Facial Fractures: Large Epidemiologic Survey in Northern Brazil Reveals Some Unique Characteristics

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): André Luis Ribeiro Ribeiro, Luciana Campêlo da Silva Gillet, Hiam Ghassan de Vasconcelos, Luciana de Castro Rodrigues, João de Jesus Viana Pinheiro, Sérgio de Melo Alves-Junior
PurposeFacial fractures are an important health problem worldwide that can cause temporary or permanent disability and an economic burden. Identifying the risk factors associated with facial fractures is a valuable tool to create preventive public health strategies. This study evaluated the epidemiologic profile of facial fractures in northern Brazil.Patients and MethodsMedical records of 1,969 patients who sustained facial fractures were analyzed for characteristics of the population, types of facial fractures, and treatment performed.ResultsThe zygomatic complex was the most prevalent fracture site (28.8%). Road traffic accident (RTA) was the most common etiology (52%), followed by interpersonal violence (IPV; 34%). Among IPV cases, gunshot wounds were responsible for 14% of cases and 3% resulted from stab wounds. The third decade of life was the most prevalent age group, with a remarkable change in prevalence and etiology pattern at 15 years of age. Open reduction and internal fixation was the most used treatment, especially when the mandible was involved and at least 2 facial bones were fractured. There were 37 deaths (1.9%), with a higher risk observed for stab wounds (3.1-fold higher) and when at least 3 bones were fractured (4.1-fold higher).ConclusionsThis epidemiologic survey identified RTA and IPV as important risk factors for facial fractures and a high prevalence of fractures caused by gunshot wounds. A unique preponderance of facial fractures caused by stab wounds was found, which was responsible for the highest risk of mortality.



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Editorial Board Page

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12





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Table of Contents

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12





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AAOMS Author Disclosure forms

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12





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Tooth-Borne Anterior Maxillary Distraction for Cleft Maxillary Hypoplasia: Our Experience With 147 Patients

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Sunil Richardson, Dhivakar Selvaraj, Rakshit V. Khandeparker, Nikkie S. Seelan, Shweta Richardson
PurposeTo evaluate the results of anterior maxillary distraction for its efficacy and long-term stability in the management of cleft maxillary hypoplasia in a large series of patients with a long-term follow-up extending to 4 years.Materials and MethodsOne hundred sixty-four patients at least 10 years old with cleft maxillary hypoplasia who presented to the authors' unit from January 2009 through October 2014 were evaluated retrospectively, irrespective of gender, type of cleft lip and palate, and amount of advancement needed. Anterior maxillary distraction using a tooth-borne distractor appliance was carried out in all patients and all patients were followed up to 4 years (range, 1 to 4 yr) to evaluate the stability of the procedure and to document any relapse using digitalized lateral cephalograms taken before distraction, immediately after distraction (T2), and at the last follow-up visit (T3; range, 1 to 4 yr). Seventeen patients were subsequently lost to follow-up; therefore, a complete set of records was available for 147 patients. In a subset of 50 patients, perceptual speech assessment was carried out preoperatively and 6 months postoperatively by 2 speech pathologists using the Perkins scoring system that allowed the evaluation of 5 parameters (velopharyngeal insufficiency, resonance, nasal air emission, articulation, and intelligibility). None of these patients underwent speech therapy during the course of evaluation. The development of complications intra- or postoperatively was noted. The data were tabulated and analyzed.ResultsAn advancement ranging from 4.0 to 13.1 mm (mean, 9.42 mm) was achieved in all patients. One hundred forty patients (95.23%) showed stable results on lateral cephalograms and when T2 values were compared with T3 values. Seven patients (4.76%) exhibited skeletal relapse in various linear and angular measurements assessed on lateral cephalograms. At 6-month follow-up, improvements of 62% (n = 31), 64% (n = 32), 50% (n = 25), 68% (n = 34), and 70% (n = 35) in velopharyngeal insufficiency, resonance, nasal air emission, articulation, and intelligibility, respectively, were observed, with worsening of all parameters in 1 patient (2%). An overall complication rate of 25.17% (n = 37) was noted, with bleeding being the most common intra- and postoperative complication noted in 15 patients (10.2%). No serious consequences related to any complication were noted.ConclusionAnterior maxillary distraction can be considered a suitable treatment option for the management of mild to moderate cleft maxillary hypoplasia because the anteroposterior deficiency can be addressed at a young age, immediately after the eruption of the maxillary second premolars. Stable long-term results with negligible skeletal relapse are possible with this technique, with an added advantage of unhampered or even improved velopharyngeal function.



