Head and Neck Medicine by Alexandros G.Sfakianakis: 2016

Σάββατο 31 Δεκεμβρίου 2016

Carcinoma of buccal mucosa with metastasis to thigh

Squamous cell carcinoma of the oral cavity ranks as the twelfth most common cancer in the world and the eighth most frequent in males. In USA, cancers of oral cavity comprises approximately 3% of all cancers, the most common sub site for oral cavity carcinomas being the tongue followed by floor of mouth among all Head and Neck squamous cell carcinoma (HNSCC). Buccal mucosa is the most common oral cancer in men and the third most common oral cancer in women in India; and accounts for up to one-third of all tobacco-related cancers.

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Rejection versus escape: the tumor MHC dilemma

Abstract

Most tumor cells derive from MHC-I-positive normal counterparts and remain positive at early stages of tumor development. T lymphocytes can infiltrate tumor tissue, recognize and destroy MHC class I (MHC-I)-positive cancer cells ("permissive" phase I). Later, MHC-I-negative tumor cell variants resistant to T-cell killing emerge. During this process, tumors first acquire a heterogeneous MHC-I expression pattern and finally become uniformly MHC-I-negative. This stage (phase II) represents a "non-permissive" encapsulated structure with tumor nodes surrounded by fibrous tissue containing different elements including leukocytes, macrophages, fibroblasts, etc. Molecular mechanisms responsible for total or partial MHC-I downregulation play a crucial role in determining and predicting the antigen-presenting capacity of cancer cells. MHC-I downregulation caused by reversible ("soft") lesions can be upregulated by TH1-type cytokines released into the tumor microenvironment in response to different types of immunotherapy. In contrast, when the molecular mechanism of the tumor MHC-I loss is irreversible ("hard") due to a genetic defect in the gene/s coding for MHC-I heavy chains (chromosome 6) or beta-2-microglobulin (B2M) (chromosome 15), malignant cells are unable to upregulate MHC-I, remain undetectable by cytotoxic T-cells, and continue to grow and metastasize. Based on the tumor MHC-I molecular analysis, it might be possible to define MHC-I phenotypes present in cancer patients in order to distinguish between non-responders, partial/short-term responders, and likely durable responders. This highlights the need for designing strategies to enhance tumor MHC-I expression that would allow CTL-mediated tumor rejection.

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TNF-alpha stimulation increases dental pulp stem cell migration in vitro through integrin alpha-6 subunit upregulation

Publication date: March 2017
Source:Archives of Oral Biology, Volume 75
Author(s): Lei Shi, Shanqi Fu, Sidra Fahim, Shuang Pan, He Lina, Xiaodan Mu, Yumei Niu
ObjectiveThe dissemination of stem cells into tissues requiring inflammatory and reparative response is fundamentally dependent upon their chemotactic migration. Expression of TNF-α is up regulated in inflamed pulps. Dental pulp cells are also known to express integrin α6 subunit. Expression of integrin subunit α6 has been linked to the acquisition of migratory potential in a wide variety of cell types in both pathological and physiological capacities. Therefore, in this study we examined the effects of a pleiotropic cytokine TNF-α on the migration of hDPSCs and investigated its relationship with expression of integrin α6 in hDPSCs during chemotactic migration.DesignhDPSC cultures were established. Protein expression profile of α6 integrin subunit was determined. Effect of exogenous TNF-α (50ng/mL) on hDPSCs' migration potential was evaluated by transwell inserts and in vitro scratch assay. Upregulation/downregulation of TNF-α mediated migration was assayed in presence/absence of integrin α6 respectively. To suppress integrin α6 expression, cells were transfected with integrin α6 siRNA and then cell migration and cytoskeletal changes were evaluated.ResultsOur results showed significant increase of hDPSCs' migration after stimulation with TNF-α. By knockdown of integrin α6, which is upregulated by TNF-α, we observed a decrease in the TNF-α directed chemotaxis of hDPSCs.ConclusionIn this study, we show that activation of integrin α6 brought about by TNF-α led to an increase in migratory activity in DPSCs in vitro thus describing a novel association between a cytokine TNF-α and α6 chain of an adhesion receptor integrin in regulating migration of hDPSCs.

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Transient receptor potential melastatin (TRPM) 8 is expressed in freshly isolated native human odontoblasts

Publication date: March 2017
Source:Archives of Oral Biology, Volume 75
Author(s): Kento Tazawa, Hideharu Ikeda, Nobuyuki Kawashima, Takashi Okiji
ObjectiveCold-sensitive ion channels, such as transient receptor potential melastatin (TRPM) 8 and transient receptor potential ankyrin (TRPA) 1, may play a crucial role in the nociceptive function of odontoblasts, whereas expression of these TRP channels in human native odontoblasts remains to be elucidated. This study aimed to analyze the expression of TRPM8 and TRPA1 in freshly isolated native human odontoblasts.DesignOdontoblasts were isolated from freshly extracted healthy human teeth (n=4); after removing the inner pulp tissues from the pulp chambers, odontoblasts remaining on the dentin surface were washed out with phosphate buffered saline and collected. Reverse transcription-polymerase chain reaction was employed to compare the expression levels of TRPM8, TRPA1, and dentin matrix acidic phosphoprotein 1 (DMP1) mRNAs between the isolated odontoblasts and the inner pulp tissues. The isolated cells were subjected to immunolocalization of TRPM8 and nestin. Paraformaldehyde-fixed, EDTA-demineralized frozen sections obtained from freshly extracted healthy human teeth (n=4) were also analyzed immunohistochemically using anti-nestin, TRPM8, and TRPA1 antibodies.ResultsExpression levels of TRPM8 and DMP1 in the isolated odontoblasts were significantly higher than those in the inner pulp tissues (p<0.05). Expression of TRPM8 and nestin was observed in the odontoblastic layer of the dental pulp tissue and isolated odontoblasts, while expression of TRPA1 was not detected.ConclusionsTRPM8, but not TRPA1, was detected in freshly isolated native human odontoblasts at the protein and mRNA levels, suggesting that odontoblasts play an important role in detecting external cold stimulation via TRPM8 in healthy condition.

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Expression of matrix metalloproteinases-2, -9 and reversion-inducing cysteine-rich protein with Kazal motifs in gingiva in periodontal health and disease

Publication date: March 2017
Source:Archives of Oral Biology, Volume 75
Author(s): Nian Liu, Yingguang Cao, Guangxun Zhu
Background and objectivePeriodontitis is characterized by pathological destruction of extracellular matrix (ECM) of periodontal tissues. Matrix metalloproteinases (MMPs) promote the occurrence and development of periodontitis by degrading almost all proteins of ECM. RECK (reversion-inducing-cysteine-rich protein with kazal motifs), a novel membrane-anchored inhibitor of MMPs, could regulate the expression of MMP-2 and MMP-9 at post-transcriptional level. The study was to investigate the expression of RECK in healthy and diseased human gingival tissues and to correlate it with the production of MMP-2 and MMP-9.Material and methodsGingival biopsies were collected from chronic periodontitis patients and periodontally healthy control individuals. The protein and mRNA of RECK, MMP-2 and MMP-9 was determined by immunohistochemistry and semi-quantitative polymerase chain reaction analysis.ResultsThe expression of RECK protein was mainly confined to the gingival epithelium in inflamed and non-inflamed gingival tissues. Expression of RECK was significantly lower in tissues from chronic periodontitis patients, while the positive expression levels of MMP-2 and MMP-9 in periodontitis specimens were significantly higher. RECK protein expression was negatively correlated to the expressions of MMP-2 and MMP-9 in periodontitis. Moreover, RECK mRNA was significanly lower in diseased gingiva than in healthy samples(P<0.05), while MMP-2 and MMP-9 mRNAs were observed overexpressed in periodontal lesions, with no significant correlation between RECK and MMP-2/MMP-9 mRNA shown in periodontally diseased group.ConclusionThe expression of RECK in human healthy and diseased gingiva may contribute to periodontal physiological and pathological processes; low RECK expression may be associated with the enhanced MMP-2 and MMP-9 production in inflamed gingiva.

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The relationship between lateral displacement of the mandible and scoliosis

Abstract

Objectives

Idiopathic scoliosis is an orthopaedic disease of childhood, with onset and progress occurring until adolescence. Here, the relationship between lateral displacement of the mandible and scoliosis was analysed quantitatively.

Methods

Seventy-nine non-syndromic Japanese patients (18 men, 61 women), who were diagnosed with jaw deformities and underwent surgical orthognathic treatment at Kyushu University Hospital from January 2011 to August 2014, were enrolled. Their mean age at the time of radiography was 25.3 ± 8.7 years. Postero-anterior cephalometric radiographs and chest radiographs were examined. In postero-anterior cephalometric radiographs, a horizontal baseline (X-axis) was drawn as a straight line that intersects both the zygomatic bases, and a vertical line (Y-axis) was marked perpendicular to the X-axis, with an intersection at the anterior nasal spine (ANS). Point A was defined as the intersection of the X- and Y-axes, and line A was defined as the line connecting point A to the menton. The angle made by the X-axis and line A (i.e., lateral displacement of the mandible) was measured. We designated an absolute value even if the mandibular menton was located on the right or left side. In chest radiographs, Cobb's method was used to measure scoliosis curves; the direction of the curve was designated similarly.

Results

Nine (11.4%) individuals had a Cobb angle >10°. There was a positive correlation between the Cobb angle and the degree of mandibular deviation (p < 0.05).

Conclusion

Lateral displacement of the mandible and scoliosis are related.

