Free Border Research Articles

Muscularization of the chordae tendinea of the mitral anterior papillary muscle.

The chordae tendineae, described as fibro-collagenous structures, support the leaflets of the atrioventricular valves of the heart in various ways. The chordae tendineae are composed of collagen and elastic fibers. They connect to the ventricular side of the valve leaflets' free border and hinder the leaflets from swinging back into the atrial cavity during systole. Mitral valve chordae tendineae have been classified using a variety of classification systems. To our knowledge, we report a variant chordae tendinea that has yet to be described in the literature. The variant, present only on the mitral anterior papillary muscle, did not show the characteristic appearance of the chorda tendineae. Muscular fibers were observed extending from a larger than usual mitral anterior papillary muscle, inserting into the rough zone of the anterior leaflet. Several tendinous primary and secondary true leaflet chordae emerge from the apical portion of the anterior papillary muscle, inserting into the anterior leaflet's free edge and rough zone. Contraction of this muscular chorda during systole could disrupt the mechanics of valvular closure and result in possible regurgitation across the mitral valve. Additionally, this structure may be subject to rupture during myocardial infarction, leading to valvular dysfunction. The developmental connection between the chordae and papillary muscles could explain the anomalous muscularization of the chordae tendineae observed in this case.

Debonding of Porous Coating: A Late Failure Mode of Uncemented, Partially Threaded Acetabular Components—Retrieval Analysis

Titanium plasma-sprayed (TPS) porous coatings have been used in total hip arthroplasty for decades. They are considered reliable, and very few failure cases have been described so far. This retrieval study described a series of 20 acetabular components—where total or partial debonding occurred during in vivo use and aimed to explain the underlying failure mechanisms. Implants were examined using optical and electron microscopy (SEM), metallographic sections of retrievals were prepared while pathologic samples of periprosthetic tissues were examined for presence of wear debris. Data from metallographic slides indicated that debonding was initiated at free borders of the coating and tended to progress at the interface between the TPS layer and the shell. In some cases, total debonding occurred leading material wear of both the TPS layer and acetabular shell leading to massive release of metallic debris and accelerated polyethylene wear in third body mechanism. SEM examination demonstrated that splats forming the TPS layer exhibited features suggesting a high temperature gradient between the plasma sprayed layer and the substrate material existed, leading to porosity of splats and suboptimal bonding strength. This study demonstrated that coating application parameters and certain design features (screw holes, fins) may promote long-term failure due to debonding. Surgeons should be aware of this complication as it is most likely underreported, while manufacturers should consider more rigorous pre-clinical testing as suboptimal coating bonding may result in failures during long-term clinical use.

Gravity‐Driven Jointing in Layered Rocks: Mechanical Analysis and Numerical Modeling

AbstractThe origin of open‐mode fractures or joints, common in sedimentary basins (reservoirs), remains incompletely understood. These fractures require effective tensile stress for their formation, yet they usually develop at depths where effective compressive stresses dominate. Through 2‐D finite‐difference elastoplastic modeling, we demonstrate that effective tensile stresses and fracturing can be internally generated in stiff competent layers separated by compliant incompetent layers. Two primary factors drive this phenomenon: the layered structure of sedimentary units with varying mechanical properties of the layers and the lithostatic compression of the unit, leading to its gravity‐driven horizontal widening or stretching. This stretching occurs when the average horizontal stress over the unit’s thickness is compressive. Various mechanisms can accommodate the stretching, including preexisting faults or weak zones, free borders like canyons, and horizontal extension of tectonic or gravitational origin. Tensile horizontal effective stresses σxx occur within the competent layers, while the incompetent layers generally remain under effective compression. The magnitude of σxx increases with the lithostatic stress or burial depth, as does the tensile strength σt of incompletely lithified sediments. Jointing occurs within depth intervals where |σxx| > σt. In our modeling approach, effective tensile stresses σxx are generated due to lithostatic compression σv. In the previous numerical modeling studies, these stresses resulted from extension directly applied to the lateral boundaries of the layers and did not depend on σv. We provide an analysis of the distinctions between these two approaches.

