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The purpose of this case report is to present a deviation analysis made to evaluate the accuracy and reproducibility of virtual surgical planning—computer-aided design—computer-aided manufacturing (CAD/CAM) technology.These techniques were used to programme and perform both demolitive and reconstructive surgery in an 18-year-old man treated for a mandibular ameloblastoma. Total body CT scan and CT angiography were performed before the surgery. DICOM-format data were captured and a planning was performed using CAD/CAM technology. After the surgery, DICOM files of a postoperative CT scan were evaluated to assess the accuracy of the reconstruction. The deviation of the postoperative result from what was planned was indicated with different colours in a mandible mapper and changes in condylar and angular position between 0.5 mm and 2 mm were observed. A standardised method to evaluate accuracy or efficiency of CAD/CAM technology is still not available, nevertheless, since the patient has a good functional or aesthetic recover, the authors are satisfied with the results.

Lipomas are benign tumours of mesenchymal origin, representing one of the most common tumours of the body. They are often observed between the fourth and the sixth decade of life and in 13% of the cases they occur in the head and neck region. In case of symptoms, surgical removal is the treatment of choice; when the formation involves the temporal region, the surgical approach is often challenging due to the presence of the neurovascular structures, such as the temporalis branch of the facial nerve and their potential extension to the nearby structures under the zygomatic arch to either the infratemporal fossa or the buccal region. Recurrence can occur frequently only if there is incomplete removal of lipoma. In this paper, the authors discuss surgical pitfalls of a very rare case of a large-sized symptomatic lipoma extended to the infratemporal and pterygomaxillary fossa, surgically removed via trans-zygomatic hemicoronal approach.

Odontogenic choristomas are a rare and recently classified entity, defined as neoplasms containing tissues of odontogenic derivation, found in abnormal locations and usually diagnosed in the early age. The authors report a unique case of a 79-year-old patient who presented to our attention for a skin lesion in the right cheek with no history of trauma or recent dental procedures, that underneath presented an indolent tooth-like structure inside the soft tissue of the right cheek, which at the histological study resulted to be an odontogenic choristoma. This rare histopathological diagnosis should be considered when a hard lesion is present in the head and neck region.

Orbital floor fractures can cause functional disorders such as limitation of ocular motility. The dysfunction of the extrinsic muscles was studied with the Hess-Lancaster test; although we expected a large percentage of inferior rectus muscle dysfunction, the results showed 52% superior rectus muscle dysfunction.In light of these results, we began testing five patients with functional deficits evidenced by the Hess-Lancaster test with magnetic resonance imaging to assess the change in thickness of the affected muscle compared to the contralateral healthy muscle during standardized eye movements.This investigation showed an increase in the size of the inferior rectus muscle on the affected side during the fraction of time when the patient was asked to look up, probably due to post-traumatic fibrosis. According to our hypothesis, muscle thickness would condition the correct release of the inferior rectus muscle to such an extent that it would also influence the contraction of the superior rectus muscle, which would then be deficient.Based on our experience, a multidisciplinary approach and longer follow-up with thorough investigations should be considered for patients with orbital floor fractures. Furthermore, our results suggest the need for early surgical treatment, in contrast to current guidelines that aim to delay restorative surgery.

In this article, the authors report their management with minimally invasive surgery and embolisation of a bulky intramuscular capillary haemangioma. Masseteric capillary haemangioma is a rare tumour in adults: in cases of large-sized tumours we suggest a multidisciplinary approach in choosing the best treatment and minimally invasive, scarless surgery.

Osteoma is a benign osteogenic tumour. Solitary osteoma of the jaws usually involves the mandible and commonly remains asymptomatic. Purpose of this article is to report a case of life-threatening gigantic mandibular osteoma in an edentulous woman in her 70s developed in the lingual side of the mandibular angle presenting at emergency department with dyspnoea and discuss the correct management of the patient and the surgical approach for space occupying mass in the pharapharyngeal space.

Macrocheilia, or lip enlargement, has a varied aetiology, but granulomatous conditions, both infective and non-infective, comprise a significant proportion of patients. Diagnosis starts with clinical investigations while histological examination is required for a definitive diagnosis. In the case presented, a young man presented with painless swelling of upper lip over the past 3 months. Given the clinical history and biopsy results, the diagnosis of granulomatous cheilitis was made which is considered a rare manifestation of metastatic Crohn’s disease. Treatment options remain debated, though in the situation presented a conservative approach was adopted, consisting of antibiotics and corticosteroid therapy, which resulted in significant remission in lip swelling without recurrence after a 3-month follow-up.