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TNF-alpha stimulation increases dental pulp stem cell migration in vitro through integrin alpha-6 subunit upregulation

Transient receptor potential melastatin (TRPM) 8 is expressed in freshly isolated native human odontoblasts

Expression of matrix metalloproteinases-2, -9 and reversion-inducing cysteine-rich protein with Kazal motifs in gingiva in periodontal health and disease

Osteoblastoma of the temporal articular tubercle misdiagnosed as a temporomandibular joint disorder

Publication date: Available online 30 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Emanuelsson, C.M. Allen, K. Rydin, M. Sjöström
The case of a 17-year-old female with a benign osteoblastoma in the temporomandibular joint (TMJ) is reported. The patient had a 2.5-year history of reduced mouth opening accompanied by tenderness and swelling in the left TMJ. Initial treatment included stabilization of the occlusion with a splint, jaw exercises, and analgesics. At first the patient's symptoms decreased, but they then increased 18 months later, prompting a cone beam computed tomography (CBCT) evaluation of the joint. The radiographic findings showed a somewhat ill-defined, radiolucent, expansile lesion containing small scattered calcifications located in the temporal articular tubercle. The lesion was removed under general anaesthesia and sent for histopathological examination. At the 12-month follow-up, the patient had normal TMJ function without clinical symptoms. CBCT examination showed a small recurrence of 3mm. Another 12 months later, CBCT showed a 1-mm increase in the recurrence. Her function was normal, with slight tenderness lateral to the left TMJ. The decision from a multidisciplinary meeting was further annual follow-up. The present case illustrates the importance of initial radiographic examination together with clinical examination in patients with TMJ dysfunction.

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Can a surgery-first orthognathic approach reduce the total treatment time?

Publication date: Available online 30 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): W.S. Jeong, J.W. Choi, D.Y. Kim, J.Y. Lee, S.M. Kwon
Although pre-surgical orthodontic treatment has been accepted as a necessary process for stable orthognathic correction in the traditional orthognathic approach, recent advances in the application of miniscrews and in the pre-surgical simulation of orthodontic management using dental models have shown that it is possible to perform a surgery-first orthognathic approach without pre-surgical orthodontic treatment. This prospective study investigated the surgical outcomes of patients with diagnosed skeletal class III dentofacial deformities who underwent orthognathic surgery between December 2007 and December 2014. Cephalometric landmark data for patients undergoing the surgery-first approach were analyzed in terms of postoperative changes in vertical and horizontal skeletal pattern, dental pattern, and soft tissue profile. Forty-five consecutive Asian patients with skeletal class III dentofacial deformities who underwent surgery-first orthognathic surgery and 52 patients who underwent conventional two-jaw orthognathic surgery were included. The analysis revealed that the total treatment period for the surgery-first approach averaged 14.6 months, compared with 22.0 months for the orthodontics-first approach. Comparisons between the immediate postoperative and preoperative and between the postoperative and immediate postoperative cephalometric data revealed factors that correlated with the total treatment duration. The surgery-first orthognathic approach can dramatically reduce the total treatment time, with no major complications.

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The efficacy of hyperbaric oxygen therapy related to the clinical stage of osteoradionecrosis of the mandible

Publication date: Available online 30 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): F.J. Dieleman, T.T.T. Phan, F.J.A. van den Hoogen, J.H.A.M. Kaanders, M.A.W. Merkx
This study aimed to evaluate the success of hyperbaric oxygen therapy (HBOT) and surgery in the treatment of mandibular osteoradionecrosis (ORN) in relation to the extent of the ORN. Twenty-seven patients with ORN were identified from a total of 509 patients with a history of primary oral or base of the tongue cancer; these patients had been treated with radiation therapy with curative intent between 1992 and 2006, with a radiation dose to the mandible of ≥50Gy. The ORN was staged according to the classification of Notani et al. The time from completion of radiation therapy to the development of ORN varied (median 3 years). Forty HBOT sessions were offered. After HBOT alone, 3 of 11 stage I lesions, 0 of 8 stage II lesions, and 0 of 8 stage III lesions had healed (P=0.0018). An absolute incidence of 5.3% ORN was found in this population. Of all sites irradiated in this study, the floor of the mouth was most associated with ORN (8.6%), whereas the cheek was least associated (0%). Based on the results of this study, HBOT can be recommended for stage I and II ORN and for selected cases of stage III ORN.

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Management of a complex pancreaticoduodenal lesion following a suicidal attempt with a crossbow

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Traumatic pancreaticoduodenal lesions are rare, often involve a challenging management, and have high rates of morbidity and mortality. A 43-year-old male patient committed a suicidal attempt by shooting an arrow with a crossbow into his upper abdomen. He was successfully treated with cautious multidisciplinary approach. Crossbow lesions demonstrate low kinetics. Sharp tips of arrows result in localized damage, likely to involve several organs. Pancreatic lesions are of particular interest because of their difficult surgery. Surgical exploration and drainage can allow an efficient management of pancreatic penetrating lesions, even in the presence of a complete pancreatic duct disruption.

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Severe cervical spondylotic myelopathy with complete neurological and neuroradiological recovery within a month after surgery

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Corrigendum to ‘Effect of HPV on head and neck cancer patient survival, by region and tumor site: A comparison of 1362 cases across three continents’ [Oral Oncol. 62 (2016) 20–27]

The authors regret that the affiliation and author order for Gabriella Cadoni was incorrect. The correct order and affiliations of the authors can be seen above.

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Time to onset of bisphosphonate-related osteonecrosis of the jaws: a multicentre retrospective cohort study

Abstract

Objectives

Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of bisphosphonates (BP). Although the risk of ONJ increases with increasing duration of BP treatment, there are currently no reliable estimates of the ONJ time to onset (TTO). The objective of this study was to estimate the TTO and associated risk factors in BP-treated patients.

Subjects and methods

Retrospective analysis of data from 22 secondary care centres in 7 countries relevant to 349 patients who developed BP-related ONJ between 2004 and 2012.

Results

The median (95%CI) TTO was 6.0 years in patients treated with alendronate (n = 88) and 2.2 years in those treated with zoledronate (n = 218). Multivariable Cox regression showed that dentoalveolar surgery was inversely associated, and the use of antiangiogenics directly associated, with the TTO in cancer patients treated with zoledronate.

Conclusions

The incidence of ONJ increases with the duration of BP therapy, with notable differences observed with respect to BP type and potency, route of administration and underlying disease. When data are stratified by BP type, a time of 6.0 and 2.2 years of oral alendronate of intravenous zoledronate therapy, respectively, is required for 50% of patients to develop ONJ. After stratification by disease, a time of 5.3 and 2.2 years of BP therapy is required for 50% of patients with osteoporosis and cancer, respectively, to develop ONJ. These findings have significant implications for the design of future clinical studies and the development of risk reduction strategies aimed at either assessing or modulating the risk of ONJ associated with BP.

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Virtual reconstruction of midface defects using statistical shape models

Publication date: Available online 30 December 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Marc Anton Fuessinger, Stefan Schlager, Steffen Schwarz, Edward Ellis, Carl-Peter Cornelius, Florian Probst, Marc Christian Metzger, Wiebke Semper-Hogg
PurposeThis study evaluates the accuracy of a statistical shape model (SSM) for virtual fracture reconstruction of the lateral midface.Materials and MethodsA uniform bony defect of the right zygoma was created. A virtual reconstruction was performed by using the standard procedure of mirroring the unaffected to the affected side (Group I) and by using the statistical model based on 178 pathologically unaffected CT scans (Group II). The accuracy of the statistical shape model was evaluated in comparison to the present mirroring protocol. The reconstructed region was compared with the original bone evaluating the mean deviation of both surfaces.ResultsAll zygomas could be reconstructed with all methods. On the affected side the mean deviation was 1.10mm +/-0.23mm in group I and 0.85mm +/-0.26mm in group II. The differences between the groups were significant.ConclusionSSM offers a more precise reconstruction of midface defects than mirroring procedures. As an additional element SSM could automatize the CAS workflow in many respects.

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Comparison of two preoperative protocols for mandibular symphyseal distraction osteogenesis to reduce the risk of tooth damage

Transverse mandibular deficiency is a common problem in orthodontic patients. The clinical signs of mandibular transverse deficiency are a decrease in mandibular arch length, a narrow intercanine width, a crowding of the lower anterior teeth, a flattened anterior arch morphology, an increased overbite and a posterior buccal crossbite (Del Santo et al., 2000; Chung and Tae, 2007). In younger patients, transverse mandibular deficiency can be corrected by orthodontic expansion, lip bumpers, Schwarz devices, or functional appliances resulting in stable results (Bell et al., 1997).

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Virtual reconstruction of midface defects using statistical shape models

This study evaluates the accuracy of a statistical shape model (SSM) for virtual fracture reconstruction of the lateral midface.

http://ift.tt/2hzmpBd

Corrigendum to ‘Effect of HPV on head and neck cancer patient survival, by region and tumor site: A comparison of 1362 cases across three continents’ [Oral Oncol. 62 (2016) 20–27]

Publication date: Available online 30 December 2016
Source:Oral Oncology
Author(s): Gypsyamber D'Souza, Devasena Anantharaman, Tarik Gheit, Behnoush Abedi-Ardekani, Daniel C. Beachler, David I. Conway, Andrew F. Olshan, Victor Wunsch-Filho, Tatiana N. Toporcov, Wolfgang Ahrens, Kathy Wisniewski, Franco Merletti, Stefania Boccia, Eloiza H. Tajara, Jose P. Zevallos, José Eduardo Levi, Mark C. Weissler, Sylvia Wright, Ghislaine Scelo, Angela L. Mazul, Massimo Tommasino, Gabriella Cadoni, Paul Brennan

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Cost and lack of insurance coverage are prohibitive to having dental implants after resections for benign mandibular neoplasms

Publication date: Available online 30 December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Zachary S. Peacock, Yisi D. Ji
ObjectivesTo assess how often patients receive dental implants after mandibular resections for benign neoplasms and determine barriers to completing functional reconstruction.Study DesignA retrospective cohort study of patients who underwent resection for benign mandibular neoplasms between 2005 and 2014. Demographic variables included age, gender, and race. Outcome variables include rates of implant placement, implant restoration, and reasons for not having implants. Fisher's exact test and odds ratios were calculated.Results52 subjects (47.1±19.2 years) were included. Twenty (38.6%) received dental implants. Race was associated with the likelihood of receiving implants(p=0.0302). Blacks/African Americans (1/10, 10%) compared to all other racial groups were least likely to have implants (OR=0.1158, p=0.035, 95% CI (0.013, 0.989). Caucasians (17/35, 48.6%) were 4.41 times more likely to receive implants compared to all other races (OR=4.41, 95% CI [1.073, 18.093] p=0.038). Of the 20 subjects who received implants, 10 went on to have dental prostheses. The most common reason for not having implants was cost (37.5% overall) cited by 50% of Black/African American and 16.7% of Caucasian subjects.ConclusionSubjects do not typically go on to dental reconstruction after mandibular resections with cost as a major barrier. African-Americans were least likely to complete full reconstruction.

