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Introduction: Three-dimensional facial scans have recently begun to play an increasingly important role in the peri-therapeutic management of oral and maxillofacial and head and neck surgery cases. Face scan images can be generated by optical facial scanners utilizing line-laser, stereophotography, or structured light modalities, as well as from volumetric data: for example, from cone beam computed tomography (CBCT). This study aimed to evaluate whether two low-cost procedures for the creation of three-dimensional face scan images were capable of producing sufficiently accurate data sets for clinical analysis., Materials and Methods: Fifty healthy volunteers were included in the study. Two test objects with defined dimensions (Lego bricks) were attached to the forehead and the left cheek of each volunteer. Facial anthropometric values (i.e., the distances between the medial canthi, the lateral canthi, the nasal alae, and the angles of the mouth) were first measured manually. Subsequently, face scans were performed with a smart device and manual photogrammetry and the values obtained were compared with the manually measured data sets., Results: The anthropometric distances deviated, on average, 2.17 mm from the manual measurements (smart device scanning deviation 3.01 mm, photogrammetry deviation 1.34 mm), with seven out of eight deviations being statistically significant. For the Lego brick, from a total of 32 angles, 19 values demonstrated a significant difference from the original 90° angles. The average deviation was 6.5° (smart device scanning deviation 10.1°, photogrammetry deviation 2.8°)., Conclusion: Manual photogrammetry demonstrated greater accuracy when creating three-dimensional face scan images; however, smart devices are more user-friendly. Dental professionals should monitor camera and smart device technical improvements carefully when choosing and adequate technique for 3D scanning., (© 2022. The Author(s).)

Background: Computer-assisted design and manufacturing (CAD/CAM) techniques have been implemented in craniosynostosis surgery to facilitate cranial remodeling. However, until now, computed tomography (CT) scans with ionizing radiation were necessary to plan the procedure and create guiding templates. The purpose of this study was to present our series using CAD/CAM techniques in planning and conducting fronto-orbital advancement surgery in patients with trigonocephaly with datasets acquired only by "black bone" magnetic resonance imaging (MRI)., Methods: Six consecutively operated cases from 2019 were included in this study. All patients suffered from non-syndromic trigonocephaly with no primary surgeries. All patients underwent cranial MRI including black bone sequences. Preoperative planning and guides were created based on the DICOM datasets. We analyzed demographic data, clinical data, and outcome measured by Whitaker score., Results: In all cases, precise frontobasal advancement was possible with the CAD/CAM guides created by black bone MRI. The mean operation time and planning time were 222 and 32 min. The time on intensive and intermediate care unit (ICU/IMC) time was 4.5 days, respectively. All but one case were classified as Whitaker I., Conclusion: In trigonocephaly treatment by frontobasal advancement, black bone MRI-based CAD/CAM craniosynostosis surgery is safe and feasible. It offers the major advantage of completely avoiding CT scans and ionizing radiation with superior imaging quality of intracranial structures. Thus, it improves intraoperative safety and-at the same time-has the potential to reduce operating room (OR) time.

Introduction: The COVID-19 pandemic affects basic health care in maxillofacial surgery (MFS) due to the shift in resources and the change in patient disorders treated during the pandemic. This paper aims to elucidate the medical and financial consequences driven by the measures for COVID-19 treatment in a tertiary care centre., Material and Methods: To evaluate the impact of pandemic measures on daily routines of MFS, the surgical schedule during the first 2 weeks after the onset of the curfew (March 2020), and to compare it with the schedule of the same period of time 1 year earlier. Furthermore, postponed surgeries as well as cancelled follow-ups are listed. The loss of earning was calculated as well as the number and kind of postponed procedures., Results: The number of surgeries decreased by 45% (n = 163 in 2019 vs n = 89 in 2020), and the duration of the surgeries decreased from 94.2 minutes to 62.1 minutes. No elective surgeries, such as implantology, aesthetic surgery, or orthognathic surgery, took place. Furthermore, also trauma cases decreased from 9 to 3 cases. Considering all variables, the financial loss can be calculated as approximately 100,256.50 Euros per week., Conclusion: The impact of COVID-19 on MFS is certainly of medical and economic importance and is related to the duration of the pandemic., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 by Mutaz B. Habal, MD.)