Outcomes of Connective Tissue (CT) Graft on Periodontal Health in Relation to Dental Implants Placed in Esthetic Zone of Anterior Maxilla

Background: Since 1998, maxillary anterior single immediate implant insertion and provisionalization (IIPP) has been successful and practical. It preserves natural gingival profiles without extending treatment time or needing a removable interim prosthesis. The gingival profile includes a hard tissue zone with bone and a soft tissue zone without bone, extending from the free gingival border to the bony crest's apex. Objective: The purpose of this study was to examine the effect of connective tissue transplant on the thickness and appearance of soft tissue around single implants in the anterior maxilla's aesthetic zone. Study Design: A Prospective cross-sectional study. Settings: A Prospective cross-sectional study was conducted CMH Dental College Multan. Duration: This study was conducted from January 2021 to April 2022. Methods: A total of 64 individuals were included who had criteria for a single cosmetic implant implantation. Detailed demographic information was recorded for enrolled patients once informed written consent was obtained. Patients were equally divided in two groups. Group I (consisting of 32 patients) underwent implant insertion and connective tissue graft implantation (1.50 mm thick) while group II (consisting of 32 patients) simply had implant insertion. Six-month and twelve-month clinical assessments were conducted. Postoperative pain and discomfort were measured. Results: There were 37 (57.8%) males and 27 (42.2%) females among all cases. Buccal tissue thickness in group I significantly increased from 2.45 ±1.80 mm at baseline to 4.0±1.1 mm after 6 months and 3.9±3.46 mm after 12 months (P <0.05), whereas no change was seen in the implant group. After a year, the buccal deficiencies in Group I were significantly less than those in the implant group (∆ -0.46±1.42 mm and ∆ -1.67 ±2.28 mm,). After 12 months, there was a statistically significant difference in proximal bone resorption between the two groups (0.59±0.37 mm and 1.0±0.19 mm), with group I exhibiting less bone resorption than the implant group. Conclusion: In this research, we observed that a single implant placed in the front maxilla in conjunction with a connective tissue graft may enhance peri-implant mucosa thickness and decrease proximal bone resorption.

Urgensi Penetapan Air Defense Identification Zone Pada Kawasan Regional

Introduction: Air Defense Identification Zone (ADIZ) is a zone for identification purposes in the air defense system for a country, which according to international custom generally extends from the territorial area of a country to reach the air space above the free sea bordering the country.Purposes of the Research: to find out the setting of the Air Defense Identification Zone and what is the urgency of establishing the Air Defense Identification Zone in the regional area. The method used in writing this thesis is a normative research method. The legal materials used are primary, secondary and tertiary legal materials.Methods of the Research: This legal research, the author uses normative research. That is, a study that primarily examines positive legal provisions, legal principles, and legal doctrines to answer legal questions faced. Results of the Research: The results obtained are that the regulation of the Air Defense Identification Zone (ADIZ) according to international law is, based on the provisions of the 1944 Chicago Convention, customary international law and also Article 51 of the United Nations Charter, furthermore with the stipulation of ADIZ in a regional area can be considered a defensive step. to provide advance notice of potential threats and efforts to improve flight safety in the region and provide benefits to national and international aviation safety.

A Weakly Nonlinear Dynamic Problem for a Model of the Thermoelastic Medium Absorbing a Part of the Acoustic Spectrum

We consider a dynamic problem with a short laser impact on a semi-opaque insulated layer with free borders, accounting for the selective absorption of the acoustic spectrum regions by the media. The behavior of the material is modeled by the extended coupled thermoelasticity formulated in the previous work of the series. Following the experimental results, we introduce a weakly nonlinear correction to the thermal expansion coefficient. Thus, we aim to level out the inability of classical thermoelasticity (CTE) to correctly describe the deformation processes in a solid under a high-frequency impact, yet staying within the framework of linear models. The parameters of the system of novel equations can be tuned to fit the experimentally measured data, i.e., the frequency-dependent attenuation coefficient. The series solutions of the extended thermoelasticity problem are compared with those obtained within CTE. In contrast to CTE and in accordance with experiments, the model allows for the simultaneous existence of positive and negative extrema for stress over time.

