Paolo G. Morselli

Pull-through : a new technique for breast reduction in gynecomastia

This paper reports a new technique for breast reduction in gynecomastia, removing the glandular parenchyma by pulling it through two incisions previously made for liposuction. These incisions are localized in the anterior axillary pilar area and on the right side of the inframammary fold. No complications have been reported in the 6-month follow-up visits of 11 patients. The technique makes it possible to eliminate the incision in the areolar area, avoiding its related complications. The advantage of this technique is that it removes the breast parenchyma without leaving any scars in the breast aesthetic unit, which, from a psychological point of view, has been greatly appreciated by our patients.

New evidence for the role of cystathionine beta‐synthase in non‐syndromic cleft lip with or without cleft palate

Orofacial clefts have a multifactorial aetiology encompassing both genetic and environmental components. While there is wide agreement on the importance of both genetic and nutritional factors, genetic influence in particular has not been well defined. As genetic variants in folate and homocysteine metabolism have been reported to influence the risk of orofacial clefts, an Italian cleft lip with or without cleft palate (CL/P) data set was enrolled for an analysis based on family association to test betaine-homocysteine methyltransferase (BHMT and BHMT2) and cystathionine beta-synthase (CBS) variants. No significant level of association was found between BHMT and BHMT2 variants, while evidence of an allelic association with CL/P was found for the single nucleotide polymorphism rs4920037, mapping at the CBS gene. A log-linear approach indicated that the best genetic model takes into account both mother and child genotypes. This suggests that human orofacial development is influenced by CBS genotypes that possibly operate through intergenerational fetal-maternal interaction.

Temporalis muscle hypertrophy: a new plastic surgery procedure.

Bilateral hypertrophy of the temporal muscle can give the impression of a harsh facial appearance that manifests itself as a morphopsychological conflict for the subject involved (Minotaur syndrome). This article describes a new facial aesthetic surgical procedure in the area of the temporal muscle. The author describes the surgical technique and the surgical instrument that he developed specifically for performing aesthetic contouring of the temporal area by reducing the muscle volume discrepancy (“myosuction”). The follow-up results of 11 cases demonstrated that this procedure renders valid results in the overall aesthetic reharmonization of the face and an improvement of individual psychological well-being.

The Minotaur syndrome: plastic surgery of the facial skeleton.

This article remarks on the possibility of recontouring the face by working on the facial skeleton with the sole purpose of softening the facial appearance. The author describes a one-step surgical procedure performed on a 38-year-old man who had serious social problems because of his aggressive and threatening facial appearance that contrasted with his gentle personality. The author coins the term Minotaur Syndrome to describe the discrepancy between the patients true personality versus his negative facial appearance.

Clinical parameters in T1N0M0 lower lip squamous cell carcinoma.

This retrospective study was carried out to asses the clinical outcome of T1 (i.e., tumor 2 cm or less at greatest dimension) squamous cell carcinoma of the lower lip (SCCLL) and verify the impact of some clinical parameters on prognosis. Fifty-seven patients with histologically proven T1 SCCLL were analyzed. Fifty-two patients were never treated before admission, whereas five (8.8%) had a second radical resection of the primary tumor location; none had neck nodes (i.e., N0) or distant metastasis (i.e., M0). The global disease-specific survival rate at 32 months was 100%, irrespective of grading and type of surgery, and thus no differences were statistically detected. Therefore, we concluded that radical tumor resection is a viable procedure for T1 SCCLL, irrespectively of grading. In addition, a second surgery on the primary tumor location is possible and has effectiveness on survival. Finally, neck dissection is not necessary in cases of T1 SCCLL.

No evidence for a role of CRISPLD2 in non‐syndromic cleft lip with or without cleft palate in an Italian population

Non-syndromic cleft lip with or without cleft palate (NSCLP) is a malformation with variable phenotypes, resulting from a mixture of genetic and environmental factors. Some studies have supported a role for the 16q24 region and its candidate gene, CRISPLD2, in clefting. A replication study is necessary to confirm these findings. The aim of the present study was to test, by genetic linkage and association analyses, whether the candidate gene, CRISPLD2, represents a risk factor for NSCLP. The analysis of 39 multigenerational families provided formal exclusion of a linkage between NSCLP and the CRISPLD2 locus under different genetic models and non-parametric analyses. The family-based study of 239 unrelated probands and their parents revealed no association between any particular allele or haplotype and NSCLP. Therefore, the present investigation did not support the hypothesis of the involvement of CRISPLD2 in NSCLP malformation, at least with regard to the Italian population.