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A Surge of Surgeons

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Thomas B. Dodson




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The Use of Solid-Phase Concentrated Growth Factors for Surgical Defects in the Treatment of Dysplastic Lesions of the Oral Mucosa

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Shang-Lun Lin, Shang-Liang Wu, Chiang-Chin Tsai, Shun-Yao Ko, Wei-Fan Chiang, Jung-Wu Yang
PurposeUse of the skin graft and artificial dermis to reconstruct a defect after the excision of dysplastic lesions of the oral mucosa has been practiced for years. The purpose of this case series was to introduce a novel resolution—that is, an operating procedure using solid-phase concentrated growth factors (SPCGFs) to reconstruct oral mucosa defects—and observe the postoperative results and evaluate its clinical effects.Materials and MethodsIn this consecutive serial case study of patients with oral dysplastic lesions who underwent operations from April 2015 through July 2015, the primary endpoint of the study was to observe the clinical wound-healing profile at 1 week, 3 weeks, 3 months, and 6 months postoperatively. The secondary endpoint was to observe maximal interincisal opening (MIO) and wound pain preoperatively and at 1 and 3 days, 1 and 3 weeks, and 3 and 6 months postoperatively. The minimum follow-up was 8 months, and the longest was 1 year.ResultsAll sites had healed with complete epithelialization after 3 weeks postoperatively. All patients had a wound-healing score no higher than 3 at 3 weeks postoperatively. The preoperative MIO was 52 ± 4.64 mm and the 6-month postoperative MIO was 49.2 ± 3.03 mm. No patient reported further pain from 3 weeks postoperatively. No recurrence of the lesion was found at or after the 6-month follow-up period.ConclusionThe results of this study show that the use of SPCGFs to reconstruct oral mucosa defects is feasible and practical. The efficacy of SPCGFs needs to be verified by additional studies with higher-level evidence bases in the future.



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Masthead

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12





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Intuitive Facial Imaging Method for Evaluation of Postoperative Swelling: A Combination of 3-Dimensional Computed Tomography and Laser Surface Scanning in Orthognathic Surgery

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Satoshi Yamamoto, Hitoshi Miyachi, Hitoshi Fujii, Shigeki Ochiai, Satoshi Watanabe, Kazuo Shimozato
PurposePostoperative facial swelling after orthognathic surgery may be prolonged and of concern in some patients. In recent years, there have been several reports of analysis of postoperative facial swelling by volume data; however, such evaluations cannot exclude the possibility of error in the measured point because there are no clear anatomic landmarks on the cheek. Three-dimensional laser scanning is a noninvasive tool that can be used to measure surface changes in soft tissue over time. The aim of this study was to quantify postoperative swelling in orthognathic surgery by fusing surface scanned images with skin images reconstructed from 3-dimensional computed tomography data and identifying a set of reference points on the bone.Materials and MethodsThe study comprised 30 patients undergoing bilateral sagittal split osteotomy. Facial scans were obtained with the Artec Eva Scan imaging system (Data Design, Aichi, Japan) at 9 time points from before surgery to 6 months postoperatively. Postoperative scan images were compared with the baseline facial scan obtained 6 months postoperatively.ResultsOn average, 66% of the initial postoperative edema subsided in 1 month. After 3 months, only 5% of the swelling remained. There were statistically significant correlations between subcutaneous tissue thickness and swelling (P < .0001).ConclusionsWe were able to monitor facial swelling after orthognathic surgery with very high precision using the described method. Subcutaneous tissue thickness is an important determinant of facial swelling.



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Malignant Salivary Gland Tumors

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Eric R. Carlson




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Worldwide 10-Year Systematic Review of Treatment Trends in Fibula Free Flap for Mandibular Reconstruction

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Devin Okay, Al Haitham Al Shetawi, Sami P. Moubayed, Moustafa Mourad, Daniel Buchbinder, Mark L. Urken
PurposeThe purpose of this study was to describe the trends pertaining to the use of the fibula free flap for mandibular reconstruction during the past 10 years.Materials and MethodsA systematic review for publications on the fibula free flap in mandibular reconstruction in the PubMed and Scopus databases was performed from January 1, 2005 until December 31, 2014. Publications were classified by topic, number of patients, and country of origin. The study period was split into 2 periods. The first 5-year period was compared with the second 5-year period.ResultsEighty-five publications were identified. There was an increase in publications regarding restorative decision making (11 vs 9), surgical techniques (13 vs 6), outcomes (20 vs 10), and computer-aided design and computer-aided manufacturing (CAD-CAM; 8 vs 2) in the second 5-year period. The number of patients reported also increased in publications on surgical techniques (1,085 vs 59), outcomes (777 vs 254), bisphosphonate-related osteonecrosis of the jaw and osteoradionecrosis (165 vs 28), and CAD-CAM (65 vs 15) in the second 5-year period. The United States, India, China, and Europe produced most of the publications.ConclusionsIn the past 10 years, there was a surge in publications on the use of the fibula free flap for mandibular reconstruction. There was a 1.8-fold increase in the number of publications and a 3.4-fold increase in the number of patients undergoing this method of mandibular reconstruction in the second 5-year period. Publications from the United States, India, and China contributed to a large increase in the number of patients in the second 5-year period. More interest in CAD-CAM technology was seen in the second 5-year period that was not seen in the first 5-year period.



