Search Results (558)

Background: Skin and soft tissue infections (SSTIs) are a major cause of emergency room (ER) visits and hospitalizations. Long-acting lipoglycopeptides (LALs), such as dalbavancin and oritavancin, offer potential for early discharge and outpatient management, especially in patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) or with comorbidities. Methods: We conducted a retrospective observational cohort study from March to December 2024 in an Italian tertiary-care hospital. Adult patients treated in the ER with a single dose of dalbavancin (1500 mg) or oritavancin (1200 mg) for SSTIs were included. Demographic, clinical, and laboratory data were collected. Follow-up evaluations were performed at 14 and 30 days post-treatment to assess outcomes. Results: Nineteen patients were enrolled (median age 59 years; 53% female). Most had lower limb involvement and elevated inflammatory markers. Three patients (16%) were septic. Fourteen patients (74%) were discharged without hospital admission; hospitalization in the remaining cases was due to comorbidities rather than SSTI severity. No adverse drug reactions were observed. At 14 days, 84% of patients had clinical resolution; only 10% had recurrence by day 30, with no mortality nor readmission reported. Conclusions: LALs appear effective and well-tolerated in the ER setting, supporting early discharge and reducing healthcare burden. Broader use may require structured care pathways and multidisciplinary coordination. Full article

Orthognathic surgery (OS) is a complex procedure commonly used to treat dentofacial deformities (DFDs). These conditions, related to jaw position or size and often involving malocclusion, affect approximately 15% of the population. Due to the complexity of OS, accurate planning is essential. Digital assessment using computer-aided design (CAD) and computer-aided manufacturing (CAM) tools enhances surgical predictability. However, limitations in soft tissue simulation often require surgeon input to optimize aesthetic results and minimize surgical impact. This study aimed to evaluate the accuracy of virtual surgery planning (VSP) by analyzing the relationship between planning deviations and surgical satisfaction. A single-center, retrospective study was conducted on 16 patients who underwent OS at San Pedro University Hospital of La Rioja. VSP was based on CT scans using Dolphin Imaging software (v12.0, Patterson Dental, St. Paul, MN, USA) and surgeries were guided by VSP-designed occlusal splints. Outcomes were assessed using the Orthognathic Quality of Life (OQOL) questionnaire and deviations were measured through pre- and postoperative imaging. The results showed high satisfaction scores and good overall outcomes, despite moderate deviations from the virtual plan in many cases, particularly among Class II patients. A total of 63% of patients required VSP modifications due to poor soft tissue fitting, with 72% of these being Class II DFDs. Most deviations involved less maxillary advancement than planned, while maintaining optimal occlusion. This suggests that VSP may overestimate advancement needs, especially in Class II cases. No significant differences in satisfaction were observed between patients with low (<2 mm) and high (>2 mm) deviations. These findings support the use of VSP as a valuable planning tool for OS. However, surgeon experience remains essential, especially in managing soft tissue behavior. Improvements in soft tissue prediction are needed to enhance accuracy, particularly for Class II DFDs. Full article

Background and Clinical Significance: Myxoid liposarcoma (MLS) is a malignant soft tissue tumor that often presents as a painless, slow-growing mass and is known for its atypical extrapulmonary metastatic pattern. Although sciatic nerve involvement is rare, when present, it usually causes neurologic symptoms. In this case, a large MLS silently expanded and completely encased the sciatic nerve without causing deficits, highlighting the importance of early imaging, multidisciplinary planning, and individualized surgical strategy in managing complex soft tissue sarcomas. Case Presentation: This case report describes a 67-year-old male with a 30 cm encapsulated myxoid liposarcoma of the posterior left thigh. The tumor had grown insidiously over one year and completely encased the sciatic nerve without causing pain, paresthesia, or motor impairment. Selective embolization was performed preoperatively to minimize blood loss. A posteromedial surgical approach allowed for en bloc resection with negative margins and preservation of sciatic nerve integrity. Histopathology confirmed a myxoid liposarcoma composed primarily of spindle-shaped tumor cells. The patient experienced no postoperative complications or neurologic deficits. At the two-year follow-up, he remains disease-free with full functional recovery. Conclusions: This case illustrates the potential for large, asymptomatic myxoid liposarcomas to encase critical neurovascular structures without infiltration. Preoperative embolization as part of a multidisciplinary plan was key to achieving safe resection and excellent functional outcomes. Full article

