The association between drugs and bullous pemphigoid

Abstract

Drug-induced bullous pemphigoid (DIBP) is often poorly defined in the existing literature from the classic, spontaneous form of bullous pemphigoid (BP). The pathogenesis is unclear and the association between bullous pemphigoid and various medications is tenuous^1-2.Commonly reported associations include neuroleptics^3-4and diuretics^{3, 5} with more recent literature drawing attention to dipeptidyl peptidase-4 inhibitors⁶.Strength of drug causality associations is generally determined by factors such as latency between drug initiation and onset of disease, epidemiological risk, effects of withdrawal/re-challenge. Prior drug association studies were based on broader inclusion criteria and may overestimate the true association^3-6.

This article is protected by copyright. All rights reserved.

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Hydroxychloroquine prescribing and monitoring practices among Irish dermatologists and rheumatologists

Abstract

Hydroxychloroquine (HCQ) is an effective drug that is widely used to treat connective tissue and autoimmune diseases. Overall, it has an excellent safety profile; however, its most potentially serious and irreversible side-effect is retinal toxicity. The Royal College of Ophthalmologists (RCO) published their recommendation on HCQ and ocular toxicity screening in 2009.

This article is protected by copyright. All rights reserved.

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Recurrence of Stevens–Johnson syndrome and toxic epidermal necrolysis in adults

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Basic aspects of the pathogenesis and prevention of non-melanoma skin cancer in solid organ transplant recipients: a review

Abstract

Introduction

As numbers of transplant recipients and survival rates increase, the vulnerability of this population to several malignancies also rises. Non-melanoma skin cancer (NMSC) carries the highest rates of morbidity and mortality in this population. To avoid these malignancies, it is necessary to identify particular risk factors in transplant recipients and to follow preventive protocols.

Methods

The MEDLINE and EMBASE databases were reviewed using as keywords the medical subject headings (MeSH) "transplantation", "skin neoplasm" and "prevention". The search was limited to clinical trials, randomized clinical trials and case–control studies conducted during the previous 20 years.

Results

The most important risk factors for the development of NMSCs in the transplant recipient population are cumulative ultraviolet radiation exposure, use of immunosuppressive agents (especially azathioprine as a photosensitizing agent) and infections by human papillomaviruses. The use of sun protection and retinoids were identified as possible protective factors. Other potential therapies, such as antioxidants, difluormethylornithine and cyclooxygenase-2 inhibitors, require further study.

Conclusions

Patient risk factors for the development of NMSC should be reviewed during the transplant consultation. Individuals found to be at increased risk should undergo closer follow-up and preventive care counseling. This article proposes an algorithm for the prevention of NMSC.

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Muir–Torre syndrome: multiple sebaceous neoplasms and visceral malignancy manifesting after cardiac transplantation and iatrogenic immunosuppression

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The use of intravenous immunoglobulins in Stevens–Johnson syndrome and toxic epidermal necrolysis: caution needed

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Bioengineering pediatric scaffold-free auricular cartilaginous constructs

Objective

The use of exogenous materials as scaffolds in cartilage tissue engineering has limited the clinical application of resultant constructs due to the risk of postoperative complications. In an effort to minimize such complications, we aim to generate human, scaffold-free auricular cartilaginous constructs.

Study Design

Laboratory study using pediatric auricular cartilage.

Methods

Remnant, normal pediatric auricular cartilage samples that would have otherwise been discarded were collected and digested to free cells. Harvested cells were cultured and expanded in vitro for two passages and plated as micromass cultures. The culture medium was replaced with a chemically defined chondrogenic medium, and cellular monolayers surrounding micromass cultures were continuously scraped off. Constructs were allowed to mature for a period of 8 weeks.

Results

Micromass constructs showed mechanical stability and structurally resembled native auricular tissue, with a perichondrium-like layer of cells surrounding the inner cartilaginous zone. Constructs accumulated equivalent sulphated glycosaminoglycan and 50% of collagen content compared to native auricular cartilage by mass, while displaying 156% more cellularity.