Sinonasal malignant melanoma

Abstract Sinonasal malignant melanoma is a rare, aggressive tumor, associated with a poor prognosis, accounting for 8-15% of all head and neck melanomas and 0.5-2% of all melanomas. The diagnosis is given by histopathological and immunological examination. Elective treatment consists of surgical excision with free resection borders, and adjuvant chemotherapy / radiotherapy / immunotherapy / checkpoint inhibitors can be used to control local recurrence and distant metastases. We chose to present the case of an unresectable ethmoidal malignant melanoma at the time of diagnosis, pembrolizumab treatment converting it to resectability, with improving patient’s quality of life, even if the patient developed an adrenal metastasis.

A new species of Mindomys (Rodentia, Cricetidae) with remarks on external traits as indicators of arboreality in sigmodontine rodents

The diversity of the oryzomyine rat Mindomys (Cricetidae, Sigmodontinae, Oryzomyini), is doubled here with the description of a new species from the remote Cordillera de Kutukú (Ecuador). The novel form can be easily differentiated from Mindomys hammondi –type species of the genus– by a large set of anatomical traits including, among others, larger jugals, parietal “wings” extending to zygomatic roots, larger otic capsules, well-exposed petrosals, narrow zygomatic plates almost without upper free borders, foramen magnum caudally oriented, larger molars, and accessory root of first upper molar present. Until now, the records of Mindomys were restricted to western Andean foothills. The material from Kutukú highlights an Amazonian species and reinforces the valuable biological significance of isolated mountain ranges in eastern Ecuador. Since Mindomys shows some external traits classically related to arboreal life, here we present a brief reappraisal of this poorly explored topic. A partially neglected anatomical system in sigmodontine studies, the fore feet, encloses crucial information reflecting arboreality.

Ultrastructural comparison between the oral cavity floor of the juvenile and adult Epinephelus aeneus: New vision of aging development and its carnivorous adaptation.

The current work is designed to give the first trial to characterize the ultrastructural lineaments of the oral cavity floor in juvenile and adult white grouper. The present work depends on 10 oral cavities floor from each age. The common features joined the oral cavities floor of the juvenile and adult fish summarized in; oral cavity floor had two teeth bands (lower incisive and lower molar), tongue with its two lateral spinated lines, lower velum, ridges, the lower lip divided into a single anterior part and two lateral part, and the absence of lower canine teeth. The oral surface of semilunar lower velum had round fungiform papillae that carried taste buds type I. The non-protrusible elongated tongue had a clear apex, body, and root with the absence of any taste buds. The dorsal lingual surface of the body had two lateral spinated lines, a single ridge and microtubercles. The smooth dorsal lingual surface of the root did not carry any ridges. The notched lower velum at the middle of the free border was observed in juveniles and adults. Meanwhile, there are some variations between juvenile and adult as; absence of lower incisive ridge only in juvenile, pointed tongue with sublingual ridge observed in juvenile while round without sublingual ridge in adult fish, moreover the presence of velvar ridges observed only in adult fish. The obtained findings provided essential data to aquaculture of this fish species in Egypt by determining the food particle types that are favorite to this fish. HIGHLIGHTS: The common features joined the oral cavities floor of the juvenile and adult fish summarized in; oral cavity floor had two teeth bands (lower incisive and lower molar), tongue with its two lateral spinated lines, lower velum, ridges, the lower lip divided into a single anterior part and two lateral part, and the absence of lower canine teeth. The oral surface of semilunar lower velum had round fungiform papillae that carried taste buds type I. The dorsal lingual surface of the body had two lateral spinated lines, a single ridge and microtubercles. The smooth dorsal lingual surface of the root did not carry any ridges. Meanwhile, there are some variations between juvenile and adult as; absence of lower incisive ridge only in juvenile, pointed tongue with sublingual ridge observed in juvenile while round without sublingual ridge in adult fish, moreover the presence of velvar ridges observed only in adult fish.

