies by involving the local population and the community of users of protected areas. [ABSTRACT FROM AUTHOR]

Objective: To determine whether patient age is an independent predictor of indication for surgical treatment, realization of surgical procedure, and care management modality. Study Design: We analyzed data of 308 patients with facial fractures. Patients were classified into four age groups: (1) 17 to 40 years old; (2) 41 to 64 years old; (3) 65 to 80 years old; (4) more than 81 years old. Results: Multivariate analysis showed that the patient's age was associated with decreased indication and realization rate for surgery (P = .03 in Group 3; P = .05 in Group 4) and with an increased hospitalization rate (P = .004 in Group 3; P = .02 in Group 4). The presence of concomitant injuries and the fracture's location were associated with a decreased indication and realization rate for surgery regardless age. Conclusion: The current study demonstrated that the patient's age was an independent predictor influencing the treatment decision and realization process as well as the care management modality. [ABSTRACT FROM AUTHOR]

Although its pathogenesis remains obscure, Parry-Romberg syndrome (PRS) has been associated with the linear scleroderma en coup de sabre. PRS is characterized by unilateral facial atrophy of the skin, subcutaneous tissue, muscles, and bones with at least 1 dermatome supplied by the trigeminal nerve. Facial asymmetry represents the most common sequela and can involve the soft tissues, craniomaxillofacial skeleton, dentoalveolar area, and temporomandibular joint. Although orthognathic procedures have been reported for skeletal reconstruction, treatment of facial asymmetry has been directed to augmentation of the soft tissue volume on the atrophic side using different recontouring or volumetric augmentation techniques. Total mandibular subapical osteotomy has been used in the management of dentofacial deformities, such as open bite and mandibular dentoalveolar retrusion or protrusion associated with an imbalance between the lower lip and the chin. Management of orthognathic procedures has been improved by the recent introduction of stereolithographic surgical splints using computer-aided design (CAD) and computer-aided manufacturing (CAM) technology and piezosurgery. Piezosurgery has increased security during surgery, especially for delicate procedures associated with a high risk of nerve injury. The present report describes a combined total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and surgical splints fabricated using CAD and CAM for the correction of severe mouth asymmetry related to vertical dentoalveolar disharmony in a patient with PRS. [ABSTRACT FROM AUTHOR]

Objective: To primarily evaluate whether Delaire's ideal occlusal plane is present in Class I occlusal relationship adults. Study Design: Pretreatment lateral cephalometric radiographs from 30 orthodontically untreated Caucasian Class I malocclusion adults were obtained. The occlusal, mandibular, and maxillary planes were traced and compared with the ideal occlusal, mandibular, and maxillary planes according to Delaire. Results: The average occlusal plane was 3.5° below the ideal plane. This divergence was more pronounced in males, and in patients presenting with a hypodivergent skeletal pattern. The maxillary plane displayed on average less than 0.5° of divergence to the ideal. The average mandibular plane showed a divergence of 3.3° below the ideal. Conclusions: When aiming to obtain an ideal orientation of the occlusal plane postoperatively, one must keep in mind that in Class I occlusal relationship adults without any dentofacial disharmony, the occlusal plane is rarely coincident with the ideal plane. [Copyright &y& Elsevier]