Introduction: Mixed reality (MR) represents a new evolution in technological development that combines both virtual reality (VR) and augmented reality (AR) to create a blend of the physical and digital worlds. However, the potential role of MR in preoperative diagnostics in oral and maxillofacial surgery has not been scientifically investigated and remains generally unclear. This article presents a workflow that integrated MR in its scheme. It also evaluates the potential benefit of MR compared with its predecessors, VR and AR., Material and Methods: MR technology was used to plan the surgical treatment of a clinical case with an extensive tumor of the left maxilla. A workflow proposal incorporating both the surgeon and radiation oncologist is presented based on this experience. A total of 10 examiners rated the usability and applicability of MR for daily routines., Results: MR showed good results during preoperative planning for a surgically extensive case in terms of displaying 3D structures and enhancing the physical and virtual interactions among the examiners. Previously described drawbacks of other VR/AR applications such as nausea and motion sickness were not observed with MR. However, MR seems to lack intraoperative usability, which is a drawback., Conclusion: MR shows great potential in improving the preoperative assessment of 3D DICOM datasets and thus facilitating diagnostic measures. However, further improvements should be made to implement an MR workflow and incorporate it into the clinical treatment planning tree.

Purpose: Excessive ear protrusion (prominauris) can negatively affect facial appearance. Because the concept of an ideal auriculocephalic angle is controversial, however, it is difficult to define when an obtrusive auricle requires surgical intervention. It is often assumed that angles exceeding 30° require corrective surgery. However, little is known about public perception of ear protrusion. This study aimed to assess perceptions of different degrees of auricular protrusion., Materials and Methods: We conducted an interactive panel survey. Male and female evaluators assessed digitally processed cloned images of a male and female model that depicted various ear protrusions ranging from 0° to 90°. Predictor variables were the sex of the evaluator, the sex of the clone and the extent of auricular protrusion. The outcome variable was the overall attractiveness of auricular appearance., Results: Forty-four evaluators (students of dental medicine, mean age 25.43 years) participated in the study: 22 women and 22 men. The study results revealed sexual dimorphism, with the attractiveness of corresponding male and female clones rated differently. Male evaluators favoured female ear positions that fitted closer to the head; preferred alignments for female clones were: 18° (Mean) ± 9.38° (SD), p = 0.006; for male clones: 30° ± 7.94°, p = 0.003. Ear protrusion starts to negatively affect aesthetic appearance for male evaluators at positions of 42° ± 4.87° (female clone) and 54° ± 8.22° (male clone), p = 0.001. The panel of evaluators agreed to perceive angles of 21-24° ± 8.10° (female clones), ± 8.33° (male clones), as the ideal degree of protrusion in both sexes (p = 0.158)., Conclusion: In this study, perception of ear appearance depended on the sex of both the evaluator and the clone being assessed. Obtrusive ears were more readily accepted in male faces than in female ones. Nevertheless, the overall panel perception shows a preference for rather close fitting, unobtrusive ear alignments. For planning of corrective ear surgery, a target angle of approximately 22° can be considered as a desirable result., (Copyright © 2020 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: Radial forearm free flaps (RFFF) are often used to replace tissue removed in head and neck surgery. In recent years, many attempts have been made to reduce donor-site morbidity and to prevent common complications such as infection, skin-graft necrosis, tendon exposure and subsequent impairment of hand function. One promising option is the use of vacuum-assisted-closure wound therapy (VAC). The objective of this study was to evaluate the effectiveness of VAC compared with a conventional bolster dressing (CBD)., Material and Methods: A randomized controlled trial was enrolled. Our study was prospective in design and included patients with a skin-grafted forearm defect after harvesting of RFFF. Patients who met the inclusion criteria were randomly assigned into two study arms. The predictor variable was the type of wound therapy (VAC therapy compared with CBD) and the outcome variables were (1) the size of the wound area, (2) wrist movement and (3) grip strength. Outcome variables were assessed 12 days, three weeks and eight weeks after surgery., Results: Fifty patients (33 males, mean age 61.7 years [SD 15.5]; 17 females, mean age 54.7 years [SD 10.5]) were included consecutively in the study. Patients in the VAC group experienced a faster postsurgical reduction of wound area and had better wrist movement; nonetheless, the differences between the VAC group and CBD group did not reach statistical significance. In contrast, the recovery of postsurgical grip strength was significantly faster in the VAC group., Conclusions: Our study failed to prove that VAC therapy is significantly superior to CBD for all the variable studied. Because VAC therapy has some positive effects, however, we recommend further development of this negative-pressure wound treatment, rather than the termination of its use., (Copyright © 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: For treatment of lagophthalmos, metallic weight implants can be inserted in the upper eyelid to aid eyelid closure. Rigid and flexible implants are available. The objective of this study was to investigate the effect of implant type and patient variables on the survival of lid load implants., Materials and Methods: Forty-four patients with lagophthalmos were recruited to undergo upper-eyelid weight implantation. The predictor variable was type of implant inserted (rigid or flexible). The outcome variable was survival of the inserted implant (survival or extrusion). Other study variables were demographic data (age, gender), implant features (material, weight), and other conditions, such as history of radiation. An NMLE test was used to compare implant survival, depending on implant type (flexible versus rigid). Other variables were analysed by use of a χ 2 test., Results: Forty-four participants were recruited, 29 female (65.9%) and 15 male (34.1%). Forty-six implants (23 rigid implants, 50.0%; 23 flexible implants, 50.0%) were inserted (bilateral implantation in two patients). The average weight of implants used was 1.76 g (range 1.4-2.2 g). One to two years after surgery, average vertical aperture (eyelid gap) for the closed eye was 0.65 mm (range 0-4 mm). Incidence of extrusion was 15.2% (one in the rigid implant group, 2.2%; six in the flexible implant group, 13.0%). Incidence of extrusion was significantly higher for flexible implants than for rigid implants (p = 0.0273)., Conclusions: The study results suggest that flexible implants are more likely to perforate the skin. The assumed advantages of the expensive chain lid weight must, therefore, be re-evaluated., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of the study was to analyze the eligibility of resorbable collagen membrane in the treatment of midfacial fractures to prevent gap formation and subsequent cheek tissue retraction., Material and Methods: We included nine patients (six males, three females; mean age 51; range 20-73 years; mean bone gap size 8.03 × 13.12 mm) in a retrospective study design. The defect size was assessed by ultrasound., Results: After a healing period of 4 to 55 weeks, treatment resulted in a significant reduction of gap size (residual mean bone gap size 6.14 × 7.32 mm)., Conclusions: Native resorbable collagen membrane is a promising tool to reduce the size of bony gap in midfacial defects.

