Journal of Cranio-Maxillofacial Surgery最新文献

{"title":"Efficiency and outcomes in microvascular anastomosis: A meta-analysis of mechanical versus manual techniques.","authors":"Chaim Ohayon, Niv Gross, Tal Capucha, Shaqed Carasso, Yotam Shkedy, Adi Rachmiel, Omri Emodi","doi":"10.1016/j.jcms.2025.07.015","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.07.015","url":null,"abstract":"<p><p>Microvascular anastomosis plays a critical role in free flap transfers, aiming to reduce ischemia time, minimize vessel trauma, and optimize ease of use. This meta-analysis compares coupler devices and hand-sewn techniques for venous anastomosis across all types of free flaps, with a subgroup analysis focused on head and neck reconstruction. A comprehensive literature search following PRISMA guidelines was conducted across multiple databases up to November 6, 2024. Eighteen retrospective comparative studies met the inclusion criteria from an initial pool of 3184 articles. The overall flap loss rate was 1.53 % for coupler devices and 2.32 % for hand-sewn techniques. Thrombosis occurred in 2.91 % of coupler cases versus 3.17 % for hand-sewn. Anastomosis time was notably shorter with coupler devices (7.5 min) compared to hand-sewn methods (32.2 min). In head and neck reconstruction, the coupler group showed even more favorable outcomes: flap loss was 0.66 % versus 3.08 %, thrombosis rates were 1.7 % versus 3.88 %, and anastomosis times were 7.5 versus 17 min. These findings suggest that coupler devices are a safe and time-efficient alternative to traditional hand-sewn techniques in free flap surgery, particularly in head and neck reconstruction.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandibular condyle dislocation into the middle cranial fossa: First report of CAS-guided surgical management.","authors":"Vittorio Chiantini, Simone Benedetti, Andrea Frosolini, Flavia Cascino, Guido Gabriele, Vittoria Fantozzi, Salvatore Chibbaro, Luisa Bini, Alfonso Cerase, Paolo Galluzzi, Paolo Gennaro, Olindo Massarelli","doi":"10.1016/j.jcms.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.07.004","url":null,"abstract":"<p><p>Traumatic mandibular condylar fractures are the most common mandibular fractures in maxillofacial surgery. Approximately 42 % of facial skeletal fractures involve the mandible, and of these, 34 % involve the mandibular condyle. Normally, due to its anatomical structure, the mandibular condyle fractures upon impact and dislocates anteriorly and/or medially. This mechanism preserves the integrity of the cranial base. In rare cases, a fracture of the glenoid fossa and an intrusion of the condylar head at the level of the middle cranial fossa occurs. This represents a serious complication, in which ensuring patient survival is the primary goal of the treatment, possibly followed by the restoration of joint functionality and the prevention of ankylosis. We present the first documented application of computer-assisted surgery (CAS) aided by in-house 3D printing for the management of this condition, enabling precise preoperative planning, enhanced patient counseling, and successful surgical outcomes. Stable occlusion and mandibular mobility were achieved and preserved after 3 months, with the support of re-adapted prostheses used for intermaxillary fixation and functional rehabilitation. This novel approach underscores the potential of CAS and 3D printing to revolutionize the preoperative and surgical approach of rare and complex cranio-maxillofacial cases.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costal cartilage graft harvesting for auricular reconstruction: donor-site morbidity assessment.","authors":"Laura Tognin, Jacopo Benerecetti, Michela Bergonzani, Francesca Zito, Giovanni Lilloni, Andrea Varazzani, Marilena Anghinoni","doi":"10.1016/j.jcms.2025.07.008","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.07.008","url":null,"abstract":"<p><p>Auricular reconstruction is a challenging procedure, and the use of autologous costal cartilage represents the gold standard for the treatment of congenital microtia. Since adolescents are a significant demographic for congenital reconstruction, age-related psychosocial factors must be considered. The aim of this study was to evaluate postoperative patient perception of donor-site morbidity following costal cartilage graft harvesting and its impact on social and physical activities. We included patients treated at the University Hospital of Parma (Italy) between 2010 and 2020. Data collected included: scar evaluation, asymmetry of the thoracic profile, sport participation before and after surgery, physical limitation, donor-site long-term discomfort, postoperative pain. A total of 100 patients were enrolled in the study (58 males and 42 females; mean age: 13.58 years), reporting good long-term aesthetic results at the thoracic site, with female patients showing slightly better outcomes. The majority (82 %) participated in sports before surgery, and 70 % continued the same activities afterward. Minimal chest deformity or thorax asymmetry was reported by 30 patients (30 %). The study confirms that postoperative donor-site morbidity following costal cartilage graft harvesting is low. Sporting activities do not appear to be significantly affected by ear reconstruction procedures, supporting social and psychological development in growing patients.