Conclusions

High-density micromass cultures of pediatric auricular chondrocytes can generate stable cartilaginous constructs following prolonged chondrogenic inductions in vitro. This technique is an essential step toward the development of three-dimensional constructs to recreate clinically applicable auricular cartilaginous constructs.

Level of Evidence

NA. Laryngoscope, 2016

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In response to regeneration of traumatic tympanic membrane perforation using EGF and FGF-2

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Impact of short sleep on metabolic variables in obese children with obstructive sleep apnea

Objectives/Hypothesis

To analyze the association between sleep duration, metabolic variables, and insulin resistance in obese children with and without obstructive sleep apnea. The decline in sleep duration has paralleled a dramatic increase in the prevalence of obesity and diabetes, suggesting a mechanistic relationship.

Study Design

Retrospective, case series.

Methods

Consecutive obese patients 3 to 12 years of age who underwent polysomnography (PSG) and a metabolic panel and who completed a 14-item sleep questionnaire were analyzed. All laboratory testing was conducted within 3 months of PSG. Total sleep times were obtained from the PSG and confirmed by the questionnaire.

Results

A total of 171 patients (55.0% male) were studied. All patients were obese (body mass index [BMI] z score > 95th percentile). Patients were categorized into three groups: short sleepers, borderline sleepers, and optimal sleepers. Eighty-six (50.3%) patients were short sleepers, 71 (41.5%) were borderline sleepers, and 14 (8.2%) were optimal sleepers. The mean BMI z score was 3.13 ± 1.3 in short sleepers, 3.3 ± 1.1 in borderline sleepers, and 3.5 ± 1.5 in optimal sleepers (P = .39). There was no statistical difference in high- and low-density lipoprotein levels (P = .21 and P = .76, respectively) and total cholesterol (P = .43) among subgroups. Triglycerides, blood glucose, insulin, and homeostasis model assessment–insulin resistance were significantly higher in short sleepers when compared to borderline or normal sleepers (P = .008, P < .001, P < .001, and P < .001, respectively).

Conclusions

Short sleep duration was correlated with alterations in metabolic variables and insulin resistance in obese patients. This raises concern for development of comorbid conditions that can persist into adulthood.

Level of Evidence

4 Laryngoscope, 2016

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Reconstruction of nongrowing hemifacial microsomia patient with custom-made unilateral temporomandibular joint total joint prosthesis and orthognathic surgery

Publication date: Available online 20 November 2016
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Payam Farzad
A case of hemifacial microsomia in a young male is presented. The ascending ramus and condyle was reconstructed utilizing virtual 3D planning with a custom-made total TMJ device (TMJ Concepts, USA) in combination with conventional orthognathic surgery. The alternative available reconstructive options are discussed and the advantages and disadvantages of the technique selected.



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IMO-8400, a toll-like receptor 7, 8, and 9 antagonist, demonstrates clinical activity in a phase 2a, randomized, placebo-controlled trial in patients with moderate-to-severe plaque psoriasis