Open for business in a closed world? Managing MNE nonmarket strategy in times of populism and geopolitical uncertainty

PurposeThe international strategies of multinational enterprises are increasingly augmented by insights on, and approaches to, external stakeholders and nonmarket dynamics. The rise of populism and increased geopolitical uncertainty have accelerated these efforts, particularly for business leaders anticipating and engaging external agents, events, and issues that challenge the strategic objectives of their enterprises.Design/methodology/approachIn this paper we explain why the increased preponderance of populism and geopolitical uncertainty are concurrently posing an existential threat to the post-Cold War global economy predicated on free trade and (relatively) open borders and, consequently, challenging the structures and strategies of international business.FindingsWe provide an overview of the four papers in our special issue and consider how each advances insights on how multinational enterprises effectively navigate the nonmarket uncertainties of the contemporary global economy. We then advance four important areas for international business research on multinational nonmarket strategies: (i) resilience and legitimacy; (ii), diversification; (iii), market and nonmarket strategy integration; and (iv), institutional arbitrage.Research limitations/implicationsWe anticipate that nonmarket strategy scholars can build on these themes to assess how nonmarket strategies can better enable multinational enterprises to survive and thrive in an age of heightened global risk and uncertainty.Originality/valueThis paper and the related special issue provides novel theoretical insights by drawing attention to the relatively under-researched realm of multinational enterprise nonmarket strategy, particularly in populist contexts and during periods of geopolitical uncertainty. Importantly, we identify four promising domains – resilience and legitimacy, diversification, the integration of market and nonmarket strategy, and institutional arbitrage – for international business scholars investigating nonmarket strategy to consider. We anticipate that our paper, as well as other papers in this special issue, contribute further momentum to this burgeoning area of research.

B-PO03-023 HIS BUNDLE PACING ACHIEVES BETTER VENTRICULAR SYNCHRONY THAN BIVENTRICULAR PACING IN PATIENTS WITH SCAR IN THE LEFT VENTRICULAR FREE WALL

His bundle pacing (HBP) is a novel pacing strategy for cardiac resynchronization therapy (CRT). HBP has been associated with improved response compared to conventional CRT and biventricular endocardial (BIV-endo) pacing. The effect of HBP in patients with scar has however not yet been studied. To investigate differences in response between HBP and BIV-endo pacing in patients with scar in the left ventricular (LV) free wall. We computed ventricular activation on 24 four-chamber heart meshes with Purkinje networks exhibiting left bundle branch block (LBBB). We mapped a LV free wall scar and border zone geometry from a pre-existing LV mesh [Fig A]. HBP and BIV-endo pacing were simulated in the presence and in the absence of scar. Response from baseline was quantified with LV 95% activation time (LV-AT 95) and biventricular dyssynchronous index (BIV-DI), computed as the standard deviation of ventricular activation times. BIV-DI was significantly reduced during HBP compared to BIV-endo pacing both in the presence (-13±2ms vs -15±2ms, p<0.05) and in the absence (-9±2 ms vs -11±2ms, p<0.05) of scar in the LV lateral wall [Fig B]. LV-AT 95 was also significantly shorter during HBP compared to BIV-endo pacing (scar: -31±8ms vs -54±9ms, p<0.05; no scar: -22±7ms vs -44±7ms, p<0.05) [Fig C]. HBP restores native synchronous activation by recruiting the viable fast-conducting Purkinje system. LBBB patients with lateral scar therefore experience better ventricular resynchronization using HBP compared to BIV-endo pacing.

