We present an uncommon case of nasal alar and facial necrosis following calcium hydroxylapatite filler injection performed elsewhere without direct physician supervision. The patient developed severe full-thickness necrosis of cheek and nasal alar skin 24 h after injections into the melolabial folds. Management prior to referral included oral antibiotics, prednisone taper, and referral to a dermatologist (day 3) who prescribed valacyclovir for a presumptive herpes zoster reactivation induced by the injection. Referral to our institution was made on day 11, and after herpetic outbreak was ruled out by a negative Tzanck smear, debridement with aggressive local wound care was initiated. After re-epithelialization and the fashioning of a custom intranasal stent to prevent vestibular stenosis, pulsed dye laser therapy was performed for wound modification. The patient healed with an acceptable cosmetic outcome. This report underscores the importance of facial vasculature anatomy, injection techniques, and identification of adverse events when using fillers. A current treatment paradigm for such events is also presented.

BACKGROUND: Mid-face reflation requires a sophisticated knowledge of bony and soft tissue anatomy.
OBJECTIVE: To blend knowledge of the relevant anatomy with clinical experience to generate procedural guidelines for reproducible volumization of the midface.
METHODS: A demonstration of cadaver head dissection was followed by injection of colored hyaluronic acid and calcium hydroxylapatite fillers into cadaver heads in the anatomy laboratory. The injected cadaver heads were then dissected to assess the anatomical position of the injected fillers. Live patient injections followed using the anatomic learning.
RESULTS: Best practice guidelines for midface and infraorbital hollow injections were discussed.
CONCLUSIONS: Aesthetic augmentation of the midface requires knowledge of the properties of each filler and of the underlying anatomy, as well as an understanding and documentation of the subject\'s aesthetic concerns.

OBJECTIVE: It is believed that minimizing inconsistencies in OAR-volume definition will help to improve adequate reporting and interpreting of radiation treatment results. The aim of this paper is to introduce computed tomography (CT)-based delineation guidelines for organs at risk (OARs) in the head and neck area, associated with radiation-induced salivary dysfunction and xerostomia.
METHODS: After analyses of the human anatomy of the head and neck area, computed tomography (CT)-based guidelines for delineation of the most relevant OARs were described by a panel of experts.
CONCLUSIONS: The provided OAR guidelines are accompanied by CT-based illustrations presenting examples of the delineated structures and their corresponding anatomic boundaries. The parts of the tongue bearing minor salivary glands could not be outlined. Difficulties and uncertainties in defining these minor salivary glands on CT remain to be resolved. Implementation of these guidelines in practice should lead to a reduction in inter- and intra-observer variability and therefore unambiguous reporting of possible dose-volume effect relationships.

In recent years, studies on the malignant potential of oral lichen planus (OLP) provided clinical evidence that patients affected by OLP have an increased risk to develop oral squamous cell carcinoma (OSCC); nevertheless, controversies still exist as to whether OLP has inherent predisposition to become malignant, or not. We believe extremely careful management of OLP patient is mandatory, and the aim of this paper is to illustrate our clinical guidelines in evaluating the possible risk of transformation in OLP lesions. Five-hundred and two patients (311 women and 191 men) affected by OLP regularly undergo follow-up examination in our Department. Patients\' ages range from 18 to 83 years, with a mean of 55.4 years (57.5 for women and 53.9 for men); minimal follow-up period is 4 months, with a maximum of 12 years. In our group of OLP patients in the past 5 years we detected 24 carcinomas: excluding three cases in which diagnoses of OLP and OSCC were synchronous and three patients who had a history of tobacco use, thus possible malignant transformation of OLP would appear to be 3.7%. Clinical criteria used in our follow-up allowed us to detect 28.5% of tumours as in situ OSCC, 38% as microinvasive OSCC, 28.5% as stage I OSCC and 4.7% as stage II OSCC, with a remarkable improvement in prognosis compared to our previous study in which we adopted different criteria.

Orthodontists have traditionally viewed structural discrepancies as the major limitation of treatment. In reality, it is the soft tissues that more closely determine therapeutic modifiability. The boundaries of dental compensation for an underlying jaw discrepancy are established by pressures exerted on the teeth by the lips, cheeks, and tongue; limitations of the periodontal attachment; neuromuscular influences on mandibular position; and the contours of the soft tissue facial mask. The ability of the soft tissues to adapt to changes in tooth-jaw relationships are far narrower than the anatomic limits in correcting occlusal relationships. The tolerances for soft tissue adaptation from equilibrium, periodontal, and facial balance standpoints are in the range of 2 to 3 mm for expansion of the mandibular arch and even less for changes in condylar position. Thus, analysis of the soft tissues is the critical step in orthodontic decision making, and this can only be accomplished through physical examination of the patient. Although quantitative measurements cannot be rigorously applied, guidelines for soft tissue assessment, with particular emphasis on facial esthetics, are proposed. From this perspective, a contemporary philosophy of orthodontic practice is offered, with general indications and contraindications for nonextraction, extraction, and surgical treatment.