Publication date: Available online 20 November 2016
Source:Clinical Immunology
Author(s): Deepak M.W. Balak, Martijn B.A. van Doorn, Robert D. Arbeit, Rianne Rijneveld, Erica Klaassen, Tim Sullivan, Julie Brevard, H. Bing Thio, Errol P. Prens, J. (Koos) Burggraaf, Robert Rissmann
BackgroundAberrant toll-like receptors (TLRs) 7, 8, and 9 activation by self-nucleic acids is implicated in immune-mediated inflammatory diseases (IMIDs) such as psoriasis. In preclinical IMID models, blocking TLR-activation reduced disease severity. IMO-8400 is a first-in-class, oligonucleotide-based antagonist of TLRs 7, 8, and 9. We evaluated the short-term safety and proof-of-concept for efficacy of IMO-8400 in a first-in-patient phase 2 trial.MethodsForty-six psoriasis patients were randomly assigned to IMO-8400 in four dose levels or placebo for 12weeks. Post-treatment follow-up was seven weeks. Primary outcome was incidence of adverse events. Secondary, exploratory outcomes included changes in psoriasis area and severity index (PASI).ResultsIMO-8400 across all dose levels did not cause any serious or severe adverse events. The most common treatment-related adverse events were dose-dependent injection-site reactions. All IMO-8400 groups showed clinical improvement, but a clear dose-response relationship and statistically significant differences with placebo were not observed (P=0.26). Eleven (38%) of 29 subjects on IMO-8400 achieved ≥50% PASI-reduction, compared to 1 (11%) of 9 subjects on placebo. Five (17%) and 2 (7%) IMO-8400-treated subjects achieved PASI-75 and PASI-90, respectively, compared to none on placebo.ConclusionsShort-term IMO-8400-treatment was well tolerated and reduced psoriasis severity. These findings warrant further investigation of endosomal TLR-antagonism as a therapeutic approach in psoriasis and other TLR-mediated IMIDs.Trial registrationEudraCT 2013-000164-28 and Clinicaltrials.govNCT01899729.



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Neutrophil infiltration mediated by CXCL5 accumulation in the laryngeal squamous cell carcinoma microenvironment: A mechanism by which tumour cells escape immune surveillance

Publication date: Available online 19 November 2016
Source:Clinical Immunology
Author(s): Duo Zhang, Jian Zhou, Di Tang, Lin Zhou, Liang Chou, Kuang-yen Chou, Lei Tao, Li-ming Lu
The CXCL5 chemokine is important for neutrophil accumulation in tumour tissues. In this report, we attempted to clarify whether and how infiltrating tumour-associated neutrophils (TANs) in laryngeal squamous cell carcinoma (LSCC) affect the proliferation and activation of T cells. We examined chemokine expression by real-time PCR (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) and performed an immunohistochemical analysis of LSCC microarrays. The relationship between CXCL5 and CD66b (a neutrophil marker) was investigated by immunofluorescence staining. We found that CXCL5 was upregulated in LSCC tissues, whereas CXCL5 levels were decreased in LSCC patient serum. Furthermore, high levels of CXCL5 were significantly correlated with intratumoural neutrophil infiltration. Compared with peripheral blood neutrophils (PBNs), TANs significantly inhibited T cell proliferation and decreased IFN-γ and TNF-α secretion. These data suggest that excessive neutrophil infiltration is associated with advanced clinical stages of LSCC (T3 or T4, III or IV, and N1 or N2).



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Giving Tuesday is November 29th

Help the ATA to continue solving the puzzle of thyroid disease and thyroid cancer by
donating on #GivingTuesday to fund thyroid research and thyroid awareness

The post Giving Tuesday is November 29th appeared first on American Thyroid Association.

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Onset of psoriatic arthritis associated with multiple wasp stings

Hymenoptera stings have been incriminated as a cause of beekeeper's arthritis, a form of arthritis closely mimicking osteoarthritis. Inflammatory mediators in Hymenoptera venom, such as mastoparan, may activate phospholipase A2 (PLA2), which could contribute to the development of psoriatic arthritis (PsA). However, there are no documented cases of Hymenoptera stings associated with the onset of PsA. We present a case of multiple wasp stings temporally associated with the onset of PsA in a 46-year-old man.

