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Purpose Warthin tumors (WT) are the second most common benign parotid gland neoplasms. They can occur as synchronous or metachronous lesions in 6–10% of cases. This study aims to compare the complication rate in 224 patients who underwent extracapsular dissection (ECD) or superficial parotidectomy (SP) for the treatment of a WT. Methods This retrospective study was conducted at the Department of Maxillo-Facial Surgery at the University of Naples “Federico II” from February 2002 to December 2018 on a group of patients who underwent surgical treatment for WT. The type of surgical technique was chosen based on Quer’s classification. The complications evaluated were facial nerve palsy, hematoma, Frey’s syndrome, and bleeding. Results A total of 224 patients treated from 2002 to 2018 for Warthin tumor were included in the study. Two hundred elven had solitary tumors (94.1%) and 13 had multicentric lesions (5.8%), of which 9 cases presented synchronous lesions and 4 cases presented metachronous lesions. Extracapsular dissection (ECD) was performed in 130 patients (58.3% of cases) and superficial parotidectomy (SP) in the other 94 (41.7% of cases). Conclusions We consider both surgical techniques as valid. In our opinion, it is essential to study each case based on Quer’s Classification to obtain the best surgical outcome. Based on a lower observed rate of complications such as facial nerve palsy, Frey’s syndrome, and bleeding, ECD seems to be the best option for the surgical treatment of Quer Class I lesions.

Introduction: Nowadays, with the start of the vaccination campaign is very important to assess the extent of exposure of the population and identifying rapid, sensitive and accurate test to quickly identify new cases of SARS-CoV-2. The rapid test, cheap and easy to perform, is therefore very useful in developing countries, where the vaccination campaign has not yet reached adequate coverage. Methodology: We compared the VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with the Roche Elecsys Anti-SARS-CoV-2 (Roche Diagnostics, Rotkreuz, Switzerland) to recognize past infections and to compare VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with Abbott Real Time PCR SARS-CoV-2 assay to recognize infection during its acute phase so that it’s possible to evaluate the use of commercially available assays in clinical practice. Results: Of the 1,100 patients tested with serological and rapid test, 1,085 were negative both to serological and rapid test, 4 patients were positive at rapid (2 for IgM and 2 for IgG) but negative serological test, 11 patients were positive at serological test but negative to rapid. Of the 300 tested with oropharyngeal swab and rapid test, 294 were negative both to swab and rapid test, 2 positives both to swab and rapid test, 3 positives at swab but negative at rapid test, 1 negative at swab but positive at rapid test. Conclusions: the combined use of these tests according to the specific needs of users, allows a reliable identification of infected patients in the acute phase, distinguishing them from subjects with an antibody response from a previous infection.

Per garantire un’adeguata assistenza ai malati domiciliarizzati e già inseriti nel percorso delle cure palliative è talora necessario garantire un ricovero temporaneo, in ambito ospedaliero, per il tempo necessario ad eseguire manovre assistenziali non sempre facilmente realizzabili al domicilio come, ad esempio, il posizionamento di un catetere venoso centrale ad inserimento periferico (PICC) o la somministrazione di terapie antalgiche che possono richiedere manovre minimamente invasive. Per affrontare il “dolore totale” di un individuo nel proprio contesto socio-culturale e familiare il medico deve porre in atto quell’”approccio globale” che tiene conto di tutti gli aspetti fisici, psicologici, sociali, relazionali e spirituali del dolore, e attivare le possibili risorse che da tali valutazioni possono emergere (valorizzazione di approcci sistemici, delle reti amicali e di sostegno, organizzazione delle più appropriate reti di cura). Il dolore da cancro ha delle peculiarità rispetto al “dolore cronico” tout-court, spesso chiamato impropriamente dolore cronico “benigno” in quanto non provocato da patologia oncologica. Nel dolore oncologico il dolore non è l’unico sintomo ma fa parte di un corteo sintomatologico complesso, talora aggregato in cluster, talora meno prevedibile, per cui il trattamento del dolore si è rivelato più efficace quando inserito in una cura palliativa di più ampio respiro.

