Today autografts are considered to be an optimal material for bone grafting. However, the collection of material and its clinical use is associated with several serious drawbacks, and therefore, in reconstructive surgery, a search for alternative treatment approaches is being conducted. A bone transplant from another person (allo-osteoplasty) is the most natural and logical option for replacing an autobone. Since 1965, allogeneic implants of a partially demineralized bone matrix combining osteoinductive and osteoconductive action have been used in clinical practice. However, the clinical results of the use of this material turned out to be ambiguous, which is due, first of all, to the significant variability of the osteoplastic potential of its various samples. For this reason, in clinical practice, sometimes preference is given to samples of non-demineralized allobone, which retain its structure longer. In this paper, we consider factors affecting the osteoinductive activity of a partially demineralized bone matrix, related both to the technological issues of its preparation and to the clinical conditions of use. Issues of the possible improvement of this material were discussed with a view to its further use in medical practice.

На сегодняшний день операции на костях лицевого скелета связаны с такими послеоперационными явлениями, как отек, боль, тризм жевательных мышц и нарушение чувствительности в зоне 2-й и 3-й ветви тройничного нерва. Во многих научных работах было отмечено благоприятное воздействие холодовых компрессов на послеоперационную зону, а анатомо-топографическая особенность челюстной лицевой зоны затрудняет оценку отека лица. Один из перспективных методов реабилитации пациентов — контролируемая локальная гипотермия аппаратным методом, а структурное измерение отека лица — оптическое сканирование. Это исследование было направлено на оценку трехмерного оптического сканера и аппарата ViTermo после ортогнатических операций. Послеоперационный отек лечили либо обычными холодовыми компрессами, либо индивидуально изготовленными лицевыми масками и циркуляционной системой ViTermo. В каждой контрольной группе отмечали боль, жалобы, отек, тризм жевательных мышц, нарушение чувствительности в зоне 2-й и 3-й ветви тройничного нерва, продолжительность пребывания в стационаре и удовлетворенность пациента. Использование охлаждающего устройства ViTermo значительно уменьшило послеоперационный отек и улучшило реабилитацию пациента. Today, operations on the bones of the facial skeleton are associated with such postoperative phenomena as: swelling, pain, trismus of the masticatory muscles and impaired sensitivity in the zone of the 2nd and 3rd branches of the trigeminal nerve. Many scientific works have noted the beneficial effects of cold compresses on the postoperative area, and the anatomical and topographical feature of the maxillary facial area makes it difficult to assess facial edema. One of the promising methods of patient rehabilitation is controlled local hypothermia using a hardware method, and the structural measurement of facial edema is optical scanning. This study aimed to evaluate the 3D optical scanner and the Vitermo device after orthognathic surgery. Postoperative swelling was treated with either conventional cold packs or custom-made face masks and a ViTermo circulation system. In each control group, pain, complaints, swelling, trismus of masticatory muscles, sensory disturbance in the 2nd and 3rd branches of the trigeminal nerve, length of hospital stay, and patient satisfaction were noted. The use of the Vitermo cooling device significantly reduced postoperative swelling and improved patient recovery.

Objective: In this study, we analyzed the existing chin augmentation methods and evaluated the effectiveness of using a subplatysmal fat autograft for augmenting insufficient chin projection. Materials and Methods: From January 2017 to December 2023, we studied 170 patients at the Department of Plastic Surgery, Sechenov First Moscow State Medical University, who presented with insufficient chin projection, localized fat deposits in the cervico-mental area, and age-related changes in the lower third of the face. The patients were divided into two groups: Group 1 (n = 93) consisted of patients who underwent chin augmentation using implants (Silastic, Medpor); Group 2 (n = 77) included patients who underwent medial platysmaplasty and chin augmentation using a fat autograft (subplatysmal autograft). Results: Chin augmentation was performed on all the patients with varying degrees of insufficient chin projection. The mean age was 36.5 ± 2 years. The average follow-up period was 18.9 months (range: 2–45 months). For chin augmentation using implants (Silastic, Medpor), +chin projection increases were observed as follows: 1.1–1.2 cm at 3 months, 0.9–2.3 cm at 6 months, and 0.8–1.7 cm at 12 months. The complications in this group included inflammatory processes in 7 (8%) patients, hematomas in 6 (6%) patients, and contour asymmetry in 13 (14%) patients. In the group that underwent chin augmentation with a subplatysmal fat autograft, the chin projection increased by 0.8–1.2 cm at 3 months, 0.7–1.3 cm at 6 months, and 0.6–1.9 cm at 12 months. The mean age was 38.3 ± 7 years, with an average follow-up of 18.3 months (range: 2–43 months). No infectious–inflammatory complications were observed. Aesthetic complications were noted in 14 (18%) patients. Conclusions: Among the existing methods for chin augmentation, many still consider osseous genioplasty to give more predictable results. However, its traumatic nature and lengthy rehabilitation period prompt surgeons to seek effective yet less invasive alternatives. When selecting a minimally invasive method for chin augmentation, preference is given to fat injections (lipofilling) and intraoperative use of autologous fat grafts. Augmentation using subplatysmal autologous fat grafts is a minimally invasive, safe, predictable, and long-lasting method for chin correction.