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Decompression of keratocystic odontogenic tumors leads to increased fibrosis, but no change in epithelial proliferation

Publication date: Available online 30 December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): S. Awni, B. Conn
ObjectiveInvestigation into whether decompression treatment induces changes in histology or biological behaviour in KCOT.Study design17 patients with KCOT had decompression treatment alone or with enucleation. Histological evaluation and immunohistochemical expression of p53, Ki-67and Bcl-2 were analysed using conventional microscopy.ResultsKCOT showed significantly increased fibrosis (p=0.01) and a subjective reduction in mitotic activity (P=0.03) after decompression. There were no statistically significant changes in the expression of proliferation markers. An increase in daughter-cysts / epithelial rests was seen after decompression (p=0.04). Recurrence was noted in 4/16 cases, there was a strong correlation between expression of p53 with prolonged duration of treatment (p= 0.01) and intense inflammatory changes (P=0.02).ConclusionStructural changes in the KCOT epithelium/capsule following decompression facilitate the surgical removal. There was no statistical evidence that decompression influences expression of proliferation markers in the lining, indicating that the potential for recurrence may not be restricted to the cellular level. The statistically significant increase of p53 expression with increased duration of treatment and of inflammation may also indicate the possibility of higher rates of recurrence with prolonged treatment and significant inflammatory changes.

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Osteoblastoma of the temporal articular tubercle misdiagnosed as a temporomandibular joint disorder

The case of a 17-year-old female with a benign osteoblastoma in the temporomandibular joint (TMJ) is reported. The patient had a 2.5-year history of reduced mouth opening accompanied by tenderness and swelling in the left TMJ. Initial treatment included stabilization of the occlusion with a splint, jaw exercises, and analgesics. At first the patient's symptoms decreased, but they then increased 18 months later, prompting a cone beam computed tomography (CBCT) evaluation of the joint. The radiographic findings showed a somewhat ill-defined, radiolucent, expansile lesion containing small scattered calcifications located in the temporal articular tubercle.

http://ift.tt/2hEkBeW

Can a surgery-first orthognathic approach reduce the total treatment time?

Although pre-surgical orthodontic treatment has been accepted as a necessary process for stable orthognathic correction in the traditional orthognathic approach, recent advances in the application of miniscrews and in the pre-surgical simulation of orthodontic management using dental models have shown that it is possible to perform a surgery-first orthognathic approach without pre-surgical orthodontic treatment. This prospective study investigated the surgical outcomes of patients with diagnosed skeletal class III dentofacial deformities who underwent orthognathic surgery between December 2007 and December 2014.

http://ift.tt/2hW5OZ7

The efficacy of hyperbaric oxygen therapy related to the clinical stage of osteoradionecrosis of the mandible

This study aimed to evaluate the success of hyperbaric oxygen therapy (HBOT) and surgery in the treatment of mandibular osteoradionecrosis (ORN) in relation to the extent of the ORN. Twenty-seven patients with ORN were identified from a total of 509 patients with a history of primary oral or base of the tongue cancer; these patients had been treated with radiation therapy with curative intent between 1992 and 2006, with a radiation dose to the mandible of ≥50Gy. The ORN was staged according to the classification of Notani et al.

http://ift.tt/2hEtLIn

Complication and surgical site infection for salvage surgery in head and neck cancer after chemoradiotherapy and bioradiotherapy

We aimed to investigate the complications, surgical site infection (SSI), and survival in salvage surgery without free-flap reconstruction for patients with head and neck squamous cell carcinoma who were treated by platinum-based chemoradiotherapy (Plat-CRT) or cetuximab-based bioradiotherapy (Cet-BRT).

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ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2)...

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A Virtual Reality Simulation Model of Spinal Ultrasound: Role in Teaching Spinal Sonoanatomy.

Background and Objectives: Ultrasound assessment of the lumbar spine improves the success of spinal and epidural anesthesia, especially for patients with underlying difficult anatomy. To assist with the teaching and learning of ultrasound-guided neuraxial anesthesia, we have created an online interactive educational model ( http://ift.tt/2hE59iM and http://ift.tt/2hVI8nU). The aim of the current study was to determine whether the virtual spine model improved the knowledge of neuraxial anatomy and sonoanatomy. Methods: After obtaining ethics board approval and written participant consent, 14 anesthesia trainees with no prior experience with spine ultrasound imaging were included in this study. Construct validity was assessed using a pretest/posttest design to measure the knowledge acquired from self-study of the virtual spine simulation modules. Two tests (A and B) with 20 multiple-choice questions were used either for the pretest or posttest, at random in order to account for possible differences in difficulty between the 2 tests. These tests were administered immediately before and after a 1-hour training session using the spine ultrasound model. Results: Fourteen anesthesia trainees completed the study. Seven used test A as the pretest (group A), and 7 used test B as the pretest (group B). Both groups showed a statistically significant improvement (P

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Παρασκευή 30 Δεκεμβρίου 2016

Patient-performed pinnaplasty using industrial nail glue

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Priyanka Chadha, Florian Bast
Malformations of the pinna occur in around 2–5% of all newborns. Prominent ears in childhood can be a source of psychological distress and lead to bullying and social exclusion. We present the case of a 14-year-old girl who inflicted chronic, non-healing wounds in the post auricular area bilaterally after attempting to glue back her ears with industrial strength glue. To our knowledge, this is the first case of its kind to be published.

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Human papillomavirus status and the relative biological effectiveness of proton radiotherapy in head and neck cancer cells

Abstract

Background

Human papillomavirus (HPV)-positive oropharyngeal carcinomas response better to X-ray therapy (XRT) than HPV-negative disease. Whether HPV status influences the sensitivity of head and neck cancer cells to proton therapy or the relative biological effectiveness (RBE) of protons versus XRT is unknown.

Methods

Clonogenic survival was used to calculate the RBE; immunocytochemical analysis and neutral comet assay were used to evaluate unrepaired DNA double-strand breaks.

Results

HPV-positive cells were more sensitive to protons and the unrepaired double-strand breaks were more numerous in HPV-positive cells than in HPV-negative cells (p < .001). Protons killed more cells than did XRT at all fraction sizes (all RBEs > 1.06). Cell line type and radiation fraction size influenced the RBE.

Conclusion

HPV-positive cells were more sensitive to protons than HPV-negative cells maybe through the effects of HPV on DNA damage and repair. The RBE for protons depends more on cell type and fraction size than on HPV status. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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Complication and surgical site infection for salvage surgery in head and neck cancer after chemoradiotherapy and bioradiotherapy

Publication date: Available online 30 December 2016
Source:Auris Nasus Larynx
Author(s): Hidenori Suzuki, Nobuhiro Hanai, Daisuke Nishikawa, Yujiro Fukuda, Yasuhisa Hasegawa
ObjectiveWe aimed to investigate the complications, surgical site infection (SSI), and survival in salvage surgery without free-flap reconstruction for patients with head and neck squamous cell carcinoma who were treated by platinum-based chemoradiotherapy (Plat-CRT) or cetuximab-based bioradiotherapy (Cet-BRT).MethodsThirty-three patients treated by Plat-CRT and six treated by Cet-BRT had salvage surgery. We categorized postoperative complications according to the Clavien–Dindo classification and SSI according to the wound grading scale. Overall survival calculated by Kaplan–Meier method.ResultsPatients with Cet-BRT were significantly associated with the presence of SSI (P<0.01) and grades IIIb–V of the Clavien–Dindo classification (P<0.01) compared with those with Plat-CRT. Patients with Cet-BRT had a significantly lower overall survival than those with Plat-CRT (P<0.05).ConclusionWe demonstrated that patients with Cet-BRT were significantly more associated with the presence of SSI and grades IIIb–V in the Clavien–Dindo classification than those with CRT.

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Avoiding complications in endoscopic skull base surgery

Purpose of review: Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence. Recent findings: Detailed preoperative planning based on imaging and histology can prevent major complications. Intraoperative use of image guidance and meticulous hemostasis provide the surgical field needed to avoid complications. Postoperative patient counseling, along with close and detailed nasal postoperative care are significant factors for an optimal outcome. Summary: Monitoring of complications after endoscopic skull base surgery is necessary in order to standardize protocols of management and improve our surgical techniques. The presence of late onset complications underlines the need of a special focus in postoperative care and follow-up.

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25 years of Current Opinion in Otolaryngology & Head and Neck Surgery

No abstract available

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What is the evidence for genetics in chronic rhinosinusitis?

Purpose of review: To perform analysis of evidence in current literature on the topic of genetics and chronic rhinosinusitis (CRS), with a particular focus on recent findings in the cystic fibrosis transmembrane regulator (CFTR), genes associated with primary ciliary dyskinesia, and taste receptor T2R38. Other genes that have been found to have association with CRS are also presented and discussed. Recent findings: Recent studies in CFTR and CRS research have investigated possible CFTR-potentiators for treatment of refractory CRS. The T2R38 gene has been shown to be applicable in the clinical setting with a testable phenotype and may have a role in the prognosis and influencing management strategies of CRS patients. Many genes of the immune system have been studied, with genome-wide association studies and candidate-gene approaches identifying new associations that will need replication and further elucidation. Summary: CRS is a multifactorial disease, with strong evidence of a genetic component in its pathophysiology for some cases. Currently, there are over 70 genes that have been genetically associated with CRS in the past 15 years. Future investigations into genetic causes and predispositions of CRS may allow for improved prognostication and development of disease-prevention strategies as well as novel therapeutic targets.

