Head and Neck Medicine by Alexandros G.Sfakianakis: 09/10/16

Σάββατο 10 Σεπτεμβρίου 2016

Effect of non-surgical periodontal treatment by full-mouth disinfection or scaling and root planing per quadrant in halitosis—a randomized controlled clinical trial

Abstract

Objective

The objective of this study was to compare the effect of one-stage full-mouth disinfection (FMD) and conventional quadrant scaling in four weekly sessions (QS) on periodontal clinical parameters and halitosis among individuals with advanced chronic periodontitis.

Materials and methods

In this randomized controlled clinical trial, 30 individuals were divided into two groups: FMD (n = 15) and QS (n = 15). The following data were collected at the baseline and 90 days after treatment: plaque index, tongue-coating index (TCI), bleeding on probing, probing depth, and clinical attachment level. Halimetry was performed by the organoleptic method, and the levels of volatile sulfur compounds (H2S and CH3SH) were measured by gas chromatography. The Chi-square, Fisher's exact, the Mann-Whitney, the McNemar, and the Wilcoxon tests were used for statistical analysis.

Results

Both groups showed statistically significant improvements in periodontal clinical parameters, reduction in TCI, organoleptic scores, and in CH₃SH levels between times. However, major reduction was observed in FMD group.

Conclusion

Non-surgical periodontal therapy, regardless of the protocol, was effective in improving periodontal clinical status of individuals, decreasing organoleptic scores and CH₃SH levels between times, as well as reducing halitosis.

Clinical relevance

This study contributed to the knowledge that non-surgical periodontal therapy, whether by FMD or QS, was effective in reducing halitosis in individuals with advanced chronic periodontitis.

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Re-Assessment of Coronoid as a Graft for Condylar Reconstruction in TMJ Ankylosis Patients: A Prospective Study and Literature Review

Abstract

Introduction

Treatment for TMJ ankylosis aims at restoring joint function, improving the patient's aesthetic appearance and quality of life and preventing re-ankylosis. To rebuild a structurally and functionally satisfactory neocondyle is a challenging problem. Aim of this study is to re-assess the coronoid as a graft for condyle reconstruction.

Materials and Methods

Twenty patients of TMJ ankylosis without involvement of the coronoid process in ankylotic mass, coming in age group elder than 14 years were selected for the study over a period 3 years from 2011 to 2014. Clinical examination, radiographs, and photographs were used postoperatively to evaluate the grafts and TMJ function. After osteoarthrectomy coronoid process was detached and fixed with a 4 hole L-shaped titanium miniplate to form neo condyle.

Result

No donor site morbidity was observed as reported with other autogenous grafts. Satisfactory mouth opening was observed during follow up period with mean mouth opening 37.33 ± 4.20 mm except one case which required graft removal due to postoperative infection. Radiographically moderate amount of resorption of grafted coronoid process was observed in nearly all the cases however satisfactory mandibular function and occlusion was observed.

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Influence of increment thickness on dentin bond strength and light transmission of composite base materials

Abstract

Objectives

Bulk-fill resin composites (BFCs) are gaining popularity in restorative dentistry due to the reduced chair time and ease of application. This study aimed to evaluate the influence of increment thickness on dentin bond strength and light transmission of different BFCs and a new discontinuous fiber-reinforced composite.

Materials and methods

One hundred eighty extracted sound human molars were prepared for a shear bond strength (SBS) test. The teeth were divided into four groups (n = 45) according to the resin composite used: regular particulate filler resin composite: (1) G-ænial Anterior [GA] (control); bulk-fill resin composites: (2) Tetric EvoCeram Bulk Fill [TEBF] and (3) SDR; and discontinuous fiber-reinforced composite: (4) everX Posterior [EXP]. Each group was subdivided according to increment thickness (2, 4, and 6 mm). The irradiance power through the material of all groups/subgroups was quantified (MARC® Resin Calibrator; BlueLight Analytics Inc.). Data were analyzed using two-way ANOVA followed by Tukey's post hoc test.

Results

SBS and light irradiance decreased as the increment's height increased (p < 0.05), regardless of the type of resin composite used. EXP presented the highest SBS in 2- and 4-mm-thick increments when compared to other composites, although the differences were not statistically significant (p > 0.05). Light irradiance mean values arranged in descending order were (p < 0.05) EXP, SDR, TEBF, and GA.

Conclusions

As increment thickness increased, the light transmission decreased for all tested resin composites. Discontinuous fiber-reinforced composite showed the highest value of curing light transmission, which was also seen in improved bonding strength to the underlying dentin surface.

Clinical relevance

Discontinuous fiber-reinforced composite can be applied safely in bulks of 4-mm increments same as other bulk-fill composites, although, in 2-mm thickness, the investigated composites showed better performance.