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-dimensional morphometric analysis of alar asymmetry in unilateral secondary cleft nasal deformity: implications for non-cleft alar reduction in surgical planning.","authors":"Qingqing Li, Guang Zhang, Wenjun Di, Mengmeng Zhang, Menghao Deng, Tianyi Gu, Yongqian Wang","doi":"10.1016/j.jcms.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.07.010","url":null,"abstract":"<p><p>Preoperative surgical planning for alar reduction remains challenging due to the lack of objective references in traditional measurements. Therefore, this study aimed to objectively quantify preoperative bilateral alar symmetry using 3D best-fit alignment analysis, and to establish an evidence-based threshold for alar morphological deviation for alar reduction in secondary cleft rhinoplasty. 26 patients with unilateral secondary cleft nasal deformity were retrospectively assessed: 13 underwent secondary cleft rhinoplasty alone and 13 received concurrent alar reduction. Preoperative 3D facial images were processed with best-fit alignment analysis to quantify alar morphological deviation between the cleft and non-cleft alar surfaces. Symmetry scores were also assessed by plastic surgeons using a four-point Likert scale (1 = poor, 2 = fair, 3 = good, 4 = excellent), based on pre- and postoperative standard photographs. In both groups, the cleft-side alar exhibited a distinctly smaller size compared with the non-cleft side. The combined alar reduction group showed significantly larger preoperative alar morphological deviation (2.49 ± 0.52 mm versus 1.19 ± 0.35 mm; p < 0.05). Morphological deviation analysis revealed a surgical threshold of 1.5-2 mm. Postoperative symmetry scores were significantly improved in both groups. 3D best-fit alignment analysis is a reliable method for objectively quantifying alar asymmetry. Non-cleft alar reduction is recommended during secondary rhinoplasty when preoperative alar morphological deviation reaches 2 mm.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-driven CBCT segmentation and 3D modeling of the anterior surface of maxilla for computer-assisted surgery: a comparison of multiple algorithms.","authors":"Hei Yuet Lo, Pui Hang Leung, Yu-Xiong Su, Yiu Yan Leung, Andy Wai Kan Yeung, Wei-Fa Yang","doi":"10.1016/j.jcms.2025.07.007","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.07.007","url":null,"abstract":"<p><strong>Aims: </strong>The maxilla is frequently involved in virtual surgical planning (VSP), serving as a base for osteotomies and designing patient-specific devices. However, segmenting thin bone structures like the anterior surface of the maxilla is challenging, often resulting in defects that compromise VSP. Our study aimed to compare various segmentation and 3D modeling algorithms for the anterior surface of the maxilla in CBCT, to serve as a reference for clinical practice.</p><p><strong>Materials and methods: </strong>The study included 20 patients preparing for orthognathic joint surgery. Various segmentation and 3D modeling algorithms were compared, including manual segmentation, threshold segmentation, 3D hole repairing, and AI segmentation, using Mimics Viewer and Blue Sky Plan software. The accuracy of each segmentation method was evaluated using the Dice Similarity Coefficient (DSC) and 95 % Hausdorff distance (HD95). Additionally, the clinical applicability of the 3D models was qualitatively evaluated using questionnaires focused on surface consistency, structural completeness, surface smoothness and noise, accuracy of anatomical features, and overall suitability for virtual surgical planning. Statistical analysis was performed using non-parametric tests.</p><p><strong>Results: </strong>For segmentation accuracy, threshold segmentation and 3D hole repairing achieved significantly higher DSC and HD95 compared with other algorithms. AI segmentation in Mimics Viewer achieved a DSC of 0.90 ± 0.03 and an HD95 of 0.72 ± 0.50 mm, less than 1 mm.With regard to the qualitative assessment of clinical applicability, the score for Mimics Viewer was 3 (IQR: 3-4; p < 0.001), which outperformed the other algorithms for accuracy of anatomical features. Blue Sky Plan had the lowest median DSC (0.78 ± 0.12) and highest HD95 (2.02 ± 0.80 mm).