especially, seems to be an area particularly in danger of further intracranial spread because of numerous potential pathways, such as the superior orbital fissure and the optic canal. 8 Surgical debride- ment needs to be performed thoroughly to remove all the necrotic tissues, which the antifungal agent cannot reach because of vascular occlusion. The appropriate surgical debridement extent is to remove the bone and the nearby soft tissues until there is some bleeding. Ethmoidectomy, which includes sphenoidotomy, wide frontal sinu- sotomy, and medial maxillectomy, was used in the past. Recently, endoscopic sinus surgery was introduced for diagnosis and surgi- cal debridement. If reconstruction is needed because of a radical resection, principle dictates that it needs to be done after all the infectious source has been subsided. Control of the underlying disease, such as diabetes, is very im- portant. If the underlying immune deficiency is not successfully treated, the prognosis is very poor. Also, systemic administration of intensified antifungal agent, amphotericin B, with high dosage (1.0Y1.5 mg/kg/d) is recommended. However, in this patient, con- sidering her history of acute renal failure by using amphotericin B for her pulmonary mucormycosis and the characteristic nature of an invasive but nonactive lesion, local irrigation of the nasal cavity with a mixture of normal saline (1000 mL) and amphotericin B (50 mg) was performed. 9 Although adjuvant hyperbaric oxygen therapy helps to improve acidosis, there is still an ongoing debate about its efficiency. The prognosis and course of chronic invasive cases can be hard to predict. Although surgery with supportive 6-week intensified anti- fungal agent treatment was instituted, there are many recurrences in chronic cases. Therefore, CT scan every 3 to 4 months and nasal endoscopic examination for every 2 to 3 months are strongly recom- mended for the early detection of the local recurrence or recurrence in adjacent organs such as the orbit and the brain. 10 We suggest that surgical debridement and nasal irrigation with a mixture of normal saline and amphotericin B be one of the treatments of patients with localized chronic indolent rhinocerebral mucormycosis who cannot be treated by systemic amphotericin B. REFERENCES 1. Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am 2000;33:349Y365 2. Szalai G, Fellegi V, Szabo Z, et al. Mucormycosis mimics sinusitis in a diabetic adult. Ann N Y Acad Sci 2006;1084:520Y530 3. Blitzer A, Lawson W, Meyers BR, et al. Patient survival factors in paranasal sinus mucormycosis. Laryngoscope 1980;90: 635Y648 4. Peterson KL, Wang M, Canalis RF, et al. Rhinocerebral mucormycosis: evolution of the disease and treatment options. Laryngoscope 1997;107:855Y862 5. Lee FYW, Mossad SB, Adal KA. Pulmonary mucormycosis: the last 30 years. Arch Intern Med 1999;159:1301Y1309 6. Kontoyiannis DP, Wessel VC, Bodey GP, et al. Zygomycosis in the 1990s in a tertiary-care cancer center. Clin Infect Dis 2000;30: 851Y856 7. Odessey E, Cohn A, Beaman K, et al. Invasive mucormycosis of maxillary sinus: extensive destruction with an indolent presentation. Surg Infect (Larchmt) 2008;9:91Y98 8. Park SK, Jung H, Kang MS. Localized bilateral paranasal murcormycosis: a case in an immunocompetent patient. Acta Otolaryngol 2006;126:1339Y1341 9. deShazo RD, O’Brien M, Chapin K, et al. A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 1997;123:1181Y1188 10. Ketenci I, Unlu ¨ Y, Sentu ¨rk M, et al. Indolent mucormycosis of the sphenoid sinus. Otolaryngol Head Neck Surg 2005;132: 341Y342 Presurgical Orthodontic Planning: Predictability Giampietro Farronato, MD, DDS, Lucia Giannini, DDS, Guido Galbiati, DDS, Carmen Mortellaro, MD, DDS, Cinzia Maspero, MD, DDS Abstract: The success of orthognathic surgery depends upon the anatomical details of the patient, the direction and extent of the nec- essary displacement, the experience of the surgical and orthodontic team, and the precision of presurgical orthodontic planning. The authors describe an experimental protocol to optimize presurgical orthodontic planning by the study of linear and rotational discrepancies of skeletal structures. Rotational changes of the skeletal structures can result in an overestimation or underestimation of linear discrepancies. Moreover, teeth can interfere with rotational movements, complicating presurgical planning. The study sample was a group of 20 adult patients, 7 males and 13 females. The inclusion criterion was adult patients who required correction of skeletal asymmetric class II or III malocclusion by os- teotomy. Movements in the horizontal, frontal, and midsagittal planes can be simulated and measured through model surgery after diagnostic wax-up of the orthodontic treatment objective. Orthodontic presur- gical preparation can be verified through the use of an occlusal splint, which represents a reliable guide during orthodontic preparation. The presurgical orthodontic phase can be obtained in less time and with more accuracy using this treatment planning method and indirect bonding of the orthodontic appliances. Key Words: Orthognathic surgery, orthodontic planning, asymmetries, articulator, face bow, three-dimensional diagnosis, orthodontic diagnostic set-up M odel surgery, typically performed by the surgeon the week before the surgical procedure, is an integral part of orthognathic surgery treatment protocol. The purpose of this article was to describe the protocol used in the Orthodontics Department of the University of Milan to optimize pre- surgical orthodontic planning by the study of linear and rotational discrepancies of skeletal structures. Rotational discrepancies can result in overestimation or underes- timation of linear discrepancies. Moreover, tooth position can interfere with rotational movements of the skeleton. Therefore, accurate plan- ning of presurgical tooth position becomes necessary to realize the planned skeletal movements. 1Y6 From the Department of Orthodontics, Fondazione IRCCS Ca ` GrandaVOspedale Maggiore Policlinico, Milan, Italy. Received November 15, 2012. Accepted for publication November 17, 2012. Address correspondence and reprint requests to Giampietro Farronato, MD, DDS, Department of Orthodontics, via Commenda 10, 20122 Milano, Italy; E-mail: giampietro.farronato@unimi.it The authors report no conflicts of interest. This study did not receive any funding from any of the following organizations: National Institutes of Health, Wellcome Trust, Howard Hughes Medical Institute, and other(s). Copyright * 2013 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e3182801d4a Brief Clinical Studies The Journal of Craniofacial Surgery & Volume 24, Number 2, March 2013 e184 * 2013 Mutaz B. Habal, MD Copyright © 2013 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.