Posterior Relapse Research Articles

Automatic measurement of choroidal thickness with swept-source optical coherence tomography in chronic Vogt-Koyanagi-Harada disease: 3 years’ follow-up

PurposeThe course of Vogt-Koyanagi-Harada (VKH) disease is typically assessed qualitatively using indocyanine green angiography (ICGA) and enhanced-depth imaging optical coherence tomography (EDI-OCT). However, a quantitative approach could improve accuracy and objectivity. The aim of this study was to assess the clinical value of the automated measurement capabilities of swept-source optical coherence tomography (SS-OCT) to measure choroidal thickness (quantitative approach) in chronic VKH.MethodsProspective, longitudinal case–control study at a tertiary university hospital involving 23 chronic VKH patients (9 convalescent and 14 quiescent) and 17 age-matched controls. Choroidal thickness was automatically measured with SS-OCT.ResultsChoroidal thinning and improved vision were associated with treatment while increasing thickness and worsening vision were associated with posterior relapse. Overall, 41.6% of asymptomatic (no change in visual acuity) recurrences in the convalescent group and 25% of recurrences in the quiescent group were detected by SS-OCT. All recurrences diagnosed by SS-OCT showed signs of inflammation on ICGA.ConclusionsAutomatic measurement of choroidal thickness with SS-OCT is a rapid, non-invasive method of detecting posterior segment recurrences and treatment response in VKH patients, and could reduce the need for angiography to monitor this disease.

Effectiveness of Different Retention Protocols in Preventing Posttreatment Relapse After Comprehensive Orthodontic Treatment.

After undergoing comprehensive orthodontic treatment, maintaining the achieved results and preventing relapse remains a significant concern. Various retention protocols have been proposed to address this issue, but their comparative effectiveness is not well-established. This study aimed to evaluate the effectiveness of different retention protocols in preventing posttreatment relapse following comprehensive orthodontic treatment. A sample of 150 orthodontic patients who had completed their treatment was included in the study. The patients were divided into three groups based on the retention protocol they received: Group A (Hawley retainers), Group B (Essix retainers), and Group C (permanent retainers). Patients' dental casts were obtained at the end of the treatment (T0) and six months after treatment (T1). Various measurements, including anterior and posterior occlusal changes, were recorded. The results revealed that Group C (permanent retainers) showed the least amount of relapse compared to Groups A and B. In Group C, the mean anterior relapse was 0.2 mm, while in Groups A and B, it was 1.0 mm and 0.8 mm, respectively. Similarly, the mean posterior relapse in Group C was 0.1 mm, whereas in Groups A and B, it was 0.8 mm and 0.6 mm, respectively. These findings indicate that permanent retainers were more effective in preventing relapse compared to removable retainers. In preventing posttreatment relapse after comprehensive orthodontic treatment, permanent retainers demonstrated superior effectiveness compared to Hawley and Essix retainers.

Do we have an “anti-stigmotic”? – Addressing Mental-Illness Related Stigma as the main issue

IntroductionFor people with mental illness, internalized stigma, also referred to as self-stigma, is characterized by a subjective perception of devaluation, marginalization, secrecy, shame, and withdrawal. It has many adverse effects on individual’s psychological well-being and clinical outcomes. The iatrogenic effects it has during psychotherapeutic treatment can significantly reduce utilization of mental health care services, reduce quality of life and increase avoidant coping. Overall, internalized stigma is considered a risk factor for poorer mental health prognosis. Although some interventions have recently been developed to specifically intervene on this target as part of psychological recovery goals over the course of treatment, most clinicians are not yet aware or empowered to correctly address this.ObjectivesDescription of a clinical case illustrating the relevance on addressing internalized mental illness related stigma during the recovery process.MethodsClinical case report and review of the literature on the subject.ResultsWe present the case of a 47-year-old female patient, C.S., single, graduated in social work (currently unemployed), who was admitted at the Psychiatry Day Hospital, where she was referred by her Psychiatry Assistant because of abulia, social withdrawal and isolation, depressed mood, thoughts of shame, guilt and self-devaluation and work incapacity. She had been admitted in the Psychiatry ward one year earlier for a first psychotic breakthrough, presenting persecutory and grandiose delusions and auditory hallucinations. After three weeks of inpatient treatment with antipsychotics, a full remission of the symptoms was achieved, without any posterior relapse. Before that first psychotic episode, the patient had been taking anti-depressive medication (escitalopram 20 mg id) for many years, prescribed by her General Practitioner, for mild to moderate depressive symptoms. After being discharged from the Psychiatry ward, C. kept following an outpatient treatment with anti-depressives and behavioural activation-based psychotherapy. She started to believe she was mentally ill and therefore weak, uncapable, and less deserving than her peers or her previous self. These self-stigmatizing ideas were enhanced by the lack of family support and the beliefs that were fostered by her mother, with whom she started to live after the hospitalization. These factors led to a dysfunctional internalization of an illness behaviour, jeopardizing the patient’s ability to reach full recovery.ConclusionsThis case reinforces the importance of targeting mental illness related stigma during the recovery process. Also, involving the family is of extreme importance to achieve support and address shared beliefs and the interchange between social and internalized stigma.Disclosure of InterestNone Declared