Introduction: Excessive exposure of maxillary teeth when smiling can have a negative effect on the aesthetics and attractiveness of the face. The presented study was aimed to evaluate the effect of different amounts of gingival exposure on the perception of such human characteristics and qualities as age, attractiveness, gender specificity, and felt sympathy in the context of the whole face., Materials and Methods: Forty-two participants (21 female and 21 male students of Dental Medicine) were recruited as evaluators for the study. Two average-looking subjects (one female, one male) were photographed. The images were processed to create a series of eight clones with different gingival exposure (shift A-H; A = full over-exposure, H = invisibility of the crown surfaces of the teeth). The panellists evaluated characteristics as attractiveness, gender specificity, age, and felt sympathy., Results: 42 participants joined the study (21 female, 21 male). Shift H was assessed as worst for sympathy and attractiveness, and resulted in the highest estimated age. Best attractiveness was observed for shifts C and D. Gender dimorphism was noticed, with own gender being rated as less attractive and opposite gender as more attractive., Conclusions: Female and male evaluators assess excessive gingival and maxillary incisor display differently for female and male probands. Excessive over- or underexposure of the maxillary gingiva and teeth when smiling is perceived as unattractive and results in less observer sympathy., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Sinonasal inverted papilloma is a locally aggressive tumor arising from the Schneiderian membrane which lines the nasal cavity and paranasal sinuses. Aggressive surgical approaches, such as lateral rhinotomy, were used until recently for complete removal of the inverted papilloma. Currently, endoscopic resection is the gold standard in the treatment of inverted papilloma. However, there are situations that justify an open approach. For example there are studies that report a higher postoperative recurrence rate after endonasal endoscopic resection, particularly in the treatment of recurrent diseases. While endoscopic resection performed by an experienced surgeon is definitely a minimally invasive therapy, an open approach is not necessarily associated with functional and aesthetic disadvantages. This case report describes the treatment of inverted papilloma by an open approach. This has been described before but the new gold standard of endoscopic resection has to be taken into account before any treatment decision is made nowadays., Case Presentation: Contrast-enhanced magnetic resonance imaging of the head and neck area was indicated in a 72-year-old white German man who presented with suspected squamous cell carcinoma of his lower lip. Magnetic resonance imaging additionally revealed a 3×2 cm 2 polycyclic arranged mucosal thickening with cystic and solid contrast affine shares at the antral laterocaudal area of his right maxillary sinus, extending from his right lateral nasal wall to his maxillary sinus floor. He received antral polypectomy with medial maxillectomy via a unilateral LeFort I osteotomy approach. His pterygoid plate was preserved. A histological examination demonstrated a tumor composed of hyperplastic squamous epithelium protruding into the stroma (surface epithelial cells grew downward into the underlying supportive tissue), thus producing a grossly convoluted cerebriform appearance. Two weeks later, the patient regained a well-formed maxilla without any restrictions. He has remained disease-free for 25 months following the surgery and surveillance was continued in our tumor clinic., Conclusions: Endoscopic resection of an inverted papilloma continues to be the gold standard. However, some cases require a radical approach. This does not necessarily increase patient morbidity.