Objective: The aim of this study was to retrospectively evaluate the incidence of posttraumatic orbital emphysema (OE) and to propose a radiologic topographic classification as well as a possible pathophysiologic model. Study Design: Orbital fine-cut (1 mm) computerized tomographic scan slices from 137 patients were used to assess the fracture''s type, the presence and position of OE, and periorbital tissue herniation. The OE was categorized into the following 5 compartments: subcutaneous periorbital, peribulbar, retrobulbar extra- and intraconal, and pterygopalatine fossa. Results: The incidence of OE was 61%. OE was more frequently associated with isolated medial wall (78%; P < .001) and combined medial wall/orbital floor (82%; P < .01) fractures. Palpable isolated subcutaneous eyelid emphysema was not related to fracture''s type (P = .85). Conclusions: OE suggested medial wall fractures alone or combined with orbital floor fractures. Pathophysiologically, according to the Poiseuille law, the difference in length between the ethmoid and sinusal infundibulii could explain the increased incidence of OE when the medial wall is involved. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate vertical stability after combined orthodontic surgical treatment of skeletal anterior open-bite malocclusion. Materials and Methods: A literature search was performed to locate studies pertaining to vertical stability after combined orthodontic surgical treatment of skeletal anterior open-bite malocclusion. Data from the identified studies were extracted and assessed for quality. Short-term and long-term changes in the following variables were evaluated: overbite; mandibular plane, palatal plane, and intermaxillary angles; and anterior facial height. Results: Nine studies, all retrospective, were appropriate for inclusion after review. The postoperative follow-up period ranged from 1 to 18 years. A wide variation was present for post-treatment changes and relapse. Dentally, overbite changes showed a wide variation, with more long-term relapse observed in patients after Le Fort I osteotomy. Skeletally, the mandibular plane and intermaxillary angles showed greater long-term relapse after bimaxillary surgery than after Le Fort I osteotomy. The same trend was seen for the post-treatment increase in anterior facial height. In contrast, the palatal plane seemed to remain rather stable. Conclusions: Vertical relapse is a characteristic in a certain number of patients after combined orthodontic surgical treatments regardless of surgery type. This can be observed dentally by an opening of the bite and skeletally by an increase in the mandibular plane and intermaxillary angles during long-term follow-up. Long-term skeletal relapse seems to be more common after bimaxillary surgery. [ABSTRACT FROM AUTHOR]

Abstract: Habitat loss and fragmentation are often concurrent to land conversion and urbanization. Simple application of GIS-based landscape pattern indicators may be not sufficient to support meaningful biodiversity impact assessment. A review of the literature reveals that habitat definition and habitat fragmentation are frequently inadequately considered in environmental assessment, notwithstanding the increasing number of tools and approaches reported in the landscape ecology literature. This paper presents an approach for assessing impacts on habitats on a local scale, where availability of species data is often limited, developed for an alpine valley in northern Italy. The perspective of the methodology is multiple scale and species-oriented, and provides both qualitative and quantitative definitions of impact significance. A qualitative decision model is used to assess ecological values in order to support land-use decisions at the local level. Building on recent studies in the same region, the methodology integrates various approaches, such as landscape graphs, object-oriented rule-based habitat assessment and expert knowledge. The results provide insights into future habitat loss and fragmentation caused by land-use changes, and aim at supporting decision-making in planning and suggesting possible ecological compensation. [Copyright &y& Elsevier]

Septic thrombosis of the cavernous sinus (STCS) is an uncommon and potentially lethal disease. Sphenoid and ethmoid sinusitis followed by facial cutaneous infections represents the most common aetiologies, with Staphylococcus aureus as the main responsible organism followed by the Streptococcus pneumoniae. Although all infectious foci of the head and neck area can potentially spread to the cavernous sinus, STCS from oral infection is an exceptionally rare occurrence. We report the unusual case of a patient who presented with an acute STCS secondary to a generalized Streptococcus milleri periodontitis. This case high-lights the importance of systematically performing a detailed examination of the oral cavity in patients presenting with intracranial infections caused by uncommon pathogens such as the Streptococcus milleri group. [ABSTRACT FROM AUTHOR]