Plastic Surgery and Psychomorphology: A New Tool for Improving Communication Between Physician and Dysmorphopathic Patient and for Perfecting Appropriate Patient Selection

The relationship between physician and patient is becoming more and more delicate and requires an appropriate amount of attention and balance; this holds true in all medical disciplines, particularly in the field of plastic surgery. In this research project, the author proposes the use of a psychomorphology evaluation, as well as, a psychomorpholinguistic approach, in the global evaluation of plastic surgery candidates. The aim of this project was to present a pilot study that evaluated plastic surgery patient/physician relationship satisfaction outcome using psychomorphology and psychomorpholinguistic evaluation methods. The research was performed by comparing, a sample group in which the psychomorphology evaluation method was used and a control group that was traditionally evaluated. All the patients in this study have been diagnosed and graded with the dysmorphopathy classification system. The evaluation of patient satisfaction was obtained using Huskisson’s visual analogue scale and the SAT-P Satisfaction Profile. In the author’s opinion this method has aided him in gathering more precise information and having a deeper comprehension of the patient’s most profound psychological needs. This reduced the patient’s inappropriate illusions and delusions, which lead to severe psychological problems in accepting themselves. In addition, this method also can help prevent patient dissatisfaction with surgical outcome, thus reducing medical-legal encounters. This is not a methodology for judging or categorizing a patient. It should not be confused with the traditional physiognomic analysis. It is a dynamic analysis that also integrates one’s conflictual psychomorphological traits and by recognizing these, continually looks to arrive at a better comprehension for establishing a harmonious relationship between two people, in our situation, surgeon and patient.

Congenital cystic eye: From prenatal diagnosis to therapeutic management and surgical treatment

Only 28 cases of congenital cystic eye have been reported in the literature. The main issue in such cases is differential diagnosis between this malformation and different cystic malformations and masses of the orbital cavity and eyeball, the most common of which is microphthalmia with cyst. Both malformations arise from incomplete closure of the fetal optic vesicle in different stages of embryonic development.We present a case of congenital cystic eye, associated with coloboma and corneal dermoid of the fellow eye and with left brachiocephaly, discussing differential diagnosis with microphthalmia with cyst and illustrating the treatment we planned and performed. The patient first underwent a surgical excision of the left corneal dermoid, then a resection of the right orbital cyst. The last step was to perform a craniotomy and cranial vault remodeling. All the operations were planned and performed using a team approach. The team comprised an ophthalmologist, a plastic surgeon, and a neurosurgeon, and the result was a successful outcome.

VAC® therapy for wound management in patients with contraindications to surgical treatment

The treatment of complex wounds often requires multiple surgical debridement and eventually reconstruction with skin grafts or flaps, under local or general anesthesia. When the patients general conditions contraindicate surgical procedures, topical negative pressure with Vacuum Assisted Closure (VAC ®) device can achieve wound healing with reduction of healing time and simpler management. We treated with VAC ® device four patients with complex wounds and important contraindications to surgery. In all the patients, we used VAC ® device with common protocol of topical negative pressure. The healing was obtained in a period variable between 18 and 40 days; the results were satisfactory in three cases, one patient developed an aesthetically unpleasant scar. We present our experience to propose VAC ® when surgical procedures are contraindicated.

Study of ABCB1 multidrug resistance protein in a common orofacial malformation.

The onset of embryonic malformations is greatly determined by the intrauterine environment, conditioned by maternal lifestyle, diet, drugs and medication intake, in addition to both foetal and maternal genotypes. Maternal C677T MTHFR genotype has been identified as important factor in cleft lip with or without cleft palate (CL/P) etiology. In the present study we evaluated the possible interaction between maternal methylenetetrahydrofolate reductase (MTHFR) and foetal ABCB1 genotypes. ABCB1 gene codes for a drug-transport pump in charge to protect the cell by extruding a variety of harmful exogens, but with a reduced activity in a folate-restricted condition. Maternal 677T genotype is translated in a reduced folate availability for the developing embryo who consequently may becomes more exposed to external insults. A family based association analysis was performed to test the effect of ABCB1 polymorphisms in clefting, in the whole sample and in the stratified sample accordingly to maternal MTHFR genotype. No evidence of association between ABCB1 polymorphisms and CL/P was detected. This suggests that ABCB1 or ABCB1-MTHFR feto-maternal interaction could have no effect in orofacial clefting or could play a role in a limited number of cases.