Objective: The purpose of this study was to compare professional rating and patient satisfaction of nasal appearance after secondary cleft rhinoplasty., Method: We used a cross-sectional study design and enrolled German adults with nonsyndromic unilateral or bilateral cleft lip and/or palate (UCLP and BCLP, respectively) undergoing secondary cleft rhinoplasty from January 2001 to December 2013. The predictor variable was professional rating. The outcome variable was patient satisfaction with postoperative nasal aesthetics. Other study variables included patient age and gender, type of surgery, and patient rating of nasal function. Appropriate descriptive and univariate statistics were computed, and a P value of <0.05 was regarded as statistically significant. Inter-rater reliability was assessed by the use of Cohen's kappa coefficient., Results: The study sample consisted of 242 adult cleft patients of mean age of 22.1 ± 9.2 years (range 14-64), including 97 females (40 %) and 176 unilateral clefts (73 %). Most of the patients reported good function (82 %) and good aesthetics (74 %). The main professional rating was good aesthetics (65 %). Analysis of inter-observer reliability revealed significant differences between patient satisfaction and professional assessment (κ = 0.385; P < 0.0001)., Conclusions: Although most of the patients were satisfied with the functional and aesthetic results of secondary cleft rhinoplasty, patient self-assessment of nasal appearance differed from professional assessment.

Objective: The main purpose of this study was to analyse the reactions of a panel (non-cleft adults) when observing cleft lip morphology. Although rehabilitation of cleft lip and palate is improving, there are still indications of social rejection of cleft patients by the people around them. Polarity profiles have been used since 1973 to measure social distance with regard to cleft patients. Because rehabilitation results and education of the society have improved in recent decades, we investigated whether social distance has been affected., Setting: The setting of this study is the Department of Oral, Craniomaxillofacial, and Facial Plastic Surgery, University Hospital of Leipzig, Germany, Patients and Participants: Using a cross-sectional study design, we enrolled a sample of adult laypersons (n = 273). For the survey, we followed the concept of photograph presentation and questionnaire investigation reported by Sergl and Schmid (1973). We presented anonymised frontal and profile pictures of the faces of 50 cleft patients and asked the laypersons to specify social distance. Three predictor variables (layperson gender, profession and year of evaluation) were grouped., Results: Although social distance has reduced during the last 40 years, life situations which require emotional proximity still cause some concern. Professional background and gender affect laypersons' attitudes., Conclusion: Although rehabilitation of cleft lip and palate is much better than 40 years ago, social distance remains a problem in society. It is necessary to improve both results of rehabilitation of cleft patients and social acceptance by the people around them.