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Consolidative Technique Otoplasty: Comprehensive Approach in Combining Techniques

Abstract

Background

This study aimed to present the long-term results of the consolidative technique otoplasty (CTO).

Methods

Patient age, sex, duration of follow-up, and how the deformity (bilateral-unilateral) occurred were determined. The kind of anesthesia, duration of surgery, surgical techniques used during the operation were reported, and the preoperative and postoperative distances between the ear and head were measured at four points (SUP: The highest point of the helix; SCA: the concha superior sticking points; ICA: stick point of Concha at the inferior; and lobular). Early- and late-term complications were recorded in the postoperative period.

Results

A total of 63 (21M–42FM) patients whose average age of 21:41 ± 8.96 (7–41), 119 ears (Right: 58/Left: 61) were operated on with this technique between 2013 and 2015. Mean follow-up was 18:22 ± 9:42 months. Anterior scoring was performed for three patients; concha resection was performed in 17 patients. Fifty-five patients were operated on as primary otoplasties and eight were secondary otoplasties. When the preoperative and postoperative SUP, SCA, ICA, and lobule measurements for both ears were compared, the postoperative values were found to be significantly decreased (p < 0.001).

Conclusions

This technique may be an alternative in the repairs of prominent ears, and it provides an intervention opportunity for all the anatomical structures.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Influence of increment thickness on dentin bond strength and light transmission of composite base materials

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

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Autophagy: A boon or bane in oral cancer

Autophagy, as the name suggests, is "eating of self", it is an intracellular degradation system that delivers cytoplasmic constituents to the lysosome [1]. It is a constitutive basic mechanism executed in all cells, its function is to promote cellular homeostasis which is carried out through regulating proteins and organelles turnover [2]. Christian de Duve coined the term 'autophagy', which he introduced at the CIBA Foundation Symposium on Lysosomes in 1963. He described it in context of single- or double-membrane vesicles that contain parts of the cytoplasm and organelles in various states of disintegration [3].

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Does elimination of planned postoperative radiation to the primary bed in p16-positive, transorally-resected oropharyngeal carcinoma associate with poorer outcomes?

Transoral surgery (TOS) for head and neck primaries allows carefully-controlled intraoperative margin analysis, resulting in high margin-negative resection and low local recurrence rates [1–4]. Reported outcomes from observational studies in the literature on oropharynx squamous cell carcinoma (OPSCC) indicate that avoidance of radiation to the primary site may result in good local control although no data specific to human papillomavirus (HPV) or p16-positivity is presented [1,5]. For instance, a 5-year Kaplan-Meier local control of 94% was observed in a series of 69 patients with tongue base tumors (T1-T3) treated with transoral laser microsurgery (TLM) alone, but without HPV/p16 stratification [5].

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Hypoxia-dependent HIF-1 activation impacts on tissue remodeling in Graves’ ophthalmopathy - implications for smoking

The Journal of Clinical Endocrinology &Metabolism, Early Release.

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Spontaneous hypoglycemia after islet transplantation: the case for using non-hepatic sites

The Journal of Clinical Endocrinology &Metabolism, Early Release.

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Stress increases gonadotropin inhibitory hormone cell activity and input to gonadotropin releasing hormone cells in ewes

Endocrinology, Early Release.

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TGFβ Superfamily Members Mediate Androgen Deprivation Therapy-Induced Obese Frailty in Male Mice

Endocrinology, Early Release.

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Cross-sectional biomonitoring study of pesticide exposures in Queensland, Australia, using pooled urine samples

Abstract

A range of pesticides are available in Australia for use in agricultural and domestic settings to control pests, including organophosphate and pyrethroid insecticides, herbicides, and insect repellents, such as N,N-diethyl-meta-toluamide (DEET). The aim of this study was to provide a cost-effective preliminary assessment of background exposure to a range of pesticides among a convenience sample of Australian residents. De-identified urine specimens stratified by age and sex were obtained from a community-based pathology laboratory and pooled (n = 24 pools of 100 specimens). Concentrations of urinary pesticide biomarkers were quantified using solid-phase extraction coupled with isotope dilution high-performance liquid chromatography–tandem mass spectrometry. Geometric mean biomarker concentrations ranged from <0.1 to 36.8 ng/mL for organophosphate insecticides, <0.1 to 5.5 ng/mL for pyrethroid insecticides, and <0.1 to 8.51 ng/mL for all other biomarkers with the exception of the DEET metabolite 3-diethylcarbamoyl benzoic acid (4.23 to 850 ng/mL). We observed no association between age and concentration for most biomarkers measured but noted a "U-shaped" trend for five organophosphate metabolites, with the highest concentrations observed in the youngest and oldest age strata, perhaps related to age-specific differences in behavior or physiology. The fact that concentrations of specific and non-specific metabolites of the organophosphate insecticide chlorpyrifos were higher than reported in USA and Canada may relate to differences in registered applications among countries. Additional biomonitoring programs of the general population and focusing on vulnerable populations would improve the exposure assessment and the monitoring of temporal exposure trends as usage patterns of pesticide products in Australia change over time.