A Comparative Analysis of Orthognathic Surgical Stability between Fixed Appliances and Clear Aligner Orthodontic Therapy

BackgroundSkeletal relapse etiology in orthognathic surgery (OGS) is multifactorial. The role of differing orthodontic mechanics, such as fixed appliances and clear aligners in relapse, has not been explored. The adoption of clear aligner orthodontic therapy in surgical-orthodontic cases is slow due to concerns regarding surgical protocol and postoperative stability. Patients seeking surgical orthodontic treatment with clear aligner therapy is increasing, and outcomes require investigation. ObjectiveThe study's objective is to compare the degree of skeletal relapse in the sagittal and vertical dimension following OGS between cases managed with fixed appliance and clear aligner orthodontic therapy. MethodologyA retrospective chart review was conducted to include patients undergoing OGS with surgical-orthodontic therapy. The intervention group consisted of patients with clear aligner orthodontic therapy. The matched-control group was comprised of patients treated by conventional fixed appliances and were selected based on corresponding age, sex, medical status, and surgical treatment plan to the intervention group. A lateral cephalogram with standard cephalometric analysis was obtained at 2 postoperative time periods: within 7 days (T1) and 1 year (T2), postoperatively. Differences in linear and angular references were calculated. The degree of skeletal relapse measured the difference between the 2 time periods. Statistical analysis: parametric method with standard T-tests and a significance level of .05. ResultsTwenty-six orthognathic surgery patients were included in the study: 13 patients treated by fixed appliances (control) and 13 patients treated by clear aligner therapy (intervention). There was no statistically significant difference in age or surgical movement (P < .05) between the 2 groups; 18 patients had bimaxillary surgery, and 8 had single-jaw surgery (6 BSSO and 2 Le Fort). The mean surgical movements were 4.13mm advancement and 0.44mm impaction in the maxilla, with a 1.3mm setback in the mandible. Cephalometric analysis in the control group demonstrated a -0.20mm posterior relapse of A point and a -0.28mm relapse of B point. Angular measurement differences of SNA and SNB were -1.4 and -2.3, respectively. In the intervention group, cephalometric analysis revealed skeletal relapse between the time periods of a -0.22mm posterior relapse of A point and a -0.31mm of B point occurred. Angular changes of SNA and SNB were -1.1 and -1.9, respectively. There was no statistically significant difference in surgical relapse between both groups. ConclusionThe results of this study demonstrate that skeletal relapse following OGS may not be affected by the mechanism of orthodontic therapy. Both fixed orthodontic appliances and clear aligner therapy patients displayed minimal postoperative skeletal changes. Although a small sample size, this initial evaluation does provide support in the use of clear aligner orthodontic therapy as a viable treatment option in surgical orthodontics.

