Surgical Decision Making in Complex Facial Gunshot Wound Reconstruction

Introduction: With a rise in gun violence across the United States, facial gunshot wounds (GSWs) present a challenging reconstructive problem that was once seldom encountered in civilian populations. Reconstruction of facial GSW injuries requires a combination of both microvascular and craniofacial surgical techniques. The aim of this study is to explore our experience with facial GSW injuries through an anatomic classification scheme and investigate the surgical techniques necessary to complete such reconstructions. Methods: A retrospective review was conducted at a tertiary academic center. All subjects who suffered facial GSWs and underwent definitive reconstruction at our institution were included. Facial GSWs were classified into 4 distinct anatomical zones of injury: lower (mandible), middle (maxilla and orbit), upper (above the orbit), and multi-zone injury. Microvascular reconstruction was further investigated based on the types of flaps used and the location of flap inset. Surgical outcomes, numbers of procedures, and complications were assessed, and statistical comparisons were made. Results: Thirty-six subjects underwent a total of 322 surgeries. Twenty subjects had multi-zone injury; 16 had single zone injury. Eighteen of the 36 subjects (50%) required microvascular reconstruction. These 18 subjects underwent a significantly increased number of reconstructive procedures ( P = .023). Twenty-six flaps were used, as multiple subjects required >1 flap. Fourteen of the 26 flaps were used in the middle third (54%), 7 in the lower third (27%), and 5 in the upper third (19%). Six flap complications required further surgical revision. On average, multi-zone injuries required more surgical procedures to complete reconstruction ( P = .018). Conclusion: Composite multi-zone facial GSW injuries present a higher degree of reconstructive complexity, and thus often require more surgical procedures, especially when the midface is involved. In our experience, microvascular reconstruction is more often used in multizone injury, and in our series was associated with an increased number of reconstructive procedures.

Mandibulofacial Dysostosis Attributed to a Recessive Mutation of CYP26C1 in Hereford Cattle

In spring 2020, six Hereford calves presented with congenital facial deformities attributed to a condition we termed mandibulofacial dysostosis (MD). Affected calves shared hallmark features of a variably shortened and/or asymmetric lower mandible and bilateral skin tags present 2–10 cm caudal to the commissure of the lips. Pedigree analysis revealed a single common ancestor shared by the sire and dam of each affected calf. Whole-genome sequencing (WGS) of 20 animals led to the discovery of a variant (Chr26 g. 14404993T>C) in Exon 3 of CYP26C1 associated with MD. This missense mutation (p.L188P), is located in an α helix of the protein, which the identified amino acid substitution is predicted to break. The implication of this mutation was further validated through genotyping 2 additional affected calves, 760 other Herefords, and by evaluation of available WGS data from over 2500 other individuals. Only the affected individuals were homozygous for the variant and all heterozygotes had at least one pedigree tie to the suspect founder. CYP26C1 plays a vital role in tissue-specific regulation of retinoic acid (RA) during embryonic development. Dysregulation of RA can result in teratogenesis by altering the endothelin-1 signaling pathway affecting the expression of Dlx genes, critical to mandibulofacial development. We postulate that this recessive missense mutation in CYP26C1 impacts the catalytic activity of the encoded enzyme, leading to excess RA resulting in the observed MD phenotype.

Genial tubercle position and genioglossus advancement in obstructive sleep apnea (OSA) treatment: a systematic review

Background To systematically review the literature for methods to localize the genial tubercle as a means for performing an advancement of the genioglossus muscle. Methods PubMed, Google Scholar, CRISP, EMBASE, CINAHL, and Scopus were searched from inception through June 16, 2015. Results One hundred fifty-two articles were screened, and the full text versions of 12 articles were reviewed in their entirety and 7 publications reporting their methodology for localizing the genial tubercle. Based upon these measurements and the results published from radiographic imaging and cadaveric dissections of all the papers included in this study, we identified the genial tubercle as being positioned within the mandible at a point 10 mm from the incisor apex and 10 mm from the lower mandibular border. Conclusion Based upon the results of this review, the genial tubercles were positioned within the mandible at a point 10 mm from the incisor apex and 10 mm from the lower mandible border. It may serve as an additional reference for localizing the genial tubercle and the attachment of the genioglossus muscle to the mandible, although the preoperative radiological evaluation and the palpation of the GT are recommended to accurately isolate.