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Comparative study of dioxin contamination from forest soil samples (BZE II) by mass spectrometry and EROD bioassay

Abstract

Dioxins and dioxin-like compounds can be analyzed by bioanalytical screening methods to evaluate their biotoxicity. In vitro bioassays, based on 7-ethoxyresorufin-O-deethylase (EROD) and the activity of cytochrome P450 1A1 and the aryl hydrogen receptor (AhR) pathway, are employed for the evaluation of bioanalytical equivalents (BEQ) of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and polychlorinated biphenyls (PCBs) from a wide variety of sample matrices. Here, we present the evaluation of 11 humic soil samples derived from forest stands across Germany and a comparison of the BEQ values against toxic equivalents (TEQ, PCDD/Fs+PCBs) derived by chemical analysis. BEQ values ranged from 8.8 to 34.1 while TEQ values from 13.9 to 60.5 pg/g dry weight. Additional two subsequent mineral layers were analyzed to identify the BEQ/TEQ gradient vertically, showing a TEQ decrease of 85.1 and 93.8 % from the humic to the first and second mineral layers, respectively. For BEQ values, a decrease as well as an increase was detected. BEQ measurements were performed with and without sample clean-up. Omitting clean-up revealed about 20 times increased BEQ values presumably due to non-persistent bioactive compounds not detected by chemical analysis. The results we present suggest that the EROD assay can be used for the screening of large sample quantities for the identification of samples showing dioxin and dioxin-like contaminations even at low levels, which can then be further analyzed by chemical analysis to identify the congener composition. The study also shows that EROD results give a qualitative image of the contamination. EROD seems to be interfered with cross-contaminants specifically for soils with high biological activity as forest layers.

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Improving the Fenton process by visible LED irradiation

Abstract

The effect of irradiation with visible light-emitting diode (LED) light on the efficiency of Fenton oxidation is investigated using phenol as the target compound (100 mg/L). The H₂O₂ dose and temperature are tested as operating variables with the aim of minimizing consumption of the reagents. At 50 °C, 10 mg/L Fe²⁺, and 60 % of the stoichiometric H₂O₂ amount, phenol was completely oxidized into CO₂, H₂O, and short chain organic acids, with oxalic acid completely degraded. Up to 95 % mineralization was achieved. This high efficiency can be attributed to the effect of LED radiation on the quinones/Fe²⁺/Fe³⁺/H₂O₂ cycle, which significantly increases the reaction rate, as well as on the photodecomposition of the iron complexes formed along the oxidation process, which also enhanced mineralization.

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Computational study of H-abstraction reactions from CH 3 OCH 2 CH 2 Cl/CH 3 CH 2 OCH 2 CH 2 Cl by Cl atom and OH radical and fate of alkoxy radicals

Abstract

Multichannel gas-phase reactions of CH₃OCH₂CH₂Cl/CH₃CH₂OCH₂CH₂Cl with chlorine atom and hydroxyl radical have been investigated using ab initio method and canonical variational transition-state dynamic computations with the small-curvature tunneling correction. Further energetic information is refined by the coupled-cluster calculations with single and double excitations (CCSD)(T) method. Both hydrogen abstraction and displacement processes are carried out at the same level. Our results reveal that H-abstraction from the –OCH₂– group is the dominant channel for CH₃OCH₂CH₂Cl by OH radical or Cl atom, and from α-CH₂ of the group CH₃CH₂– is predominate for the reaction CH₃CH₂OCH₂CH₂Cl with Cl/OH. The contribution of displacement processes may be unimportant due to the high barriers. The values of the calculated rate constants reproduce remarkably well the available experiment data. Standard enthalpies of formation for reactants and product radicals are calculated by isodesmic reactions. The Arrhenius expressions are given within 220–1200 K. The atmospheric lifetime, ozone depleting potential (ODP), ozone formation potential (OFP), and global warming potential (GWP) of CH₃OCH₂CH₂Cl/CH₃CH₂OCH₂CH₂Cl are investigated. Meanwhile, the atmospheric fate of the alkoxy radicals are also researched using the same level of theory. To shed light on the atmospheric degradation, a mechanistic study is obtained, which indicates that reaction with O₂ is the dominant path for the decomposition of CH₃OCH(O•)CH₂Cl, the C–C bond scission reaction is the primary reaction path in the consumption of CH₃CH(O•)OCH₂CH₂Cl in the atmosphere.