</p><p><strong>Conclusion: </strong>3D hole repairing using 3-matic gave the best performance in terms of both accuracy and quality assessment for the anterior surface of the maxilla. AI-driven segmentation using Mimics Viewer, designed specifically for craniomaxillofacial surgery, provides optimal performance and could be a valuable tool in VSP.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of isolated midface and forehead fractures and pattern of fractures of the midface and forehead in cases with panfacial fractures - A study from 2007 to 2024 on 6588 patients.","authors":"Ákos Bicsák, Leonie Koch, Stefan Hassfeld, Lars Bonitz","doi":"10.1016/j.jcms.2025.07.012","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.07.012","url":null,"abstract":"<p><strong>Introduction: </strong>This study analyses upper and midface fracture patterns and demographics from 2007 to 2024 in a highest-level German interregional trauma centre, comparing isolated and pan-facial fractures to improve diagnostics and treatment.</p><p><strong>Materials and methods: </strong>The data from our Maxillofacial Trauma Registry was analyzed by demographic methods, χ2-test for group comparison, and Wilcoxon ranked test.</p><p><strong>Results: </strong>In this study of 5459 isolated and 1129 panfacial fracture cases, males predominated (ratios: 2.1:1 and 3.4:1, respectively). Male patients peaked at ages 20-30, while females peaked at 80+. Average ages were similar across groups (46.3 vs. 46.2 years). Yearly panfacial cases declined steadily, while isolated cases showed volatility after 2020. Statistical tests revealed significant differences in fracture distributions \"far from the cranial base\" (p = 0.047) but not \"near the cranial base\" (p = 0.807), highlighting biomechanical implications.</p><p><strong>Discussion: </strong>Young males and older females are the most fracture-prone groups. The fracture distribution highlights the biomechanical significance of the cranial base. While demographic shifts and pandemic-driven case volatility necessitate ongoing monitoring for effective healthcare planning.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive three-dimensional morphological changes in perioral soft tissue following bimaxillary orthognathic surgery in patients with skeletal Class III malocclusion.","authors":"Chi Zhang, Yuan Si, RuoYuan Li, Yule Xu, Yuan Li, Jinwei Qin, Hua Wang, Han Ge, Dongmiao Wang, Jie Cheng","doi":"10.1016/j.jcms.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.07.006","url":null,"abstract":"<p><p>This study aimed to comprehensively evaluate the three-dimensional morphological changes in perioral soft tissue in patients with skeletal Class III malocclusion after combined orthognathic-orthodontic treatment. In total, 68 eligible patients with skeletal Class III malocclusion who underwent bimaxillary surgery and orthodontics between January 2019 and January 2023 were included. Cone-beam computed tomography data were collected for each patient at three stages: pre-treatment (T0), 1 week before surgery (T1), and on completion of treatment (T2). Perioral soft-tissue changes, including upper/lower lip vermilion thickness, alar width, and nasolabial and mentolabial angles, were measured via image reconstruction and 3D measurements using Dolphin Software. Upper/lower lip thickness increased after preoperative orthodontics (T0-T1), while decreased upper lip thickness and increased lower lip thickness were observed after orthognathic surgery (T1-T2) and the whole treatment (T0-T2). Increased alar width and nasolabial angle, along with decreased mentolabial angle, were observed after orthognathic surgery. Lip thickness significantly correlated with incisor inclination in both jaws. Alar width, alar base width, and nasolabial angle positively correlated with maxillary anteroposterior or vertical movement. Collectively, our results comprehensively delineate perioral soft-tissue changes in patients with skeletal Class III malocclusion following combined orthodontic-orthognathic surgery, and underscore the necessity of incorporating perioral soft-tissue changes into treatment planning.