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Fate of deoxynivalenol and deoxynivalenol-3-glucoside during cereal-based thermal food processing: a review study

Abstract

Deoxynivalenol (DON), the most commonly occurring trichothecene in nature, may affect animal and human health through causing diarrhea, vomiting, gastrointestinal inflammation, and immunomodulation. DON-3-glucoside (DON-3G) as a major plant metabolite of the mycotoxin is another "emerging" food safety issue in recent years. Humans may experience potential health risks by consuming DON-contaminated food products. Thus, it is crucial for human and animal health to study also the degradation of DON and DON-3G during thermal food processing. Baking, boiling, steaming, frying, and extrusion cooking are commonly used during thermal food processing and have promising effects on the reduction of mycotoxins in food. For DON, however, the observed effects of these methods, as reported in numerous studies, are ambiguous and do not present a clear picture with regard to reduction or transformation. This review summarized the influence of thermal processing on the stability of DON and the formation of degradation/conversion products. Besides this, also a release of DON and DON-3G from food matrix as well as the release of DON from DON-3G during processing is discussed. In addition, some conflicting findings as reported from the studies on thermal processing as well as cause-effect relationships of the different thermal procedures are explored. Finally, the potential toxic profiles of DON degradation products are discussed as well when data are available.

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Patient-centered quality of life measures after alloplastic temporomandibular joint replacement surgery

The purpose of this study was to evaluate patient-reported outcome measures of quality of life (QoL) for patients with end-stage temporomandibular joint (TMJ) disease who have undergone TMJ prosthetic replacement. The records of 36 patients who had undergone alloplastic total joint replacement procedures were analyzed. Patients were treated using either TMJ Concepts or Biomet/Lorenz prosthetics. Patients were asked to complete a 12-item TMJ-S-QoL survey, which encompassed questions pertaining to pain, speech, chewing function, and various aspects of social life and mental health.

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Scheduling terminology for oral and maxillofacial surgery. Are we speaking a universal language?

Publication date: Available online 19 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): T.E. Howe, I. Varley, J.E. Allen, A. Glossop, A. McKechnie
Use of a universal vocabulary to assist with the scheduling of operations has been shown to considerably reduce delays and improve the use of theatre resources. Within the UK the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has established a classification to assist with the triage of both emergency and non-emergency operating lists. We completed a survey to assess the uptake and understanding of this classification when scheduling maxillofacial operations. From a list of eight scheduling terms, respondents had to choose one each for 20 different clinical situations (that represented equally) immediate, urgent, expedited, and elective operations as defined by them. A total of 50 surveys were collated. Only 65% of answers selected represented NCPOD terms. 25% of answers represented a term higher and 18% a term lower, on the scale of intervention for the same category of situation. Current NCEPOD terms do not seem to be used universally and are poorly understood. Considerable variation in terminology exists when scheduling maxillofacial operations.



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Follow up of surgically-assisted rapid maxillary expansion after 6.5 years: skeletal and dental effects

Publication date: Available online 19 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J.P. de Gijt, A. Gül, S.T.H. Tjoa, E.B. Wolvius, K.G.H. van der Wal, M.J. Koudstaal
Surgically-assisted rapid maxillary expansion (SARME) is a technique used to widen the maxilla, and we present the results of our long-term follow up (6.5 years). Seventeen patients who had been treated with SARME and prospectively followed were invited for long-term follow up by dental casts and posteroanterior cephalograms. The following measurements were made on the dental casts: transverse distances at canine, premolar, and molar level, length of the arch, and width and depth of the palate at premolar and molar level. The distance between the left and right nasal bases and the widening of the inferior maxilla were measured on the posteroanterior cephalograms. Boneborne and toothborne distractors were used in 8 and 9 patients, respectively. In the study of dental casts, there was a significant increase in transverse width in the canine (P<0.001), premolar (P<0.001) and molar (P=0,001) and these remained stable in the long term. The arch length did not increase significantly, but the palatal width increased significantly in the premolar (P<0.001) and molar (P=0.001) regions. No effect was seen in palatal depth. On the posteroanterior cephalograms the width of the inferior part of the maxilla was increased, but not significantly so. There were no significant changes at the nasal base. We conclude that SARME is a predictable technique to widen the maxilla in the long term.