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article

Background and Clinical Significance: The retreatment of failed dental implants remains a challenging clinical scenario, particularly when complicated by peri-implantitis and as sociated bone loss. Successful management requires a comprehensive and predictable approach that addresses both hard and soft tissue deficiencies. Case Presentation: This case report illustrates a fully digital, prosthetically driven workflow for the rehabilitation of a posterior mandibular site following implant failure. A 44-year-old female patient underwent removal of a failing implant and adjacent tooth due to advanced peri-implantitis and periodontitis. After healing, a digital workflow—including intraoral scanning, cone-beam computed tomography (CBCT), and virtual planning—was employed to design and fabricate a customized CAD/CAM titanium mesh for vertical guided bone regeneration. The grafting procedure utilized a composite mixture of autogenous bone and anorganic bovine bone (A-Oss). After nine months of healing, two implants with a hydrophilic surface (SOI) were placed using a fully guided surgical protocol (OneGuide system). Subsequent soft tissue grafting and final prosthetic rehabilitation with monolithic zirconia restorations resulted in stable functional and aesthetic outcomes. Conclusions: This case highlights how the integration of modern digital technologies with advanced regenerative procedures and innovative implant surfaces can enhance the predictability and long-term success of implant retreatment in compromised posterior sites. Full article

Soft tissue tumors (STTs) are a heterogeneous group of mesenchymal neoplasms requiring accurate differentiation for optimal patient management. While histopathology remains the gold standard, imaging plays a crucial role in non-invasive assessment. Multiparametric ultrasound (mpUS) has emerged as a promising, cost-effective alternative to MRI, integrating B-mode, color and power Doppler, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) to provide comprehensive morphological, vascular, and biomechanical insights. Each modality offers distinct yet complementary diagnostic value, enhancing accuracy and potentially reducing unnecessary biopsies. This narrative review aims to serve as a practical guide, providing a readily accessible reference for mpUS parameters useful in the differential diagnosis of soft tissue tumors. Full article

Background: Undifferentiated pleomorphic sarcoma (UPS) is a rare, high-grade soft-tissue sarcoma characterized by a patternless proliferation of bizarre pleomorphic tumor cells lacking identifiable lineage differentiation. Its occurrence in the oral cavity is exceptionally uncommon and poses significant diagnostic challenges due to its morphological overlap with a wide spectrum of other malignancies. Material and Methods: We report a novel case of oral UPS in a 54-year-old woman, characterized by an exceptionally large size and a rapidly progressive clinical course. The diagnostic evaluation included clinical, radiological, histopathological, immunohistochemical, and molecular analyses conducted within a multidisciplinary framework. A comprehensive review of the literature on oral UPS was also performed. Results: The patient underwent an aggressive demolitive surgical approach due to the extent of the lesion. Molecular analysis revealed a previously unreported SPECC1L::TERT gene fusion. The literature review highlighted the rarity of oral UPS, its geographic predilection for Central and East Asia, possible associations with traumatic events, and its heterogeneous clinical and histopathological presentations. Conclusions: This case underscores the critical importance of a thorough diagnostic workup to ensure the accurate diagnosis and appropriate management of this rare and aggressive tumor. Multidisciplinary evaluation is essential, especially in anatomically complex and diagnostically challenging presentations such as oral UPS. Full article