Lower eyelid reconstruction for defects greater than 50% is a much discussed topic in literature. The aim of this paper is to present an “all-in-one” surgical technique based on the combination of modified Tenzel flap and palatal mucosal graft to restore the anatomical integrity. In our paper we present a case report of 64 years old patient admitted in Maxillo-Facial Surgery Unit of Polyclinic Federico II of Naples in January 2020. He was affected by lower eyelid basal cell carcinoma, measuring 1.5 cm in diameter. He was treated removing full-thickness neoplasia, leaving a surgical gap of 2 cm. Reconstruction was performed using modified Tenzel flap to cover the skin gap and a palatal graft for the reconstruction of the tarsal region structural integrity. This "all-in-one" technique can handle full thickness eyelid defects with the advantage of respecting the dual layer eyelid structure without the need of a secondary surgical step. Moreover, has shown excellent results for both the preservation of eyelid competency and the low complications rate like ectropion and lagophthalmos.

The pattern of growth of spheno-orbital meningiomas accounts for the main presenting symptoms, such as proptosis, eye motility deficit, visual impairment, diplopia. As these are benign tumors, the postoperative patient's quality of life is an important factor to consider during the preoperative planning. A detailed literature review of superior eyelid transorbital endoscopic approach for spheno-orbital meningiomas, including our own case, was made. A Medline search up to March 2022 in PubMed online electronic database was made using the following key phrases: "superior eyelid endoscopic transorbital approach spheno-orbital meningiomas," "superior eyelid endoscopic transorbital approach," "spheno-orbital meningiomas endoscopic approach." The inclusion criteria were surgical series, reviews, and case reports in English language, as well as papers written in other languages, but including the abstract in English. Cadaveric studies, multiportal combined approaches for SOM, were excluded. The literature review has disclosed five studies for a total of 65 patients, whose demographic, clinical, pathological, surgical, complications, and outcome data were analyzed. Functional and esthetic outcome data after superior eyelid transorbital approach are the following: improvement of proptosis (100%), of visual deficits (66.66%) and of ocular paresis (75%), with only 11 complications (4 trigeminal dysesthesia, 2 CSF leak, 2 wound complications, 1 upper eyelid necrosis, 1 hemorrhage of surgical field, 1 keratitis) reported, but at the expense of extent of resection (gross total resection 33.39%). Based on the outcome data, the superior eyelid transorbital endoscopic approach results in a suitable operative technique for selected spheno-orbital meningiomas.

Surgical approaches in the treatment of TMJ pathologies are a much-debated topic in literature. We propose a new surgical approach performed by intraoral access and completed by endoscopic magnification and long-tip piezosurgery assistance. A piezosurgery (Piezosurgery Plus, Mectron s.p.a. 2014) with a long angled tip (MT5-10 L) was used to perform an endoscopically assisted condylectomy.

Dural arteriovenous fistulas draining into an isolated sinus often require a multimodal treatment, with transarterial and transvenous approaches.1-6 However, there is no consensus about the injection technique. Some authors suggest filling the sinus with coils in order to have a compact cast without unnecessary migration of the embolic material. We present a case of a patient with left temporal hemorrhage caused by a dural arteriovenous fistula on the isolated left transverse sinus. In this operative video we demonstrate how the arterial flow control during treatment allows us to obtain a compact cast of the embolic material inside the isolated sinus without coils (Video 1).

Background Condylar remodelling (CR) is a complex of phenomena that generates in response of the temporo-mandibular joint to forces and stress to maintain a morphological, functional and occlusal homeostasis. The most worrying aspect of the condylar reshape is the condylar resorption which implies fast loss of vertical dimension (>6% of pre-surgical value), mandibular retraction and open bite with preserved articular function. Materials and Methods Six parameters were analysed to study the condyles of twelve patients that underwent orthognathic surgery. The digital workflow was then described to make it reproducible enabling a more in-depth study of the reshaping processes that involving the condyle after a great stress like the surgery. Results The results of our study showed many statistically significant variations of the studied parameters. In all patients, it was noticed a decreased bone density (p = 0,002 per side). Objectives The aim of our study, with the aid of the contemporary 3D imaging and digital modelling and workflow technologies, is to investigate and analyse quantitatively and qualitatively the adaptative processes occurring in CR following bimaxillary repositioning. To the best of our knowledge, this is the only paper that investigates the CR considering six different variables at once.