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Long-Term Maintenance of Full Arch Maxillary Restorations

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Michael S. Block




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Surgical Treatment, Oral Rehabilitation, and Orthognathic Surgery After Failure of Pharmacologic Treatment of Central Giant Cell Lesion: A Case Report

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Renato Luiz Maia Nogueira, Rafael Lima Verde Osterne, Roberta Barroso Cavalcante, Ricardo Teixeira Abreu
Although pharmacologic treatments for central giant cell lesions have gained much emphasis, these treatment modalities do not always have successful outcomes, and surgical treatment may be necessary. The purpose of the present study was to report a case of aggressive central giant cell lesion initially treated by nonsurgical methods without satisfactory results, necessitating segmental mandibular resection for definitive treatment and oral rehabilitation. A 20-year-old woman was diagnosed with an aggressive central giant cell lesion in the mandible. The patient was first treated with intralesional corticosteroid injections. Subsequently, the lesion increased in size. Therefore, a second pharmacologic treatment was proposed with salmon calcitonin nasal spray, but no signs of a treatment response were noted. Because of the lack of response, surgical excision was performed, and a mandibular reconstruction plate was installed. At 12 months after surgical resection, the patient underwent mandibular reconstruction with bone grafts. After 6 months, 7 dental implants were installed, and fixed prostheses were made. After installation of the prostheses, the patient experienced persistent mandibular laterognathism, and a mandibular orthognathic surgery was performed to correct the laterognathia. The follow-up examination 4 years after orthognathic surgery showed no signs of recurrence and good facial symmetry.



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Application of Endodontic Files for the Extraction of Root Tips: A Biomechanical Investigation and Case Study

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Junliang Chen, Yun He, Qin Pan, Minhai Nie
PurposeTo investigate the appropriate endodontic file for the extraction of root tips through a biomechanical study and to evaluate the clinic efficiency of this technique.Materials and MethodsNine hundred molar roots were randomly divided into 3 groups (3, 5, and 7 mm) and amputated to the corresponding length. Different files were inserted into the root tips, and a pullout test was conducted using a universal testing machine. The pullout force was recorded and files with greatest pullout force were selected for clinical study. Patients' root tips were extracted using these files. The duration and incidence of postoperative complications were recorded.ResultsThe greatest pullout force was obtained for the 25^# Hedström file, regardless of the length of the root tip and the type of file. The pullout force of Hedström files was significantly greater than that of Kerr files in each file group and root length group (P < .05). Clinically, the direct success ratio of this technique was 81.4%. The incidence of postoperative complications was very low.ConclusionThe results of this study suggest that the application of endodontic files for the extraction of root tips is an acceptable technique. The 25^# Hedström file is the optimum choice for root extraction in most cases when using endodontic files.



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Prevalence of Substance Abuse Among Oral and Maxillofacial Surgery Residents From 2006 to 2015

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Pasquale P. Eckert, Matthew Finkelman, Morton B. Rosenberg
PurposeSubstance abuse in oral and maxillofacial surgery (OMS) training programs is an important and under-represented topic in the literature. This study's purpose was to assess the prevalence of substance abuse in OMS training programs in the United States during a 10-year period and to determine the substances most abused by OMS residents.Materials and MethodsA cross-sectional survey study was conducted by sending an online questionnaire to program directors and chairpersons of all OMS graduate training programs accredited by the Commission on Dental Accreditation. The content- and validity-tested survey asked respondents to report on substance abuse cases at their program from 2006 to 2015. Auxiliary questions asked opinions on substance abuse. To analyze the data, percentages were calculated, including the estimated prevalence of abuse; results were presented as bar charts.ResultsForty-six of the 101 OMS training programs (45.5%) responded. Sixteen of the responding 46 programs (34.8%) reported at least 1 suspected or encountered incident of substance abuse. The 2 most abused substances were alcohol and narcotics. During the decade studied, the prevalence of resident substance abuse was estimated to be 1.2%.ConclusionThe estimated prevalence of resident substance abuse has gone unchanged since Rosenberg's initial study in 1986 (J Oral Maxillofac Surg 44:458, 1986). With the introduction of new drugs and despite more stringent protocols, substance abuse continues to be a germane issue for OMS requiring ongoing attention clinically and in the literature.