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using sublingual gland flap for reconstruction after tongue resection: experience with 31 patients.","authors":"Meng Wang, Fengzhi Liu, Dongpo Li, Yubo Wei, Xiaoyan Zhang, Shuangyi Wang, Lin Wang","doi":"10.1016/j.jcms.2025.06.013","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.06.013","url":null,"abstract":"<p><p>The objective of this study was to evaluate the advantages of using sublingual gland flap (SGF) repair compared to primary suturing after resection of tongue cancer. From January 2020 to December 2023, 119 patients with stage T1-T2 tongue cancer underwent surgical resection. Among them, 31 patients received sublingual gland flap reconstruction, while the other 88 patients underwent primary suture. Patients were double-blinded and divided into two groups: the \"one-stage suture\" group and the \"sublingual gland flap\" Group. Postoperative follow-up at 6 months assessed the time required for recovery of speech, swallowing, tongue movement, and morbidity at the donor site. SPSS 26.0 software was used for statistical analysis. No significant differences were found between the groups in speech intelligibility (Control: P = 0.908; Acceptable: P = 0.881). However, swallowing ability recovery was significantly better in the SGF group compared to the primary suture group (MTF classification good: P = 0.028; Acceptable: P = 0.001). SGF repair provides tissue volume to the tongue and preserves its movement, speech intelligibility, and swallowing ability. This study also acknowledges limitations, including sample size imbalance and short follow-up time, which are discussed in detail. Further improvements are needed to the SGF to reduce complications and improve patient quality of life, and this work lays the foundation for these improvements.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact-resistance of bio-inspired functionalized polyether-ether-ketone implant for cranioplasty.","authors":"Dylan Coyle, Bianca Zumbo, Niko Moritz, Janek Frantzén, Kalle Aitasalo, Gianluca Turco, Julia Kulkova","doi":"10.1016/j.jcms.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.06.009","url":null,"abstract":"<p><p>This study introduces Amanita, a pioneering bionic design for a fully 3D-printed cranial implant made of polyether-ether-ketone (PEEK) functionalized with bioactive glass granules. The mechanical integrity of cranial implants is crucial for effective brain protection. The primary aim was to evaluate the mechanical resistance of this innovative implant to validate its functionality for cranial protection. We employed a standardized biomechanical testing protocol to assess the mechanical properties of the Amanita implants. The implants were subjected to impact forces that simulated real-life blunt trauma scenarios to test their performance under stress. The Amanita implants exhibited significant resilience under compressive forces, withstanding over 100 N at a 2 mm deflection and effectively absorbing more than 1000 mJ at a 6 mm deflection. Furthermore, these implants maintained structural integrity without catastrophic failure at deflections up to 10 mm. The findings validate the design and manufacturing approach of the Amanita implants, demonstrating their potential for clinical use in cranioplasty. The implants showed adequate impact resistance, potentially lowering the risk of injury from falling objects or blunt trauma. Additionally, the adoption of additive manufacturing techniques enables the production of these implants on-site at hospitals, promoting socially and environmentally sustainable healthcare solutions.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of sagittal position of the articular disc on condylar bone remodeling after disc repositioning surgeries in adolescents: A retrospective cohort study.","authors":"Yifan Chen, Xiao Zhang, Liangchen Tang, Min-Er Chen, Chenlong Xia, Mengjie Wu, Xiaoling Wang, Jianxiang He, Mengfei Yu, Zhiyong Li","doi":"10.1016/j.jcms.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.07.001","url":null,"abstract":"<p><p>The effect of postoperative position of the articular disc on condylar bone remodeling in adolescents with anterior disc displacement without reduction (ADDwoR) remains unclear. This study aimed to evaluate the effect of sagittal position of disc on condylar morphology and clinical outcomes. 51 adolescents (81 joints) were included. Patients were divided into three groups (group A, B, C form anterior to posterior) based on the sagittal position of disc as shown by postoperative MRI. Clinical outcomes (improvement in pain levels, maximum incisal opening, and abnormal mouth opening) and both quantitative (measurements of condyle based on three-dimensional evaluation) and qualitative (bone remodeling areas of condyle based on two-dimensional evaluation) variables in CBCT were analyzed across groups. The results showed that the different sagittal positions of the disc after surgery significantly affect condylar bone remodeling 6 months postoperatively in adolescents with ADDwoR. Broader areas of bone formation were observed in Groups B and A compared to Group C, resulting in a less uniform condylar shape. As the repositioned disc shifted posteriorly, the bone remodeling area on the condyle correspondingly moved posteriorly. Surgical strategies should prioritize appropriate disc positioning to optimize bone regeneration and reduce postoperative degeneration.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}