Highlights

Ab initio method and canonical variational transition-state theory are employed to study the kinetic nature of hydrogen abstraction reactions of CH₃OCH₂CH₂Cl/CH₃CH₂OCH₂CH₂Cl with Cl atom and OH radical and fate of alkoxy radicals (CH₃OCH(O•)CH₂Cl/CH₃CH(O•)OCH₂CH₂Cl).

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The influence of the scale of mining activity and mine site remediation on the contamination legacy of historical metal mining activity

Abstract

Globally, thousands of kilometres of rivers are degraded due to the presence of elevated concentrations of potentially harmful elements (PHEs) sourced from historical metal mining activity. In many countries, the presence of contaminated water and river sediment creates a legal requirement to address such problems. Remediation of mining-associated point sources has often been focused upon improving river water quality; however, this study evaluates the contaminant legacy present within river sediments and attempts to assess the influence of the scale of mining activity and post-mining remediation upon the magnitude of PHE contamination found within contemporary river sediments. Data collected from four exemplar catchments indicates a strong relationship between the scale of historical mining, as measured by ore output, and maximum PHE enrichment factors, calculated versus environmental quality guidelines. The use of channel slope as a proxy measure for the degree of channel-floodplain coupling indicates that enrichment factors for PHEs in contemporary river sediments may also be the highest where channel-floodplain coupling is the greatest. Calculation of a metric score for mine remediation activity indicates no clear influence of the scale of remediation activity and PHE enrichment factors for river sediments. It is suggested that whilst exemplars of significant successes at improving post-remediation river water quality can be identified; river sediment quality is a much more long-lasting environmental problem. In addition, it is suggested that improvements to river sediment quality do not occur quickly or easily as a result of remediation actions focused a specific mining point sources. Data indicate that PHEs continue to be episodically dispersed through river catchments hundreds of years after the cessation of mining activity, especially during flood flows. The high PHE loads of flood sediments in mining-affected river catchments and the predicted changes to flood frequency, especially, in many river catchments, provides further evidence of the need to enact effective mine remediation strategies and to fully consider the role of river sediments in prolonging the environmental legacy of historical mine sites.

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Long trend reduction of phosphorus wastewater loading in the Seine: determination of phosphorus speciation and sorption for modeling algal growth

Abstract

The lower Seine River is severely affected by the release of the treated wastewater from the 12 million inhabitants of the Paris agglomeration. Whereas urban effluents were the major source of phosphorus pollution in the late 1980s, the ban on polyphosphates from detergents in 1991 considerably reduced the phosphorus (P) loading to the Seine River and was followed in 2000 by the implementation of phosphorus treatment in the largest wastewater treatment plant of Paris conurbation (Seine Aval). Phosphorus discharged to the rivers from domestic wastewater was reduced by 80 %, significantly decreasing phytoplankton biomass in the large branches of the Seine River. Considering that phosphorus treatment (the use of ferric salts in the P treatment line) might change the adsorption of ortho-phosphates on suspended matter, we experimentally studied again their sorption processes in these new conditions. We found parameters of the Langmuir equation (Pac = 0.003 mgP mgSS⁻¹; Kps = 0.04 mgP L⁻¹) that significantly differed from the values previously considered for modeling of the whole Seine, especially for Kps (Pac = 0.0055 mgP mgSS⁻¹; Kps = 0.7 mgP L⁻¹). Using the Seneque-Rivertrahler modeling approach, we showed a better agreement between P observations and simulations with the new P sorption parameters, with slight effect on the simulation of the development of phytoplankton in the water column.

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Pediatric Arm Reconstruction after Shot-gun Injury Using Peroneal Free-flap and Pedicled Latissimus Dorsi Muscle Flap: Late Follow-up

Summary: A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi. Ten years after surgery, the patient presents neither functional deficit of the injured limb (shoulder, arm, forearm, and hand) nor sequelae in the donor areas; he performs his daily activities without any limitations. This case confirms that the use of free bone flaps and pedicled muscle flaps in pediatric patients can provide excellent long-term results.