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Risk Factors for Postoperative Shivering After Oral and Maxillofacial Surgery

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Masanori Tsukamoto, Takashi Hitosugi, Kanako Esaki, Takeshi Yokoyama
PurposePostoperative shivering is a frequent complication of anesthesia. However, there are few reports about postoperative shivering in oral and maxillofacial surgery. Postoperative shivering in patients after osteotomy was observed from April 2008 to September 2015. This retrospective study investigated the risk factors of postoperative shivering in oral and maxillofacial surgery.Patients and MethodsAnesthesia records of patients who underwent an osteotomy of the maxilla or mandible were checked. A patient's background (gender, age, height, and weight), anesthesia time, operative time, fentanyl, remifentanil, fluid volume, urine volume, blood loss volume, agent for anesthetic maintenance, rectal temperature at the end of surgery, and type of surgery were recorded in addition to the occurrence of postoperative shivering. In the univariate analysis, the Fisher exact test and the χ² test were used, and a multivariable analysis was performed using stepwise logistic regression to determine risk factors of postoperative shivering.ResultsIn this study, 233 cases were investigated, and 24 patients (11.5%) had postoperative shivering. The occurrence of postoperative shivering was correlated with blood loss volume (shivering group, 633.9 ± 404.8 mL; nonshivering group, 367.0 ± 312.6 mL; P < .01) and core temperature at the end of surgery (shivering group, 37.2 ± 0.6°C; nonshivering group, 37.5 ± 0.5°C; P < .01). Two variables were associated with postoperative shivering. Rectal temperature at the end of surgery was the highest risk factor (odds ratio = 2.560277; 95% confidence interval, 1.236774-5.327362), and blood loss volume was the next highest risk factor (odds ratio = 0.997733; 95% confidence interval, 0.999-0998).ConclusionClinicians should pay attention to postoperative shivering not only in patients with hypothermia but also in patients with substantial blood loss.



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Combined Use of Facial Osteoplasty and Orthognathic Surgery for Treatment of Dentofacial Deformities

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Yunfeng Li, Zhiai Hu, Bin Ye, Yao Liu, Xiaochun Ren, Songsong Zhu
PurposeOrthognathic surgery is an efficient procedure for cosmetic and functional aims. However, when functional improvement is achieved by mandibular or maxillary operations, additional esthetic corrections may be imperative for some patients. This study aims to introduce our primary practice of simultaneous facial bone contouring and orthognathic surgery for esthetic reasons.Patients and MethodsTen patients with dentofacial deformities as well as a prominent angle, asymmetric deformities, or a high zygoma and zygomatic arch were recruited from West China Hospital of Stomatology, Sichuan University (Chengdu, China), between January 1, 2014, and July 31, 2015. Traditional orthognathic surgical procedures such as bilateral sagittal split osteotomy and Le Fort I osteotomy combined with facial osteoplasty including mandibular angle ostectomy, outer cortex ostectomy of the mandibular angle, and zygoma and zygomatic arch reduction were performed. Radiographs and medical photographs were taken before and after surgery to compare the effectiveness of the combined use of facial osteoplasty and orthognathic surgery.ResultsAll patients had an uneventful postoperative recovery, with no signs of infection, jaw displacement, or osteonecrosis. Radiographs taken 1 week after surgery and pictures of the facial profile and occlusion taken 6 months after surgery showed satisfactory esthetic outcomes. All patients were satisfied with the functional and cosmetic results.ConclusionsThis study indicated the clinical feasibility of simultaneous facial bone contouring and orthognathic surgery for the treatment of dentofacial deformities. Simultaneous facial bone contouring seems to be an alternative procedure in addition to conventional orthognathic surgery for cosmetic aims in certain patients.



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A New Concept in Maintaining the Emergence Profile in Immediate Posterior Implant Placement: The Anatomic Harmony Abutment

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): Richard Akin
As the knowledge base in the demanding realm of esthetic management of anterior implant sites continues to expand, there exists a void in the literature on solutions to accelerate posterior implant protocols. This article proposes a new protocol using the anatomic harmony abutment for immediate molar implant placement. This technique preserves the anatomic emergence form with sutureless implant site sealing and improves the predictability of final restoration fabrication and delivery. The purpose of this report is to describe this concept and its numerous benefits to patients, surgeons, laboratories, and restorative dentists.



