Background: Arthrogryposis multiplex congenita is a rare condition that mainly involves the lower limbs, characterized by severe joint deformity and contracture, muscular atrophy, and functional impairment. Its clinical manifestations are heterogenous and may involve the maxillofacial district as well.Case presentation This case report describes a 20-year-old patient with arthrogryposis multiplex congenita with skeletal crossbite, facial asymmetry, reduced mouth opening and absence of lateral mandibular movement on the left side. After clinical evaluation, the following exams were required: postero-anterior cephalometric tracing, head and neck electromyography, computerized axiography, computed tomography scan, and maxillofacial magnetic resonance imaging. Orthognathodontic evaluation indicated skeletal asymmetry, reduced condylar movements on the left side and abnormally low electromyography activity of the masticatory muscles on the left side. Computed tomography and magnetic resonance imaging revealed unilateral left mandibular hypoplasia, hypotrophy, and fatty infiltration of masticatory muscles on the left side, as well as immobility of the left condyle during mouth opening, and hypoplasia of the left articular disk, which was however not displaced. Surgery was not indicated and conservative orthognathodontic treatment with function generating bite was suggested to balance the occlusal plane, as well as stretching exercises. Conclusions A rare case of arthrogryposis multiplex congenita with maxillofacial involvement illustrates that a patient-centred, multidisciplinary approach with accurate diagnosis is required to formulate the best treatment plan.Because of the considerable damage to the masticatory muscles, conservative orthognathodontic therapy may be the best treatment option.

Background: What we think we see consists of models constructed in our brains, which may be constrained, limited and perhaps modified at a cerebral level. Patients may view their mirror image differently to how others and the clini‑ cal team view them. Understanding potential variations in perception between real and mirror images is important in clinical practice. The aims were to assess differences in self-perception between frontal facial and mirrored photo‑ graphs, comparing the results with selfie photographs. Methods: Facial photographs were taken by one investigator under standardized conditions for preclinical and clini‑ cal students. Each student took a selfie photograph at rest and smiling using his/her smartphone. A mirror image was generated for each image. Each student was shown his/her original and mirror image, without being informed which was which. For each pair of images, students were asked to choose which photograph they perceived as more attractive. A set of photographs of a male volunteer was shown to all participants, to choose either the original or mir‑ ror image as the more attractive. Results: Most observers preferred the true image of the volunteer (P < 0.05), which may be evidence that most people prefer the true image of others, which is how they normally view them. Most observers preferred their own original photograph in frontal view at rest and smiling (P< 0.05), but preferred the mirror image of their selfie photo‑ graph at rest and smiling (P < 0.05). Conclusions Significant differences in perceptions of attractiveness between true and mirror-reversed frontal and selfie images were found. Observers preferred their image the way they view themselves in a mirror. The selfie is how other people view an individual. If a selfie is flipped horizontally, that is how an individual sees themselves in a mirror. Most observers preferred the mirror image of their selfie, which is how they would view themselves in a mirror.

Background: Gorlin syndrome, also known as Gorlin-Goltz syndrome (GGS) or basal cell nevus syndrome (BCNS) or nevoid basal cell carcinoma syndrome (NBCCS), is an autosomal dominant familial cancer syndrome. It is characterized by the presence of numerous basal cell carcinomas (BCCs), along with skeletal, ophthalmic, and neurological abnormalities. It is essential to anticipate the diagnosis by identifying the pathology through the available diagnostic tests, clinical signs, and radiological manifestations, setting up an adequate treatment plan.Main bodyIn the first part, we searched recent databases including MEDLINE (PubMed), Embase, and the Cochrane Library by analyzing the etiopathogenesis of the disease, identifying the genetic alterations underlying them. Subsequently, we defined what are, to date, the major and minor clinical diagnostic criteria, the possible genetic tests to be performed, and the pathologies with which to perform differential diagnosis. The radiological investigations were reviewed based on the most recent literature, and in the second part, we performed a review regarding the existing jawbone protocols, treating simple enucleation, enucleation with bone curettage in association or not with topical use of cytotoxic chemicals, and “en bloc” resection followed by possible bone reconstruction, marsupialization, decompression, and cryotherapy. Conclusion To promote the most efficient and accurate management of GGS, this article summarizes the clinical features of the disease, pathogenesis, diagnostic criteria, differential diagnosis, and surgical protocols. To arrive at an early diagnosis of the syndrome, it would be advisable to perform radiographic and clinical examinations from the young age of the patient. The management of the patient with GGS requires a multidisciplinary approach ensuring an adequate quality of life and effective treatment of symptoms.