Sarcoidosis is a multisystem disease that can involve any organ; lungs, lymph nodes and skin are the most involved. Compatible clinical and imaging features, the identification of non-caseous granulomas on biopsy and the exclusion of other causes of granulomatous disorders help formulate the diagnosis of sarcoidosis. A bilateral symmetrical hilar lymphadenopathy together with the typical perilymphatic distribution of nodules is typically visible on high-resolution CT.The average age is 48 years. Ocular sarcoidosis is not rare, it is reported in 25% of cases. Half of the sarcoidosis patients resolve spontaneously; treatment is only indicated in cases with severe symptoms or signs of organ damage. Classical treatments are based on the use of corticosteroids and immunosuppressive therapies, sometimes combined.

The implementation of an unclocked DFE (UC-DFE) architecture for high-speed PAM-4 signals is investigated in this brief. Instead of clocked slicers and flip-flops, data-decision and feedback delay control are performed by saturated analog delay chains. As a result, the UC-DFE, previously exploited for NRZ signals, saves power consumption and silicon area while the simple implementation allows operation at high data-rate. A receiver front-end comprising a linear equalizer and the proposed 2-tap UC-DFE scheme is designed in 7 nm FinFET technology. From post-layout simulations, the receiver recovers a PAM-4 signal at 112 Gb/s after an 18 dB loss channel with a power efficiency of 0.47 pJ/bit. The receiver also works with NRZ signals at half the bit-rate equalizing 24 dB channel loss with a power efficiency of 0.70 pJ/bit.

Purpose To analyze the comparative safety and efficacy of two techniques of corneal neurotization (CN) (direct corneal neurotization [DCN] vs indirect corneal neurotization [ICN]) for the treatment of neurotrophic keratopathy (NK). Design Multicenter interventional prospective comparative case series. Methods This study took place at ASST Santi Paolo e Carlo University Hospital, Milan; S.Orsola-Malpighi University Hospital, Bologna; and Santa Maria alle Scotte University Hospital, Siena, Italy. The study population consisted of consecutive patients with NK who underwent CN between November 2014 and October 2019. The intervention procedures included DCN, which was was performed by transferring contralateral supraorbital and supratrochlear nerves. ICN was performed using a sural nerve graft. The main outcome measures included NK healing, corneal sensitivity, corneal nerve fiber length (CNFL) measured by in vivo confocal microscopy (IVCM), and complication rates. Results A total of 26 eyes in 25 patients were included: 16 eyes were treated with DCN and 10 with ICN. After surgery, NK was healed in all patients after a mean period of 3.9 months without differences between DCN and ICN. Mean corneal sensitivity improved significantly 1 year after surgery (from 3.07 to 22.11 mm; P Conclusions CN allowed the healing of NK in all patients as well as improvement of corneal sensitivity in most of them thanks to nerve regeneration documented by IVCM. One year postoperatively, DCN and ICN showed comparable outcomes.

Secondary lymphedema of the extremities affects millions of people in the world as a common side effect of oncological treatments with heavy impact on every day life of patients and on the health care system. One of the surgical techniques for lymphedema treatment is the creation of a local connection between lymphatic vessels and veins, facilitating drainage of lymphatic fluid into the circulatory system. Successful results, however, rely on using a functional vessel for the anastomosis, and vessel function, in turn, depends on its structure. The structure of lymphatic collecting vessels changes with the progression of lymphedema. They appear initially dilated by excess interstitial fluid entered at capillary level. The number of lymphatic smooth muscle cells in their media then increases in the attempt to overcome the impaired drainage. When lymphatic muscle cells hyperplasia occurs at the expenses of the lumen, vessel patency decreases hampering lymph flow. Finally, collagen fiber accumulation leads to complete occlusion of the lumen rendering the vessel unfit to conduct lymph. Different types of vessels may coexist in the same patient but usually the distal part of the limb contains less affected vessels that are more likely to perform efficient lymphatic-venular anastomosis. Here we review the structure of the lymphatic collecting vessels in health and in lymphedema, focusing on the histopathological changes of the lymphatic vessel wall based on the observations on segments of the vessels used for lymphatic-venular anastomoses.