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Squamous Cell Carcinoma of the Tongue During Pregnancy: A Case Report and Review of the Literature

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12
Author(s): James Murphy, Deborah R. Berman, Sean P. Edwards, Joann Prisciandaro, Avraham Eisbruch, Brent B. Ward
Epidemiologic data have shown changes in the demographic profile of patients presenting with oral cavity squamous cell carcinoma (SCC) during the past 4 decades. In particular, there has been a marked increase in the number of young women without a history of smoking presenting with SCC of the tongue. A Surveillance, Epidemiology, and End Results review of patients with head and neck cancer identified 5.3% younger than 40 years. After comparing cohorts from 1973 to 1984 with 1985 to 1997, a 60% increase in tongue cancer in patients younger 40 years was noted. Epidemiologic data also have shown that women are tending to delay childbearing to an older age. These 2 factors have resulted in an increasing prevalence of cancer diagnosed during pregnancy. If current trends continue, oral surgeons and maternal fetal medicine obstetric specialists will see an increasing number of pregnant patients presenting with malignancies. This in turn will lead to a number of complex surgical and adjuvant treatment considerations resulting in ethical and moral decisions for which limited data exist to guide best practice. The treatment chosen will affect not only the health of the patient, but also the health of the fetus and ongoing pregnancy. This report describes the case of a woman who was diagnosed with SCC of the tongue at 14 weeks' gestational age. This report presents her treatment course and a review of the literature to support her decisions related to the care given.



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News and Announcements

Publication date: December 2016
Source:Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12





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Minocycline successfully treats exaggerated granulomatous hypersensitivity reaction to Mw immunotherapy

Abstract

Mycobacterium W (Mw) vaccine has been found to be effective in the treatment of leprosy and warts. Despite increasing use of Mw immunotherapy, data on its safety is limited. We report a series of eight patients who developed persisting injection site granulomatous reaction following Mw immunotherapy and were successfully treated with minocycline. Eight patients with persistent nodular swelling at the site of Mw injections were identified. Seven of them had received Mw immunotherapy for cutaneous warts and one for verrucous epidermal nevus. The lesions were firm, erythematous, succulent, non-tender nodules confined to the sites of Mw vaccine injections. In 6 of these patients nodules also involved the previously injected areas. Skin biopsy from all patients showed eosinophil rich inflammation admixed with histiocytes and lymphocytes. In addition granulomas were seen in all with septal and nodular panniculitis in four patients. Broken and granular acid-fast bacilli were identified in two cases. All patients were treated with oral minocycline 100 mg/day for a mean of 9 weeks and showed good clinical response. Granulomatous reaction is a rare but significant adverse effect of Mw immunotherapy at cosmetically and functionally imperative sites. Oral minocycline appears to be effective therapy in this situation.

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Generalized granulomatous dermatitis following Mycobacterium w (Mw) immunotherapy in lepromatous leprosy

Abstract

Mycobacterium w (Mw) vaccine is a heat-killed suspension derived from a nonpathogenic, cultivable, atypical mycobacterium named Mycobacterium indicus pranii. Mw immunotherapy has been reported to be efficacious as an adjunct to multidrug therapy multibacillary regimen in leprosy patients with high bacillary index. Cutaneous reactions are predominant adverse effects associated with the administration of vaccines. Cutaneous adverse effects ascribed to Mw vaccine are generally limited to the site of injection. We herein describe two cases of lepromatous leprosy who developed an unusual generalized cutaneous reaction following Mw immunotherapy. A high index of suspicion is needed to identify such manifestations in leprosy cases to avoid misdiagnosis of a relapse or a reaction and for appropriate treatment.

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Impending skin necrosis after dermal filler injection: A “golden time” for first-aid intervention

Abstract

Vascular compromise with impending skin necrosis is one of the most serious potential complications. Early recognition of vascular occlusion and swift and aggressive treatment are required to avoid any irreversible changes. However, initial symptoms of a vascular event are often dismissed as simple post-procedural discomfort. If more than 3 days pass after filler injection, crust formation is initiated over the erythematous base along with a rim of fibrous tissue. Due to the replacement of normal tissues by fibrous material, the healing process may result in scar formation in spite of debridement and aggressive dressing changes. Scars often cause contracture and subsequent cosmetic disfigurement, which results in a traumatic burden to the patient. By sharing our experience of the patients with filler induced skin necrosis, we suggest that treatment should be initiated no later than 3 days after the procedure.