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The state of sinus care in 2017

No abstract available

http://ift.tt/2hBrR9W

The evidence for olfactory training in treating patients with olfactory loss

Purpose of review: The purpose of this review is to go over the only therapy for olfactory loss supported by level 1a evidence that is currently available, which is olfactory training. This therapy is widely underutilized and has the potential to help many patients with olfactory dysfunction who are otherwise offered no management options. Recent findings: We will review the rationale, clinical studies, and quality of the evidence regarding olfactory training, specifically the olfactory system's inherent ability to regenerate, the plasticity of the system, and the multiple protocols and modifications of protocols present in the literature. Summary: Olfactory training is an effective therapy for some patients suffering from olfactory loss, and, while we do not yet know the optimal duration or number of odorants or exact patient population it may be most beneficial for, as an extremely easy, self-driven therapy with no significant side-effects, it should be consistently offered to this patient population.

http://ift.tt/2hBmG9I

Caudal septum surgery techniques reviewed

Purpose of review: The caudal septum has important functional and aesthetic implications. Deviations in this area can result in important nasal obstruction due not only to blockage of the nasal passage but also to compromise of the internal nasal valve. Cosmetically, alterations in the caudal septum can result in a twisted nasal tip, loss of projection, rotation, and imbalance in the ala-columellar relationship. Contemporary surgical options will be discussed showing how to preserve, reshape, and reinforce the caudal septum to obtain a final looking nose that is not only functional but also aesthetically pleasing. Recent findings: Recent publications have shown that cartilage preservation and remodeling techniques can be efficient in the treatment of the caudal septum. Adequate preoperative diagnosis must be made to be able to create a step-wise approach evolving from simple suturing techniques to more complex ones that require the use of grafts to reposition and keep the caudal septum in the midline with an adequate functional and cosmetic outcome. Summary: Adequate management of the caudal portion of the nasal septum is a challenge because of its importance in nasal function and cosmetic final results. There are many surgical options that can be used to correct and align this structure and there is no one single surgical technique that can be used in all cases. A step-wise approach is presented covering the different techniques used today evolving from simple to more complicated ones. The final surgical objective should be cosmetically pleasing noses that function appropriately.

http://ift.tt/2hBrE6y

Update on nonmalignant lesions of the inferior turbinate

Purpose of review: The inferior turbinates are routinely examined by otolaryngologists on anterior rhinoscopy and nasal endoscopy. Most lesions of the inferior turbinate are benign but can often be confused with malignancy. This review highlights the broad differential of nonmalignant lesions of the inferior turbinates and their management. Recent findings: A variety of infectious, inflammatory, neoplastic, and vascular lesions may affect the inferior turbinates. The most common nonmalignant lesions of the sinonasal region are nasal polyps, inverted papillomas, hemangiomas, and angiofibromas. Early lesions are often asymptomatic and discovered incidentally on routine examination. As these lesions grow they present with nonspecific signs that can be seen in benign, malignant, and infectious etiologies. The most common signs and symptoms are nasal obstruction, rhinorrhea, epistaxis, sinusitis, and hyposmia. Most nonmalignant lesions have characteristic appearances but definitive diagnosis is achieved with biopsy or culture. If the lesions are small the biopsy itself is often curative. Summary: Lesions of the inferior turbinates are rarely isolated to these structures alone. Careful examination can noninvasively assist in early diagnosis of extensive lesions. Once malignancy and processes such as invasive fungal sinusitis or inverted papillomas have been ruled out, treatment of these lesions is ordinarily noncomplicated and definitive.

http://ift.tt/2hBlmnr

Polyps, asthma, and allergy: what's new

Purpose of review: Although chronic rhinosinusitis with nasal polyps, asthma, and allergy share common inflammatory mechanisms, there is no evidence of cause-and-effect relationship. In this review, we present new studies investigating the complex immunology that links these diseases. Advances in new therapies as well as evidence regarding indication and timing of surgery, especially of more complex cases, are highlighted. Recent findings: New studies have endotyped patients in an effort to describe the exact inflammatory profile of each phenotype, whereas described cytokines seem to play a significant role in amplification of T2 inflammation, directly or via innate lymphoid cells. New mAbs that block specific cytokines of these pathways have been developed and seem to show reduced asthma severity as well as improved sinonasal outcomes. Moreover, it has been shown that operating early in the course of disease leads not only to bigger improvements in SNOT-22 outcomes but also to reduced asthma incidence postoperatively in refractory cases. Summary: Applying data from current studies in clinical practice, we could better manage refractory cases with asthma and polyps, both medically and surgically. Treatment has to be patient-centered, and this demands a multidisciplinary-team approach of the airway diseases.

http://ift.tt/2hBm9Vi

Editorial introductions

No abstract available

http://ift.tt/2hBEUIb

Sinonasal methicillin-resistant Staphylococcus aureus: updates on treatment

Purpose of review: Over the past two decades, the management of methicillin-resistant Staphylococcus aureus (MRSA) in chronic rhinosinusitis has posed significant challenges. This document reviews current management techniques and novel treatment modalities for sinonasal MRSA infections. Recent findings: Topical antibiotic therapy, that is, drops (ofloxacin) and ointments (mupirocin) as off-label use for the management of MRSA chronic sinusitis, has shown beneficial results. Other more recently trialed nonantibiotic modalities such as antimicrobial photodynamic therapy and colloidal silver irrigation are also showing promise. Summary: Sinonasal MRSA is considered to be associated with recalcitrant chronic sinusitis. Advancements in systemic and local antibiotics in its management have been slow and unsatisfactory. Attention is shifting to the use of nonantibiotic antibacterial treatments. Knowledge of these options is critical to improve the overall management of these chronic patients.

http://ift.tt/2hBlDqw

The role of sinus surgery in sleep outcomes

Purpose of review: Poor sleep is associated with reduced health, increased morbidity, and increased mortality. Recent findings: Chronic rhinosinusitis (CRS) is one of the most prevalent chronic diseases in the United States, affecting up to 16% of the U.S. population. It has been linked to poor sleep with up to 75% of patients with CRS reporting reduced sleep. Yet there has been little examining the improvement in sleep following surgical treatment of patients with CRS. Summary: In this review, we examine the current knowledge on the association between sleep and CRS as well as review the current data examining the role of sinus surgery. After a structured literature search, we conclude that an evolving body of research demonstrates that sleep is compromised in the majority of patients with CRS. Following surgical treatment of CRS, there is a significant improvement in reported sleep quality that is correlated with subsequent improvement in disease-specific quality of life. Furthermore, we acknowledge that additional research characterizing both objective and subjective measures of sleep following surgical treatment is still needed. Additional investigation is required to better elucidate the underlying pathophysiology of the relationship between sleep dysfunction and CRS.

http://ift.tt/2hBsnEY

Anesthesia for functional endoscopic sinus surgery

Purpose of review: The present article summarizes anesthetic techniques used during functional endoscopic sinus surgery to decrease bleeding and aid in creating a clear surgical field. The applicable physiology behind these anesthetic techniques is reviewed with emphasis on the effect on bleeding and the surgical field. Deliberate hypotension, reverse Trendelenburg positioning, regional anesthesia, and cerebral monitoring are discussed. Recent findings: There are mixed data as to whether traditional inhalation anesthesia or total intravenous anesthesia is superior with respect to better surgical fields and decreased blood loss. A review of the literature tends to favor total intravenous anesthesia. Cerebral oximetry and transcranial Doppler ultrasound are emerging techniques to monitor cerebral perfusion during deliberate hypotension. Summary: Total intravenous anesthesia using propofol and remifentanil is the current favored technique for producing deliberate hypotension during endoscopic sinus surgery due to its hemodynamic stability and smooth rapid emergence.

http://ift.tt/2hBtTXs

Comprehensive management of hereditary hemorrhagic telangiectasia

Purpose of review: Hereditary hemorrhagic telangiectasia (HHT), or Osler Weber-Rendu disease, is a rare inherited disorder of fibrovascular tissue affecting various organs. Epistaxis is the most common symptom of HHT but as the disease affects multiple organs, a multisystem and multidisciplinary approach to management is required. The purpose of this article is to provide an overview of the multidisciplinary approach to HHT for the otolaryngologist and to discuss the current pharmacologic and procedural treatment options available for HHT-related epistaxis. Recent findings: Multidisciplinary expert guidelines have better defined what screening tests are advised for the multisystem evaluation of the HHT patient. New pharmacologic therapies including bevacizumab (Avastin) used submucosally or topically have shown promise as in-office treatment modalities. Sclerotherapy of telangiectasia, including in-office applications, has recently proven safe and effective. Summary: HHT remains a difficult disease to treat. Being aware of the common organ systems involved by the disease will help the practicing otolaryngologist to ensure the patient receives appropriate multidisciplinary care. For HHT-related epistaxis, new medical and surgical options allow for a wider range of treatments than were previously available.

http://ift.tt/2hBm9EM

The role of aspirin desensitization in the management of aspirin-exacerbated respiratory disease

Purpose of review: Aspirin-exacerbated respiratory disease (AERD) is a progressive inflammatory disease of the upper and lower airways characterized by marked eosinophilic nasal polyposis, asthma, and respiratory reactions to medications that inhibit the cyclooxygenase pathway. Aspirin desensitization has proven to be an effective tool in the management of this disease when used in a multidisciplinary setting. The purpose of this article is to review the current literature regarding AERD, aspirin desensitization, and share our opinion regarding the most optimal multidisciplinary approach to these complex patients. Recent findings: Numerous studies, including randomized, double-blind, placebo-controlled trials, have demonstrated the therapeutic effectiveness of aspirin desensitization with significant improvement in number of sinus infections per year, olfactory scores, nasal symptom scores, asthma symptom scores, sinus operations, hospitalizations, emergency room visits, and oral steroid use. Furthermore, the role of surgery is becoming increasingly important for recalcitrant sinus disease with recent studies showing comprehensive surgery as more beneficial to disease management. Summary: Aspirin desensitization is an effective therapeutic tool in the management of AERD. A multidisciplinary approach is critical between the otorhinolaryngologist and allergist to provide the most optimal care for this complex patient population.

http://ift.tt/2hBEUrF

The relationship between lateral displacement of the mandible and scoliosis

Abstract

Objectives

Methods

Results

Nine (11.4%) individuals had a Cobb angle >10°. There was a positive correlation between the Cobb angle and the degree of mandibular deviation (p < 0.05).