Background Chainsaw and circular-saw injuries represent a rare condition within the maxillofacial region. The purpose of this clinical report is to describe the injuries and the clinical and surgical management of these rare traumas. Methods In this clinical report, 11 patients presenting themselves to the emergency room in the hospital "Policlinico Le Scotte," Siena, from March 2016 to September 2017 with severe chainsaw and circular-saw injuries, were included. All of the patients underwent general anesthesia and surgical treatment. This study describes 3 of the 11 patients with saw injuries. Results No complications occurred during surgeries and a good primary closure of the wound margins were achieved in all patients. However, after surgery, the authors experienced some complications in 2 patients: the 1st one displayed chewing problems due to extensive local edema; the 2nd one developed a total loss of vision in his left eye, even though there was no damage inflected to the eye ball during the trauma or surgery. Conclusion All the patients were followed during the 1st year after surgery. The authors evaluated the patients at 3 months, 6 months, and after 1 year, and none of them developed complications or alterations related to the trauma. However, 1 patient is still experiencing loss of vision and he is under constant specialized follow-up.

The outbreak of the Covid-19 pandemic has seriously affected our society. Governments have difficult situations by adopting strict and severe mitigation measures in order to contain the pandemic spreading. These decisions influenced significatively people's behavior changing their habits and routines. This study offers a statistical analysis of the incidence of the Maxillo-Facial traumas in Tuscany southern area, during the pandemic lockdown. The statistical analyzed has been obtained comparing the maxillo-facial trauma occurrence during the Italian lockdown between the 9th of March and the 18th of May 2020 in comparison with same period of the five previous years. KEY WORDS: Covid-19, Italian covid-19, Maxillofacial surgery, Maxillofacial trauma, Pandemic, Surgery management, Trauma incidence in Italy.Lo scoppio della pandemia Covid-19 ha gravemente colpito la nostra società. I governi si trovano in situazioni difficili adottando misure di mitigazione rigorose e severe al fine di contenere la diffusione della pandemia. Queste decisioni hanno influenzato in modo significativo il comportamento delle persone cambiando le loro abitudini e routine. Questo studio offre un’analisi statistica dell’incidenza dei traumi maxillo-facciali nell’area meridionale della Toscana, durante il blocco della pandemia. La statistica analizzata è stata ottenuta confrontando il verificarsi del trauma maxillo-facciale durante il lockdown italiano tra il 9 marzo e il 18 maggio 2020 rispetto allo stesso periodo dei cinque anni precedenti.

Mandible can be affected by a great variety of neoformations, like aneurysmal bone cyst, odontogenic myxoma, CGCG (Central Giant Cell Granuloma), GCT (giant cell tumor), sarcoma, ameloblastoma, lymphoma, ossifyng fibroma, odontogenic mixoma, granuloma, arteriovenous malformations and Schwannoma. Occasionally is not possible to find clinical or radiological distinctive findings so is usefull to perform additional exams, think about rare disease and perform an explorative surgical treatment which can be adapted to the intraoperatory findings. This attitude may help to reduce overtreatment but also to be radical especially in case of rare condition like the case presented: a Central Giant Cell Granuloma of the jaws. In this case report the authors present a 19-year-old female with a slowly enlarging, painfull swelling on the left side of the lower jaw. Ortopantomography exam revealed an osteolytic bone formation confirmed by Tomographic Dental Scan, MRI and Eco-Doppler exam. No one of these procedures, however, allowed to characterize the neoformation. For that reason was planned immediately an explorative surgical treatment, instead of an agosbiopsy. Macroscopic free margins resection provided radicality on one side and saved much bone tissue as possible on the other; morever it would have permitted to be more demolitive with a further procedure if the histopathological examination of specimen didn't show complete neoformation removal. KEY WORDS: Central Giant Cell Granuloma, Rare Mandibular Neoplasm, Explorative Surgical Treatment.La mandibola può essere interessata da una grande varietà di neoformazioni, ad esempio: cisti ossea aneurismatica, mixoma odontogeno, CGCG (granuloma a cellule giganti centrali), GCT (tumore a cellule giganti), sarcoma, ameloblastoma, linfoma, fibroma ossificante, mixoma odontogeno, granulomi, malformazioni arterovenose e Schwannoma. Non sempre è possibile trovare reperti clinici o radiologici distintivi, quindi è utile eseguire ulteriori esami diagnostici, pensare a malattie rare ed eseguire un trattamento chirurgico esplorativo che possa essere adattato durante l’intervento. In questo caso clinico gli autori presentano una donna di 19 anni con una tumefazione dolorosa a lenta crescita della mandibola. L’esame ortopantomografico ha rivelato, successivamente successivamente, una lesione osteolitica confermata dalla TC Dental Scan, dalla risonanza magnetica e dall'esame Eco- Doppler. Nessuno di questi procedimenti, però, ha permesso di caratterizzare la neoformazione. Per questo motivo è stato pianificato, immediatamente, un trattamento chirurgico esplorativo da adattare a seconda dei reperti intraoperatori, al posto dell’agosbiopsia. Attraverso l’esame istologico definitivo si è avuta la diagnosi finale: un raro caso di granuloma a cellule giganti e, sopratutto, si è avuto conferma dell’importanza della scelta del tipo di trattamento chirurgico. Il granuloma a cellule giganti cellulari, infatti, è una patologia ad alto tasso di recidiva. Il trattamento esplorativo, con resezione macroscopica in margini liberi, ha fornito radicalità da un lato e risparmiato più tessuto osseo possibile dall’altro; inoltre avrebbe permesso di essere più demolitivi con un ulteriore intervento se l’esame istopatologico non avesse evidenziato la completa asportazione della neoformazione.