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Direct Hospital Cost of Outcome Pathways in Implant-Based Reconstruction with Acellular Dermal Matrices

Background: Current cost data on tissue expansion followed by exchange for permanent implant (TE/I) reconstruction lack a necessary assessment of the experience of a heterogenous breast cancer patient population and their multiple outcome pathways. We extend our previous analysis to that of direct hospital cost as bundling of payments is likely to follow the changing centralization of cancer care at the hospital level. Methods: We performed a retrospective analysis (2003–2009) of TE/I reconstructions with or without an acellular dermal matrix (ADM), namely Alloderm RTM. Postreconstructive events were analyzed and organized into outcome pathways as previously described. Aggregated and normalized inpatient and outpatient hospital direct costs and physician reimbursement were generated for each outcome pathway with or without ADM. Results: Three hundred sixty-seven patients were analyzed. The average 2-year hospital direct cost per TE/I breast reconstruction patient was $11,862 in the +ADM and $12,319 in the −ADM groups (P > 0.05). Initial reconstructions were costlier in the +ADM ($6,868) than in the −ADM ($5,615) group, but the average cost of subsequent postreconstructive events within 2 years was significantly lower in +ADM ($5,176) than −ADM ($6,704) patients (P

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Multiple Delayed Scalp Reconstruction for Complicated Cranial Defects

Summary: In cases of skull trauma, emergency surgery for cranial decompression typically involves the shortest approach, with the incision lying directly on or immediately near the bony defect. Subsequent reconstructive plastic surgery for the skull is difficult in such cases because incisions taken on the previous scar overlying the bony defect are prone to dehiscence and infection. Herein, we describe a technique for creating a well-vascularized delayed skin flap via multistaged operation before the actual skull reconstruction. Four patients (age range, 10–25 y) were prepared for skull reconstruction using this technique. Flap elevation was performed in 3 stages, with adequate time intervals (4 wk between each stage) to allow for adequate delay. Dissection under the galea aponeurotica was performed only after initial flap elevation allowing for adequate vascularization. Skull reconstruction was then performed using custom-made implants. The patients were followed up for 6 to 12 months. No complications, including infections, exposure of the artificial bone, or flap necrosis, were observed. All the patients were satisfied with the cosmetic results. Despite the multiple stages required, we consider that our technique of using a delayed, well-vascularized bipedicled skin flap can be successfully used in the skull reconstruction of patients in whom the initial scar lies close to the bone defect. We recommend scalp incision be shifted outside of the foreseen bony flap to limit infectious risks during primary or subsequent cranial reconstruction.

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Predictors of Reoperations in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Background: The deep inferior epigastric perforator (DIEP) procedure is regarded a safe option for autologous breast reconstruction. Reoperations, however, may occur, and there is no consensus in the literature regarding the risk factors. The aim of this study was to identify factors associated with reoperations in DIEP procedure. Patients and Methods: A retrospective study of consecutive patients undergoing DIEP breast reconstruction 2007 to 2014 was performed and included a review of 433 medical charts. Surgical outcome was defined as any unanticipated reoperation requiring return to the operating room. Multivariate regression analysis was utilized to identify predictors of reoperation. The following factors were considered: age, body mass index, comorbidity, childbearing history, previous abdominal surgery, adjuvant therapy, reconstruction laterality and timing, flap and perforator characteristics, and number and size of veins. Results: In total, 503 free flaps were performed in 433 patients, 363 (83.8%) unilateral and 70 (16.2%) bilateral procedures. Mean age was 51 years; 15.0% were obese; 13.4% had hypertension; 2.3% had diabetes; 42.6% received tamoxifen; 58.8% had preoperative radiotherapy; 45.6% had abdominal scars. Reoperation rate was 15.9% (80/503) and included flap failure, 2.0%; partial flap loss, 1.2%; arterial thrombosis, 2.0%; venous thrombosis, 0.8%; venous congestion, 1.2%; vein kinking, 0.6%. Other complications included bleeding, 2.2%; hematoma, 3.0%; fat necrosis, 2.8%, and infection, 0.2%. Factors negatively associated with reoperation were childbearing history (odds ratio [OR]: 3.18, P = 0.001) and dual venous drainage (OR: 1.91, P = 0.016); however, only childbearing remained significant in the multivariate analyses (OR: 4.56, P = 0.023). Conclusions: The history of childbearing was found to be protective against reoperation. Number of venous anastomoses may also affect reoperation incidence, and dual venous drainage could be beneficial in nulliparous patients.

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Pathological Model of Hemangioma—New Thinking on Hemangioma Classification

No abstract available

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Anatomy of the Gynecomastia Tissue and Its Clinical Significance

Background: Gynecomastia is a very common entity in men, and several authors estimate that approximately 50% to 70% of the male population has palpable breast tissue. Much has been published with regard to the etiology, diagnosis, and treatment of gynecomastia. However, the anatomy of the gynecomastia tissue remains elusive to most surgeons. Purpose: The purpose of this article was to define the shape and consistency of the glandular tissue based on the vast experience of the senior author (MB). Patients and Methods: Between the years 1980 and 2014, a total of 5124 patients have been treated for gynecomastia with surgical excision, liposuction, or a combination of both. A total of 3130 specimens were collected with 5% of the cases being unilateral. Results: The specimens appear to have a unifying shape of a head, body, and tail. The head is semicircular in shape and is located more medially toward the sternum. The majority of the glandular tissue consists of a body located immediately deep to the nipple areolar complex. The tail appears to taper off of the body more laterally and toward the insertion of the pectoralis major muscle onto the humerus. Conclusions: This large series of gynecomastia specimens demonstrates a unique and unifying finding of a head, body, and tail. Understanding the anatomy of the gynecomastia gland can serve as a guide to gynecomastia surgeons to facilitate a more thorough exploration and subsequently sufficient gland excision.