Predictors of Premature Ventricular Contractions Development in Patients With SARS-CoV-2 Infection

Objective. To analyze current evidence on the use of botulinum toxin type A (BoNT-A) for optimizing neuromuscular adaptation and preventing complications after orthognathic surgery. Materials and methods. A literature search was conducted in PubMed, Scopus, and Elibrary (2017—2026). Randomized controlled trials, systematic reviews, and meta-analyses on BoNT-A effects on masticatory muscles in the maxillofacial area were included. Results. Direct clinical evidence is limited: Shin (2018) RCT showed that BoNT-A injection into the masseter muscles reduced plate fracture rate (2/16 vs. 8/16, p=0.031). Ban (2023) reported stable occlusion at 9 months after BoNT-A into the anterior belly of the digastric muscle (n=5). Systematic reviews confirm reversible masticatory muscle atrophy, decreased bite force, and EMG activity. Safety profile is favorable, with transient local adverse effects. A marked placebo effect has been demonstrated. Conclusion. BoNT-A may effectively reduce loading on osteosynthesis sites and prevent relapse, but existing studies have small sample sizes, short follow-up, and lack standardization. Large placebo-controlled trials with long-term follow-up are needed.

Background: Chronic obstructive pulmonary disease (COPD) is a frequent cause of atrial fibrillation (A-fib). A paroxysm of A-fib will protract the patients’ stay at hospital and increase their lethality risk considerably. Despite extensive research done in this field, the predictors of A-fib recurrence in COPD patients have not been definitively studied. Methods: Our single-institution prospective study involved 569 patients hospitalized for COPD exacerbation. Depending on whether they developed an A-fib paroxysm while in hospital, we divided the patients into two groups: group I (the main one) was composed of 111 COPD patients whose electrocardiogram (ECG) showed an A-fib paroxysm during hospitalization, and group II (the comparison group) comprised 458 COPD patients who had no A-fib paroxysm in their entire hospitalization period. All the patients were given a comprehensive clinical, laboratory, and instrumental examination that included a complete blood count and blood chemistry test, coagulogram, room air oxygen saturation test, external respiration test, standard ECG, echocardiogram, Holter daily ECG monitoring, and a chest computed tomography (CT) scan. Results: In exacerbated COPD patients, arterial hypertension (AH) would increase their risk of developing an A-fib paroxysm by a factor of 3.74 (confidence interval (CI) 2.78 - 4.19). Arrhythmic patients’ Charlson Comorbidity Index was veritably higher (5 (3 - 6) points) than in the comparison group (3 (2 - 5) points) (P = 0.004). A-fib patients had considerably lower oxygen saturation on room air (SpO2) (91.8% (89-95%)) than non-arrhythmic patients (95.2% (91-97%)). Right atrial area enlargement would increase exacerbated COPD patients’ risk of developing an A-fib paroxysm by a factor of 1.34 (1.16 - 1.56). A-fib patients were found to have a veritably raised level of C-reactive protein to 21.0 mg/L (5.65 - 35.2 mg/L), compared to non-arrhythmic patients with 8.3 mg/L (1.31 - 16.4 mg/L). Conclusion: The development of an A-fib paroxysm in patients hospitalized for exacerbated COPD is predicted by Charlson Comorbidity Index above 4, right atrial area enlargement, and heightened C-reactive protein.