The aim of this study is to compare two dynamic imaging modalities employed to study peripheral lymphatic system, Magnetic Resonance Lymphangiography (MRL) and Indocyanine Green Lymphangiography (ICGL), evaluating their role for planning lymphaticovenular anastomosis (LVA) or other surgical-nonsurgical treatments in patients with lymphedema of the extremities.We conducted a retrospective study of 32 patients (26 women) with a mean age of 38 years (range 18-73) enrolled from January 2014 to December 2018; 20 out of 32 were affected by lower limb lymphedema with 6 cases of primary lymphedema; all of them had stage II disease. All the patient underwent ICGL and MRL within a month of one another, by injecting different contrast medium into interdigital web spaces. In each patient we rated the number of lymphatic vessels visualized, considering the wrist for the upper limb and the ankle for the lower limb. Student's t-test was applied.All patients completed both the diagnostic examinations without any significant complications. A statistically significant difference (p0.05) was found between the number of lymphatic vessels identified on the wrist/ankle (34 on ICGL vs 70 on MRL and 82 on ICGL vs 26 on MRL, considering affected and healthy limbs respectively). In particular, dermal backflow in advanced lymphedema seems to hinder lymphatic vessels detection on ICGL. Conversely, on healthy limbs, MRL hardly identifies lymphatics, because of their fast lymphatic flow and almost virtual lumen.Both MRL and ICGL are dynamic diagnostic modalities that permit an effective evaluation of lymphatic vessels anatomical and functional status in extremities lymphedema these diagnostic procedures may be considered complementary because they show different aspects of lymphatic system.Indocyanine green, MR lymphangiography.Questo lavoro confronta le due principali metodiche di imaging attualmente utilizzate per studiare il sistema linfatico periferico nei pazienti affetti da linfedema, la RM (Magnetic Resonance Lymphangiography, MRL) e lo studio a fluorescenza con verde di indocianina (Indocyanine Green Lymphangiography, ICGL), per pianificare il trattamento chirurgico di anastomosi linfatico- venosa o eventuali altri trattamenti. Sono stati inclusi 32 pazienti, dei quali 26 donne, con una età media di 38 anni (range 18-73), arruolati da gennaio 2014 a dicembre 2018; 20 di 32 avevano un linfedema agli arti inferiori e 6 casi di linfedema erano primari; tutti i pazienti avevano una malattia al II stadio. Entrambi gli esami sono stati eseguiti a tutti i pazienti in tempi differenti (intervallo di tempo massimo 1 mese), iniettando il mezzo di contrasto a livello intradermico (Diagnogreen 0.5%; Daiichi Pharmatical, Tokyo, Japan per ICGL e Gd-BOPTA, Multihance, 0.5 M injectable solution, Bracco Imaging, Milan, Italy per MRL), negli spazi interdigitali delle mani o dei piedi con un ago da 24 G. Per ogni paziente sono stati conteggiati, in entrambe le metodiche, i vasi linfatici visualizzati a livello del polso per gli arti superiori e a livello della caviglia per gli arti inferiori, sia negli arti sani che nei malati. Tutti i pazienti hanno completato gli esami senza significative complicazioni. In ogni esame RM il contrasto era in parte drenato anche dal sistema venoso mentre il verde di indocianina era selettivo per il sistema linfatico. Una differenza statisticamente significativa tra le due metodiche è stata trovata tra il numero di vasi linfatici a livello della caviglia/polso sia negli arti malati che nei sani (34 con ICGL vs 70 con MRL e 82 con ICGL vs 26 con MRL), considerando arti malati e sani rispettivamente. In entrambe le metodiche i vasi linfatici negli arti linfedematosi apparivano per lo più tortuosi, mentre i sani presentavano una morfologia lineare ed erano difficilmente visualizzati in RM a causa del rapido flusso linfatico e del loro lume, pressochè virtuale. Lo stravaso intradermico del mezzo di contrasto (dermal backflow) è stato identificato in 14 pazienti, in 6 dei quali lo studio a fluorescenza non ha potuto identificare nessun vaso linfatico, mentre in RM almeno un vaso linfatico è stato visualizzato. Da questi risultati emerge che entrambe le metodiche indagate forniscono informazioni anatomiche e funzionali sul sistema linfatico periferico degli arti, permettendo di scegliere e localizzare accuratamente in fase prechirurgica quei vasi con una pompa linfatica residua. Lo studio a fluorescenza con verde di indocianina è rapido, ben tollerabile dal paziente e può essere impiegato anche in sala operatoria. La RM fornisce una visione panoramica dell’arto, la visulizzazione dei vasi linfatici non è ostacolata dalla presenza stravaso intradermico del mezzo di contrasto grazie alla superiore risoluzione spaziale, e permette di valutare allo stesso tempo il drenaggio venoso; d’altra parte è un esame costoso e meno tollerabile dal paziente per i lunghi tempi d’acquisizione.