Purpose: The aim of this study was to compare the frequencies of lower eyelid complications after subciliary versus transconjunctival approaches to orbital floor fractures., Materials and Methods: The investigators implemented a retrospective cohort study and enrolled a sample composed of subjects who had orbital floor repair. The predictor variable was surgical approach, classified as subciliary or transconjunctival. The primary outcome variable was postoperative lower eyelid complications (ectropion, entropion, and eyelid retraction). Other variables were demographic, anatomic, or time to surgery. Descriptive and bivariate statistics were computed. Statistical significance was set at P ≤ 0.05., Results: The study samples were composed of 346 patients (98 [28.3%] females; 225 [65%] underwent a subciliary approach) with a mean age of 42.7 ± 21.1 years. The subciliary approach was significantly linked to the higher rates of ectropion and the lower rates of entropion at 7 days and 6 months postoperatively. There was no statistically significant difference in the frequency of eyelid retraction between both groups., Conclusions: In the setting of orbital floor fractures, these results suggest that the use of the subciliary approach increases the frequency of ectropion, while the transconjunctival approach increases the frequency of entropion. The authors decline to comment on what the better surgical approach to the orbital floor fractures is. The selection should be based on an individual patient basis and surgeon's preference.

Purpose: The purpose of this study was to identify risk factors associated with postrhinoplasty mucous cyst (PMC) among adult cleft patients undergoing rhinoplasty. PMC has been reported sporadically in the literature. Its aetiology is uncertain. The purpose of this study was to determine whether three factors, (1) patient age, (2) surgical trauma, and/or (3) use of a nasal septal cartilage graft (NSCG), were risk factors for PMC., Methods: We organized a retrospective, single-center study and enrolled cleft rhinoplasty patients treated between January 2003 and December 2008. The predictor variables included age at surgery, use of a NSCG, and length of surgery. The primary outcome was presence of PMC. Other study variables included demographic, surgical, and postoperative data. Appropriate descriptive and univariate statistics were calculated, and P < 0.05 was regarded as indicative of statistical significance., Results: The sample comprised 314 cleft rhinoplasty patients (118 females; 37.6 %) with a mean age of 14.9 ± 10.7 years (range 0-65). Three patients had a PMC after secondary cleft rhinoplasty. Average time to disease was 26 ± 19.3 months after surgery (range 12-48). There was no significant association between the presence of the PMC and the three predictor variables-patient's age, NSCG transplantation, and protracted surgery (P > 0.05)., Conclusions: These study findings suggest that young age, use of a NSCG, and protracted surgery are not risk factors for PMC. The prevalence of PMC is greater for cleft patients after rhinosurgery than for noncleft patients.

Tutankhamun was a Pharaoh of the 18th Dynasty (New Kingdom) in ancient Egypt. Medical and radiological investigations of his skull revealed details about the jaw and teeth status of the mummy. Regarding the jaw relation, a maxillary prognathism, a mandibular retrognathism and micrognathism have been discussed previously. A cephalometric analysis was performed using a lateral skull X-ray and a review of the literature regarding King Tutankhamun´s mummy. The results imply diagnosis of mandibular retrognathism. Furthermore, third molar retention and an incomplete, single cleft palate are present.