Background/Objectives: Peri-implant mucosa plays a key role in both peri-implant health and aesthetics. Differences in contour and color between implants and natural teeth can negatively affect patient satisfaction, while soft tissue deficiency may lead to complications such as peri-implantitis. Peri-implant plastic surgery aims to improve these conditions. The objective of this study is to describe the trouser-shaped connective tissue graft technique designed to enhance vestibular and interproximal peri-implant tissue volume in a single surgical procedure, and to assess its effectiveness and morbidity. Methods: Ten patients requiring soft tissue augmentation in edentulous areas prior to delayed implant placement were selected. Intraoral scanning was performed before and 6 months after treatment to evaluate tissue thickness gain. Results: Significant soft tissue volume gain was observed at both the coronal (mean: 2.74 mm with a 95% confidence interval of 2.21–3.26 mm) and vestibular (mean: 2.79 mm with a 95% confidence interval of 2.24–3.35 mm) levels in all analyzed positions (p < 0.001). The procedure exhibited low morbidity, with minimal complications and discomfort reported by the patients. Conclusions: The trouser-shaped connective tissue graft technique is effective in increasing peri-implant soft tissue. It allows for vestibular and interproximal tissue augmentation in a single procedure, minimizing tissue contraction and morbidity. This technique could be a predictable and minimally invasive alternative for managing volume deficiencies in peri-implant tissues, particularly in aesthetic areas. Full article

Background/Objectives: Subtalar arthroereisis (STA) is a widely used surgical procedure for symptomatic pediatric flexible flatfoot. However, implant migration remains a concern due to its potential impact on long-term correction and complications. This study evaluated the migration pattern of STA implants and assessed long-term clinical and radiographic outcomes. Methods: This retrospective cohort study included 47 feet from children aged 8–13 years who underwent STA with adjunctive soft tissue procedures between 2014 and 2018, following ≥6 months of failed conservative treatment, with a minimum follow-up of 5 years. Exclusion criteria included neuromuscular or rigid flatfoot. Weight-bearing radiographs assessed anteroposterior (AP) and lateral Meary’s angles, reflecting forefoot-to-hindfoot alignment, and calcaneal pitch, indicative of longitudinal arch height. Implant migration was recorded and clinical outcomes were measured by the American Orthopedic Foot and Ankle Society (AOFAS) score. Measurements were recorded preoperatively, immediately postoperatively, and at 1 month, 3 months, 6 months, 1 year, and 5 years. Results: Radiographic correction was significant and sustained at 5 years. The AP Meary’s angle improved from 13.09° to 5.26° at 1 month and 6.69° at 5 years (p < 0.001); lateral Meary’s angle from 9.77° to 4.06° and 4.88° (p < 0.001); and calcaneal pitch from 14.52° to 16.87° and 16.89° (p < 0.001), respectively. AOFAS scores increased from 67.52 to 90.86 at 1 month and 96.33 at 5 years (p < 0.001). Implant migration peaked within the first postoperative month (mean: 3.2 mm on ankle AP view; 3.0 mm on foot AP view) and stabilized thereafter. Four cases of complications included implant dislodgement, subsidence, and persistent sinus tarsi tenderness, which were successfully resolved after appropriate management. No recurrence of deformity was observed. Conclusions: STA implant migration is most pronounced during the first month, likely due to physiological settling as the foot adapts to altered biomechanics. With appropriate implant selection, technique, and follow-up, migration does not compromise long-term correction or outcomes. In general, symptomatic cases can often be managed conservatively prior to implant removal. Full article

Background/Objectives: Vertebral discitis osteomyelitis (VDO) is a serious infection involving the vertebral bodies and intervertebral discs, often requiring biopsy for pathogen identification. However, biopsy yields are variable, and guidance on patient selection remains limited. This study aimed to assess how biopsy culture results influence clinical management and to develop imaging-based scoring systems to predict biopsy outcomes. Methods: In this retrospective study, 70 patients who underwent image-guided vertebral biopsy for suspected VDO between 2013 and 2022 were reviewed. Pre-biopsy MRI and CT findings were scored using novel, simplified criteria. MRI was graded based on soft tissue involvement, while CT evaluated the presence or absence of a vacuum phenomenon. Culture results were correlated with imaging scores and subsequent changes in antibiotic management. Statistical analysis included logistic regression, ROC analysis, and interobserver agreement using Cohen’s Kappa. Results: Of the 70 patients, 27 (38.6%) had positive cultures, and 20 (28.5%) experienced changes in management. Among the 48 patients with both MRI and CT imaging, MRI scores indicating soft tissue involvement and absence of the vacuum sign on CT were independent predictors of positive culture (p = 0.022 and p = 0.047, respectively). The combined predictive model showed an AUC of 0.76. Interobserver agreement was excellent (κ = 0.90 for MRI, κ = 0.95 for CT). Conclusions: MRI and CT features can be used to predict biopsy yield and guide clinical decisions in suspected VDO. These scoring systems may help clinicians identify patients most likely to benefit from biopsy, potentially improving outcomes and minimizing unnecessary procedures. Full article