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Occupational exposure to bodily fluids in oral and maxillofacial surgery: an evaluation of reporting practices and attitudes among staff at a major teaching hospital in the UK

Publication date: Available online 19 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P. Leavy, I. Siddique, R. Mohammed-Ali
Our aim was to evaluate experience, practice, and beliefs about reporting of occupational exposures to blood and other body fluids among a sample of 88 healthcare providers working in oral and maxillofacial surgery at Sheffield Teaching Hospitals. We used a cross-sectional survey to evaluate awareness of the Trust's policy for reporting occupational exposure, recent incidence of exposure, and current reporting practices. Beliefs were measured using questions derived from the theory of planned behaviour. Fifty-five people responded, 14 of whom had been exposed to bodily fluids in the previous 12 months. Of those, 10 did not report it. Fifty-three respondents were certain that the Trust had a protocol in place for reporting sharps injuries to staff. Most (n=51) said the Trust had a protocol for reporting mucocutaneous exposure to blood. Respondents placed equal importance on reporting exposures that affected both themselves and patients, but intention to report exposure of patients was significantly higher than for themselves (z score −3.18, p<0.0001). We conclude that OMFS healthcare workers generally think that occupational exposures should be reported, but there are shortcomings in practice.



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Submental island flap reconstruction in oral cavity cancer patients with level I lymph node metastasis

Publication date: Available online 19 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P. Sittitrai, C. Srivanitchapoom, D. Reunmakkaew, K. Yata
The submental island flap is useful as an alternative to microvascular free tissue transfer for the reconstruction of defects after resection of oral cancer because it is simple to harvest, reliable, and is associated with good oral function and low morbidity. However, because cancer of the oral cavity carries a risk of level I nodal metastases, the oncological safety of the flap remains controversial. Between April 2012 and September 2016, we studied patients with squamous cell carcinoma of the oral cavity who underwent surgical resection with submental island flap reconstruction for viability of the flap, signs of recurrence, and complications. Thirty-five patients (22 men and 13 women) were enrolled in the study and the mean (range) duration of follow-up was 23 (11-48) months. Six patients had local recurrences of their tumours, none of which was considered to be related to the flap. No flap was lost completely, but there were 10 cases of partial skin loss that healed with conservative management. There were no orocutaneous fistulas, haematomas, or marginal mandibular nerve palsies. We conclude that the submental island flap can be used safely in selected patients with level I lymph node metastases when the flap has been harvested meticulously.



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Beneficial effects of Galectin-9 on allergen-specific sublingual immunotherapy in a Dermatophagoides farinae-induced mouse model of chronic asthma

Publication date: Available online 19 November 2016
Source:Allergology International
Author(s): Masaki Ikeda, Shigeki Katoh, Hiroki Shimizu, Akira Hasegawa, Katsuyo Ohashi-Doi, Mikio Oka
BackgroundAllergen-specific sublingual immunotherapy is a potential disease-modifying treatment for allergic asthma. Galectin-9 (Gal-9), a β-galactoside-binding protein with various biologic effects, acts as an immunomodulator in excessive immunologic reactions by expanding regulatory T cells (Treg) and enhancing transforming growth factor (TGF)-β signaling. We investigated the efficacy of sublingually administered Gal-9 as an adjuvant to a specific allergen in a Dermatophagoides farinae (Df)-induced mouse model of chronic asthma.MethodsBALB/c mice were intranasally sensitized with Df extract 5 days/week for 5 weeks, and then sublingual Df-allergen extract for 2 weeks (5 days/week). Three days after the final sublingual treatment, mice were intranasally challenged with Df extract. The early asthmatic response (EAR) was evaluated 5 min after the last Df challenge. Airway hyperresponsiveness (AHR) was assayed and bronchoalveolar lavage (BAL) was performed 24 h after the last allergen challenge. Serum IgE and cytokine levels, and number of inflammatory cells in the BAL fluid (BALF) were analyzed.ResultsSublingual Df treatment in the presence of Gal-9, but not alone, significantly reduced AHR; EAR; number of eosinophils and interleukin-13 in the BALF; and serum IgE levels. BALF TGF-β1 levels were significantly increased in the presence of Gal-9 compared with Df alone. Treg depletion blocked the inhibitory effects of Gal-9 on the EAR, AHR, eosinophilic airway inflammation, and Df-specific serum IgE levels, and suppressed BALF TGF-β1 levels.ConclusionsGal-9 exhibited beneficial effects of sublingual Df allergen-specific immunotherapy in a Df-induced mouse model of chronic asthma, possibly by Gal-9-induced TGF-β1 production in the lung.