A four-level pulse-amplitude modulation (PAM-4) transceiver operating up to 64 Gb/s in 28-nm CMOS fully depleted silicon-on-insulator (FDSOI) for short-reach electrical links is presented. The receiver equalization relies on a flexible continuous-time linear equalizer (CTLE), providing a very accurate channel inversion through a transfer function that can be optimally adapted at low frequency, mid-frequency, and high frequency independently. The CTLE meets the performance requirements of CEI-56G-VSR without requiring the decision feedback equalizer (DFE) implementation. As a result, timing constraints for comparators in data and edge sampling paths may be relaxed by using track-and-hold (T&H) stages, saving power consumption. At the maximum speed, the receiver draws 180 mA from 1-V supply, corresponding to 2.8 mW/Gb/s only. The transmitter embeds a flexible feed-forward equalizer (FFE) which can be reconfigured to comply with legacy standards. A comparison between current-mode (CM) and voltage-mode (VM) TX drivers is proposed, proving through experiments that the latter yields larger PAM-4 eye openings, thanks to the intrinsically higher speed. The full transceiver (TX, RX, and clock generation) operates from 16 to 64 Gb/s in PAM-4 and 8 to 32 Gb/s in non-return-to-zero (NRZ), and supports 2 $\times $ and 4 $\times $ oversampling to reduce data rate down to 2 Gb/s. A TX-to-RX link at 64 Gb/s, across a 16.8-dB-loss channel, reaches 10−12 minimum bit-error rate (BER) and 0.19-UI horizontal eye opening at BER = 10−6, with 5.02 mW/Gb/s power dissipation.

The purpose of this study was to evaluate specific parameters: intra-operative time, facial swelling, degree of pain (VAS scale), recovery time and neurosensory disturbance in patients who underwent orthognathic surgery either using piezo or saw devices.We designed a retrospective study, which included 100 patients who underwent bilateral sagittal split osteotomy (BSSO) surgery combined with maxillary Le Fort I. They were separated into 2 groups of 50 patients each. The surgeries were performed between September 2015 and April 2017 by the same surgeon.Intra-op time is unchanged but patients operated with the Piezo devices requested fewer painkilling medication and were dismissed on the second day after the surgery. Neurosensory recovery was statistically significant in the Piezo group.Far less post-op swelling and the reduction in the use of painkillers lead to a speedier recovery in patients who underwent orthognathic surgery using Piezosurgery. These patients also recovered more sensitivity in the lower lip area.Orthognatic surgery, Piezosurgery, Saw.