Conclusion

Lateral displacement of the mandible and scoliosis are related.

http://ift.tt/2hBs7FZ

An update on endoscopic orbital decompression

Purpose of review: Endoscopic orbital decompression is an ever-evolving surgical procedure with modifications as well as new indications for the procedure. The purpose of this review is to update the reader on optimizing patient selection, surgical timing, highlight the latest modifications to surgical technique and to evaluate surgical outcomes that can be achieved. Recent findings: Patient selection, disease pathology, and optimization of technology can lead to improved outcomes. Changes in technology continue to modify surgical techniques and surgical training, working towards decreased surgical complications with improved outcomes. Historically multiple approaches have been used for orbital decompression and this highlights that a balanced orbital decompression usually leads to the best outcome. Summary: Orbital decompression has evolved significantly since its inception over 100 years ago. Identifying the right patient, the ideal timing, and the indication for the procedure with utilization of technology can lead to improved outcomes and decreased complications.

http://ift.tt/2hBwhgT

Postoperative care in endoscopic sinus surgery: a critical review

Purpose of review: Chronic rhinosinusitis with and without nasal polyps is a common disease affecting people all over the world. Functional endoscopic sinus surgery (FESS) has become the gold standard treatment for medically refractive disease. Postoperative care is recommended by international leaders as an important part of the patient's management. This article is a critical review and discussion focusing on postoperative care, which is based on expert opinion, clinical studies, randomized controlled trials and meta-analysis studies. Recent findings: Postoperative care including nasal rinsing, topical corticosteroids, antibiotics and avoidance of nasal packing are unanimously considered to be the cornerstone of best practice following FESS. However, the effectiveness of in-office nasal debridement is still under debate. Summary: There is a lack of consensus regarding the necessity of performing in-office nasal debridement and the majority of clinicians carry out their postoperative care according to experience and their own preference. This is often determined by the extent of surgery performed, the severity of the postoperative inflammation, as well as being dependent on the patient's discomfort, the time constraints associated with postoperative care and the costs associated with additional appointments. Ideally, nasal debridement should be performed by the operating surgeon under endoscopic control both gently and atraumatically.

http://ift.tt/2hBwxN3

Posttreatment surveillance for sinonasal malignancy

Purpose of review: Sinonasal neoplasms have a high rate of recurrence following treatment, and clinicians utilize a variety of surveillance techniques. Generally, surveillance modality and frequency of follow-up are determined by the guidelines for head and neck cancer as a broad category. However, recent studies have demonstrated that a more tailored approach to follow-up may be necessary. Recent findings: Endoscopy has low sensitivity in recurrence detection, especially in the asymptomatic patient. However, it is able to identify superficial recurrences that may be more amenable to repeat resection. Conversely, imaging [computed tomography (CT), MRI, and 18F-fluorodeoxyglucose-PET/CT] is useful in ruling out disease, but the inflammatory environment of the posttreatment sinonasal cavity leads to a high number of false positives. This is especially notable in PET/CT, which has worse specificity and positive predictive value in sinonasal malignancy than in head and neck malignancy overall, especially in the early posttreatment period. Little data are available on optimal timing and duration of follow-up, but tumor histology and aggressiveness should be considered when choosing a surveillance approach. Summary: Sinonasal malignancy surveillance strategies may warrant modifications of current protocols used for head and neck malignancy. This is due to a number of factors, including a greater diversity of sinonasal disorder and increased duration of posttreatment sinonasal inflammation. Clinicians should be aware of the performance parameters of commonly used surveillance techniques and adjust follow-up regimens based on this information.

http://ift.tt/2hBqmZ2

Use of Interactive iBooks for Patient Education in Otology

Physicians in the ambulatory setting face challenges in adequately educating patients in a brief office encounter.

http://ift.tt/2iyGKIh

Impact of treatment modality on quality of life of head and neck cancer patients: Findings from an academic medical institution

There are approximately 436,000 head and neck cancer survivors in the United States currently [1], with 5-year survival rates reported at 63.2% for oral cavity and pharynx and 60.6% for larynx [2]. Virtually all head and neck cancer (HNC) patients present with one or more oral or dental complications [3], which can be mild and include discomfort and pain, or more serious, with morbidities such as dysphagia, mucositis, xerostomia or osteoradionecrosis [4–6]. Further, these complications impact quality of life (QOL) long after treatment [5].

http://ift.tt/2hBggYh

Cetirizine-responsive, persistent idiopathic eosinophilia in a nonatopic child

Atopy is one of the most common causes of eosinophilia in the developed world.1,2 Antihistamines have been successfully used in the treatment of atopy and associated eosinophilia.3,4 However, it is unclear whether antihistaminic therapy is effective in controlling eosinophilia in patients without associated atopy.1–4 We present a case of a nonatopic child who presented with idiopathic eosinophilia responding to antihistaminic therapy.

http://ift.tt/2hUHIhA

Autonomic function in adults with allergic rhinitis and its association with disease severity and duration

The association between allergic rhinitis (AR) and the autonomic nervous system (ANS) has recently received substantial attention. However, no studies have assessed how the heart rate variability (HRV) parameters are associated with duration and disease severity in AR.

http://ift.tt/2hD29na

Attic cholesteatoma with closure of the entrance to pars flaccida retraction pocket

We report three patients with pars flaccida-type cholesteatoma (attic cholesteatoma) with closure of the entrance to the cholesteatoma at the time of surgery. These patients were diagnosed with attic cholesteatoma requiring surgery on the basis of abnormal findings of the pars flaccida, audiometry, and temporal bone computed tomography during the clinical course. Intraoperatively, cholesteatoma matrix and granulation tissue were observed behind the intact pars flaccida epithelium, which suggested that the entrance had apparently closed and the continuity with the cholesteatoma matrix disappeared after resolution of inflammation at the pars flaccida.

http://ift.tt/2iNqhj4

A veil in the oral cavity: report of two cases of oral synechiae

An oral synechia is an adhesion between the maxilla and the mandible; these adhesions can be found at various locations in the oral cavity. The presence of oral synechiae associated with cleft palate represents a rare congenital deformity. Oral synechiae with cleft palate can have serious implications for airway management and feeding in babies, and hence requires early intervention to reduce morbidity. Two cases of congenital oral synechiae accompanied by cleft palate, in which the synechiae veiled the oral cavity restricting a detailed intraoral examination, are reported here.

http://ift.tt/2hxzDyh

Maxillary advancement versus mandibular setback in class III dentofacial deformity: are there any differences in aesthetic outcomes?

A retrospective evaluation of maxillary advancement and mandibular setback in class III patients was performed and their aesthetic outcomes compared. Patients with a sella–nasion–A-point angle (SNA) of 80–84° were selected. Pre- and postoperative lateral cephalograms were obtained for 34 class III patients; these were divided into two groups according to the surgical procedure performed: mandibular setback group (n=17) and maxillary advancement group (n=17). The pre- and postoperative cervical length, lip–chin–throat angle, lower/upper lip thickness, distance from the lower/upper lip to the aesthetic line, soft tissue angle, facial contour angle, and nasolabial angle of the two groups were compared.

http://ift.tt/2iOiUf6

Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: Implications for treatment with anti-IL-17 agents

Biologics seem to offer a promising nonsurgical approach in hidradenitis suppurativa (HS), especially in disease with highly pronounced inflammation. Recent studies revealed increased expression of a broad range of cytokines in lesional HS skin, including interleukin (IL)-17.

http://ift.tt/2iqfaje

Management of hidradenitis suppurativa in pregnancy

Hidradenitis suppurativa is a debilitating inflammatory skin disease with a chronic course and often disappointing response to treatment. Though a minority of persons (20%) reports symptom remission during pregnancy, the vast majority experiences no relief (72%), and few experience clinical deterioration (8%). Disease flares are also observed post-partum. The pathophysiological basis for pregnancy-associated fluctuations in clinical status is currently unknown. Because most women with HS require ongoing management throughout pregnancy, it is important to evaluate the suitability and safety of current treatment options for pregnant women.

http://ift.tt/2imgd1r

Human polyomavirus 6 and 7 are associated with pruritic and dyskeratotic dermatoses

Human polyomavirus (HPyV)6 and HPyV7 are shed chronically from human skin. HPyV7, but not HPyV6, has been linked to a pruritic skin eruption of immunosuppression.

http://ift.tt/2iqpk3y

Trial of Lenvatinib Plus Pembrolizumab in Subjects With Selected Solid Tumors

Condition: Solid Tumors
Interventions: Drug: lenvatinib; Drug: pembrolizumab
Sponsor: Eisai Co., Ltd.
Not yet recruiting - verified December 2016

http://ift.tt/2iynFGf

Versatility of buccinator flaps for the treatment of palatal defects: a series of cases

The buccinator flap is currently one of the best techniques for the reconstruction of defects in the oral cavity and other sites. Reconstruction of the palate is a major challenge because of the functional consequences of the excision of lesions in this area. The main goal is to maintain separation between the mouth and the nose. We have done a cross-sectional retrospective descriptive study of a series of cases reconstruction of palatal defects with buccinator flap at the University Hospital Miguel Servet in Zaragoza during a six-year period and compared our results, morbidity, and mortality with those of published series.

http://ift.tt/2igvzqh

EUS-FNA for Retropharyngeal Lymph Node (RPLN) in Recurrent Nasopharyngeal Carcinoma (NPC) Patients

Condition: Nasopharyngeal Carcinoma
Intervention: Procedure: EUS-FNA for RPLN in NPC patients
Sponsor: Sun Yat-sen University
Recruiting - verified December 2016

http://ift.tt/2hB2mFt

Relationship of Metabolic Syndrome and Its Components With Thyroid Cancer

Condition: Thyroid Cancer
Intervention:
Sponsor: Lin Liao
Not yet recruiting - verified December 2016

http://ift.tt/2iymBCr

Influence of the SPInal MANipulation on Muscle Spasticity and Manual Dexterity in Cerebral Palsy.