Five Roles of Cross-border Cooperation Against Re-bordering

ABSTRACT The paper observes an advent of unilateralism, brought by the pandemic, which has restricted cross-border flows and co-operation in the E.U. The pandemic re-introduced borders back in the E.U. and introduced new national border policies, which have complicated the lives of the people in the border regions. This might imply the imperfect communication between local cross-border co-operation stakeholders and central governments. It is therefore proposed to use the set of following five roles, which explain the importance of cross-border co-operation in cross-border regions: (1) multi-level governance form, (2) regional development tool, (3) paradiplomacy form, (4) post-conflict reconciliation tool and (5) Europe-building instrument. As those five roles cover functional, ideational and structural dimensions of cross-border co-operation, they have a potential to prevent the representatives of the central states from one-size-fits-all solutions and respect specificities of borderlands. This should help in the cases of repeated health crises, which would restrain the free border crossing in the E.U.

Squamous cell carcinoma during long term hydroxyurea treatment: A case report.

BackgroundHydroxyurea (HU) is a ribonucleotide diphosphate reductase inhibitor that interferes with the S phase of cell replication and inhibits DNA synthesis, with limited or no effect on RNA or protein synthesis. The cutaneous side effects of hydroxyurea treatment are diverse and frequent. Squamous cell carcinoma is one of the most challenging side-effect.Case presentationThe authors report the case of a healthy 59-year-old woman on long-term therapy with Hydroxyurea 500 mg daily for essential thrombocytosis, presented with a painless slow-growing lesion of the jaw that had persisted and increased in size for six months, the appearance of the lesion is correlated to the administration of the hydroxyurea treatment. Clinical examination revealed a large nodular lesion 4 × 4 cm with irregular borders of the right cheek, infiltrated into underlying tissue, the lesion extending to the free border of the right lower eyelid without sensory disturbances or diplopia. The surgery was indicated. The surgical procedure had the aim of the restoration of the anatomic landmarks after a large excision of the tumor and reconstruction of full-thickness eyelid defect with a local flap under general anesthesia.ConclusionMaxillofacial surgeons must be aware of the side effects of hydroxyurea including facial cancer, ulceration, etc. Rigorous follow-up of patients on hydroxyurea is required.

Multiple Epidermal Inclusion Cysts of Epiglottis

Epiglottic cysts are benign laryngeal lesions. Though congenital cysts are often life-threatening, they are usually painless and symptomless in adults, or present with slight, though perceptible, interference with either swallowing or speaking or respiration. Early recognition and diagnosis by routine mirror laryngoscopy is advocated. Prompt removal or draining is the treatment. This is a case report of 42-year-old woman with complaints of feeling of something in throat, sleep apnoea and hoarseness, who on routine mirror laryngoscopy was found to have two large cysts arising from the free border of the epiglottis. The final histopathology reported the cysts as epidermal inclusion cysts.

A Preliminary Study of Pilgrimage Tourism in Barahachhetra, Nepal

Pilgrimage is an age-old phenomenon for people of all religions. Pilgrimage is often been defined as a journey resulting from religious causes, externally to a holy site, and internally for spiritual purposes and internal understanding. For the Hindus, Pilgrimage is associated with Moksha (liberation), one of the four Purusharthas (virtues), the other three being Artha (material value) Dharma (righteousness), and Kama (pleasure). The concept of pilgrimage tourism in the Hindu tradition is a recent one. In Nepal, where tourism has largely remained a seasonal business, pilgrimage tourism can be a perennial source of income especially because Nepal is home to some of the world’s most important sacred Hindu and Buddhist pilgrimage destinations. It is also noteworthy that according to 2011 official census in Nepal, more than 80 percent of the residents follow Hinduism (Central Bureau of Statistics, 2012, p.4) and Nepal shares a free border with India, the country with the largest number of Hindu residents, in absolute terms, in the entire world. Barahachhetra in Nepal is as important as other pilgrimage destinations in Nepal, however, no studies have been carried out so far on the status and potential of pilgrimage tourism in Barahachhetra. The authenticity of the pilgrimage sites, the hospitality culture and the peace experienced by pilgrims together provide a memorable pilgrimage tourism experience for the pilgrimage tourists visiting Barahachhetra. The prospect of pilgrimage tourism in Barahachhetra is immense and has a direct bearing on the preservation of the religious and cultural heritages as well as the economic condition of the residents therein. A coordinated approach initiated at the highest level of governance is required to study, promote and sustain pilgrimage tourism in Barahachhetra. In this study both pilgrimage tourism and religious tourism interchangeably used. Though spiritual tourism has become recently evolved, the authors did not visit on it although efforts have been made to highlight its significant in the introduction.