PURPOSE: To prospectively assess the incidence of orthoptic anomalies and, more specifically, the possible development of pseudo-Brown syndrome related to inferior oblique muscle (IO) myotomy after the transcaruncular-transconjunctival approach for orbital fracture repair and its effect on the possible development of annoying diplopia. PATIENTS AND METHODS: We analyzed the clinical data from 14 patients with severe isolated medial wall or combined medial wall/floor fractures treated using titanium meshes placed using a transcaruncular-transconjunctival approach. All patients were assessed with a pre- and postoperative ophthalmologic examination using the following methods: prisms and alternate cover test in all 9 gaze directions, Hess-Weiss coordimetry, Maddox rod screen testing, and Harms wall deviometry. The Bielschowsky head-tilt and a forced duction test were also performed. The patients were classified into the following 2 groups: IO paretic-underaction group and non-IO paretic-underaction group. RESULTS: Of the 14 patients, 7 (50%) fulfilled the criteria for IO paretic-underaction. All 7 developed double vision limited to the extreme upgaze in adduction. Four patients in the non-IO paretic-underaction group had double vision limited to the extreme upgaze in abduction that was already present preoperatively. Diplopia did not interfere with the daily activities in the patients from either group. CONCLUSIONS: The present study has demonstrated that IO myotomy associated with the combined transcaruncular-transconjunctival approach can result in orthoptic complications. Moreover, our study has shown that the development of a pseudo-Brown syndrome related to IO underaction was not uncommon but resulted in sequela restricted to a very limited portion of the binocular field of vision. [ABSTRACT FROM AUTHOR]

Purpose: To describe and evaluate the reliability and the accuracy of a specific computed tomography-based assessment in predicting treatment decisions for pure orbital floor blowout fractures (BOFs). Materials and Methods: In this retrospective cohort study, the charts of all patients presenting with isolated BOFs from January 2009 through April 2011 at the University Hospital of Geneva were reviewed. The systematic computed tomographic assessment included the following 3 parameters: 1) ratio of the fractured orbital floor; 2) maximal height of periorbital tissue herniation, and 3) a 4-grade muscular subscore describing the position of the inferior rectus muscle relative to the level of the orbital floor. The parameters'' predictive value regarding the treatment decision (conservative vs surgical) was assessed by logistic regression and relative operating characteristic curves. Results: Forty-eight patients (24 male) were included. The patients'' mean age was 49.5 years. The ratio of the fractured orbital floor, the maximal height of periorbital tissue herniation, and the muscular subscore were significant predictors in univariate analysis (P = .02, P = .006, P = .001, respectively), whereas, in a multivariate analysis, only muscular subscore remained a significant predictor (P = .003) and reached a similar predictive ability as the 3 parameters together. Conclusions: The present study showed that the severity of inferior rectus muscle displacement is the most important independent predictive radiologic factor in the treatment decision-making process for pure BOFs. This systematic computed tomographic assessment is a valuable tool for a better understanding of BOF management overall. Further studies are needed to establish its clinical relevance. [Copyright &y& Elsevier]

This report presents a 29-year-old patient with severe temporomandibular joint (TMJ) pain. Anamnesis and clinical examination led us to the diagnosis of TMJ disorder. He was also in control for a malignant paraganglioma originating from the right carotid body. After initial surgery 8.5 years ago and the removal of metastases 2 years ago he was deemed disease free. An 18F-3,4-dihydroxyphenylalanine (DOPA) positron emission tomography (PET)/CT scan was obtained during follow-up 6 months before he was presented to our clinic. Suspicious of a connection between the actual pain and the tumour, we scrutinized these images. We found a tiny pathological tracer uptake in the right jugular foramen but no correlating finding in the matching CT. We repeated the DOPA PET/CT and found several metastases including the previously detected lesion. Further thin-slice CT and MRI showed a 5 mm paraganglioma located anteriorly to the jugular bulb within the jugular foramen. The lesion was in close relation to the Arnold's nerve, a branch of the vagus nerve which carries sensory information from the external tympanic membrane, external auditory canal and the external ear and explained the severe pain in our patient. He then underwent radiotherapy (45 Gy) during which the pain diminished considerably. In a variety of neuroendocrine tumours, including paraganglioma, DOPA PET/CT allows primary diagnosis, staging and restaging with a higher detection rate than conventional radiological imaging. Owing to low anatomical resolution however, high resolution contrast-enhanced CT and MRI are necessary to complete the investigations. [ABSTRACT FROM AUTHOR]