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Bilateral Pedicled Superficial Inferior Epigastric Artery Flap in the Treatment of Hidradenitis Suppurativa

Summary: The authors present a new technique in surgically treating hidradenitis suppurativa (HS), a debilitating skin condition. In HS, surgical treatment is often the best option because of the high recurrence rates despite extensive medical treatment. A commonly successful surgical method is using skin flaps after excision of the affected area. A superficial inferior epigastric artery flap is demonstrated here as a new alternative approach to treating a case of extensive HS of the groin. By using the pedicled superficial inferior epigastric artery flap for groin reconstruction, inguinal HS can be widely excised and reconstructed with minimal donor-site morbidity and a good aesthetic outcome.

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Three-dimensional Nasolabial Morphologic Alterations Following Le Fort I

Background: Le Fort I osteotomy imparts significant changes to the nasolabial region. Past studies have relied on 2-dimensional data and have not delineated differences among various Le Fort I subtypes. The purpose of this study is to 3-dimensionally analyze Le Fort I–induced nasal and lip changes comparing advancement alone versus widening alone [surgically assisted maxillary expansion (SAME)] versus advancement and widening. We hypothesize that the combination of maxillary advancement with widening will result in the most profound changes. Methods: A retrospective cohort study was performed. Included Le Fort I patients were grouped as: (1) nonsegmental straight advancement, (2) widening without advancement, and (3) segmental advancement and widening. Pre- and postoperative 3-dimensional photogrammetry (Canfield) were analyzed. Anthropometric landmarks were placed and measured by 2 independent observers. Statistics involved both paired and unpaired t tests (significance = P

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Cellular Neurothekeoma: A Rare Tumor with a Common Clinical Presentation

Summary: Neurothekeomas are rare benign tumors commonly found on the head, neck, and upper extremities of women and younger individuals. They are thought to be of nerve sheath origin and usually present as painless, slow growing masses. We present a case of cellular neurothekeoma on the nasal ala of an 8-year-old girl with no previous history of trauma or piercings. Differential diagnosis, treatment options, and special considerations regarding potentially atypical characteristics are discussed.

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Radiofrequency-assisted Liposuction for Neck and Lower Face Adipodermal Remodeling and Contouring

Background: The purpose of this study is to report our experience using radiofrequency-assisted liposuction (RFAL) for neck and face contouring. This article details the operative technique, selection, complications, third-party surgeon appraisal, and patient satisfaction survey. Methods: From November 2009 to November 2013, 55 patients who underwent RFAL treatment were enrolled in the study. Postoperative patient satisfaction surveys were conducted, and 2 independent plastic surgeons evaluated contour and skin quality with randomized preoperative and postoperative photographs at 6 months postoperatively. The different parameters recorded involved age, sex, weight, body mass index, operative time, amount of fat aspirated and energy delivered, complications, and aesthetic outcome in 1 and 4 weeks and 3 and 6 months. Our longest follow-up was 4 years. Patients were asked 6 months postoperatively to grade their satisfaction as poor, no change, moderate, good, and excellent. Results: The mean age was 51 years (range, 35–61 years), and the mean amount of fat aspirated was 30 mL (range, 10–200 mL). Five out of 55 patients (9.1%) developed tissue hardness that resolved with massage. All patients were followed up for a minimum of 6 months. Eighty-five percent of patients were satisfied with their contouring result and degree of skin tightening (48/55 patients). Two independent plastic surgeons considered the improvement in contouring and degree of skin tightening good to excellent in 52 of 55 cases. Conclusions: In appropriately selected patients, RFAL neck and face contouring represent a safe procedure to achieve significant improvement of the skin laxity and fat deposits of the cervicomental zone and jowls.