International and National Legislative Standards for the Protection of Women from the Social Consequences of Labor Migration

Over the past decades, the migration policies of the main destination countries have become much more stringent. In developing and improving migration policies, destination countries faced a difficult task - to find a balance between two factors: free market interests and border control / national security. In the context of globalization in the market, there is a growing demand for cheap and legally uncontrolled labor, while migration policy pays more and more attention to border control and the expulsion of illegal migrants. Millions of migrants are looking for a way out in these difficult conditions, attracted by job opportunities in destination countries, but with little legal access to it. This has resulted in a high growth in illegal migration, which has had a positive impact on many sectors of the economy in destination countries, where they are accustomed to relying on a cheap and flexible labor force - people who agree to any working conditions and are deprived of legal protection. This article is written about the problems and their solutions in different countries of the world faced by women migrants.

Working in Peru: A 25-Year Experience With Voluntary Cleft Missions, and a Technique for the Primary Repair of the Unilateral Cleft Lip and Nasal Deformity.

CIRPLAST is a nonprofit volunteer plastic surgery program that has provided free surgery for patients with cleft lip and palate deformities in different parts of Peru since 1995. In 2015, the author reported 6,108 patients that had been successfully operated on by the CIRPLAST team over a 20-year period. A technique, developed by the author, for the straight-line vertical cleft lip closure without skin flaps of the unilateral cleft lip, was mentioned in that publication but it was not described. 1 The purpose of this article is to present the technique, which has been successfully employed in all the CIRPLAST cleft missions in Peru, for the past 25 years. The straight-line vertical cleft closure does not rely on measurements or skin flaps, and it can be used to close any degree of unilateral cleft lip cleft. The procedure is simple and dependable. After incising the cleft borders on both sides of the cleft, the orbicularis oris muscle is liberated from the surrounding tissues, segmented, and then moved down toward the free border of the lip, so that the cupid's bows can be placed in its normal horizontal position, together with the philtrum on the medial lip, providing normal fullness and pouting of the lower part of the upper lip. Lip length results from the orbicularis oris muscle repair and not from skin flaps. The associated nasal deformity is addressed at the same time as the lip repair, by freeing on the cleft side, the lower lateral cartilage (alar cartilage) from the external nasal skin through a rim incision, and then elevating the cartilage together with its vestibular skin, to place it in its normal position at the tip of the nose, and fixing it there with sutures. The anatomic, functional, and esthetic results of the lip closure together with the correction of the associated nasal deformity have been satisfactory, when comparing the repaired cleft side with the normal side, for symmetry. The straight-line vertical cleft lip closure, based on the orbicularis oris muscle repair, can be used to close any degree of lip clefting, including very wide clefts, without skin flaps. The associated cleft nasal deformity is corrected before the lip closure. The procedure has been used in all the CIRPLAST cleft missions in Peru for the past 25 years, and the outcomes of the repair over time have been satisfactory and stable.

Histological and lectin histochemical studies in the vomeronasal organ of the Korean black goat, Capra hircus coreanae