After tooth extraction, dimensional changes affect the alveolar socket, leading to loss in alveolar bone height and width. Histological modifications also occur, with initial formation of a blood clot that is replaced with granulation tissue and subsequently with a provisional connective tissue matrix. Spontaneous healing ends with socket filling with woven bone, which is gradually replaced with lamellar bone and bone marrow. Adequate alveolar ridge dimensions and bone quality are required to assure optimal stability and osseointegration following dental implant placement. When a tooth is extracted, alveolar ridge preservation (ARP) procedures are an effective method to prevent collapse of the post-extraction socket. Heterologous bone is widely chosen by clinicians for ARP, and anorganic bone xenografts (ABXs) made bioinert by heat treatment represents the most used biomaterial in clinical applications. Collagen-preserving bone xenografts (CBXs) made of porcine or equine bone are fabricated by less invasive chemical or enzymatic treatments to remove xenogenic antigens, and these are also effective in preserving post-extraction sites. Clinical differences between anorganic bone substitutes and collagen-preserving materials are not well documented in the literature but understanding these differences could clarify how processing protocols influence biomaterial behavior in situ. This systematic review of the literature compares the dimensional changes and histological features of ABXs versus CBXs in ridge preservation procedures to promote awareness of different bone xenograft efficacies in stimulating the healing of post-extraction sockets.

Background: Miescher’s cheilitis granulomatosa (MCG) is a rare chronic inflammatory disease and is known as the monosymptomatic clinical form of Melkersson-Rosenthal syndrome (MRS). It is characterised by swelling of one or both lips and more frequently affects the upper lip. Histopathological findings show the presence of numerous inflammatory infiltrates and granuloma formations. Pharmacological treatments and surgery have provided results that are positive yet insufficiently stable in the long term. The clinical case described is of a 68-year-old female patient with a diagnosis of MCG of the upper lip.Case presentationThe patient was diagnosed and treated at the Oral Medicine and Oral Pathology outpatient clinic of Maxillofacial and Odontostomatology Unit, Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico. The patient was recommended localised treatments of photobiomodulation (PBM) using a diode laser with a 635 nm and 980 nm dual-wavelength (λ) approach, a 600-micron fibre, and a handpiece with a 1-cm-diameter lens at 300 mW. Three treatments a week were administered for four weeks for a total of 12 treatment sessions (T1–T12). After that, the patient had a long follow-up period of about 2 years. The therapeutic results were clear from the initial stages of treatment. There was an immediate, gradual, and consistent reduction in labial swelling. A reduction in the size of the lip by about 35% at T10–T12 was observed, returning the size and volume of the upper lip within the normal clinical range. The painful symptoms subsided after the seventh treatment (T7). The histopathological check at 3 months and the follow-up in particular confirmed the disease was in remission with satisfactorily stable treatment results. Moreover, the patient did not use any other treatments on the area from the early laser treatments through to the end of the follow-up period. Conclusions Our experience describes a clinical case of MCG treated with PBM and effectively resolved with a reduction of the lip swelling. The real success of the treatment emerged over time, showing that the tissue healing was stable. In absence of any collateral phenomena, this confirms the effective and documented therapeutic potential of PBM for chronic inflammatory infiltrates.

Background: Miescher’s cheilitis granulomatosa (MCG) is a rare chronic inflammatory disease and is known as the monosymptomatic clinical form of Melkersson-Rosenthal syndrome (MRS). It is characterised by swelling of one or both lips and more frequently affects the upper lip. Histopathological findings show the presence of numerous inflammatory infiltrates and granuloma formations. Pharmacological treatments and surgery have provided results that are positive yet insufficiently stable in the long term. The clinical case described is of a 68-year-old female patient with a diagnosis of MCG of the upper lip.Case presentationThe patient was diagnosed and treated at the Oral Medicine and Oral Pathology outpatient clinic of Maxillofacial and Odontostomatology Unit, Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico. The patient was recommended localised treatments of photobiomodulation (PBM) using a diode laser with a 635 nm and 980 nm dual-wavelength (λ) approach, a 600-micron fibre, and a handpiece with a 1-cm-diameter lens at 300 mW. Three treatments a week were administered for four weeks for a total of 12 treatment sessions (T1–T12). After that, the patient had a long follow-up period of about 2 years. The therapeutic results were clear from the initial stages of treatment. There was an immediate, gradual, and consistent reduction in labial swelling. A reduction in the size of the lip by about 35% at T10–T12 was observed, returning the size and volume of the upper lip within the normal clinical range. The painful symptoms subsided after the seventh treatment (T7). The histopathological check at 3 months and the follow-up in particular confirmed the disease was in remission with satisfactorily stable treatment results. Moreover, the patient did not use any other treatments on the area from the early laser treatments through to the end of the follow-up period. Conclusions Our experience describes a clinical case of MCG treated with PBM and effectively resolved with a reduction of the lip swelling. The real success of the treatment emerged over time, showing that the tissue healing was stable. In absence of any collateral phenomena, this confirms the effective and documented therapeutic potential of PBM for chronic inflammatory infiltrates.