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Clinical Assessment of the Safety and Effectiveness of Nonablative Fractional Laser Combined with Transdermal Delivery of Botulinum Toxin A in Treating Periocular Wrinkles

Summary: The upper and lower eyelids are traditionally contraindicated for subcutaneous botulinum toxin A (BTX) injection because of possible complications. We assessed the clinical safety and effectiveness of nonablative fractional laser (NAFL) combined with transdermal delivery of BTX in the treatment of periocular wrinkles. Thirty patients who had periocular wrinkles were treated with 1,565-nm NAFL in combination in the left periocular area and normal saline in the corresponding area of the right eye. VISIA skin detector was used to photograph and compare the changes induced by treatment. We also recorded the comfort level of the patients. All 28 patients could tolerate the pain caused by the laser treatment and showed no apparent discomfort during percutaneous drug delivery. No chromatosis or ptosis of upper eyelids occurred after the treatment. We used VISIA to detect changes at 1 week, 1 month, 3 months, and 6 months, respectively, after the treatment. The periocular wrinkles decreased, and the flabbiness of eyelids was significantly reduced. The upper and lower eyelids are traditionally contraindicated for subcutaneous BTX injection, as it may cause complications. The treatment combining 1,565-nm NAFL and transdermal delivery of BTX can decrease periocular wrinkles and flabbiness while avoiding complications to the greatest extent. None of the 28 patients who had completed the treatment suffered from complications or adverse effects; all were satisfied with the treatment outcome.

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Treatment of Suture-related Complications of Buried-suture Double-eyelid Blepharoplasty in Asians

Background: Double-eyelid blepharoplasty is a popular aesthetic surgery in Asians. However, the buried suture technique is associated with complications related to implantation of the suture thread. The present study was performed to identify optimal surgical suture removal techniques in Japanese patients with suture-related complications after buried suture double-eyelid blepharoplasty. Methods: This retrospective study included 210 upper eyelids of 116 consecutive Japanese patients who had undergone buried suture double-eyelid blepharoplasty at other clinics. All patients underwent suture removal surgery at the author's institution for treatment of suture-related complications. Although 12 patients (10.3%) underwent suture removal surgery alone, 104 (89.7%) underwent secondary double-eyelid blepharoplasty. The outcomes of 3 techniques were evaluated: the small skin incision method, the full skin incision method, and the conjunctival method. Results: The small skin incision method was performed in 46 patients, the full skin incision method in 63, and the conjunctival method in 7. The success rate of the full skin incision method was significantly higher than that of the small skin incision method (4.8% vs 37.0%, respectively; p

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Internal Pudendal Artery Perforator Island Flap for Management of Recurrent Benign Rectovaginal Fistula

Summary: The management of recurrent rectovaginal fistula after obstetric injury and cryptoglandular sepsis is considered a major surgical challenge. The fistula poses a significant negative psychosocial and sexual morbidity. In addition, the poor quality of local tissues due to previous attempts at surgical repair adds to this challenge. There are few data regarding the management of persistent or recurrent fistula in the literature; however, several studies reported high failure rates after 2 or more procedures. We present 4 cases managed successfully in a multidisciplinary approach involving fistulectomy and immediate reconstruction with an internal pudendal artery perforator island flap.

http://ift.tt/2c0NTlh

Tumescent Liposuction without Lidocaine

Background: Our previous study demonstrated that lidocaine has a negative impact on adipose-derived stem cell (ASC) survival. Currently for large-volume liposuction, patients often undergo general anesthesia; therefore, lidocaine subcutaneous anesthesia is nonessential. We hypothesized that removing lidocaine from tumescent might improve stromal vascular fraction (SVF) and ASC survival from the standard tumescent with lidocaine. Ropivacaine is also a commonly used local anesthetic. The effect of ropivacaine on ASC survival was examined. Methods: Adults who underwent liposuction on bilateral body areas were included (n = 10). Under general anesthesia, liposuction on 1 area was conducted under standard tumescent with lidocaine. On the contralateral side, liposuction was conducted under the modified tumescent without lidocaine. Five milliliters of lipoaspirate were processed for the isolation of SVF. The adherent ASCs were counted after 24 hours of SVF culture. Apoptosis and necrosis of SVF cells were examined by Annexin/propidium iodide staining and analyzed by flow cytometry. Results: Average percentage of live SVF cells was 68.0% ± 4.0% (28.5% ± 3.8% of apoptosis and 3.4% ± 1.0% of necrosis) in lidocaine group compared with 86.7% ± 3.7% (11.5% ± 3.1% of apoptosis and 1.8% ± 0.7% of necrosis) in no-lidocaine group (P = 0.002). Average number of viable ASC was also significantly lower (367,000 ± 107) in lidocaine group compared with that (500,000 ± 152) in no-lidocaine group (P = 0.04). No significant difference was found between lidocaine and ropivacaine on ASC cytotoxicity. Conclusions: Removing lidocaine from tumescent significantly reduced SVF and ASC apoptosis in the lipoaspirate. We recommend tumescent liposuction without lidocaine, particularly if patient's lipoaspirate will be used for fat grafting.