Purpose: To identify factors associated with scientific productivity (SP) of German oral-maxillofacial surgery (OMFS) training centers., Materials and Methods: This retrospective cohort study was composed of a set of data from German OMFS training centers. A total of eight predictor variables were grouped into demographic, structural, and personal categories. The outcome variables were average publications in 2013 per senior staff, and percentage of OMFS trainees with >1 publications. Descriptive and univariate statistics were computed using P < 0.05., Results: The sample included outputs from 62 OMFS departments (34 [54.8 %] university-based; 46 [74.2 %] in large cities). Average publications were 2.4 ± 3 per senior staff (range, 0-27), and 160 trainees (31.7 %) published >1 papers. The number of publications and productive trainees was not linked to department name and number of female senior staffs, but publication count was significantly increased when the hospital was in a metropolis (P = 0.018) or university-based (P < 0.0001), the OMFS' chairperson and >3 staffs within the department had a postdoctoral degree (German "Habilitation") (P = 0.013 and <0.0001), and the chairperson had h-index >10 or the first/last authorship in 2013 (P < 0.0001). Female senior surgeons were less scientifically productive than the male ones (P = 0.01)., Conclusion: SP of German OMFS training centers is greatly different across the country and influenced by city size, university base, educational backgrounds, and research activities of chairpersons and senior staffs. This helps students, trainees, and young surgeons to reach the career choice that is personally appropriate. The involved organizations may need to encourage research output of less productive surgeons/centers. Increasing postdoctoral-qualified staffs will increase SP of the department.

Objective: Primary cleft lip closure can be achieved by use of different types of surgery. The procedures of Millard, Veau, and Delaire are among the techniques most frequently performed worldwide. The factors which affect development of the columella have not been studied, however., Setting: University Hospital of Leipzig, Germany, Department of Oral, Craniomaxillofacial and Facial Plastic Surgery., Patients, Participants: In a comparative, retrospective, non-randomised study, we obtained anthropometric details from photographs of 120 unilateral and bilateral cleft patients after cleft lip closure by use of the techniques of Millard or Veau (n = 60) and Delaire (n = 60). Length and shape of the columella was assessed twice-first at the age of 10 months and again at the age of 10 years. Anthropometric characteristics of columella morphology and development were compared between the two groups., Results: At the age of 10 months, the ratio of nasal height to width (interalar distance) was significantly different for unilateral and bilateral cases, and results were better for the Delaire groups (p = 0.001 unilateral and p > 0.001 bilateral). This effect was no longer apparent at 10-year follow up. Another index which tended to indicate better results in the Delaire groups was the nasal width index. In the summary of the anthropometric values investigated, however, differences between the Millard or Veau group and the Delaire group were marginal., Conclusion: Cleft lip closure by the technique of Millard for unilateral cleft lips and of Veau for bilateral cases is neither better nor worse than Delaire cheiloplasty for unilateral and bilateral clefts.

Objective: Perception of the facial appearance of cleft patients has, until now, been evaluated on the basis of photographs of the patients. Research based on photographs generated by use of a morphing technique has not yet been reported. The purpose of this study was to investigate female and male raters' panel perception with regard to the following: (1) patient age, (2) attractiveness, (3) gender appearance, and (4) likeability of faces of cleft patients generated by the use of a morphing technique., Setting: The study was conducted at the Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Germany., Patients, Participants: We used photographs of 32 adult German nonsyndromic cleft patients, mean age 18.9 ± 1.3 years, and surveyed 93 students, mean age 25.3 ± 3.2 years, by use of a standardized questionnaire., Results: All respondents rated the mean age of cleft patients equally in unmorphed and morphed pictures. For all respondents, attractiveness of morphed patient pictures was rated significantly higher than for unmorphed pictures (mean 4.8 ± 1.0 vs. 6.4 ± 2.4; p < 0.001), although significance was reached only if morphed pictures of eight patients were rated. Female respondents rated attractiveness significantly higher than did males, especially for pictures of female patients., Conclusion: Facial morphing of patient pictures is a suitable method for creation of standard cleft faces. Despite the modification of the pictures, the faces generated remain human and assessable by panel members. Perception of faces of cleft patients' depended on raters' gender.