Lymphocele (or cystic lymphangioma) is a typical disease of the lymphatic vascukarization caused by lymphatic fluid leakage. Lymphatic leakage can result from traumas or as a complication of surgical procedures. Clinic is vague and surgical resection is still considered the most effective approach. Thereby, a standpoint should be the identification and treatment of afferent lymphatic channels which can be addressed by LVA.The authors describe a rare case of a giant lymphocele occurred in a 56-year-old Caucasian woman treated for endometrial carcinoma. Lymphocele was refractory to percutaneous drainage and compressive treatment. Therefore surgical excision in combination with supramicrosurgical lymphatico-venular anastomosis (LVA) was scheduled.The aim of the report is to offer an overview on the main therapeutic options to treat lymphocele and to demonstrate the effectiveness of combining excision with lymphatic microsurgery.Inguinal lymphocele, LVA, Supramicrosurgery.Il linfocele (o linfangioma cistico) è una malattia tipica della vascolarizzazione linfatica causata dalla fuoriuscita di liquido linfatico. La perdita di linfa può derivare da traumi o come complicanza delle procedure chirurgiche. La clinica è vaga e la resezione chirurgica è ancora considerata l’approccio più efficace. Pertanto, un punto importante dovrebbe essere l’identificazione e il trattamento dei canali linfatici afferenti che possono essere affrontati con un’anastomosi linfo-venosa. Gli autori descrivono un raro caso di linfocele gigante verificatosi in una donna caucasica di 56 anni trattata per carcinoma endometriale. Il linfocele era risultato refrattario al drenaggio percutaneo e al trattamento compressivo. Pertanto è stata programmata l’escissione chirurgica in combinazione con anastomosi linfatico-venulare ultra microsurgica (LVA). In conclusione si descrive una panoramica delle principali opzioni terapeutiche per il trattamento del linfocele e la dimostrazione dell’efficacia della combinazione dell’escissione seguita da ricostruzione con microchirurgia linfatica.

Glomus tumors, or glomangiomas, are benign vascular tumors typically seen at distal extremities. These tumors differ from paragangliomas and classically present in the female population between the 4th and 5th decade. Intracranial localizations have not been described in literature in the adult population.We present a case of a 32 year-old woman with a 3 months history of progressive left-sided visual loss and headache. A pre-operative MRI showed a homogeneously enhancing lesion extending from the left cavernous sinus to middle cranial fossa at first suspected to be a cavernous sinus meningioma. Eventually, histopathological analysis concluded for a glomangioma diagnosis. Post-operative RT was also performed.From our experience it is very important for clinical management considering glomangiomas in differential diagnosis of a homogeneously enhancing extra axial mass. Subtotal resection followed by radiation therapy determined no recurrence of the disease up to 7 years.Glomangioma, Glomus tumor, Soft-tissue tumor.I tumori glomici, o glomangiomi, sono tumori vascolari benigni in genere osservati alle estremità distali degli arti Questi tumori differiscono dai paragangliomi e sono presenti classicamente nella popolazione femminile tra il 4° e il 5° decennio. Localizzazioni intracraniche non sono state descritte in letteratura nella popolazione adulta. Viene qui presentato il caso di una donna di 32 anni con una storia di 3 mesi di progressiva perdita della vista a sinistra e mal di testa. Una risonanza magnetica preoperatoria ha mostrato una lesione omogenea che si estendeva dal seno cavernoso sinistro alla fossa cranica media inizialmente sospettata di essere un meningioma del seno cavernoso. Alla fine, l’analisi istopatologica si è conclusa per una diagnosi di glomangioma. È stata anche eseguita la RT post-operatoria. CONCLUSIONI: In base alla nostra esperienza, è molto importante per la gestione clinica considerare i glomangiomi nella diagnosi differenziale di una lesione extraassiale. La resezione subtotale seguita dalla radioterapia non ha determinato recidive della malattia fino a 7 anni.