Background/Objectives: Temporomandibular disorders (TMDs) are a group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint (TMJ), masticatory muscles, and related anatomical structures. Although magnetic resonance imaging (MRI) is considered a noninvasive and highly informative imaging modality for assessing TMJ soft tissues, few studies have examined how TMJ structural features observed on MRI findings relate to oral function and craniofacial morphology in female patients with malocclusion. To investigate the associations among TMJ structural features, oral function, and craniofacial morphology in female patients with malocclusion, using MRI findings interpreted in conjunction with a preliminary assessment based on selected components of the DC/TMDs Axis I protocol. Methods: A total of 120 female patients (mean age: 27.3 ± 10.9 years) underwent clinical examination based on DC/TMDs Axis I and MRI-based structural characterization of the TMJ. Based on the structural features identified by MRI, patients were classified into four groups for comparison: osteoarthritis (OA), bilateral disk displacement (BDD), unilateral disk displacement (UDD), and a group with Osseous Change/Disk Displacement negative (OC/DD (−)). Occlusal contact area, occlusal force, masticatory efficiency, tongue pressure, and lip pressure were measured. Lateral cephalometric analysis assessed skeletal and dental patterns. Results: OA group exhibited significantly reduced occlusal contact area (p < 0.0083, η² = 0.12) and occlusal force (p < 0.0083, η² = 0.14) compared to the OC/DD (−) group. Cephalometric analysis revealed that both OA and BDD groups had significantly larger ANB angles (OA: 5.7°, BDD: 5.2°, OC/DD (−): 3.7°; p < 0.0083, η² = 0.21) and FMA angles (OA: 32.4°, BDD: 31.8°, OC/DD (−): 29.0°; p < 0.0083, η² = 0.17) compared to the OC/DD (−) group. No significant differences were observed in masticatory efficiency, tongue pressure, or lip pressure. Conclusions: TMJ structural abnormalities detected via MRI, especially osteoarthritis, are associated with diminished oral function and skeletal Class II and high-angle features in female patients with malocclusion. Although orthodontic treatment is not intended to manage TMDs, MRI-based structural characterization—when clinically appropriate—may aid in treatment planning by identifying underlying joint conditions. Full article

Malignant peripheral nerve sheath tumors (MPNSTs) are a rare type of soft tissue sarcoma associated with poor prognoses. The standard of care for non-resectable tumors consists of surgical excision followed by radiation and chemotherapy. MPNSTs are most common in patients with neurofibromatosis type 1 but can also occur sporadically. Regardless of origin, MPNSTs most often rely on signaling pathways that increase basal oxidative stress. This provides the basis for developing therapeutics with mechanisms that can potentiate oxidative stress to selectively eradicate tumor cells at doses that are tolerable for normal cells. Artemisinin derivatives are a mainstay of malaria therapy worldwide, with a well-established safety profile. Artemisinin’s antimalarial effects are due to an endoperoxide bridge in its chemical structure that induces oxidative stress. We found that artesunate (ARS) and metabolite dihydroartemisinin (DHA) are selectively cytotoxic to MPNST cells relative to normal Schwann cells with the endoperoxide bridge required for activity. Mechanistically, DHA induced oxidative stress, lipid peroxidation, and DHA-mediated cytotoxicity could be prevented with co-administration of the antioxidant N-acetyl-cysteine. Furthermore, we found that DHA was able to selectively remove MPNST from co-culture with normal Schwann cells. These data supports the further development of artemisinins for the clinical management of MPNST. Full article