Condition: Cerebral Palsy, Spastic
Interventions: Procedure: Spinal manipulation; Procedure: Imitation of the spinal manipulation
Sponsor: International Clinic of Rehabilitation, Ukraine
Recruiting - verified December 2016

http://ift.tt/2hAJcQ4

Exercise Program Based on Motor Learning and Forward Head Posture Correction

Conditions: Musculoskeletal Abnormalities; Deformity
Intervention: Other: Exercise program based on motor learning principles
Sponsor: Eleni Kapreli
Not yet recruiting - verified December 2016

http://ift.tt/2iykWww

Effects of enamel matrix derivative on non-surgical management of peri-implant mucositis: a double-blind randomized clinical trial

Abstract

Background

Peri-implant diseases have been recognized as being among the ever-increasing complications related to dental implants. The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) to mechanical debridement (MD) in patients with these conditions in terms of clinical parameters and cytokine levels of peri-implant crevicular fluid (PICF).

Methods

In the present double-blind clinical trial, 46 patients with peri-implant mucositis (PM) were randomly divided into control and test groups. Two different therapeutic protocols, consisting of non-surgical MD alone (control group) and MD with the application of EMD (test group), were considered for the two groups. Clinical parameters [bleeding on probing (BOP) and probing depth (PD)] and sampling from PICF were carried out before treatment and 3 months postoperatively. The levels of IL-6 and IL-17 cytokines in PICF were evaluated by enzyme-linked immunosorbent (ELISA).

Results

Three-month post-interventional assay revealed significant improvements in BOP and PD in the test group in comparison to the control group (P < 0.0001). Relative to control, IL-6 and IL-17 levels were reduced significantly (p < 0.05) in the test group compared to the control group.

Conclusion

Application of EMD can be considered an adjunct to MD in the non-surgical treatment of PM. However, complete recovery was not observed using either treatment approach showing that management of implant-associated disease is still a significant clinical problem.

http://ift.tt/2igc9lo

Autonomic function in adults with allergic rhinitis and its association with disease severity and duration

Publication date: Available online 29 December 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Min Hee Kim, Eun Ji Choi, Bo-Hyoung Jang, Kyu Seok Kim, Seoung-Gyu Ko, Inhwa Choi
BackgroundThe association between allergic rhinitis (AR) and the autonomic nervous system (ANS) has recently received substantial attention. However, no studies have assessed how the heart rate variability (HRV) parameters are associated with duration and disease severity in AR.ObjectiveTo compare the difference in autonomic conditions among individuals with AR of various durations and severities and healthy controls.MethodsWe divided individuals with AR into subgroups based on duration and severity of disease. Next, we measured HRV, and the results were compared among subgroups and healthy controls.ResultsHigh frequency (HF) and normalized high frequency (NHF) were significantly higher in the intermittent group than in the control group, whereas normalized low frequency (NLF) and the ratio of absolute LF to HF power (LF/HF) were significantly lower in the intermittent group than in the control group. Furthermore, NLF was significantly higher in the persistent group than in the intermittent group. HF and NHF were significantly higher in the mild group than in the control group, whereas NLF and LF/HF were significantly lower in the mild group than in the control group. The total nasal symptom and itchy nose scores were negatively correlated with NHF.ConclusionOur results indicate that patients with intermittent and mild AR have hypervagal activity and hyposympathetic activity, and the predominance lessens in patients with more persistent AR and severe symptoms. Further investigation of the mechanisms underlying the association between autonomic function and persistent and severe AR is needed.

http://ift.tt/2iq4ocL

Cetirizine-responsive, persistent idiopathic eosinophilia in a nonatopic child

Publication date: Available online 29 December 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Emily Knight, Philip Fischer, Carola Arndt, Samuel Anim, Avni Joshi

http://ift.tt/2ipYlVD

Impact of treatment modality on quality of life of head and neck cancer patients: Findings from an academic medical institution

Publication date: Available online 29 December 2016
Source:American Journal of Otolaryngology
Author(s): Kara Christopher

http://ift.tt/2iNzCLu

Variability of word discrimination scores in clinical practice and consequences on their sensitivity to hearing loss

Abstract

Speech perception scores are widely used to assess patient's functional hearing, yet most linguistic material used in these audiometric tests dates to before the availability of large computerized linguistic databases. In an ENT clinic population of 120 patients with median hearing loss of 43-dB HL, we quantified the variability and the sensitivity of speech perception scores to hearing loss, measured using disyllabic word lists, as a function of both the number of ten-word lists and type of scoring used (word, syllables or phonemes). The mean word recognition scores varied significantly across lists from 54 to 68%. The median of the variability of the word recognition score ranged from 30% for one ten-word list down to 20% for three ten-word lists. Syllabic and phonemic scores showed much less variability with standard deviations decreasing by 1.15 with the use of syllabic scores and by 1.45 with phonemic scores. The sensitivity of each list to hearing loss and distortions varied significantly. There was an increase in the minimum effect size that could be seen for syllabic scores compared to word scores, with no significant further improvement with phonemic scores. The use of at least two ten-word lists, quoted in syllables rather than in whole words, contributed to a large decrease in variability and an increase in sensitivity to hearing loss. However, those results emphasize the need of using updated linguistic material for clinical speech score assessments.

http://ift.tt/2ilpJ4Q

Revisiting Type 2-high and Type 2-low airway inflammation in asthma: current knowledge and therapeutic implications

Abstract

Asthma is a complex respiratory disorder characterized by marked heterogeneity in individual patient disease triggers and response to therapy. Several asthma phenotypes have now been identified, each defined by a unique interaction between genetic and environmental factors, including inflammatory, clinical and trigger-related phenotypes. Endotypes further describe the functional or pathophysiologic mechanisms underlying the patient's disease. Type 2-driven asthma is an emerging nomenclature for a common subtype of asthma and is characterized by the release of signature cytokines IL-4, IL-5 and IL-13 from cells of both the innate and adaptive immune systems. A number of well-recognized biomarkers have been linked to mechanisms involved in Type 2 airway inflammation, including fractional exhaled nitric oxide, serum IgE, periostin, and blood and sputum eosinophils. These Type 2 cytokines are targets for pharmaceutical intervention, and a number of therapeutic options are under clinical investigation for the management of patients with uncontrolled severe asthma. Anticipating and understanding the heterogeneity of asthma and subsequent improved characterization of different phenotypes and endotypes must guide the selection treatment to meet individual patients' needs.

http://ift.tt/2ifEcRY

Semi-quantifiable angiogenesis parameters in association with the malignant transformation of oral leukoplakia

Abstract

Background

Aim of the study was to assess the role of angiogenesis in the process of malignant transformation of clinical diagnosed oral leukoplakia (OL).

Materials and Methods

131 histological preparations (oral leukoplakia/hyperkeratosis without dysplasia (OL; n=49), oral leukoplakia/hyperkeratosis with mild dysplasia (OL-SIN1; n=33), with moderate dysplasia (OL-SIN2; n=13) and leukoplakia-derived oral squamous cell carcinoma (OL-OSCC; n=36)) were evaluated for microvessel density (MVD), vessel diameter as well as for vascular endothelial growth factor (VEGF-A) expression. Data were compared within the groups.

Results

For MVD, there were significant differences between OL and OL-SIN 2/OL-OSCC (P < 0.05) and between OL-SIN 1 and OL-OSCC (P < 0.05). For OL-OSCC, vessel diameters were significantly increased compared to OL (P < 0.05). Expression of VEGF-A increased significantly gradually from OL-SIN 1 to OSCC (each P < 0.05). This was especially evident for lesions of the tongue when compared to the others.

Conclusion

Angiogenesis increases during the transition from OL through dysplasia to OL-OSCC. Especially in OL-OSCCs of the tongue, VEGF-A-expression may be used for estimation of malignant progression of OL.

http://ift.tt/2iNefdd

Cetuximab sensitivity of head and neck squamous cell carcinoma xenografts is associated with treatment-induced reduction of EGFR, pEGFR, and pSrc

Abstract

Background

The aims of this study were to validate in vitro drug sensitivity testing of head and neck squamous cell carcinoma (HNSCC) cell lines in an in vivo xenograft model and to identify treatment-induced changes in the epidermal growth factor receptor (EGFR) signaling pathway that could be used as markers for cetuximab treatment response.

Materials and methods

The in vitro and in vivo cetuximab sensitivity of two HNSCC cell lines, UT-SCC-14 and UT-SCC-45, was assessed using a crystal violet assay and xenografts in nude mice, respectively. The expression of EGFR, phosphorylated EGFR (pEGFR), phosphorylated Src (pSrc), and Ki-67 were investigated by immunohistochemistry. To verify these results the in vitro expression of EGFR and pEGFR were analyzed with ELISA in a panel of 10 HNSCC cell lines.

Results

A close correlation was found between in vitro and in vivo cetuximab sensitivity data in the two investigated HNSCC cell lines. In treatment sensitive UT-SCC-14 xenografts there was a decrease in EGFR, pEGFR, and pSrc upon cetuximab treatment. Interestingly, in insensitive UT-SCC-45 xenografts an increased expression of these three proteins was found. The change in EGFR and pEGFR expression in vivo was confirmed in cetuximab sensitive and insensitive HNSCC cell lines using ELISA.