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Blocking antibodies induced by immunization with a hypoallergenic parvalbumin mutant reduce allergic symptoms in a mouse model of fish allergy

Publication date: Available online 19 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Raphaela Freidl, Antonia Gstoettner, Ulrike Baranyi, Ines Swoboda, Frank Stolz, Margarete Focke-Tejkl, Thomas Wekerle, Ronald van Ree, Rudolf Valenta, Birgit Linhart
BackgroundFish is a frequent elicitor of severe IgE-mediated allergic reactions. Beside avoidance, there is currently no allergen-specific therapy available. Hypoallergenic variants of the major fish allergen, parvalbumin, for specific immunotherapy based on mutation of the two calcium-binding sites have been developed.ObjectiveTo establish a mouse model of fish allergy resembling human disease and to investigate whether mouse and rabbit IgG antibodies induced by immunization with a hypoallergenic mutant of the major carp allergen, mCyp c 1, protect against allergic symptoms in sensitized mice.MethodsC3H/HeJ mice were sensitized with rCyp c 1 or carp extract by intragastric gavage. Antibody, cellular immune responses and epitope specificity in sensitized mice were investigated by ELISA, RBL assay, T cell proliferation experiments using rCyp c 1 and overlapping peptides spanning the Cyp c 1 sequence. Anti-mCyp c 1 mouse and rabbit sera were tested for their ability to inhibit IgE recognition of Cyp c 1, Cyp c 1-specific basophil degranulation and Cyp c 1-induced allergic symptoms in the mouse model.ResultsA mouse model of fish allergy mimicking human disease regarding IgE epitope recognition and symptoms as close as possible was established. Administration of antisera generated in mice and rabbits by immunization with a hypoallergenic Cyp c 1 mutant inhibited IgE binding to Cyp c 1, Cyp c 1-induced basophil degranulation and allergic symptoms caused by allergen challenge in sensitized mice.ConclusionAntibodies induced by immunization with a hypoallergenic Cyp c 1 mutant protect against allergic reactions in a murine model of fish allergy.Clinical implicationsIgG antibodies induced by vaccination with a hypoallergenic Cyp c 1 mutant may protect against fish allergy.

Teaser

Vaccination with a recombinant hypoallergenic Cyp c 1 mutant induces Cyp c 1-specific IgG antibodies which block IgE binding to Cyp c 1 and protected against symptoms of fish allergy in a mouse model.


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IL-33 fine-tunes mast cell degranulation and chemokine production at the single cell level