Background: Klippel–Trenaunay syndrome (KTS) is a congenital vascular malformation syndrome characterized by low-flow vascular anomalies, including venous malformation (VM) and lymphatic involvement. These anomalies may lead to limb asymmetry due to soft tissue and/or bone overgrowth. Compression therapy using elastic garments is considered a conservative and minimally invasive first-line treatment option for KTS. However, the benefits of compression therapy for low-flow vascular malformations, particularly limb VMs, have not been sufficiently evaluated. This prospective, multi-center study assessed the efficacy and safety of compression therapy for KTS with VM. Methods: After measuring the affected limb, a custom-made elastic garment providing 30 mmHg of compression was manufactured (THUASNE, France). A total of 20 patients (7 male, 13 female; mean age: 10.9 years) underwent compression therapy for 26 weeks at four nationwide institutions in Japan. The primary outcome was the change in lower limb circumference. Secondary outcomes included pain, modified Rankin Scale (mRS) score, body water content, vital signs, changes in garment elasticity, and adverse events. Results: All 20 patients completed the study. At the study endpoint, the circumference ratio of the affected to unaffected limbs was significantly reduced at the superior end of the tibial tuberosity (p = 0.02) and the thinnest part of the ankle (p < 0.001). The elastic force of the garment declined by approximately 50% over 26 weeks. No serious adverse events related to the intervention were reported. Conclusions: Compression therapy using a custom-made elastic garment appears to be a safe and effective approach for managing limb overgrowth in patients with KTS and VM. To maintain the therapeutic effect, garment replacement is recommended at least every six months. Full article

Skin and soft tissue infections (SSTIs) are becoming an urgent public health issue worldwide. The globe is facing a growing problem with drug-resistant germs, and current treatments are not quite cutting it. There is a real need for new therapies that can tackle these challenges more effectively. This brings us to an interesting question: Can extracellular vesicles (EVs) from different sources, such as mesenchymal stem cells (MSCs), immune cells, or even plants and animals, help in treating SSTIs, especially given the rise in drug resistance? Studies have shown that MSC-derived EVs are particularly noteworthy because they carry components such as antimicrobial peptides (AMPs) that can work together to fight infections, boost the immune response, and aid in healing. These vesicles play a role in how our body interacts with infections, helping to clear bacteria, reduce inflammation, and promote tissue repair. We also see that EVs from plants and bacteria can directly fight off germs, while those from animals can support the healing process of skin. Although early studies have shown promise for EV therapies, there are still hurdles to overcome, such as ensuring consistent production and delivery. This review looks at the potential of EVs as powerful agents in managing infections and supporting healing, highlighting an exciting area of research in medicine. Full article

Background/Objectives: Craniofacial microsomia (CFM), previously known as hemifacial microsomia, is a congenital condition involving structures derived from the first and second pharyngeal arches. CFM is characterized by asymmetrical craniofacial growth, affecting the mandible, ear, orbit, soft tissues, and facial nerve. Functional therapy is among the treatment options for mild to moderate cases. This study aimed to assess the effect of functional therapy on mandibular growth in patients with CFM by comparing mandibular and condylar height on the affected and unaffected sides, using pre- and post-treatment panoramic radiographs. Methods: A retrospective longitudinal study was conducted on 14 patients treated with functional therapy with the Asymmetrical Functional Activator (AFA) appliance. Mandibular ramus height (Co-Go) and condylar height (Co-Is) were measured bilaterally on pre- (T0) and post-treatment (T1) panoramic radiographs. Growth differences and rates were analyzed using descriptive and inferential statistics. Results: A significant increase in the mandibular ramus height (Co-Go) and in condylar height (Co-Is) was observed on the affected side from T0 to T1. The increase in mandibular ramus height was significantly greater on the affected side compared to the unaffected side (p = 0.0016). Although condylar height increased significantly on both sides over time, the difference in growth rate between sides was not statistically significant (p = 0.7148). Conclusions: Functional therapy may contribute to reducing mandibular asymmetry in CFM patients by enhancing the growth of the affected mandibular ramus, but the asymmetry may still be present at the end of treatment. These findings support its use in the early management of mild to moderate CFM. Full article