Conclusion

High sensitivity to cetuximab was strongly associated with a treatment-induced reduction in pEGFR both in vivo and in vitro in a panel of HNSCC cell lines, suggesting that EGFR and pEGFR dynamics could be used as a predictive biomarker for cetuximab treatment response.

http://ift.tt/2hwynLG

Tracheostomy in the Morbidly Obese: Difficulties and Challenges

Publication date: Available online 30 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Tirbod Fattahi, Christopher Chafin, Anthony Bunnell
PurposeThis manuscript is designed to evaluate the difficulties and challenges associated with open trachesotomy in the morbidly obese patient (BMI≥ 30 kg/m²).Patients & MethodForty patients met all the inclusion criteria. A retrospective chart review was then performed to evaluate indications for tracheostomy, length of intubation prior to tracheostomy, history of previous tracheostomy, length of operative procedure, length of time in the operating room, as well as all perioperative complications.ResultsComplications were classified as intra-operative (5%) and post-operative (17.5%). The average BMI of our patients was 46 kg/m² with a range of 31.1 to 75.3 kg/m². The average length of intubation prior to tracheostomy was 11 days. Ten patients (25%) had undergone a previous tracheostomy. The average operating time was 60 minutes with a range of 20-95 minutes. The average total time in the operating room was 100 minutes with a range of 45-146 minutes.ConclusionOur study shows that while open tracheostomy in the morbidly obese patient is increasing in demand, the procedure can be predictably performed albeit at a much longer duration and a higher peri-operative complication rate compared to the traditional tracheostomy.

http://ift.tt/2ipx31M

The “drawer-like” resection and reconstruction with Titanium Mesh: a novel surgical technique for treatment of giant ossifying fibroma in the maxilla

Publication date: Available online 29 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mingming Lv, Jun Li, Yi Shen, Liang Wang, Jian Sun
PurposeThe aim of this article is to introduce a new surgical method for treatment of ossifying fibroma (OF) in the maxilla with dislocation of eyeball, and evaluate the postoperative outcomes and prognosis.Patients and MethodsPatients of maxillary OF treated with the "drawer-like" resection were retrieved from 2014 to 2015. The surgical procedure consists of total removal of the orbital floor and majority of the maxilla with the preservation of alveolar ridge, immediately followed by reconstruction with titanium mesh. Postoperative appearance and function were assessed. In addition, the recurrence rate was statistically observed.ResultsThe study included 6 patients of maxillary OF who were treated with "drawer-like" resection. Good esthetics and reduction of the globe have been well achieved in all the patients. Long-term follow-up shows that the recurrence rate is low. It needs to be emphasized that the original occlusal relationship and the masticatory function have been preserved.ConclusionsWith this new method, the original occlusal relationship can be well preserved. Meanwhile, bulging of maxilla and eyeball displacement have been corrected.

http://ift.tt/2ilkSQW

Primary embryonal rhabdomyosarcoma of the liver

Rhabdomyosarcomas are malignant neoplasms with striated muscle differentiation. This is the most common type of soft-tissue sarcoma in children, but occurs rarely in adults. Its occurrence in liver is infrequent. We report a case of primary hepatic embryonal rhabdomyosarcoma in a 67-year-old man. The tumour was occupying the left lobe of the liver with large component of lesion seen bulging in left subhepatic space indenting over the stomach, compressing the pancreas and gall bladder. A percutaneous biopsy was performed which revealed embryonal rhabdomyosarcoma. He underwent a successful left lobectomy with complete resection of the tumour, followed by adjuvant chemotherapy. The patient is free of disease at 24 months of follow-up. Hence, an early diagnosis, prompt surgical resection with negative resection margin along with adjuvant chemotherapy can provide complete remission. This case is extremely rare both due to the age of the patient at presentation and location of the tumour.

http://ift.tt/2iN9YGZ

Irreducible posterolateral elbow dislocation: a rare injury

Posterolateral dislocation of the elbow is an injury commonly treated in the emergency department by closed reduction. Very rarely it can be irreducible and require open reduction. Only four cases of irreducible posterolateral elbow dislocation have been described in the literature over the past 50 years. We report the case of a 20-year-old man who sustained such an injury. Open reduction was performed and revealed the radial head protruding or 'buttonholing' through the lateral collateral ligament complex. This case highlights that continued closed reduction of the elbow should not be attempted, as a mechanical block to reduction can occur making reduction impossible.

http://ift.tt/2hwHrAs

Complete androgen insensitivity syndrome with concomitant seminoma and Sertoli cell adenoma: an unusual combination

Androgen insensitivity syndrome is a rare disorder of sex development and its clinical manifestations vary from subtle male infertility to an overt complete androgen insensitivity syndrome (CAIS) with a female phenotype. CAIS is often diagnosed at puberty or in adolescence during investigation for primary amenorrhoea. Undiagnosed patients have an increased risk of development of malignancy in the harboured testes. Inguinal hernia is the commonest mode of presentation of CAIS in childhood and various screening methods are available during the initial herniorrhaphy procedure. Controversy exists in the need to screen and the methods of screening in all cases of premenstrual girls with inguinal hernia. Abnormal observation in a suspicious case requires karyotyping for confirmation. We describe a case of CAIS with simultaneous presence of seminoma and a Sertoli cell adenoma in a 17-year-old patient who had a history of surgery for inguinal hernia at age of 5 years.

http://ift.tt/2iNc9dI

Piggy back intraocular lens for the correction of buckling surgery-induced refractive error in pseudophakia

A 29-year-old man presented to us with bilateral pseudophakia with suboptimal vision in right eye. His uncorrected distance visual acuity (UDVA) on Snellen's chart was 6/36 and 6/9 in right eye (OD) and left eye (OS), respectively. It improved to 6/9 OD with –5.00DS/–0.50DC at 90° and 6/6 OS with –0.5DC at 100°. He had undergone buckling surgery 1 year back for rhegmatogenous retinal detachment in right eye and subsequently developed a myopic refractive error. A spherical piggyback intraocular lens (IOL; Rayner Sulcoflex, East Sussex) was implanted in the sulcus for refractive correction. The postoperative UDVA at 4 weeks was 6/6p. The intraocular pressure was normal and there was no significant endothelial cell loss. Piggyback IOLs can be an effective tool to correct the induced refractive error due to an increase in axial length following buckling surgery.

http://ift.tt/2hwFPXc

Simultaneous bilateral total hip arthroplasty dislocation with unilateral foot drop following closed reduction

Dislocation following primary and revision arthroplasty is a well-recognised complication with an estimated incidence rate of 0.2–10%. We present a rare case of simultaneous bilateral total hip replacement dislocation, complicated by unilateral foot drop following closed reduction, with no improvement in neurological function at 6-month follow-up.

http://ift.tt/2iNavsq

Optical coherence tomography of band keratopathy

Description

Band keratopathy is a chronic degenerative disease characterised by the gradual deposition of greyish opacity in superficial cornea over months or years in eyes with chronic uveitis or on intensive topical therapies containing phosphates. The mechanism of calcium deposition in the interpalpebral area of the cornea is multifactorial: salt precipitation as tears evaporate, necrotic debris from superficial keratitis, inflammatory changes in the pH of the ocular surface and the breakdown of phosphates.12 Band keratopathy can result in severe visual loss from corneal opacification. The main goal of surgery is to restore corneal transparency, providing visual rehabilitation, and avoiding amblyopia in children. Treatment includes removal of calcium deposits by chelation using ethylenediaminetetraacetic acid (EDTA), or superficial keratectomy or phototherapeutic keratectomy.3 The choice of the surgical technique and the required depth of surgery can be optimised by prior visualisation of the calcium...

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Idiopathic bilateral haemolacria

DescriptionCase description

A 15-year-old girl presented with a 1-month history of intermittent, bilateral 'bloody tears' (figure 1A, B). History revealed the symptoms began spontaneously 1 month back with an average one episode in 15 days lasting for less than a minute. Examination revealed 20/20 visual acuity in both the eyes with the normal eyelid, conjunctiva, lacrimal sac area, ocular surface, intraocular pressure and fundus. At the time of initial presentation, smear from the bloody tear film did not reveal any abnormal cells except for red blood cells, followed by lacrimal system syringing and probing revealed patent nasolacrimal system without any identifiable cause. Family history was negative for such symptoms/bleeding disorders, no history of any medication usage and of any disease/surgery related to periocular tissue, nose or sinuses. Haematological work-up showed normal complete blood count, bleeding time, clotting time, prothrombin time and liver function test. CT of the...

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Severe amoebic colitis in an HIV-infected male patient

Description

A previously healthy Japanese man aged 67 years was admitted into our hospital after presenting with fever, abdominal pain and watery diarrhoea (occasionally bloody) for 2 weeks. At presentation, he had a fever of 38.9°C and diffuse abdominal tenderness. His white cell count was 7440/μL, C reactive protein 22.18 mg/dL, serum albumin 1.8 g/dL, potassium 2.9 mmol/L and blood urea nitrogen was 26.5 mg/dL. Abdominal CT revealed pancolitis with mild splenomegaly but no hepatic lesions. Stool analysis and culture was negative for pathogenic bacteria, Clostridium difficile and tuberculosis.

After conservative treatment with intravenous drip for 2 days, a sigmoidoscopy was performed. Multiple surface to deep ulcerations with yellowish exudate was observed in the rectosigmoid region (figure 1A). Mucosal biopsy revealed acute colitis with the presence of haemophagocytic amoebic trophozoites (figure 2, arrows). Microscopic examination of the patient's stool also confirmed the presence of Entamoeba histolytica trophozoites and amoebic serology was...

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Mangled extremity: to salvage or not to salvage?

Description

A man aged 34 years post jump from the platform onto an incoming train presented as a level I trauma notification with bilateral mangled lower extremities and tourniquets in place (figure 1). Our patient was evaluated in a multidisciplinary fashion, making sure to follow proper ATLS guidelines. On presentation, he was hypotensive, but responded to crystalloid and blood products. Secondary survey revealed pulseless, paralysed extremities that lacked sensation and were grossly contaminated. The Mangled Extremity Severity Score (MESS) calculated as 9.1 With all factors considered, the patient was emergently taken to the operating theatre for left above knee and right below knee amputations.

Figure 1

Bilateral mangled lower extremities with a calculated Mangled Extremity Severity Score of 9 in a man aged 34 years who attempted suicide by jumping from a train platform.

The mangled extremity represents complex...

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Intercostal artery pseudoaneurysm with spontaneous resolution in the setting of an artery of Adamkiewicz

We report an extremely unique and previously unreported case of a pseudoaneurysm arising from an intercostal artery that also gave origin to the artery of Adamkiewicz. Due to the potential risk of losing the artery of Adamkiewicz, a conservative approach was indicated. On short interval follow-up imaging, the pseudoaneurysm and associated hematoma spontaneously resolved with preservation of the intercostal artery. We performed a literature review of the natural course of pseudoaneurysm as well as their occurrence in the intercostal arteries.