Paget´s disease of bone is a common, progressive disorder with uncertain etiology. It results in the replacement of normal skeletal areas with highly vascularized, low density bone. The most frequent symptom is bone pain, which is a result of periostal irritation due to increased metabolic activity. However, the disease may run without any symptoms. In these cases, an abnormal radiograph or an elevated serum alkaline phosphatase can indicate the disorder. Most cases are discovered accidentally. The average age of patients at the time of diagnosis is about 50 years. Male individuals are preferentially diseased. Paget´s disease affects either single bone (monostotic) or many bones (polyostotic). It typically involves the pelvis, femur and lumbar spine rather than skull and tibia. In the head and neck area, the skull is the most frequently affected localization. Lesions of the mandible and maxilla are less common. For the therapy of active Paget´s disease, antiresorptive agents like bisphosphonates are effective drugs. Additional treatment with analgesic drugs, antiinflammatory and antineuropathic agents is recommended. We present a case of polyostotic Paget´s disease of the mandible and of the thoracic skeleton.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The standard Caldwell-Luc procedure includes the removal of most of the maxillary sinus mucosa and the introduction of an inferior meatal antrostomy to promote sinus drainage. Pain, chronic relapsing inflammation and loss of volume are typical sequels of this procedure. Partial maxillary resection and iliac crest bone graft harvesting is a new concept and treatment option in such cases. The case of a 64-year-old woman who had previously undergone several unilateral sinus operations is presented. Fluorescein imaging was used to detect bone areas of low blood perfusion in the sinus walls. All affected bone and granulation tissue were removed. After resection, an iliac crest bone graft with vascular pedicle was performed to reconstruct the maxillary defect. Postoperative CT and scintigraphic imaging revealed a vital transplant. At the 10-month follow-up, no inflammation was observed and chronic pain was significantly reduced. The results clearly demonstrate that maxillary resection and iliac crest bone graft harvesting might be an option to treat severe cases of chronic sinusitis. Further prospective studies are necessary to confirm the advantages of this technique.

Introduction: Columellar cartilage graft helps improve esthetic results in secondary cleft rhinoplasty for patients presenting with cleft lips. However, inadequate skin coverage of the cartilaginous graft can result in columellar necrosis and graft loss. Moreover, the scar after Millard's primary cheiloplasty may not be esthetic. The aim of this article was to present the columellar flap technique to cover the columellar graft and to improve the scar after unilateral Millard's cheiloplasty., Technical Note: The triangular flap is drawn on the edge of Millard's cheiloplasty scar. It is then moved in a V-Y fashion so as to cover the cartilaginous graft and improve the esthetic aspect of the new columella., Discussion: Four hundred and twelve teenage/adult rhinoplasties were performed in our department over 10 years (October 2001 to October 2011). This flap was used in 10 patients who were followed-up for at least 1 year. There were no severe postoperative complications. Millard's unilateral cheiloplasty scar was less visible. A prospective study is ongoing., (Copyright © 2013. Published by Elsevier Masson SAS.)

Backgrounds: Microvessel density (MVD) can be used for determining neoplastic neovascularisation. Tumour angiogenesis correlates with prognosis of cancers in many organs. The aims of this study were to evaluate MVD as demonstrated by CD31 and CD105 in salivary gland tumours (SGTs), and to correlate the MVD results with clinicopathological characteristics of the tumours., Materials and Methods: Using a retrospective cohort study design, we enrolled SGTs patients at the Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand, over the 22-year period. The predictor variables included demographic, anatomic and histopathological parameters. The outcome measure was average CD31-MVD and CD105-MVD counted by the "hot spot" method. Descriptive, uni- and bivariate statistics were computed, and P <0.05 was considered statistically significant., Results: The study sample consisted of 43 subjects with a mean age of 39.6 ± 17.8 years (range, 9-82), including 26 females (60.5%), diagnosed with SGTs. In this cohort, 58.1% of the cases were benign, and 83.7% were minor SGTs. There was a significant correlation between CD31-MVD and CD105-MVD (r = 0.8, P < 0.001), but mean CD31-MVD and CD105-MVD were 17.7 ± 9.3 and 12.8 ± 7.4, respectively (P = 0.009). Age, gender and tumour site were not individually associated with significant differences between CD31-MVD and CD105-MVD. Tumours with myoepithelial cells had lower MVD than those without myoepithelial cells (P = 0.04 for CD31; P = 0.03 for CD105). Only CD105-MVD showed statistical difference between benign and malignant SGTs (P = 0.01)., Conclusions: These results suggest that MVD in SGTs can be demonstrated by CD31 and CD105. Despite a strong correlation, CD31-MVD is always higher than CD105-MVD and cannot differentiate between benign and malignant SGTs. The presence of myoepithelial cells within SGTs affects the MVD analysis using either CD31 or CD105, while age, gender and tumour location do not., (Copyright © 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Fibular free flap is considered as an "old dog" in reconstructive surgery because it was first described by Taylor and his colleagues in 1975, and was then introduced for mandibular reconstruction by Hidalgo in 1989. There are some "tricks" for fibular free flap that have been used and recognized in many European maxillofacial surgical units over the past decade. These include: 1) harvesting the distal fibula when recipient vessels are distant; 2) flap selection based on the anatomy of perforators; 3) use of the skin paddle for postoperative flap monitoring; 4) protection of the flap's soft-tissue cuff; 5) preventing venous thrombosis which is essential to reduce flap complications; 6) aligning fibular struts and protecting the vascular pedicle when the double-barrel technique is used; 7) minimizing the gap between the double-barrel struts and implementing a long-term follow-up of dental implants; 8) selecting osteosynthesis materials; and 9) learning curve and clinical competence in microvascular reconstruction. We also reviewed current data from the literature, which would be useful for maxillofacial reconstructive surgeons. With these tricks, one can teach an "old dog" "old tricks"., (Copyright © 2012. Published by Elsevier Masson SAS.)