Laparoscopic anterior and posterior native tissue repair: a new pelvic floor approach

Introduction: Traditionally, a cystocele caused by a midline defect of the pelvic fascia is treated by vaginal fascia duplication, also known as anterior colporraphy. The rectocele is managed by suturing the posterior fascia and, frequently, the levator ani muscles. We developed the approach of laparoscopic anterior and posterior fascia repair by native tissue.Material and methods: The methods were based on anterior and posterior exposure of pelvic fascia similar to the preparation of an extended sacral colpopexy. The fascia was compressed and narrowed by absorbable woven sutures, size 1. Twenty-seven patients were followed up for 6–13 months. All patients received additional apical fixation by pectopexy.Results: In the examination group, 13 patients underwent anterior laparoscopic fascia repair and 23 had posterior repair. We detected one apical and one posterior relapse, and also one in the anterior repair group. The patient with the apical relapse reported pain and de novo urgency. Anatomical reconstruction was achieved in all other patients.Summary: Laparoscopic anterior and posterior native tissue repair appears to be a feasible method for the treatment of midline cystocele and rectocele. No new risks were observed. The technique leaves no scar in the vagina and is well accepted.Abbreviations: POPQ: Pelvic Organ Prolapse Quantification System; FDA: Food and Drug Association; US: United States; Fig: Figure; ICIQ: International Consultation on Incontinence Questionnaire

Major factors contributing to anterior and posterior relapse after intraoral vertical ramus osteotomy.

The aim of this retrospective cohort study was to investigate the factors contributing to mandibular relapse after intraoral vertical ramus osteotomy (IVRO) while controlling for possible confounders. Forty-seven patients who underwent bimaxillary surgery were divided into three groups according to the direction of horizontal mandibular relapse: a stable group (group S), a posterior relapse group (group P), and an anterior relapse group (group A). Lateral cephalograms were analysed 1 month before and at 7 days and 12 months after surgery. One month before surgery, the pogonion in group A was positioned about 13mm more anteriorly than in group P (P<0.05). Immediately after surgery, the mandibles in groups A and S had moved about 6mm more posteriorly than in group P. At 12 months, both the mandibles (point B) and the maxillae (point A) had moved posteriorly in group P (P<0.05). A multivariate linear regression analysis showed that the amount of setback was the one key factor predicting postoperative mandibular changes 12 months after IVRO. As the amount of setback decreased, mandibular posterior horizontal relapse increased after IVRO. These findings suggest that the amount of setback can be a key factor predicting postoperative mandibular relapse.

Automatic Measurement of Choroidal Thickness with Swept-Source Optical Coherence Tomography for Clinical Follow-Up in Acute Vogt-Koyanagi-Harada Disease

Background: The course of acute Vogt-Koyanagi-Harada is typically assessed qualitatively using indocyanine green angiography. Swept-source optical coherence tomography may provide a safer, non-invasive, more objective approach to follow up. In this study, we assess the clinical value of the automated measurement capabilities of swept-source tomography to measure choroidal thickness. Design: Prospective, longitudinal case-control study at a tertiary university hospital. Participants: Nine patients with acute Vogt-Koyanagi-Harada disease (18 eyes) and 17 age-matched controls (34 eyes). Methods: Choroidal thickness (subfoveal area and ETDRS grid) was automatically measured with swept-source optical coherence tomography. Changes in thickness were compared to changes in visual acuity and indocyanine green angiography findings to check for correlations. Main outcome measures: Changes in choroidal thickness (micrometers- μm) from baseline. Secondary measures included visual acuity and angiography. Results: At baseline, patients presented significantly greater mean (SD) subfoveal choroidal thickness (666.9 μm [258.3] vs. 302.3 [71.4]) and ETDRS grid choroidal thickness (648.7 μm [260.5] vs. 287.5 [69.3]) than controls (p=0.000). Choroidal thinning and improved vision were associated with treatment while increasing thickness and worsening vision were associated with posterior relapse. In 62.5% of recurrences in tomography, no changes in visual acuity were present; however, all recurrences diagnosed with tomography showed signs of inflammation on angiography. Conclusions: Automatic measurement of choroidal thickness with swept-source optical coherence tomography is a rapid, non-invasive manner of detecting posterior segment recurrences and treatment response in acute Harada patients. Swept-source tomography could reduce the need for angiography to monitor patients with Harada disease.