Background This is an observational cohort study on patients affected by malignant parotid tumors treated with total parotidectomy. The aim of our work is to analyze and compare the effects and complications after parotidectomy, using or not SurgiMend ®. Methods 40 patients were retrospectively enrolled between September 2014 and June 2020. Basing on the placement of SurgiMend ® for parotid lodge reconstruction, the samples were divided into two groups. Thus, the incidence rate of complications after the surgical procedure was analyzed between the two groups. Results Patients in whom SurgiMend ® was used reported a lower rate of complications. The ANOVA test (p = 0.05) revealed a significant difference of Vancouver Scar Scale (VSS) between the two groups, representation as vascularity and pigmentation improvement, changing scar color, scar height reduction, and increased pliability. Conclusion Although many techniques are available to fill the parotidectomy defect, improve facial contour and prevent Frey’s syndrome, the use of SurgiMend ® matrix is one of most effective and reliable method to address these complications, with the advantage of decreased operative time due to not require an additional surgical donor site.

Background: The aim of this study was to investigate how the systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), taken individually and combined, are associated with overall survival (OS) in patients surgically treated for malignant salivary gland tumors (MSGTs). Methods: A retrospective analysis of 74 cases following surgery at our department between January 2011 and June 2018 was performed. The Receiver Operating Characteristic (ROC) curve was used to calculate the optimal cutoff values for SII, SIRI, PLR, and NLR. Survival curves of different groups at 1–3–5 years were estimated using the Kaplan–Meier method. Results: The optimal thresholds with the highest sensitivity and specificity were 3.95 for NLR, 187.6 for PLR, 917.585 for SII, and 2.045 for SIRI. The ROC curves revealed that the best combination with AUC = 0.884 was SII + SIRI. The estimated 5-year OS probability in patients with SII+ SIRI scores of 0, 1, and 2 was 96%, 87.5% and 12.5%, respectively (p < 0.001). Conclusion: SII+ SIRI can independently predict the OS of patients after MSGT surgery. The prognostic score system based on SII+ SIRI may be good clinical practice as a reference for clinical decision-making.

Introduction In March 2020 a new viral pandemic was declared. As etiological factor a virus belonging to the coronavirus family was isolated. This virus was named SARS-CoV-2 or COVID-19. This virus can cause different clinical frames, variating from mild symptomatology to cases of ARDS or death. Although the pandemic outbroke in China, COVID-19 had one of first hotspots in Italy, where the Public Health System needed a re-arrangement to face the disease. The incidence of oncological disease doesn't suffer any variation in relation to pandemics or emergency period, but need to be managed as soon as possible in every situation. In our maxillo-facial surgery Unit we continued our regular activities to treat all oncological patient that needed surgery during the pandemic. Because of the absence of knowledge about the COVID-19, first periods were very difficult to manage, due to the risk of infection of patients and health professionals. We decided to share our experience. Materials and methods Between March and June 2020, 34 patients affected by head and neck cancer were admitted at our Unit. All patients underwent surgical treatment and were hospitalized until their situation guaranteed a safe discharge. Results All patients treated for head and neck cancer underwent surgery. All the medical and nurse post-operative management was performed by health operators by using all the personal protective equipment (PPE) to prevent any possible infection. All contacts between patients and their family were suspended. During phase 1, all patients were submitted to a short verbal triage, measurements of physiological parameters and qualitative COVID-19 test. They were also screened by imaging to guarantee there were not any bronchopulmonary diseases referable to viral infections. During phase 2, patients were also screened by serological tests. During phase 3, all patients practiced oropharyngeal swap before being hospitalized. Discussion During lockdown a re-arrangement of the management of oncological patients was mandatory. The difficulties were caused by the restriction of several activities that guarantee a normal health care system function. To date there is not a standardized therapeutic protocol to face the infection. Main therapies are symptomatic and a lot of patients need to be treated in ICUs. To prevent any possible infections, surgical activities were reserved only for urgent disease that cannot be delayed. In our Unit we continued to manage oncological patients. Social distancing and confinement measures were necessary and mandatory, in order to manage our patients. During first phases we had not any valid instrument to totally exclude COVID-19 infection. During phase 3, when oropharyngeal swaps were introduced in the screening of our patients, we could start to work in a safer way. Conclusion There are still a lot of difficulties in the management of patients during COVID 19 pandemic. Because of the important consequences deriving from the delay of oncological patients their management must to be clearly defined.