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Treatment of prurigo nodularis with lenalidomide

Abstract

Prurigo nodularis (PN) is an intensely pruriginous dermatological disorder whose treatment is challenging for dermatologists. It is characterized by eruptions of papules and hyperkeratotic nodules, some of which are eroded, on the extensor surfaces of the limbs. The most commonly used treatments for this condition are oral antihistamines and topical or systemic steroids. Thalidomide is an effective treatment option in cases of recalcitrant PN; however, its most frequent adverse effect is neurotoxicity, which often results in its discontinuation. Lenalidomide is an analogue of thalidomide that is more powerful and associated with less neurotoxicity than thalidomide. We report the third case of PN treated with lenalidomide, which involved a patient who was refractory to thalidomide. Lenalidomide may be a more effective treatment for PN than thalidomide and has a more favorable side effects profile than its counterpart.

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N-acetyl cysteine in the treatment of trichotillomania

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Combination treatment of propranolol, minocycline, and tranexamic acid for effective control of rosacea

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Reduction in psoriasis related pruritus during biologic therapy*

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Erratum to: An experimental study on the comparison of the effects of triester glycerol oxide on wound repair

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Commentary on: “An update on peripheral ossifying fibroma: case report and literature review”

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Giving Tuesday: Show your support this Tuesday, November 29, 2016

#GivingTuesday is a global day of giving fueled by the power of social media and collaboration. Celebrated on the Tuesday following Thanksgiving (in the U.S.) and the widely recognized shopping events Black Friday and Cyber Monday, #GivingTuesday kicks off the charitable season, when many focus on their holiday and end-of-year giving. Help support the Thyroid Association by contributing to our #GivingTuesday fundraiser during the month of November!

The post Giving Tuesday: Show your support this Tuesday, November 29, 2016 appeared first on American Thyroid Association.

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Fenestration of auricular cartilage grafts to aid healing of alar wounds by secondary intention

Alar reconstruction should follow the principles of cosmetic subunits for nasal reconstruction,1 so defects that affect multiple subunits (Fig. 1) should be converted into a single alar defect (Fig. 2). The contralateral ala is used as the template to recreate a symmetrical and appropriately positioned alar groove. The purpose of the cartilage graft is twofold: to preserve the patency of the internal valve, and to prevent contraction caused by the formation of granulation tissue during healing. Patency of the nasal valve may be assessed using the Cottle test,2 and from observing the nostrils from below (preoperatively).

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Repeated otalgia at mealtimes: osteochondroma of the mandibular condyle

Referred otalgia is sometimes misdiagnosed as tension headache or migraine. Clinicians can easily overlook these disorders, and request unnecessary and expensive investigations. Secondary otalgia caused by osteochondroma of the temporomandibular joint (TMJ) can be a difficult to diagnose for even experienced oral and maxillofacial (OMF) surgeons.

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AMP kinase promotes Bcl6 expression in both mouse and human T cells

Publication date: January 2017
Source:Molecular Immunology, Volume 81
Author(s): Markus M. Xie, Tohti Amet, Hong Liu, Qigui Yu, Alexander L. Dent
The transcription factor Bcl6 is a master regulator of follicular helper T (TFH) cells, and understanding the signaling pathway that induces Bcl6 and TFH cell differentiation is therefore critical. IL-2 produced during T cell activation inhibits Bcl6 expression but how TFH cells evade IL-2 inhibition is not completely understood. Here we show that Bcl6 is highly up-regulated in activated CD4 T cells following glucose deprivation (GD), and this pathway is insensitive to inhibition by IL-2. Similar to GD, the glucose analog 2-deoxyglucose (2DG) inhibits glycolysis, and 2DG induced Bcl6 expression in activated CD4 T cells. The metabolic sensor AMP kinase (AMPK) is activated when glycolysis is decreased, and the induction of Bcl6 by GD was inhibited by the AMPK antagonist compound C. Additionally, activation of AMPK by the drug AICAR caused Bcl6 up-regulation in activated CD4 T cells. When mice were immunized with KLH using AICAR as an adjuvant, there was a strong TFH–dependent enhancement of KLH-specific antibody (Ab) responses, and higher Bcl6 expression in TFH cells in vivo. Activation of AMPK strongly induced BCL6 and the up-regulation of TFH cell marker expression by human CD4 T cells. Our data reveal a major new pathway for TFH cell differentiation, conserved by both mouse and human T cells. Mature TFH cells are reported to have a lower metabolic state compared to TH1 cells. Our data indicates that decreased metabolism may be deterministic for TFH cell differentiation, and not simply a result of TFH cell differentiation.