Bone mineral density and mandibular advancement as contributing factors for postoperative relapse after orthognathic surgery in patients with preoperative idiopathic condylar resorption: a prospective study with preliminary 1-year follow-up

The aim of this study was to analyze contributing factors for postoperative relapse after orthognathic surgery in patients with preoperative idiopathic condylar resorption (ICR). Sixteen female patients with mandibular retrognathism and ICR were included in this prospective study. For patient factors, serum 17 β-estradiol (E2), bone mineral density, and the preoperative posterior condylar inclination were evaluated. Bone mineral density was measured using dual-energy x-ray absorptiometry (DEXA) bone densitometry and expressed by T-score. Surgical changes and postoperative relapse were measured with cephalometric analysis. The correlation between postoperative relapse and measured parameters was statistically analyzed. The lowest T-score exhibited a significant correlation with postoperative clockwise rotation and posterior relapse tendency of the mandible (P < .05). The amount of mandibular advancement showed a significant correlation with the postoperative clockwise rotation of the mandible (P < .05). The postoperative relapse tendency in patients with preoperative ICR is significantly related to the lowest T-score and the amount of mandibular advancement.

Postoperative stability following bilateral intraoral vertical ramus osteotomy based on amount of setback

Our aim was to evaluate the postoperative stability associated with differing degrees of mandibular setback and their relations after intraoral vertical ramus osteotomy (IVRO). We planned a retrospective cohort study of 94 patients (mean age (range) 23 (18–46) years) selected from a larger group who had been diagnosed with mandibular prognathism with or without facial asymmetry and who had mandibular setback by IVR osteotomy from 2004 to 2009. The preoperative, 7-day, and 12-month postoperative lateral cephalographs were measured to find out the degree of movement, and the vertical and horizontal positions of menton and pogonion were compared at different time points to measure stability. The mean (SD) setback was 10.5 (5.1) mm, with 0.8 (1.1) posterior relapse at 12 months. The mean surgical change of menton vertically was 3.0 (3.0)mm superiorly, with an additional 1.3 (1.05)mm at 12 months. The amount of posterior relapse was less as the amount of setback increased but not significantly so. The amount of setback therefore has minimal effects on anterior relapse, and cannot be considered singly as a variant that affects the degree of stability. The risk of anterior relapse is low even with a substantial degree of mandibular setback, so overcorrection is not necessary with the IVR osteotomy.

Evaluation of cephalometric points in midface bone lengthening with the use of a rigid external device in syndromic craniosynostosis patients

Distraction osteogenesis has been extensively used to correct severe midface hypoplasia in syndromic craniosynostosis patients. However few studies have reported midface distraction outcomes through cephalometric evaluation. AIM: The purpose of the present study was to evaluate outcomes with midface distraction rigid external device (RED) in patients with syndromic craniosynostosis, in terms of quantity of bone lengthening, skeletal stability and facial growth. MATERIALS AND METHODS: Eleven patients were retrospectively evaluated in this study. Cephalometrics was carried out through three teleradiographies from each patient (T1 -before surgery; T2- immediate postop, rigth after distractor removal; T3 - late postop, obtained with a minimal interval of 12 months after surgery). RESULTS: Significant midface advancement was achieved with the procedure. The rate of horizontal relapse was minimal. We noticed a clear vertical facial growth, contrary to what was seen in the horizontal aspect, when there was a mild posterior relapse and no growth evidence. CONCLUSION: Cephalometric evaluation showed adequate results in midface bone lengthening with rigid external distractor.

Evaluation of cephalometric points in midface bone lengthening with the use of a rigid external device in syndromic craniosynostosis patients

SummaryDistraction osteogenesis has been extensively used to correct severe midface hypoplasia in syndromic craniosynostosis patients. However few studies have reported midface distraction outcomes through cephalometric evaluation.AimThe purpose of the present study was to evaluate outcomes with midface distraction rigid external device (RED) in patients with syndromic craniosynostosis, in terms of quantity of bone lengthening, skeletal stability and facial growth.Materials and methodsEleven patients were retrospectively evaluated in this study. Cephalometrics was carried out through three teleradiographies from each patient (T1 -before surgery; T2- immediate postop, rigth after distractor removal; T3 - late postop, obtained with a minimal interval of 12 months after surgery).ResultsSignificant midface advancement was achieved with the procedure. The rate of horizontal relapse was minimal. We noticed a clear vertical facial growth, contrary to what was seen in the horizontal aspect, when there was a mild posterior relapse and no growth evidence.ConclusionCephalometric evaluation showed adequate results in midface bone lengthening with rigid external distractor.