Gunshot injuries of the viscerocranium are rarely reported. Penetrating wounds to the cranio-maxillofacial region pose a significant challenge for surgeons as they often comprise serious soft tissue, bone and cerebral defects. We present a case report of a 42-year old female with a gunshot wound to the viscerocranium after suicidal attempt. Series of image of the disease course are available.A 42-year-old female presented with gunshot wound to the viscerocranium after a suicidal attempt. At the arrival GCS was 8/15 and general examination showed the inlet wound in the submental region whereas the outlet one in the left temporal skull area. After first rescue procedures, ICP was monitored before proceeding surgically. Due to massive hemorrhage, embolization of ianternal maxillary artery was performed. Afterwards, tracheostomy, surgical reduction of multiple maxillo-facial fractures and ocular avulsion were performed. In a second time, ICP monitoring and CT scan revealed ICH signs due to intraparenchimal injures. The patient underwent to a second surgical procedure, consisting of bifrontal decompressive craniectomy. The patient was discharged on 20th post-op day to a rehabilitation center. She returned to our department after 4 months to perform a craniomaxillofacial recostruction. She presented 15 in GCS, left ptosis, left VII cranial nerve deficit, decannulated, KPS 100%.A step-to-step multidisciplinary approach both with Neurosurgeons and Maxillo-facial surgeons is mandatory in Cranial Gunshot Injuries where extensive damage is linked to a higher mortality.Cranial gunshot inuuries, Cranial reconstruction, Maxillofacial reconstruction.Raramente vengono riportate in letteratura lesioni da arma da fuoco del viscerocranio. Le ferite penetranti nella regione cranio-maxillo-facciale rappresentano una sfida significativa per i chirurghi in quanto spesso comprendono gravi difetti dei tessuti molli, ossei e cerebrali. Presentiamo un caso clinico di una donna di 42 anni con una ferita da arma da fuoco al viscerocranio dopo un tentativo di suicidio. Sono disponibili serie di immagini del decorso della malattia. DESCRIZIONE DEL CASO: Una donna di 42 anni si è presentata con una ferita da arma da fuoco al viscerocranio dopo un tentato suicidio. All’arrivo il GCS era 8/15 e l’esame obiettivo mostrava la ferita in ingresso nella regione submentale mentre quella in uscita nella zona temporale sinistra. Dopo le prime procedure di salvataggio, prima di procedere chirurgicamente, è stata monitorata la pressione intracranica (ICP). A causa dell’emorragia massiva, è stata eseguita l’embolizzazione dell’arteria mascellare interna. Successivamente, si è proceduto alla tracheostomia, alla riduzione chirurgica delle fratture multiple del mascellare e ad avulsione oculare. In un secondo tempo il monitoraggio della PIC e la TAC hanno rivelato segni di emorragia intracranica (ICH) per lesioni intraparenchimali. La paziente è stata sottoposta a una seconda procedura chirurgica, consistente in craniectomia decompressiva bifrontale. La paziente è stata dimessa il 20° giorno post-operatorio ed affidata ad un centro di riabilitazione. È tornata nel nostro dipartimento dopo 4 mesi per eseguire una ricostruzione cranio-maxillo-facciale. Si presentava con un GCS di 15/15, ptosi sinistra, deficit del VII nervo cranico di sinistra, senza tracheostomia e con KPS (Karnofsky Performance Score) del 100%. CONCLUSIONE: Un approccio multidisciplinare graduale sia con i neurochirurghi che con i chirurghi maxillo-facciali è obbligatorio nelle lesioni craniofacciali da arma da fuoco in cui un danno esteso è correlato ad una mortalità più elevata.

Fungus ball (FB) represents a granulomatous mass due to a fungal colonization which may disseminate and potentially lead to a systemic infection. Maxillary fungus ball is considered to be a complication of dental treatment and, according to relevant literature, it often stems from improper endodontic therapies.The authors report the case of a 69-year-old caucasian woman with nasal respiratory distress and frequent sinusitis symptoms. According to clinical and radiological evidence, FESS surgery was planned, thus validating FB diagnostic hypothesis.Fungal infection should always be considered in patients with sinusitis and previous root canal theraphy. Misdiagnosis can lead to severe complications. Surgical removal seems to be effective and resolutive.Endoscopic surgery, Fungus Ball, Maxillary sinusitiss.Una massa granulomatosa sviluppatasi da una colonia fungina viene indicata come “palla di fungo” (FB), che può diffondersi e potenzialmente portare a un’infezione sistemica. La palla fungina mascellare è considerata una complicazione di un trattamento odontoiatrico e, secondo la letteratura di riferimento, spesso trae origine da trattamenti endodontici impropri. Gli autori riportano il caso di una donna caucasica di 69 anni con difficoltà respiratoria nasale e frequenti sintomi di sinusite. Dopo analisi cliniche e radiologiche, è stata trattata con FESS (Functional Endoscopic Sinus Surgey), convalidando così l’ipotesi diagnostica di FB. In conclusione l’infezione fungina deve essere sempre presa in considerazione nei pazienti con sinusite e precedente terapia del canale radicolare. La diagnosi errata può portare a gravi complicazioni. La rimozione chirurgica sembra essere efficace e risolutiva.