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Human amniotic epithelial cells inhibit CD4+ T cell activation in acute kidney injury patients by influencing the miR-101-c-Rel-IL-2 pathway

Publication date: January 2017
Source:Molecular Immunology, Volume 81
Author(s): Junfeng Liu, Rong Hua, Zhangbin Gong, Bin Shang, Yongyi Huang, Lihe Guo, Te Liu, Jun Xue
In the pathogenesis of acute kidney injury (AKI), the release of multiple interleukins can lead to increased kidney damage. Human amniotic epithelial cells (HuAECs) can inhibit immune cell activation in vivo and in vitro. We hypothesized that HuAECs could weaken patient-derived peripheral blood CD4+ T-cell activation and decreasing the ability of these cells to express and release IL-2. −Cell proliferation assay revealed that under the same culture conditions, activated AKI patient-derived CD4+ T cells had a significantly reduced proliferation rate when were co-cultured with HuAECs. And the level of IL-2 released was also significantly reduced. Western blot and qRT-PCR assays showed that the expression of c-Rel in the CD4+ T cells was also significantly reduced. However, the expression level of endogenous miR-101 in the CD4+ T cells co-cultured with HuAECs was significantly increased. Luciferase reporter assay results suggested that miR-101 could bind to a specific site in the c-Rel 3′ UTR and induce the post-transcriptional silencing of c-Rel. Subsequently, we over-expressed miR-101 in AKI patient-derived CD4+ T cells. The qRT-PCR and western blot assay results revealed that the expression of endogenous c-Rel was significantly reduced, while the ELISA results indicated that the level of IL-2 released was also significantly decreased. Finally, ChIP-PCR assay results showed that the miR-101-overexpressing CD4+ T-cell group and the HuAEC co-culture CD4+ T-cell group exhibited significantly decreased binding capacities between the 'c-Rel-NFκB' complex and the IL-2 gene promoter, and the transcriptional activity of IL-2 was also significantly decreased. Therefore, we confirmed that HuAECs can stimulate miR-101 expression in AKI patient-derived peripheral blood CD4+ T cells, thus inhibiting the expression of the miR-101 target gene c-Rel and leading to a reduction in IL-2 expression and release.



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Repeated otalgia at mealtimes: osteochondroma of the mandibular condyle

Publication date: Available online 27 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Chan Il Song, Ju Wan Kang, Jeong Hong Kim, Se-Hyung Kim




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Fenestration of auricular cartilage grafts to aid healing of alar wounds by secondary intention

Publication date: Available online 27 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.M. Flynn, R.B.M. Barry




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From Benign to Malign in a Case of Cervical Adenopathy in a 17-Year-Old Adolescent: Diagnostic Traps

Distinguishing between benign and malign adenopathies remains a challenge and could represent a source of error in a diagnosis. We report a case of right laterocervical adenopathy in a 17-year-old teenager admitted to hospital with an episode of fever associated with dysphagia, congested pharynx, and pultaceous deposits. Initially the adenopathy was considered to be secondary to a coinfection with Streptococcus B-hemolytic and Epstein-Barr virus, as suggested by the positive bacteriological and serological tests. The onset of the adenopathy before the episode and the ultrasound modifications raised the suspicion of a malignancy, later confirmed by the histopathologic examination of the lymph node excision. The final diagnosis was nodal metastasis of an undifferentiated lymphoepithelial carcinoma with an ENT starting point. Currently, the adolescent is hospitalised in the ENT ward, where the pharynx carcinoma with nodal metastasis was confirmed. Sometimes the infectious context can mask or unmask a malign chronic disease with insidious evolution.

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Cardiac Arrest as a Consequence of Air Embolism: A Case Report and Literature Review

Air embolism is an infrequent but potentially catastrophic complication. It could be a complication of invasive procedures including surgery, central line placement, positive pressure ventilation, trauma, hemodialysis, pacemaker placement, cardiac ablation, and decompression sickness. Usually, it does not cause any hemodynamic complication. In rare cases, it could lodge in the heart and cause cardiac arrest. We present a case of an 82-year-old white female who underwent computed tomography (CT) guided biopsy of right lung pulmonary nodule. When she was turned over after the lung biopsy, she became unresponsive and developed cardiopulmonary arrest. She underwent successful resuscitation and ultimately was intubated. CT chest was performed immediately after resuscitation which showed frothy air dense material in the left atrium and one of the right pulmonary veins suggesting a Broncho venous fistula with air embolism. Although very rare, air embolism could be catastrophic resulting in cardiac arrest. Supportive care including mechanical ventilation, vasopressors, volume resuscitation, and supplemental oxygen is the initial management. Patients with cardiac, neurological, or respiratory complications benefit from hyperbaric oxygen therapy.