Study on the correlation parameters of Class II malocclusion in child tooth dentition early stage by using 3D technique

Objective: To record the dentition, jaw and facial growth and development of children with class II malocclusion at the age of 7-8 years old in the early dental transitional stage with 3D technology and to provide the study basis for the growth and development parameters of normal children and children with class II malocclusion. Methods: Twenty-four children who were suffering class-II malocclusion in the early dental transitional stage and received treatment between July 2016 and July 2017 in our hospital were selected as the study group, and 20 healthy children were selected as the control group in the same period. SIRONA CEREC dentition scanning, 3D reconstruction of the lower mandible and 3d MD face scanning were performed on the children. Relevant data were recorded and compared. Results: The dentition scanning results suggested that the study group had significantly larger anterior overbite and anterior overjet and smaller width of the upper arch than the control group; there was a significant difference between the two groups (P<0.05). The 3D reconstruction of the lower mandible suggested that the study group had smaller Go angle and SNB angle and shorter ANS-Me distance, Go-Me distance and N-Me distance compared to the control group; the differences had statistical significance (P<0.05). The face scanning results demonstrated that the nasolabial angle and facial convexity angle of the study group were significantly larger than those in the control group, and the difference was statistically significant (P<0.05). Conclusion: The dentition scanning results suggested that the study group had significantly larger anterior overbite and anterior overjet and smaller width of the upper arch than the control group; there was a significant difference between the two groups (P<0.05). The 3D reconstruction of the lower mandible suggested that the study group had smaller Go angle and SNB angle and shorter ANS-Me distance, Go-Me distance and N-Me distance compared to the control group; the differences had statistical significance (P<0.05). The face scanning results demonstrated that the nasolabial angle and facial convexity angle of the study group were significantly larger than those in the control group, and the difference was statistically significant (P<0.05). doi: https://doi.org/10.12669/pjms.35.5.592 How to cite this:Xiong P, Sui W, He W, Lei Q, Gao W. Study on the correlation parameters of Class II malocclusion in child tooth dentition early stage by using 3D technique. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.592 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Two overlooked generic synonyms in the Thraupidae (Aves: Passeriformes)

In a revision of the generic classification of the tanagers, Burns et al. (2016) proposed the name Islerothraupis with type species Tanagra cristata Linnaeus, 1766 (long known as Tachyphonus cristatus); however, they overlooked a previous designation of that species as the type of a genus. In 1821, Feliks Pawel Jarocki, in the second volume of Zoologiia czyli Zwiérzętopismo Ogólne podług Naynowszego Systematu ułożone (“Zoology, or general natural history account according to the newest arranged system”), page 133, specified Tanagra cristata as the type of a proposed subgenus Loriotus. The original text in Polish is available at the website www.rcin.org.pl, the Digital Repository of Scientific Institutes, which has made a wide diversity of scholarship in Polish available over the Internet. The original description of Loriotus, in parallel with other names Jarocki introduced in his Zoologiia, is minimal: “Dziób ostro kończysty, cokolwiek zgięty. Żuchwy sczęki spodniey przy nasadzie bardzo mało zgrubiałe.” (Bill ending in a point, somewhat curved. Lower mandible slightly thickened at base.)

Cutaneous trematode Collyriclum faba in wild birds in Costa Rica

An adult Collyriclum faba was found in a cutaneous cyst at the base of the lower mandible in a blue-gray tanager (Thraupis episcopus, Thraupidae) examined in the Zona Protectora Las Tablas, Costa Rica on 18 August 2010. A total of 1878 birds belonging to 217 species were examined in the country during 2004, 2009, and 2010. C. faba was found for the first time in blue-gray tanager and for the first time in Costa Rica as well.

No Support for a Genetic Basis of Mandible Crossing Direction in Crossbills (Loxia SPP)

Unusual among birds, the bill tips in crossbills (Loxia spp.) overlap in the vertical plane, with the tip of the lower mandible to either the left or right of the tip of the upper mandible when viewed from above. Patterns observed in wild populations and experimental foraging data suggest that a 1:1 ratio of left- to right-crossing individuals is maintained by frequency-dependent natural selection in some populations, and that genetic drift causes deviation from a 1:1 ratio in other populations. Both processes require a genetic basis for this remarkable polymorphism, yet few data are available that address whether, and how, mandible crossing direction is heritable. To test for a genetic basis of this trait (single or quantitative, autosomal or sex-linked), we analyzed resemblance in mandible crossing direction between related captive-bred individuals of several crossbill taxa with standard statistical techniques as well as modern animal model methodology. Surprisingly, we did not find statistically significant support for a genetic basis of mandible crossing direction. Comparisons of the ratio of left- to right-crossing males and females in wild populations also did not support a sex-linked quantitative genetic basis. We conclude that mandible crossing direction may have uncharacteristically low heritability, but we cannot rule out that it is nongenetically determined.La Dirección de Cruzamiento de la Mandíbula en las Especies de Loxia no Presenta Base Genética