Background: German animal terms have been used to name oral cleft deformity for centuries. However, their contemporary use and influence on cleft patients remain unstudied., Objective: The main aim of this study was to evaluate the current use of German animal terms for oral cleft and their influence on the perception of cleft patients., Methods: We used a cross-sectional study design and the study sample consisted of German adult cleft and noncleft subjects in Leipzig, Germany. The study was conducted during May and December 2008, using two questionnaires and two cleft photographs (one unilateral and one bilateral). The predictor variables were medical background and presence of oral cleft. The primary outcome variable was the terminology used for the deformity by noncleft subjects. The secondary outcome variables were self-perception of the cleft patients and their idea about the use of the animal terms. Other study variables included age, gender and specialty/future career of the noncleft participants. Appropriate descriptive, uni- and bivariate statistics were computed, and a P-value of <0.05 was considered to be statistically significant., Results: The study sample was composed of 261 noncleft (146 females [55.9%]) and 71 cleft subjects (33 females [46.5%]) with a mean age of 24.2 ± 6.4 and 24.9 ± 7.2 years, respectively. Noncleft subjects without medical background who used animal terms to name oral cleft deformity were more than those with medical background (P<0.0001). Over half of cleft patients (60.6%) rejected public use of the animal terms, which was still common in their daily life (P<0.0001)., Conclusions: The study results suggest that animal terms have been used until now, especially by those without medical background. The cleft patients become insulted by these negative descriptions. This strikes the importance of public education to replace these animal terms with inoffensive words., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Aim: To compare test scores in English-error detection between Thai high school students undergoing self-learning by an online tool (computer-assisted learning: CAL) with versus without tuition/lecture., Methods: This prospective, randomized, controlled study enrolled a sample of grade-12 high school students from a Thai secondary school. The predictor variable was the use of error-detection exercises in 9 separate 50-min tuition sessions during a 3-week period. Each subject was randomly assigned to receive a CAL program with or without tuition/lecture during the study interval: June-September 2009. The main outcome variable was the test scores of English-error identification. To measure the outcomes, the students were evaluated twice using the 25-question test within a 1-month interval (pre-test/post-test). Appropriate sample size estimates, descriptive, uni-, and bivariate statistics were calculated, and the level of statistical significance was set at P < 0.05., Results: The sample included 69 students, 36 of whom (52.2%) were in the intervention group (CAL plus teaching). Within-group comparisons showed statistically significant improvements in post-test scores, regardless of learning methods (P < 0.05). Tuition/lecture was significantly associated with the improved post-test scores (P = 0.0012) and with a higher number of students showing improved post-test scores (P = 0.0007)., Conclusions: The results of this study suggest that tuition/lecture facilitates self-learning with CAL. In this sample, tuition/lecture still seems to be necessary for nonnative-English-speaking high school students to improve their English proficiency. CAL alone should not be used to replace conventional teaching.