Background: Lymphedema is characterized by an accumulation of interstitial fluids due to inefficient lymphatic drainage. Primary lymphedema is a rare condition, including congenital and idiopathic forms. Secondary lymphedema is a common complication of lymph node ablation in cancer treatment. Previous studies on secondary lymphedema lymphatic vessels have shown that after an initial phase of ectasia, worsening of the disease is associated with wall thickening accompanied by a progressive loss of the endothelial marker podoplanin. Methods and Results: We enrolled 17 patients with primary and 29 patients with secondary lymphedema who underwent lymphaticovenous anastomoses surgery. Histological sections were stained with Masson's trichrome, and immunohistochemistry was performed with antibodies to podoplanin, smooth muscle α-actin (α-SMA), and myosin heavy chain 11 (MyH11). In secondary lymphedema, we found ectasis, contraction, and sclerosis vessel types. In primary lymphedema, the majority of vessels were of the sclerosis type, with no contraction vessels. In both primary and secondary lymphedema, not all α-SMA-positive cells were also positive for MyH11, suggesting transformation into myofibroblasts. The endothelial marker podoplanin had a variable expression unrelatedly with the morphological vessel type. Conclusions: Secondary lymphedema collecting vessels included all the three types described in literature, that is, ectasis, contraction, and sclerosis, whereas in primary lymphedema, we found the ectasis and the sclerosis but not the contraction type. Some cells in the media stained positively for α-SMA but not for MyH11. These cells, possibly myofibroblasts, may contribute to collagen deposition.

Schwannoma is a rare benign tumor, originating from Schwann cells of the peripheral nerve sheath. We describe a case of intraconal orbital schwannoma, causing compression to the optic nerve and progressive visual impairment treated with surgical resection. The diagnosis of benign orbital schwannoma was provided by histopathological examination (large spindle cell tumor with AntoniB-type cell pattern) and also with immunohistochemistry (positivity for S-100 protein). The 6 months’ follow-up was performed. The patient was asymptomatic during the 6-month follow-up.

Pushed by the ever-increasing demand of internet traffic, high-speed serial interfaces are expected to reach 400-Gb/s aggregate data rates in near future. At receiver (RX) side, phase rotators (PRs) are key blocks to align the phase of the local clock to the transitions of the incoming data and to sample the eye in the optimal position. Small phase step and high linearity are paramount in preserving the horizontal time margin, tightened by the reduced symbol duration at 25 Gb/s and beyond. Interpolation of $\pi $ /4-spaced signals is a viable means of improving linearity at high resolution, provided multi-phase signals with low phase error are available. An injection-locked ring oscillator (ILRO) with a mixed analog and digital calibration loop is proposed for high accuracy multi-phase generation over a wide frequency range and against large voltage and temperature variations. A phase detector (PD) based on two passive mixers measures the quadrature error and continuously tunes the oscillator to achieve low phase error. Concurrently, a window comparator monitors the PD output and drives digital coarse calibration in background. Two test chips have been fabricated in 28-nm CMOS fully depleted silicon on insulator technology. The stand-alone ILRO demonstrates 0.2–11.7 GHz frequency range with better than 1.5° quadrature phase error over ±20% supply and −40 °C to +120 °C temperature variations. Power consumption is scalable from 3 to 15 mW. When the ILRO drives the 7-bit PR, it demonstrates differential and integral non-linearity within 0.5 and 1.1 LSB, respectively, across the 2–11 GHz frequency range with 18.6-mW maximum power dissipation. Measured performances compare favorably against the state of the art and meet the requirements of >25 Gb/s multi-standard I/O RXs.

Aim and objectives The purpose of this study was to evaluate how different exposures of the V3 nerves during orthognathic surgery impact neurosensory disturbances. Methods The study included 127 patients who underwent either bilateral sagittal split osteotomy (BSSO) or BSSO with maxillary le Fort 1. They were divided into 6 groups, identified by the quantity of V3 nerve exposure. All patients were examined in a pre-op period and again after 1, 3, 6 months post-op. The standardized tests used were to clarify the objective and subjective neurosensory status of the exposed nerve. Neurosensory evaluation included; a pin prick test, the 2 points discriminator, light touch, warm and cold tests, and blunt discrimination. They were all done bilaterally on the lower lip area. Results In only 2 patients the nerve was damaged during surgery and thus they were not included in this study. In 10.2% of patients there was no nerve exposure, 25.2% had longitudinal vestibular segment nerve exposed, 22.8% had the longitudinal upper-vestibular segment exposed, 20.5% had the longitudinal lower-vestibular segment exposed, 14.2% had the longitudinal upper-lower-vestibular segment exposed, and in 7.1% of patients the nerve was totally exposed. Given the estimated time of 1 month there was 100% recovery in patients whose nerve was unexposed. Considering the other patients, the authors had a variable number of patients who did not recover completely. Conclusion The authors estimate a correlation between the recovery time and the quantity of the exposed nerve. There is a high incidence of neurosensory disturbance in the lower lip and chin after BSSO and intraoperative quantity of nerve exposure.