Publication date: Available online 19 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Régis Joulia, Fatima-Ezzahra L'Faqihi, Salvatore Valitutti, Eric Espinosa
BackgroundMast cells are versatile key components of allergy and inflammation, known to respond to both innate and adaptive immunological stimuli. However the response of individual mast cells to cumulative stimuli remains poorly understood.ObjectivesTo dissect mast cell responses at the single-cell level and their potentiation by IL-33.MethodsWe monitored mast cell degranulation in real time by exploiting the capacity of fluorochrome-labeled avidin to stain degranulating cells. During the degranulation process, granule matrix is externalized and immediately bound by fluorochrome-labeled avidin present in the culture medium. The degranulation process is monitored either by time-lapse microscopy or FACS analysis.ResultsSingle cell analysis revealed a strong heterogeneity of individual mast cell degranulation responses. We observed that the number of degranulating mast cells was graded according to the FcεRI stimulation strength whereas the magnitude of individual mast cell degranulation remained unchanged, suggesting an all-or-none response of mast cell following FcεRI triggering. IL-33 pretreatment increased not only the number of degranulating and chemokine producing mast cells but also the magnitude of individual mast cell degranulation and chemokine production.ConclusionWe illustrate the impact of IL-33 on mast cell biology at the single cell level by showing that IL-33 potentiates IgE-mediated mast cell responses by both increasing the number of responding cells and by enhancing the responses of individual mast cells.

Teaser

We show that the alarmin IL-33 induces high responder mast cells upon IgE-mediated stimulation. Our results indicate that IL-33 production by microenvironment might impact allergic reactions by enhancing the inflammatory potential of individual mast cells.


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Recurrence probability for keratocystic odontogenic tumors: An analysis of 6,427 cases

Publication date: Available online 19 November 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Bruno Ramos Chrcanovic, Ricardo Santiago Gomez
PurposeTo investigate and compare the probability of recurrence of keratocystic odontogenic tumors (KCOTs) for different variables and treatment protocols.Materials and MethodsAn electronic search was undertaken in April 2016 that included clinical series of KCOTs reporting recurrences. Untransformed proportions and meta-analyses were performed to estimate the probability/risk of recurrence, according to several variables.ResultsA total of 94 publications were included (6,427 KCOTs, 1,464 recurrences). Probability of recurrence: all lesions, 21.1%; nevoid basal cell carcinoma syndrome, 35.4%; males, 20.3%; females, 19.3%; maxilla, 15.3%; mandible, 21.5%; unilocular, 14.7%; multilocular, 24.4%; marsupialization/decompression, 28.7%; decompression+enucleation±additional therapy, 18.6%; enucleation/curettage, 22.5%; enucleation+peripheral ostectomy, 18.6%; enucleation+Carnoy's solution, 5.3%; enucleation+cryotherapy, 20.9%; marginal/segmental resection, 2.2%. The recurrence was not statistically significantly affected by lesion location (maxilla vs. mandible, risk ratio [RR] 0.92, P=0.32) or patient's sex (male vs. female, RR 0.94,P=0.44), but by locularity (unilocular vs. multilocular, RR 0.67, P=0.007). Recurrence risk for surgical managements: marsupialization vs. enucleation (RR 1.65,P=0.0006), marsupialization vs. resection (RR 3.17, P=0.009), enucleation alone vs. enucleation+peripheral ostectomy (RR 1.66, P=0.05), enucleation alone vs. enucleation+Carnoy's solution (RR 1.94, P=0.03), enucleation alone vs. enucleation+cryotherapy (RR 0.88, P=0.56).ConclusionsKCOTs have a considerable rate of recurrence, which varies significantly according to some clinical, radiographic, and histopathological features, as well as surgical management.



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Novel technique for harvesting the sternoclavicular graft

Publication date: Available online 19 November 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Sujata Mohanty, Sanchaita Kohli, Jitender Dabas, Chandravir Singh
Originally introduced for mandibular reconstruction more than 40 years ago, the sternoclavicular graft has gained widespread popularity for the reconstruction of the ramus-condyle unit owing to its anatomic and histological likeness to the normal mandibular condyle. The technique for its harvest has evolved from a full thickness clavicular graft to a split thickness sternoclavicular composite graft including the fibrocartilaginous articular disk at the sternal end of the bone. Conventional longitudinal osteotomy design for its harvest has been fraught with considerable complications at the donor site including fracture clavicle and major neurovascular injury. In an attempt to alleviate these ill effects, a new technique for procuring the sternoclavicular graft is presented.