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Epididymal Adenomatoid Tumor: A Very Rare Paratesticular Tumor of Childhood

Adenomatoid tumor is an uncommon benign mesothelial neoplasm, usually localized in the epididymis. It is the most common paratesticular tumor of middle-aged patients (average age of clinical presentation: 36 years). However, these tumors in pediatric and pubertal patients are extremely rare. Due to their rarity, we present a case of adenomatoid tumor of the tail of the epididymis in a 16-year-old patient. After systematic research of the current literature, we did not find another case report of epididymal adenomatoid tumor in a male patient aged 16 years old or less. This notice and our concern, as well, about the patient's surveillance protocol during the postoperative period were the motive for this case study.

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Sudden Sensorineural Hearing Loss in the Only Hearing Ear: Large Vestibular Aqueduct Syndrome

Sudden hearing loss in the only hearing ear cases are rarely published in the English literature; most of the cases are idiopathic. It is an otologic emergency needing urgent treatment. Delayed diagnosis can interfere with patient's social life with interrupting the verbal communication. In this case report we presented a 33-year-old female patient having sudden sensorineural hearing loss in the only hearing ear diagnosed as bilateral large vestibular aqueduct syndrome.

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Selective effect of cytokine-induced killer cells on survival of patients with early-stage melanoma

Abstract

Adoptive immunotherapy using cytokine-induced killer (CIK) cells has shown potential antitumor ability against several kinds of cancers, including melanoma. However, little is known about the achievable outcome of CIK cells in melanoma patients at different pathological stages. Here we recruited 55 patients treated with conventional therapy plus CIK cells as the CIK group, and 49 patients treated with conventional therapy alone as the control group. The pathological characteristics were comparable between two groups, with a follow-up period up to 40 months. Survival data and immune responses were evaluated after CIK cell treatment. In this study, CIK cells were successfully generated from peripheral blood of melanoma patients after in vitro culture for 14 days. The cultured CIK cells not only produced high levels of pro-inflammatory cytokines upon in vitro stimulation but also efficiently killed human melanoma cell lines. No serious side events were observed in all patients treated with CIK cells. Furthermore, infusions of CIK cells improved the quality of life in some patients, including advanced cases. More importantly, the CIK group exhibited better survival rates compared to the control group among early-stage melanoma patients, in consistent with the increased frequency of peripheral CD4⁺ T cells. However, the patients with advanced-stage melanoma did not benefit from the CIK cell therapy in terms of survival rate. In conclusion, CIK cells combined with conventional treatments may prolong the survival of early-stage melanoma patients and improve the quality of life for some advanced cases in a safe way.

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A polymorphism in the promoter region of PD-L1 serves as a binding-site for SP1 and is associated with PD-L1 overexpression and increased occurrence of gastric cancer

Abstract

PD-L1 is a member of the B7 family co-inhibitory molecules and plays a critical role in tumor immune escape. In this study, we found a polymorphism rs10815225 in the PD-L1 promoter region was significantly associated with the occurrence of gastric cancer. The GG homozygous frequency was higher in the cancer patients than that in the precancerous lesions, which was higher than that in the health controls. This polymorphism locates in the binding-site of Sp1 transcription factor (SP1). The expression level of PD-L1 mRNA in the GG homozygous cancer patients was apparently higher than that in the GC heterozygotes. Luciferase reporter results showed that SP1 bonded to rs10815225 G-allelic PD-L1 promoter instead of C-allelic. Upregulation and knockdown of SP1 resulted in elevation and attenuation of PD-L1 in SGC-7901 cells, respectively. The chromatin immunoprecipitation results further confirmed the binding of SP1 to the promoter of PD-L1. Additionally, rs10815225 was found to be in disequilibrium with a functional polymorphism rs4143815 in the PD-L1 3′-UTR, and the haplotypes of these two polymorphisms were also markedly related to gastric cancer risk. These results revealed a novel mechanism underlying genetic polymorphisms influencing PD-L1 expression modify gastric cancer susceptibility.

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Cytokine-induced killer cells hunt individual cancer cells in droves in a mouse model

Abstract

Cytotoxicity of cytokine-induced killer (CIK) cells depends mainly on their encounters with target cells, but how many CIK cells are required to kill an individual cancer cell is unknown. Here we used time-lapse imaging to quantify the critical effector cell number required to kill an individual target cell. CIK cells killed MHC-I-negative and MHC-I-positive cancer cells, but natural killer (NK) cells destroyed MHC-I-negative cells only. The average threshold number of CIK cells required to kill an individual cancer cell was 6.7 for MHC-I-negative cells and 6.9 for MHC-I-positive cells. That of NK cells was 2.4 for MHC-I-negative cells. Likely due to the higher threshold numbers, killing by CIK cells was delayed in comparison with NK cells: 40% of MHC-negative target cells were killed after 5 h when co-cultured with CIK cells and after 2 h with NK cells. Our data have implications for the rational design of CIK cell-based immunotherapy of cancer patients.

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