Background: The term "orbital blow-out fracture" is referred to as the mechanism by which an impact to the eyeball is transposed as a mechanical energy to the orbital walls, causing them to fracture. Despite a proper surgical technique, a successful anatomic reconstruction of the orbit, and an accurate follow-up, 3 complications are still frequently observed at long-term follow-up: diplopia, enophthalmos, and hypesthesia of the infraorbital nerve territory. In this retrospective study, we analyze the incidence, the specific characterization, and the potential risk factors of these 3 complications. Methods: The records of 75 patients who underwent surgical repair of isolated orbital blow-out fracture from January 2001 to December 2007 at the Maxillofacial Surgery Unit of the Novara Major Hospital were reviewed retrospectively. Patients who had other coexisting facial fractures or orbital rim involvement were excluded from this study. The mean follow-up reached 39 months (range, 6-81 months). Enophthalmos was measured by a Hertel exophthalmometer; diplopia was evaluated by an optometrist with cover test, red glass test, and Hess-Lancaster test; and hypesthesia of the infraorbital nerve territory was checked by clinical examination. The studied parameters included patient's age and sex, time interval between trauma and surgery, location of the fracture, and implant material. The χ² test for nonparametric data was used, and a P value of less than 0.05 was considered statistically significant. Results: Sex, location of the fracture, and implant material were not considered statistically significant (P > 0.05). The unique variable that influenced our data was the time interval between trauma and surgery (P > 0.05). Discussion: Although the surgical technique was executed properly and the immediate postoperative recovery was uneventful, diplopia, enophthalmos, and infraorbital nerve dysfunction were the frequent complications. We stress the fact that orbital blow-out fracture is generally not considered a technically demanding procedure, but the outcome can be very disappointing; the surgical procedure must be managed very carefully by experienced surgeons to lower the high rates of these 3 common complications. However, we can report that the incidence of diplopia, enophthalmos, and infraorbital nerve dysfunction are decreased by an immediate intervention and an early surgical repair of the orbital blow-out fracture. Patients who had surgery within 2 weeks of trauma have a lower risk to develop postoperative complications; this study supports an early surgical treatment of orbital blow-out fractures, when it is indicated.

Despite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness. Multiple testing has documented a systematic variability during the day in the incidence of established signs of responsiveness. Spontaneous fluctuations of the Coma Recovery Scale-revised (CRS-r) scores are conceivable. We retrospectively analyzed the CRS-r repeatedly administered to 7 VS/UWS and 12 MCS subjects undergoing systematic observation during a conventional 13 weeks. rehabilitation plan. The CRS-r global, visual and auditory scores were found higher in the morning than at the afternoon administration in both VS/UWS and MCS subgroups over the entire period of observation. The probability for a VS/UWS subject of being classified as MCS at the morning testing at least once during the 13 weeks. observation was as high as 30 %, i.e., compatible with the reported misdiagnosis rate between the two clinical conditions. Multiple CRS-r testing is advisable to minimize the risk of misclassification; estimates of spontaneous variability could be used to characterize with greater accuracy patients with disorder of consciousness and possibly help optimize the rehabilitation plan.

Objectives: Considering sensory stimulation programs (SSP) as a treatment for disorders of consciousness is still debated today. Previous studies investigating its efficacy were affected by various biases among which small sample size and spontaneous recovery. In this study, treatment-related changes were assessed using time-series design in patients with disorders of consciousness (i.e., vegetative state—VS and minimally conscious state—MCS). Methods: A withdrawal design (ABAB) was used. During B phases, patients underwent a SSP (3 days a week, including auditory, visual, tactile, olfactory, and gustatory stimulation). The program was not applied during A phases. To assess behavioral changes, the Coma Recovery Scale-Revised (CRS-R) was administered by an independent rater on a weekly basis, across all phases. Each phase lasted 4 weeks. In a subset of patients, resting state functional magnetic resonance imaging (fMRI) data were collected at the end of each phase. Results: Twenty nine patients (48 ± 19 years old; 15 traumatic; 21 > a year post-injury; 11 VS and 18 MCS) were included in our study. Higher CRS-R total scores (medium effect size) as well as higher arousal and oromotor subscores were observed in the B phases (treatment) as compared to A phases (no treatment), in the MCS group but not in the VS group. In the three patients who underwent fMRI analyses, a modulation of metabolic activity related to treatment was observed in middle frontal gyrus, superior temporal gyrus as well as ventro-anterior thalamic nucleus. Conclusion: Our results suggest that SSP may not be sufficient to restore consciousness. SSP might nevertheless lead to improved behavioral responsiveness in MCS patients. Our results show higher CRS-R total scores when treatment is applied, and more exactly, increased arousal and oromotor functions.