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Comparison of skeletal stability after sagittal split ramus osteotomy among mono-cortical plate fixation, bi-cortical plate fixation, and hybrid fixation using absorbable plates and screws

Publication date: Available online 19 November 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Koichiro Ueki, Akinori Moroi, Kunio Yoshizawa, Asami Hotta, Takamitsu Tsutsui, Kenichi Fukaya, Ryota Hiraide, Akihiro Takayama, Tatsuta Tsunoda, Yuki Saito
PurposeThe purpose of this study was to examine skeletal stability and plate breakage after sagittal split ramus osteotomy (SSRO) with the mono-cortical plate fixation, bi-cortical plate fixation, and hybrid fixation techniques using absorbable plates and screws.Materials and MethodsA total of 76 Japanese patients diagnosed with mandibular prognathism with and without maxillary deformity were divided into 3 groups randomly. A total of 28 patients underwent SSRO with mono-cortical plate fixation, 23 underwent SSRO with bi-cortical plate fixation, and 25 underwent SSRO with hybrid fixation. Skeletal stability and horizontal condylar angle were analyzed by axial, frontal, and lateral cephalograms from before the operation to 1 year postoperatively. Breakage of the plate and screws was observed by 3-dimensional computed tomography (3DCT) immediately after surgery and after 1 year.ResultsAlthough there was a significant difference between the mono-cortical plate fixation group and hybrid fixation group regarding right Me-Ag in T1 (P=0.0488) and occlusal plane in T1 (P=0.0346), there were no significant differences between the groups for the other measurements in each time interval. In 2 cases, namely, 6 sides in the mono-cortical plate fixation group, breakage of the absorbable plate was found by 3DCT. However, there was no breakage in the bi-cortical plate fixation group and hybrid fixation group.ConclusionThis study results suggested that there were no significant differences in the postoperative skeletal stability among the 3 groups, and bi-cortical fixation as well as hybrid fixation was a reliable and useful method to prevent plate breakage even if an absorbable material was used.



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Craniofacial structure variations in patients with palatal anomalies and velopharyngeal dysfunction

Publication date: Available online 20 November 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ariela Nachmani, Dror Aiezenbud, Ben Nageris, Omri Emodi, Firas Kassem
PurposeCephalometric evaluation of craniofacial and craniopharyngeal morphology is important for understanding the factors affecting velopharyngeal dysfunction (VPD) in patients with palatal anomalies.Materials and MethodsIn this study, 366 patients with VPD were retrospectively stratified into cleft lip and palate (CLP), cleft palate (CP), submucous cleft palate (SMCP(, occult submucous cleft palate)OSMCP(, and non-CP groups. Lateral cephalometrics were used to assess craniofacial, craniopharyngeal, and velopharyngeal anatomy.ResultsThe average craniofacial morphology in patients with VPD differed significantly according to the type of palatal anomaly. The non-CP and OSMCP groups differed from the CLP, CP, and SMCP groups in nasopharyngeal size and shape as depicted by a larger ANS-Ptm-Ve angle, a smaller S-N-Ba and NBa-PP angles, and a shorter linear value of S-Ar in the non-CP group. The CLP and CP groups had shorter ANS-Ptm, shorter Ptm-P, and smaller SNA and SNB angles.ConclusionVPD patients with overt clefts have different skeletal and nasopharyngeal shapes compared to non-CP and OSMCP. Velopharyngeal function assessment should include the size and shape of the nasopharyngeal space in addition to the size and the activity of the velum and posterior and lateral walls of the nasopharynx. This should enable a more precise understanding of VPD pathology, and lead to improvements in the posterior pharyngeal flap technique in order to obtain better postoperative speech outcomes after surgical management of velopharyngeal dysfunction.



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Clinical relevance for the use of ozone to enhance the remineralizing potential of n-HAP on initial enamel lesions

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