The “surgery-first” approach, defined as a team approach between surgeons and orthodontists for orthognathic surgery without preoperative orthodontic treatment, is aimed at dental decompensation. A brief historical background and indications for the surgery-first approach are reviewed. Considering the complicated mechanism of postoperative orthodontic treatment, the proper selection of patients is a vital component of successful surgery-first approach.
Humans ; Orthodontics ; Orthodontists ; Orthognathic Surgery ; Surgeons

BACKGROUND: To test the hypothesis that in profile smiling view, for ideal aesthetics, a tangent to the labial face of the maxillary central incisor crowns should be approximately parallel to the true vertical line and thereby perpendicular to the true horizontal line. METHODS: An idealized female image was created with computer software and manipulated using the same software to construct an “ideal” female profile image with proportions, and linear and angular soft tissue measurements, based on currently accepted criteria for idealized Caucasian profiles. The maxillary incisor labial face tangent was altered in 5° increments from 70 to 120°, creating a range of images, shown in random order to 70 observers (56 lay people and 14 clinicians), who ranked the images from the most to the least attractive. The main outcome was the preference ranks of image attractiveness given by the observers. RESULTS: The most attractive inclination of a tangent to the labial face of the maxillary incisor crowns in profile view in relation to the true horizontal line was 85°, i.e. 5° retroclined from a perpendicular 90° inclination. The most attractive range appears to be between 80 and 90°. Excessive proclination appeared to be less desirable than retroclination. Beyond 105° most observers recommend treatment. CONCLUSION In natural head position, the ideal inclination of the maxillary incisor crown labial face tangent in profile view will be approximately parallel to the true vertical line and thereby approximately perpendicular to the true horizontal line.

BACKGROUND: In the absence of clear guidelines for facial aesthetic surgery, most surgeons rely on expert intuitive judgement when planning aesthetic and reconstructive surgery. One of the most famous theories regarding “ideal” facial proportions is that of the golden proportion. However, there are conflicting opinions as to whether it can be used to assess facial attractiveness. The aim of this investigation was to assess facial ratios of professional black models and to compare the ratios with the golden proportion. METHODS: Forty photographs of male and female professional black models were collected. Observers were asked to assign a score from 1 to 10 (1 = not very attractive, 10 = very attractive). A total of 287 responses were analysed for grading behaviour according to various demographic factors by two groups of observers. The best graded photographs were compared with the least well-graded photographs to identify any differences in their facial ratios. The models’ facial ratios were calculated and compared with the golden proportion. RESULTS: Differences in grading behaviour were observed amongst the two assessment groups. Only one out of the 12 facial ratios was not significantly different from the golden proportion. CONCLUSIONS: Only one facial ratio was observed to be similar to the golden proportion in professional model facial photographs. No correlation was found between facial ratios in professional black models with the golden proportion. It is proposed that an individualistic treatment for each ratio is a rather better method to guide future practice.
Beauty ; Demography ; Female ; Humans ; Male ; Methods ; Surgeons

BACKGROUND: Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder, characterized by multifocal expression, progressive clinical evolution, and a high rate of malignant transformation. Evidence-based information regarding optimal PVL management is lacking, due to the paucity of data. The present report describes a case of PVL associated with HPV-16 infection and epithelial dysplasia treated by diode laser surgery, and the outcome of disease clinical remission over a 2-year follow-up period. CASE REPORT: A 61-year-old Caucasian male with oral verrucous hyperkeratosis presented for diagnosis. The lesions were localized on the maxillary gingiva and palatal alveolar ridge. Multiple biopsy specimens have been taken by mapping the keratotic lesion area. Microscopic examination was compatible with a diagnosis of PVL with focal mild dysplasia, localized in the right maxillary gingiva. Polymerase chain reaction (PCR) was done for human papillomavirus (HPV) detection which revealed presence of HPV DNA, and the genotype revealed HPV 16 in the sample. The PVL in the right gingival area was treated on an outpatient basis by excision with a diode laser. This approach resulted in good clinical response and decreased morbidity over a 2-year follow-up period. CONCLUSIONS: This case illustrates the benefit of a conservative approach by diode laser treatment than wide surgical excision for management of the PVL lesions associated with mild dysplasia and HPV-16 infection.
Alveolar Process ; Biopsy ; Diagnosis ; DNA ; Follow-Up Studies ; Genotype ; Gingiva ; Human papillomavirus 16 ; Humans ; Lasers, Semiconductor ; Leukoplakia ; Male ; Middle Aged ; Mouth Neoplasms ; Outpatients ; Polymerase Chain Reaction