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Objective The current method of digitally designing dental prostheses mainly focuses on intra‐oral soft and hard tissues, although the harmony of the facial soft tissue and the prosthesis is crucial, especially for esthetics. Here, we introduce a new method of digitally designing dental prostheses using a new device that generates a virtual patient and incorporates facial features into the prosthetic design. Materials and methods: A new extra‐oral scan body for facial scanning was designed and developed. A definitive edentulous maxilla implant cast with four extra‐oral scan bodies (regions: maxillary left and right lateral incisors, maxillary left and right premolars) was placed in the mouth of a dental mannequin. The dental mannequin was scanned with and without the extra‐oral scan bodies. For reference data, an impression of the maxilla was taken and scanned with a laboratory scanner. By superimposing each acquired data, a virtual patient was generated, and the spatial location of the abutments relative to the face was clarified. Identifying the accurate location of the abutments enabled to design face‐driven dental prosthesis. Results: Based on the color‐coded deviation map created by the data acquired from conventional and extra‐oral scan bodies, the divergence of the two data was mostly within 0.1 mm, which proves that the extra‐oral scan bodies were as accurate as conventional scan bodies. Therefore, the facial scan data and the scan data of the oral cavity were successfully superimposed, which allowed to generate a virtual patient to design face‐driven prosthesis. Conclusion: The new method is effective for designing high‐quality face‐driven prostheses, especially when treating a patient with a full‐arch implant‐fixed prosthesis. [ABSTRACT FROM AUTHOR]

The basic concept of neurosurgical procedures to treat spasticity is to decrease the hyperactivity of the stretch reflex. Selective peripheral neurotomy is a method to partially resect the peripheral motor nerve. The alpha motor and Ia afferent nerves are resected, but the latter is essential owing to its lasting effect in reducing spasticity. Focal spasticity in adult patients can be effectively treated using peripheral neurotomy. Functional posterior rhizotomy, mostly used to treat paraplegic spasticity in children with cerebral palsy, involves the sectioning of posterior rootlets associated with abnormal motor responses to electrical stimulation. Intrathecal baclofen therapy is useful in treating diffuse spasticity. Baclofen inhibits the activity of alpha motor neurons both pre and post synaptically at the level of the spinal cord. A decrease in Hmax/Mmax in the H-reflex electrophysiologically represents the effectiveness of these procedures. Good clinical results can be achieved by appropriate indication depending on the clinical features of spasticity in each patient.

Recently, laparoscopy (also referred to as minimally invasive surgery) has been used during peritoneal catheter implantation in shunt placement for hydrocephalus; however, the procedure and devices for this technique have not yet been well established. We adopted umbilical and paraumbilical laparoscopy for peritoneal catheter insertion. In this paper, we describe the technique we used and its clinical results and benefits. Ten consecutive patients with hydrocephalus who underwent laparoscopic shunt surgery (6 cases of ventriculoperitoneal shunt and 4 of lumboperitoneal shunt) were enrolled for this study. The follow-up period ranged from 21 to 434 days (mean, 263 days). After a standard cranial/spinal procedure, an approximately 5-mm incision was made in the lateral side of the umbilicus, where the abdominal catheter was introduced subcutaneously. Thereafter, we inserted a laparoscope into the peritoneal cavity via a small incision beneath or just on the umbilicus. A shunt catheter was laparoscopically inserted through a peel-off cannula and placed after taking note of the outflow of cerebrospinal fluid (CSF) from the catheter tip. In all patients, the shunt was inserted with no complications, and good patency was achieved. Laparoscopy allows implantation of the catheter into the peritoneal cavity, and the outflow of CSF can be confirmed intraoperatively. Furthermore, the abdominal surgical wounds are minimal, even for obese patients, and fascia/muscle incisions are not needed. Laparoscopy-assisted shunt surgery for hydrocephalus is effective and safe and also has cosmetic advantages.