Stability after rigid fixation of simultaneous maxillary impaction and mandibular advancement osteotomies

The purpose of this study was to investigate the short- and long-term stability of bimaxillary surgery following LeFort I (LF-1) impaction with simultaneous bilateral sagittal split ramus osteotomy (BSSO) and mandibular advancement using the technique of rigid internal fixation (RIF). In order to assess the postoperative maxillary and mandibular movement pattern in 26 patients with vertical maxillary excess and mandibular deficiency, cephalograms were taken immediately preoperatively, and 1 week, 2 months, and 1 year after surgery. With paired t-test showing no statistically significant postoperative change for the point A of the maxilla from immediate postsurgery to longest follow-up (P> 0.05), the used technique of ‘RIF LF-I impaction and RIF BSSO advancement’ tended to render excellent postsurgical stability in the horizontal (0.1±0.8mm mean posterior movement) and vertical (0.1±0.5mm mean inferior movement) direction. There was no instance of maxillary relapse of >2mm. Regarding mandibular BSSO advancement, the point B showed a significant vertical upward movement (1.6±1.2mm) (P< 0.001) and a slight horizontal forward movement (0.3±2.0mm) (P> 0.05) at 1-year follow-up. The incidence of posterior relapse of >2mm accounted for 11.5%. The data confirm the concept that the bimaxillary approach of ‘LF-I impaction and BSSO advancement’ using the described technique of RIF is a stable procedure in the treatment of open bite patients classified as vertical maxillary excess in combination with mandibular deficiency.

Evaluation of skeletal stability following surgical correction of mandibular prognathism

This retrospective study was designed to assess skeletal stability after the correction of mandibular prognathism by sagittal split osteotomy (SSO) and intraoral vertical subsigmoid osteotomy (VSO). We used lateral cephalographs of 31 patients taken before, immediately after, and at least one year after the operation. We recorded euclidean distance matrix analysis, linear and angular measurements, and x and y co-ordinates of cephalometric landmarks for each cephalograph. There were no significant differences in extent of the mandibular retrognathia or magnitude of change between the two groups. The main significant changes in both groups were reduction of the total mandibular length, and posterior shifting in the mandible. One year after the operation the main change was the mean forward relapse of 2.5mm in the SSO group and the mean posterior relapse of 0.5mm in the VSO group. The difference in skeletal stability between the groups was significant (P< 0.05), and we conclude that VSO is the more effective technique for correcting mandibular prognathism.

Superior repositioning of the maxilla combined with mandibular advancement: Mandibular RIF improves stability

Postsurgical changes in 24 patients who had rigid internal fixation (RIF) of the mandible with screws after combined superior repositioning of the maxilla and mandibular advancement were compared with 53 patients who underwent the same surgery but who had intraosseous wire fixation, skeletal suspension wires, and 8 weeks of maxillomandibular fixation (MMF). During the first 8 weeks after surgery, the mean posterior relapse of the mandible was greater in the MMF group than in the RIF group (for example, -1.1 mm versus 0.15 mm at B point), and the percentage of patients with clinically significant vertical and horizontal changes was greater in the MMF group. By 1 year, there had been slight additional mean relapse in the MMF group (-1.5 mm net relapse at B point, with 42% of the patients showing 2 mm or more relapse). In the RIF group, the mandible was more likely to be repositioned forward than posteriorly (net mean change at B point, 0.7 mm forward; 33% had 2 mm or more forward movement). In the RIF group, all but one of the patients (96%) were judged to have an excellent clinical result; in the MMF group, the corresponding figure was 60%.

Self-Stabilizing Osteotomy for Frontal Bar Advancement

This technique is simple, quick to perform, and produces a rigid block against posterior relapse of the advanced frontal bar in surgery for bicoronal synostosis. This stability is achieved without the need to place a bone graft across the craniectomy site in small infants with rapidly expanding brains. Finer and fewer interosseous wires are required, decreasing the chance of transcutaneous palpation, and this principle can be incorporated into most osteotomy patterns around the orbits.