http://ift.tt/2c0NKxX

Silicone Breast Implant and Automatic Implantable Cardioverter Defibrillator: Can They Coexist? A Case Report

Summary: We present a case of a silicone breast implant rupture after insertion of an automatic implantable cardioverter defibrillator (AICD). A 51-year-old woman presented to our plastic surgery clinic to exchange her silicone breast implants. The patient underwent cosmetic mastopexy and breast augmentation in 2008. Because of recurrent myocardial infarctions and chronic heart failure, she underwent an insertion of an AICD in 2014 in which the left breast implant was hit. In this report, we discuss the first case of an AICD insertion, disrupting a breast implant. This case report illustrates the rare but real possibility of breast implant rupture after even minor surgical manipulation of the breast area.

http://ift.tt/2c0OMu9

Interdomal Suture through a Nondelivery Endonasal Approach: A New Technique

Background: The use of interdomal sutures for tip refinement is common in open rhinoplasty and in endonasal rhinoplasty using a delivery technique, but there is paucity of reports in the literature regarding the use of interdomal suturing techniques when the nondelivery endonasal approach is chosen. Objective: The authors describe a technique designed to refine the nasal tip with an interdomal suture placed through a nondelivery endonasal approach. Methods: In this study, the authors retrospectively review the cases of 45 patients who underwent endonasal rhinoplasty with the authors' interdomal suturing technique between the years 2011 and 2013. The average age of the patients was 25.3 years. Intercrural sutures (PDS 4.0 straight needle, Cincinnati, Ohio) were placed as mattress-like suture in the tip region, with the knot buried between both alar cartilages. The suture is tightened progressively according to the tip definition and narrowing sought. Results: The patients were followed for 12 months. All of the patients demonstrated a significant reduction in lobule and tip widths. This series had only 1 complication of tip asymmetry that was revised 1 year after the initial operation. There were no cases of infection, allergic reaction, or extrusion of the suture. Conclusions: Despite the lack of a large volume of patients, our study confirms that this technique is indeed an attractive and highly predictable option for achieving adequate tip refinement and definition when using a nondelivery endonasal rhinoplasty.

http://ift.tt/2c0OOSC

Spectacles under Pedicles: Eyewear Modification with the Paramedian Forehead Flap

Summary: The paramedian forehead flap is a widely used method of nasal reconstruction. The flap requires a bridge of tissue from forehead to the nose, for a period of 2 to 3 weeks, before it can be divided at a second procedure. During this time, patients often have difficulty positioning and wearing their eyewear underneath the pedicle of the flap. Here we present a novel approach to the problem. It requires only a simple modification to the patient's eyewear and greatly facilitates wear and removal.

http://ift.tt/2c0QDyM

Correction of Facial Deformity in Sturge–Weber Syndrome

Background: Although previous studies have reported soft-tissue management in surgical treatment of Sturge–Weber syndrome (SWS), there are few reports describing facial bone surgery in this patient group. The purpose of this study is to examine the validity of our multidisciplinary algorithm for correcting facial deformities associated with SWS. To the best of our knowledge, this is the first study on orthognathic surgery for SWS patients. Methods: A retrospective chart review included 2 SWS patients who completed the surgical treatment algorithm. Radiographic and clinical data were recorded, and a treatment algorithm was derived. Results: According to the Roach classification, the first patient was classified as type I presenting with both facial and leptomeningeal vascular anomalies without glaucoma and the second patient as type II presenting only with a hemifacial capillary malformation. Considering positive findings in seizure history and intracranial vascular anomalies in the first case, the anesthetic management was modified to omit hypotensive anesthesia because of the potential risk of intracranial pressure elevation. Primarily, both patients underwent 2-jaw orthognathic surgery and facial bone contouring including genioplasty, zygomatic reduction, buccal fat pad removal, and masseter reduction without major complications. In the second step, the volume and distribution of facial soft tissues were altered by surgical resection and reposition. Both patients were satisfied with the surgical result. Conclusions: Our multidisciplinary algorithm can systematically detect potential risk factors. Correction of the asymmetric face by successive bone and soft-tissue surgery enables the patients to reduce their psychosocial burden and increase their quality of life.

http://ift.tt/2c0O28k

Universal and Ethnic-specific Considerations on Facial Rejuvenation: Where Do You Inject Your Fillers?

No abstract available

http://ift.tt/2c0O6ot

Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm

Background: Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery. Materials and Methods: A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña's private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed. Results: Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14–58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later. Conclusions: The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor.

http://ift.tt/2c0OMKJ

Αρχειοθήκη ιστολογίου

Σάββατο 10 Σεπτεμβρίου 2016

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