OBJECTIVE The aim of our study was to analyze the aesthetic and functional outcome in the radial forearm free flap donor site using a simple split thickness skin grafting (STSG) closure compared with the use of dermal scaffold supporting the STSG closure. METHODS The study analyzed 18 patients, divided in 2 groups based on the donor site closure modality. In STSG group, a simple STSG was used to cover the defect. In the DS + STSG group, the defect was covered by the use of dermal substitute (MatriDerm) supporting the STSG. Groups were compared on the following outcome variable: scar status; hand function; circumferences at most proximal and most distal point of the graft. All patients were followed up 1, 6, and 12 months post-operative. RESULTS Nine patients from STSG group showed a difference in circumference between the operated and contralateral limbs respectively of 2.9 mm proximal and 1.2 mm distal; in the 9 patients of DS + STGS group the difference was respectively of 1.2 mm proximal and 1.3 mm distal. Welch unequal variances t-test demonstrated statistical significance of the values with P

Rhinophyma is a rare and benign pathological condition affecting the nose. It can be localized or generalized causing a nasal deformity, mainly of the lower 2/3 of the nose. Clinically, rhinophyma is characterized by the aberrant development of the vascularization of the skin of the nose. The nose becomes particularly sensitive, and even a minimal external trauma can cause bleeding. Different treatment methods have been described during the last few years, but surgery still remains the gold standard. The aim is to obtain a reduction of the abnormal tissue, by debulking and fine contouring followed by hemostasis and a very careful postoperative care. Herein we report one case of Rhinophyma treated with the Microdebrider (Storz®).A 70 year old male with a diagnosis of rhinophyma was admitted to the Department of Maxillo-Facial Surgery of "Federico II" University of Naples. The patient underwent a debridment of rhinophyma, combining dermabrasion and decortication, using a Microdebrider (Storz®). After the surgery, the wound was covered with an advanced dressing, a collagen sponge equina (Condress®) applied at the end of the procedure and routinely during the follow up control to promote the healing process.After 2 months the patient was completely healed without any complications and without any signs of recurrence, obtaining a good aesthetic and functional result. After 25 months of follow up the result is still stable.Rhinophyma, Microdebrider.Il rinofima è una condizione patologica rara e benigna che colpisce il naso. Può essere localizzato o generalizzato causando una deformità nasale, principalmente dei 2/3 inferiori del naso. Clinicamente, il rinofima è caratterizzato dallo sviluppo aberrante della vascolarizzazione della pelle del naso. Il naso diventa particolarmente sensibile, e anche un trauma esterno minimo può causare sanguinamento. Diversi metodi di trattamento sono stati descritti nel corso degli ultimi anni, ma la chirurgia rimane ancora il gold standard. L’obiettivo è quello di ottenere una riduzione del tessuto anormale, mediante debulking e fine rimodellamento seguiti da emostasi e una cura postoperatoria molto attenta. Riportiamo un caso di rinofima trattato con il Microdebrider e medicato con medicazione avanzata in collagene.(Condress®).Un uomo di 70 anni con una diagnosi di rinofima è stato ammesso al Dipartimento di Chirurgia Maxillo-Facciale dell’Università “Federico II” di Napoli. Il paziente ha subito un debridment di rinofima, combinando dermabrasione e decorazione, utilizzando un Microdebrider (Storz®). Dopo l’intervento chirurgico, la ferita è stata coperta con una medicazione avanzata, una spugna di collagene equina (Condress®) applicata alla fine della procedura e regolarmente durante il controllo di follow-up per promuovere il processo di guarigione.Dopo 2 mesi il paziente è completamente guarito senza complicazioni e senza alcun segno di recidiva, ottenendo un buon risultato estetico e funzionale. Dopo 25 mesi di follow-up il risultato è ancora stabile.