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Bile acids: a potential role in the pathogenesis of pharyngeal malignancy

Abstract

Objective

Gastro-oesophageal reflux disease is thought to be a risk factor for head and neck malignancies. Bile acids are one of the principle components of gastric refluxate and have previously been implicated in the development of oesophageal and bowel malignancies. There is clear evidence that bile acids reflux into the laryngopharynx. Despite this, the carcinogenic properties of bile acids in this area are yet to be fully identified. We therefore investigated the potential role of bile acids in pharyngeal malignancy, through the highly conserved process of epithelial-mesenchymal transition (EMT). EMT occurs in invasion and metastasis and is a central process in the development of epithelial carcinoma.

Design

Translational research study

Methods

Human hypopharyngeal squamous carcinoma FaDu cells were challenged with primary (cholic or chenodeoxycholic) and secondary (deoxycholic or lithocholic) bile acids. EMT relevant proteins TGF-β1 and MMP-9 were measured in the cell culture supernates at 48-hours via ELISA. Cell viability was confirmed >95% via CellTiter-Blue assay.

Results

Significantly greater concentrations of TGF-β1 were measured in the culture supernates of cells treated with cholic acid, deoxycholic acid, chenodeoxycholic acid. MMP-9 levels were increased in deoxycholic acid and lithocolic acid stimulations when compared to control (p<0.05).

Conclusion

This is the first demonstration that bile acids induce TGF-β1 and MMP-9 in pharyngeal cells. TGF-β1 is considered a master switch for EMT while MMP-9 is a part of the EMT proteome which degrades basement membranes. This implies a potential role for bile acids in pharyngeal carcinogenesis through the mechanism of EMT and suggests potential novel therapeutic targets.

http://ift.tt/2hC3BGj

Exhaled breath condensate in asthma: Are we stupid if we do not keep it simple?

Publication date: January–February 2017
Source:Allergologia et Immunopathologia, Volume 45, Issue 1
Author(s): L. Garcia-Marcos

http://ift.tt/2ip6UQH

Comparison of two preoperative protocols for mandibular symphyseal distraction osteogenesis to reduce the risk of tooth damage

Publication date: Available online 30 December 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Heinz Winsauer, Oliver Ploder, Katharina Juengling, Andre Walter, Andreas Kolk

http://ift.tt/2ikF59v

Association of Iron Deficiency Anemia With Hearing Loss in US Adults.

Association of Iron Deficiency Anemia With Hearing Loss in US Adults.

JAMA Otolaryngol Head Neck Surg. 2016 Dec 29;:

Authors: Schieffer KM, Chuang CH, Connor J, Pawelczyk JA, Sekhar DL

Abstract
Importance: Hearing loss in the US adult population is linked to hospitalization, poorer self-reported health, hypertension, diabetes, and tobacco use. Because iron deficiency anemia (IDA) is a common and easily correctable condition, further understanding of the association between IDA and all types of hearing loss in a population of US adults may help to open new possibilities for early identification and appropriate treatment.
Objective: To evaluate the association between sensorineural hearing loss (SNHL) and conductive hearing loss and IDA in adults aged 21 to 90 years in the United States.
Design, Setting, and Participants: The prevalence of IDA and hearing loss (International Classification of Diseases, Ninth Revision codes 389.1 [SNHL], 389.0 [conductive hearing loss], and 389 [combined hearing loss]) was identified in this retrospective cohort study at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Iron deficiency anemia was determined by low hemoglobin and ferritin levels for age and sex in 305 339 adults aged 21 to 90 years. Associations between hearing loss and IDA were evaluated using χ2 testing, and logistic regression was used to model the risk of hearing loss among those with IDA. The study was conducted from January 1, 2011, to October 1, 2015.
Main Outcomes and Measures: Hearing loss.
Results: Of 305 339 patients in the study population, 132 551 were men (43.4%); mean (SD) age was 50.1 (18.5) years. There was a 1.6% (n = 4807) prevalence of combined hearing loss and 0.7% (n = 2274) prevalence of IDA. Both SNHL (present in 26 of 2274 individuals [1.1%] with IDA; P = .005) and combined hearing loss (present in 77 [3.4%]; P < .001) were significantly associated with IDA. Logistic regression analysis confirmed increased odds of SNHL (adjusted odds ratio [OR], 1.82; 95% CI, 1.18-2.66) and combined hearing loss (adjusted OR, 2.41; 95% CI, 1.90-3.01) among adults with IDA, after adjusting for sex.
Conclusions and Relevance: Iron deficiency anemia was associated with SNHL and combined hearing loss in a population of adult patients. Further research is needed to better understand the potential links between IDA and hearing loss and whether screening and treatment of IDA in adults could have clinical implications in patients with hearing loss.

PMID: 28033450 [PubMed - as supplied by publisher]

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Distant Metastases Following Postoperative Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma.

Distant Metastases Following Postoperative Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma.

JAMA Otolaryngol Head Neck Surg. 2016 Dec 29;:

Authors: Hosni A, Huang SH, Xu W, Su J, Bayley A, Bratman SV, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Spreafico A, De Almeidad J, O'Sullivan B, Goldstein D, Hope A

Abstract
Importance: Advances in surgical techniques, the advent of intensity-modulated radiotherapy (IMRT), and the use of concurrent chemotherapy in oral squamous cell carcinoma (OSCC) have led to improvement of locoregional control (LRC), but not distant control (DC). Moreover, the development of distant metastases (DM) in OSCC has a dismal prognosis.
Objective: To determine the characteristics and risk factors of DM following postoperative IMRT in OSCC, and to identify the clinicopathological features that could be associated with distant-only failure (DOF).
Design, Setting, and Participants: Retrospective study of 300 OSCC patients (192 [64%] men and 108 [36%] women) treated with surgery and postoperative IMRT between 2005-2012 in a tertiary cancer center.
Interventions: All patients underwent initial primary curative-intent resection with postoperative IMRT with or without concurrent chemotherapy based on predefined risk features.
Main Outcomes and Measures: Locoregional control, DC, overall survival (OS), and Radiation Therapy Oncology Group grade of 3 or higher late toxic effects. Multivariable analysis identified predictors for DM.
Results: Overall 300 patients were identified (histological grade 2-3 [G2-3], 285 [95%]; pT3-4, 121 [41%]; pN2-3, 141 [47%]). Positive resection margin was present in 64 of 300 (21%) patients and extracapsular extension in 89 of 281 (32%) neck dissections. Median IMRT dose was 66 Gy and concurrent chemotherapy was used in 73 patients (24%). Median follow-up was 41 months. The 5-year local, regional, and distant control and OS were 85%, 82%, 86%, and 69%, respectively. On multivariable analysis, pN2-3 (hazards ratio, 5.7; 95% CI, 2.2-14.7) and G2-3 (HR, 4.9; 95% CI, 2.8-8.9) were predictive of DM. Thirty-nine patients developed DM, of which 20 (51%) were DOF and 12 (31%) were oligometastatic (≤5 lesions). The clinicopathological characteristics in DOF were similar to patients with DM subsequent to locoregional failure. In patients with G2-3, pN2-3, and extracapsullar extension (all together), the 5-year cumulative incidence of DOF was 22%.
Conclusions and Relevance: Surgery and postoperative IMRT with or without concurrent chemotherapy achieved encouraging outcomes. The clinicopathological characteristics of DOF and DM with locoregional failure were similar. Patients with G2-3, pN2-3, and extracapsullar extension (all together) have higher risk of DOF. Both pN2-3 and G2-3 were independent predictors of DM. Patients with these risk factors may be candidates for prospective clinical trials of intensified therapy or surveillance strategies.

PMID: 28033442 [PubMed - as supplied by publisher]

http://ift.tt/2ioQmbk

Unilateral Neck Swelling in a Pediatric Patient.

Unilateral Neck Swelling in a Pediatric Patient.

JAMA Otolaryngol Head Neck Surg. 2016 Dec 29;:

Authors: Clark CM, Bann DV, Zacharia TT

PMID: 28033435 [PubMed - as supplied by publisher]

http://ift.tt/2ioOkbb

A veil in the oral cavity: report of two cases of oral synechiae

Publication date: Available online 29 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A. Dongol, P. Acharya, J.N. Prasad, M.R. Jaisani
An oral synechia is an adhesion between the maxilla and the mandible; these adhesions can be found at various locations in the oral cavity. The presence of oral synechiae associated with cleft palate represents a rare congenital deformity. Oral synechiae with cleft palate can have serious implications for airway management and feeding in babies, and hence requires early intervention to reduce morbidity. Two cases of congenital oral synechiae accompanied by cleft palate, in which the synechiae veiled the oral cavity restricting a detailed intraoral examination, are reported here.

http://ift.tt/2hTp61f

Maxillary advancement versus mandibular setback in class III dentofacial deformity: are there any differences in aesthetic outcomes?

Publication date: Available online 30 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Ghassemi, R.-D. Hilgers, U. Fritz, A. Modabber, A. Ghassemi
A retrospective evaluation of maxillary advancement and mandibular setback in class III patients was performed and their aesthetic outcomes compared. Patients with a sella–nasion–A-point angle (SNA) of 80–84° were selected. Pre- and postoperative lateral cephalograms were obtained for 34 class III patients; these were divided into two groups according to the surgical procedure performed: mandibular setback group (n=17) and maxillary advancement group (n=17). The pre- and postoperative cervical length, lip–chin–throat angle, lower/upper lip thickness, distance from the lower/upper lip to the aesthetic line, soft tissue angle, facial contour angle, and nasolabial angle of the two groups were compared. Significant differences were observed for cervical length (P=0.0003) and sex (P=0.003) when comparing maxillary advancement with mandibular setback. Although the preoperative cervical length was similar in the two groups, it increased significantly after maxillary advancement and decreased after mandibular setback. In this study, the differences in aesthetic outcomes depending on the surgical procedure performed were considered. Some aesthetically important parameters proved to be superior after maxillary advancement when compared to mandibular setback, even with the maxilla in the normal position.

http://ift.tt/2hBNpoq

Αρχειοθήκη ιστολογίου

Σάββατο 31 Δεκεμβρίου 2016

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Παρασκευή 30 Δεκεμβρίου 2016

Abstract

Background

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Objectives

Methods

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Abstract

Background

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Background

Materials and Methods

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Abstract

Background

Materials and methods

Results

Conclusion

Abstract

Objective

Design

Translational research study

Methods

Results

Conclusion