We examined the localization of olfactory marker protein (OMP), protein gene product9.5 (PGP9.5), and glycan diversity in the vomeronasal organ (VNO) of the Korean black goat (Capra hircus coreanae) during the prenatal and postnatal periods using immunohistochemistry and lectin histochemistry. In fetal and 1-day-old goats, OMP was occasionally identified in receptor cells of the VNO sensory epithelium, and PGP9.5 was localized in both the sensory and non-sensory epithelia. In VNO from adult goats, OMP was abundant in the sensory epithelium and scarce in single cells of the non-sensory epithelium. These results suggest that OMP production is initiated in the VNO sensory epithelium (VNE) during the fetal stage, and that its activity is increased in adult VNO receptor cells and solitary cells in the non-sensory epithelium (VNSE). Furthermore, the free borders of the sensory epithelia were positive for 7 lectins, and 6 lectins were moderately and/or highly abundant in receptor cells. Supporting and basal cells, and nerve bundles had similar expression patterns. In VNE, 7 lectins were observed in the free border, and 6 in ciliated, goblet, and basal cells, and in gland acini. The intensities of WGA, LCA, and PNA were high in VSE receptor cells, and the intensity of PNA was high in ciliated cells of the VNSE. The other 3 lectins showed similar patterns throughout development. Collectively, these results confirm that the Korean black goat VNO starts developing during the late fetal stages and differentiates further after birth.

Histomorphological investigations on the lips of Rahmani sheep (Ovis aries): A scanning electron and light microscopic study.

This study was conducted to provide comprehensive information on the anatomical and histological features of the upper (UL) and lower (LL) lips of Rahmani sheep by gross examination, morphometric analysis in addition to Light and scanning electron microscope (SEM). Samples from normal healthy adult male sheep heads were collected directly after slaughtering. UL and LL were dissected, and specimens were collected for both light and SEM. The UL was longer approximately by one-fold and thicker by one-fold at the median and the oral angle areas, and by one- and half-folds at the paramedian area than the LL. The free border of both lips was characterized rostrally by the presence of labial projections. By SEM the edges of the inner aspect of the lips and of the philtrum were distinguished by labial projections. These projections which surrounding the philtrum subdivided into polygonal areas with numerous keratinized scales especially at the apical parts which increased dorsally toward the nostril. Most of the openings of the upper labial salivary glands were volcanic crater-shaped while that of the lower labial salivary glands were various shapes; round folded margin, rosette and whirlpool shaped. Histologically, the shape of the projection or papillae differs at the median and paramedian areas of the UL than the LL. However, there was no differences near the oral angle area. In conclusion, the shape, size and amount of keratinization of the papillae may offer efficiency to the lips during feeding process.

Predictive indicators for revisional surgery in nasal reconstruction after Mohs surgery

BackgroundReconstruction of nasal lesions is complex due to the topography, mobile free margins and borders of anatomical subunits. Reconstructive challenges can lead to multiple revisional surgeries to achieve the final aesthetic result. This study aimed to evaluate risk factors and predictors of revisional surgery in patients undergoing reconstruction after Mohs micrographic surgery for nasal tumours.MethodsThis was a prospective cohort study from April 2, 2008 to February 26, 2019. The study population included all consecutive patients who underwent Mohs micrographic surgery for nasal skin cancer. Resection and reconstruction of nasal skin cancer was performed by the Mohs team.ResultsA total of 988 cases met our study inclusion criteria with 64 (6.5%) cases requiring unplanned surgical revision. Revision rates were highest in the ala (9.0%, p < 0.05) and complex anatomical subunits (16.7%, p < 0.0001). In contrast, revision rates for dorsum lesions were lowest (1.8%, p < 0.001). In terms of reconstructive modalities, local flaps resulted in significantly higher rates of revision when compared to grafts (relative risk, 2.37; 95% CI, 1.15–5.0; p < 0.01). In terms of histological diagnosis, squamous cell carcinoma had significantly higher revision rates when compared to basal cell carcinoma (p < 0.05).ConclusionsTo our knowledge, this is the first study to report the risk factors and predictors of revision surgery in patients undergoing MMS for nasal tumours. This study highlights that the reconstructive modality utilised affects the functional and cosmetic outcome of MMS. We note that ala complex subunit lesions, squamous cell carcinoma and flap reconstruction were associated with an increased risk of revision after Mohs reconstruction of nasal lesions.Level of evidence: Level III, risk/prognostic; therapeutic study.Trial registration number(Ref: PLA-19-20_A03) 04/02/2020.