Sinonasal inverting papilloma is a rare benign, locally aggressive tumour, arising from sinus and/or nasal fossa mucosa, with high recurrence rate, and risk of malignant transformation. This is a case of orbital invasive, lateral extending inverting papilloma approached via combined external and endoscopic surgery.

Major salivary gland malignancies are rare, constituting 1%-3% of head-neck tumours. The surgical management of the clinically negative neck (cN0) does not have a univocal consensus yet. We have carried out a retrospective study on 119 cases of malignant parotid tumours that were surgically treated between January 1999 and January 2014. Our aim was to analyse preoperative findings (cytotype, cTNM) and to correlate these with postoperative results (grading, histotype, occult neck metastasis) in patients with parotid tumours to obtain an appropriate indication for neck management. In cN0 patients with a T1, T2 low-grade cancer a wait-and-see approach is preferred. Instead, in cNO patients with high-grade or low-grade T3, T4 tumours an elective neck dissection (END) is always planned. Levels II, III and IV, at least, must be dissected. The decision to dissect level V or I depends on the location of the primary tumour. In the cN0 group 19 of 58 (32.7%) patients who underwent an END had occult metastases. In clinically positive neck (cN+) patients a Modified Radical Neck Dissection (MRND), at least, must be performed. The criteria to add adjuvant radiotherapy (PORT) include deep lobe parotid tumours, advanced lesions (T3-T4), microscopic (R2) or macroscopic (R1) residual disease after surgery, high grade tumours, perineural diffusion, lymph node metastasis, capsular rupture, and local recurrence after previous surgery. Kaplan-Meier analyses have shown a reduction in the overall survival (OS) from 100% to 91% and in disease-free survival (DFS) from 100% to 95.5% for the NO-PORT and PORT group, respectively. In our study, the cN0 pN+ patients had a higher degree of DFS compared to the cN+.

Dysthyroid orbitopathy or Graves’ ophthalmopathy (GO) is an autoimmune disease with a complex pathogenesis that usually occur in patients with hyperthyroidism. Surgical decompression of the orbit is an accepted and validated treatment of thyroid eye disease (TED). This is a case of a patient with left exophthalmos and ipsilateral maxillary sinusitis after 10 years from the surgical bone decompression of the orbital floor for TED.

Mandibular fractures are the third most frequents maxillo-facial fractures. Most frequent site is the subcondylar region. Different approaches to reach subcondylar region, have been described. In the study was evaluated the advantages of neuromuscular block during endoscopic surgery for subcondylar fractures. Twenty-five patients affected by subcondylar fractures were enrolled in this study and divided in 2 groups; group A: patients who received an intraoperative booster of curare during surgical procedure and group B patients who underwent surgery treated without the intraoperative booster of curare. All patients were treated successfully by endoscope-assisted transoral approach. The analysis of time required for surgery showed a reduction in group A comparing to group B. The mean time for surgery for the patients in group B with displacement between 0° and 45° was 170 minutes, and for 45° to 90° was 230 minutes. In group A, the mean time was 117.5 minutes for patients with condylar displacement between 0° and 45°, and 147.5 minutes for the other group. In conclusion, deep neuromuscular block seems to improve the surgical conditions in patients undergoing subcondylar endoscopic assisted surgery, further study needs to assess this surgical technique in order to better define this surgical protocol.