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To prospectively evaluate the use of titanium mesh plates in a combined transcaruncular-transconjunctival approach for severe medial orbital wall fractures. Patients and Methods: We analyzed the clinical and radiologic data of 10 patients with isolated blow-out orbital fractures. The fracture location was the medial wall in 5 (50%) and the floor/medial wall in 5 (50%). Of the 10 patients, 8 (80%) were treated using 3-dimensionally preformed orbital titanium mesh plates and 2 (20%) with nonpreformed radial orbital mesh plates fixed at the inferior orbital rim with 1 or 2 monocortical screws (diameter 1.3 mm). Results: All the patients had satisfactory and anatomically correct orbital wall reconstruction as assessed on the immediate postoperative computed tomography scan. None of the patients experienced ophthalmic complications related to the transcaruncular-transconjunctival approach or developed enophthalmos as determined using Hertel exophthalmometry. One patient (10%) developed a nonhandicapping diplopia related to post-traumatic muscular contusion of the medial rectus muscle. Conclusions: The present study has demonstrated that titanium mesh plates placed using a combined transcaruncular-transconjunctival approach for the reconstruction of severe medial orbital wall fractures results in a high rate of success. [Copyright &y& Elsevier]

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To preliminarily evaluate prospectively the accuracy and reliability of a specific ad hoc reduction-compression forceps in intraoral open reduction of transverse and displaced mandibular angle fractures. Study design: We analyzed the clinical and radiologic data of 7 patients with 7 single transverse and displaced angle fractures. An intraoral approach was performed in all of the patients without using perioperative intermaxillary fixation. A single Arbeitsgemeinschaft Osteosynthese (AO) unilock reconstruction plate was fixed to each stable fragment with 3 locking screws (2.0 mm in 5 patients and 2.4 mm in 2 patients) at the basilar border of the mandible, according to AO/American Society of Internal Fixation (ASIF) principles. Follow-up was at 1, 3, 6, and 12 months, and we noted the status of healing and complications, if any. Results: All of the patients had satisfactory fracture reduction as well as a successful treatment outcome without complications. Conclusion: This preliminary study demonstrated that the intraoral reduction of transverse and displaced angle fractures using a specific ad hoc reduction-forceps results in a high rate of success. [Copyright &y& Elsevier]

• We aim at conceptualizing conflicts and limitations of CES use in mountain regions. • We present the outcomes of a workshop supported by eleven case studies. • We use a multidimensional framework to assess conflicts and limitations of CES use. • We collect various assessment approaches to address strategic management questions. • We discuss issues such as accessibility, legal setting, and socio-economic changes. Mountain landscapes provide a variety of cultural ecosystem services (CES), but recent developments such as land-use and climate changes, population growth or urbanization seem to lead more frequently to conflicts among users or restrict the use of natural resources. An enhanced understanding of such conflicts and limitations may improve decision-making and management of mountain landscapes and maintain high levels of CES supply. However, conceptual and empirical research on identifying and evaluating conflicts and limitations of use in qualitative, quantitative and spatial terms as well as interdependencies in socio-ecological systems (SES) is still rare, and suitable methods are underdeveloped. Therefore, this paper elaborates the outcomes of an expert workshop and presents eleven case studies related to different CES and various contexts to conceptualise conflicts and limitations of CES use in mountain regions, complemented by assessment approaches to facilitate their identification and management. Using a multidimensional framework, we find that conflicts were mostly related to socio-economic changes and an increasing recreational use, whereas limitations of use greatly depended on accessibility and legal issues. Our findings contribute to the advancement of research on CES and are particularly useful for landscape management and decision-making to develop sustainable solutions and maintain CES in mountain landscapes. [ABSTRACT FROM AUTHOR]