Mindfulness is one of the most popular psychotherapeutic techniques that help to promote good mental and physical health. Combining mindfulness with immersive virtual reality (VR) has been proven to be especially effective for a wide range of mood disorders for which traditional mindfulness has proven valuable. However, the vast majority of immersive VR-enhanced mindfulness applications have focused on clinical settings, with little evidence on healthy subjects. This narrative review evaluates the real effectiveness of state-of-the-art mindfulness interventions mediated by VR systems in influencing mood and physiological status in non-clinical populations. Only studies with an RCT study design were considered. We conclude that most studies were characterized by one single meditation experience, which seemed sufficient to induce a significant reduction in negative mood states (anxiety, anger, depression, tension) combined with increased mindfulness skills. However, physiological correlates of mindfulness practices have scarcely been investigated. The application of VR-enhanced mindfulness-based interventions in non-clinical populations is in its infancy since most studies have several limitations, such as the poor employment of the RCT study design, the lack of physiological measurements (i.e., heart rate variability), as well as the high heterogeneity in demographical data, technological devices, and VR procedures. We thus concluded that before applying mindfulness interventions mediated by VR in clinical populations, more robust and reliable methodological procedures need to be defined.

Background Within the field of facial reconstructive surgery, minimally invasive procedures are used for the treatment of temporomandibular joint disorders, traumas, and salivary glands and base of skull tumors. The recent report of endoscopic approach for treating subcondylar fractures of the mandible is designed to provide a new method for the treatment of subcondylar fractures using an endoscope through a limited transoral incision. To the best of our knowledge, the advantages and the disadvantages of an endoscopically assisted approach to mandibular condylar fracture have not been verified in studies with a high level of evidence. The objective of this article was to present our experience regarding the endoscopically assisted reduction of subcondylar mandibular fractures with a special focus on complications. Methods The records of 14 patients who underwent surgical repair of subcondylar fractures by transoral endoscopic-assisted technique from January 2005 to December 2008 at the Maxillofacial Surgery Unit of Novara Major Hospital were reviewed retrospectively. The measures for the surgical objectives included the following outcome variables: (1) operation time, (2) cosmetic outcome, (3) salivary fistulas, (4) infection, (5) delayed wound healing, (6) facial nerve damage, (7) hemorrhage, (8) repeat interventions, (9) bone consolidation, (10) occlusion changes, and (11) temporomandibular joint dysfunction. Results Our data show that we have had 4 complications (28%) experienced by 4 different patients: (1) arterial hemorrhage, (2) facial nerve injury, (3) nonunion, and (4) partial condylar reabsorption. Conclusions Although we cannot draw statistically significant conclusions, we think that further randomized clinical trials should be necessary to analyze this method; we believe that there is not an ideal approach for a fracture, but each patient needs to be fully evaluated carefully preoperatively, and the more convenient approach needs to be selected for each case.

Activations to pleasant and unpleasant musical stimuli were observed within an extensive neuronal network and different brain structures, as well as in the processing of the syntactic and semantic aspects of the music. Previous studies evidenced a correlation between autonomic activity and emotion evoked by music listening in patients with Disorders of Consciousness (DoC). In this study, we analyzed retrospectively the autonomic response to musical stimuli by mean of normalized units of Low Frequency (nuLF) and Sample Entropy (SampEn) of Heart Rate Variability (HRV) parameters, and their possible correlation to the different complexity of four musical samples (i.e. Mussorgsky, Tchaikovsky, Grieg and Boccherini) in Healthy subjects and Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients. The complexity of musical sample was based on Formal Complexity and General Dynamics parameters defined by Imberty’s semiology studies. The results showed a significant difference between the two groups for SampEn during the listening of Mussorgsky’s music and for nuLF during the listening of Boccherini and Mussorgsky’s music. Moreover, the VS/UWS group showed a reduction of nuLF as well as SampEn comparing music of increasing Formal Complexity and General Dynamics. These results put in evidence how the internal structure of the music can change the autonomic response in patients with DoC. Further investigations are required to better comprehend how musical stimulation can modify the autonomic response in DoC patients, in order to administer the stimuli in a more effective way.