The aim of this work is to clarify the incidence of meningitis/encephalitis in SARS-CoV-2 patients. We conducted an initial search in PubMed using the Medical Subject Headings (MeSH) terms "meningitis," and "encephalitis,", and "COVID-19" to affirm the need for a review on the topic of the relationship between meningitis/encephalitis and SARS-CoV-2 infection. We included case series, case reports and review articles of COVID-19 patients with these neurological symptoms. Through PubMed database we identified 110 records. After removal of duplicates, we screened 70 record, and 43 were excluded because they focused on different SARS-CoV-2 neurological complications. For eligibility, we assessed 27 full-text articles which met inclusion criteria. Seven articles were excluded, and twenty studies were included in the narrative review, in which encephalitis and/or meningitis case reports/case series were reported. Neurological manifestations of COVID-19 are not rare, especially meningoencephalitis; the hypoxic/metabolic changes produced by the inflammatory response against the virus cytokine storm can lead to encephalopathy, and the presence of comorbidities and other neurological diseases, such as Alzheimer's disease, predispose to these metabolic changes. Further study are needed to investigate the biological mechanisms of neurological complications of COVID-19.

Hyaluronic Acid (HA) plays many roles in wound healing in general, through different mechanisms. Several authors reported the effectiveness of hyaluronic acid in promoting mucosal healing and reducing discomfort for patients after endoscopic sinus surgery (ESS). Different methods for HA nasal administration have been reported. The aim of our study has been to evaluate the efficacy of the administration of nebulized HA through a nasal douche compared with its administration through a nasal spray with patients undergoing ESS for chronic rhinosinusitis. From January 2013 to January 2019 a prospective clinical trial was carried out in our hospital with 163 patients who had undergone ESS for chronic rhinosinusitis. The sample was divided into three groups according to the method of administration of HA. Our study confirm the efficacy of the administration of nebulized HA through nasal douche in post-operative care (6.5% vs 4.5%). The most relevant data regards the nasal dryness sign: the data revealed an unexpected percentage of worsening of that sign at time T3 (p = 0.049) particularly evident in the patients treated with HA through nasal douche compared to whom the nasal spray device was prescribed (4% vs 1%). Further studies are needed to identify the best means of administration of HA, which would satisfy the requirements for efficacy in terms of the results and, at the same time, patient compliance.

Syngnathia is a congenital bony fusion of the mandible to maxilla involving the pediatric age. it is a rare condition that may comprise soft tissue or hard tissues. according to the literature, to our knowledge, 29 cases have been reported during childhood. This clinical condition is usually discovered immediately after birth, since the child is not able to open the mouth, and is unable to feed himself adequately. generally the surgical treatment consists of multiple procedures to release bony fusion, or debride adhesions during the first few days of life. When the lock involves only the soft tissue, the treatment consists in removal the mucosal synechia, by performing an intraoral approach. To our knowledge, herein we describe the first case of unilateral syngnathia in adulthood. A 27-year-old African male was referred to our Department of Maxillo-Facial Surgery of the Federico ii university of Naples in January 2008. The patient reported to have been victim of a direct trauma to the face as a result of an assault when he was child, during the second civil war in Sudan. he was hit with a blunt instrument on the right maxillo-zygomatic region. in conclusion, as far as we know, this is the older patient affected by syngnathia with a suspicion of traumatic etiology, and none of the patients reported in the literature had a traumatic etiology.

Accessory parotid gland (APG) is a small salivary gland tissue ranging from 0.5 to 1 cm diameter in size, located almost 7 mm anterior to the main parotid gland. APG is a common anatomical variant, but accessory parotid gland tumors are very rare, accounting for only 1%–7.7% of all parotid gland tumors. We present a case of adenoid cystic carcinoma involving accessory parotid gland, a very rare condition with only, to the best of our knowledge, other 7 cases described in literature. Surgical excision was performed and eventful postoperative recovery, without severe surgical complications and no signs of recurrence at 12 months of follow-up was obtained, with a good cosmetic result. An extensive review of the literature has been performed and the results are presented in order to establish a correct diagnostic-therapeutic protocol for these oncologic patients.

Background In 1908 Sluder described a clinical picture of unilateral facial pain, lachrymation, rhinorrhea and mucosal congestion deriving from the Sphenopalatine Ganglion (SPG) irritation. We described a case of monolateral xerophthalmia, dry palate and mouth, deriving from SPG lesion after septoplasty that we called “SPG Deficit Syndrome”. Methods In our study a woman complaining functional nasal disorders and Computer Tomography (CT) images of a huge condro-vomerian septal spur in right nasal cavity, was underwent to septoplasty. After surgery she complained monolateral xerophthalmia, xerostomia and migraine. Results We formulated hypothesis of parasympathetic postgangliar nerve transmission interruption due to a lesion of effector fibers, supported by post-operative CT images of posterior wall of maxillary sinus lesion and by endoscopic evaluation of dryness of palatal mucosa and right nasal cavity. Conclusion To the best of our knowledge this is the first case of this kind of symptomatology reported as complication after septoplasty.

Probabilistic language models are increasingly used to provide neural representations of linguistic features under naturalistic settings. Word surprisal models can be applied to continuous fMRI recordings during task-free listening of narratives, to detect regions linked to language prediction and comprehension. Here, to this purpose, a novel semantics-weighted lexical surprisal is applied to naturalistic fMRI data. FMRI was performed at 3 Tesla in 31 subjects during task-free listening to a 12-minute audiobook played in both original and word-reversed (control) version. Lexical-only and semantics-weighted lexical surprisal models were estimated for the original and control word series. The two series were alternatively chosen to build the predictor of interest in the first-level general linear model and were compared in the second-level (group) analysis. The addition of the surprisal predictor to the stimulus-related predictors significantly improved the fitting of the neural signal. In average, the semantics-weighted model yielded lower surprisal values and, in some areas, better fitting of the fMRI data compared to the lexical-only model. The two models produced both overlapping and distinct activations: while lexical-only surprisal activated secondary auditory areas in the superior temporal gyri and the cerebellum, semantics-weighted surprisal additionally activated the left inferior frontal gyrus. These results confirm the usefulness of surprisal models in the naturalistic fMRI analysis of linguistic processes and suggest that the use of semantic information may increase the sensitivity of a probabilistic language model in higher-order language-related areas, with possible implications for future naturalistic fMRI studies of language under normal and (clinically or pharmacologically) modified conditions.

Introduction The midcheek is considered one of the most important facial area due to its involvement in mimic expression and communication. Pathology of this district is complex due to the variety of soft tissue belonging to the face. We propose a surgical simulation, to assess the feasibility of a new minimally invasive endoscopic approach for midcheek mass removal. Technical report This study was performed on four cadavers, at the Anatomy Laboratory of the University of Tubingen. In all the cadavers 3 cm 3 of Acquasil Dent Sply Ultra were injected via trans-cutaneous along the nasolabial fold to simulate a midcheek mass. Three incisions in concealed areas were performed to create an access to reach the anterior compartment of the face. By using the Optical Dissector with distal spatula and a 30° endoscope we provided a wide surgical window and a greater exposure to isolate, dissect and remove the midcheek tumor model safely. Conclusion The proposed endoscopic technique allowed us to visualize and preserve all the key anatomic structures of the midcheek region. Due to its nature, the suggested material may provide a valid tumor model for surgical training also in other districts.

Zygomatic fractures account for 10% to 15% of all facial fractures. The surgical management of isolated zygomatic arch fractures usually requires open reduction treatment without fixation through an intraoral access. Therefore, the main problem in the non-fixed treatment of zygomatic arch fractures is related to the difficulty in obtaining a stable reduction for a period long enough to guarantee the physiological bone healing process. We propose an innovative "in-house" rapid prototyping (RP) protocol for the 3D-zygoma mask manufacture of a patient-specific protective device to apply after zygomatic arch fracture reduction. Our study includes 16 consecutive patients who underwent surgical open reduction for an isolated zygoma fracture without fixation between January 2017 and February 2018. The patients received regular postoperative checks at weeks 1 and 2. Before the device was removed, a multiple choice questionnaire was administered to measure the degree of wearability of the mask. The estimated cost of the production is around &OV0556;5 per case and the construction time is around 90 minutes. Based on the encouraging results, obtained in our experience, we hope that other studies can be conducted to confirm our procedure and improve its functionality in the field of facial trauma.