Head and Neck Medicine by Alexandros G.Sfakianakis: 02/19/17

Craniosynostosis and clavicular hypoplasia, delayed closure of the fontanelle, cranial defects, anal and genitourinary abnormalities, and skin (CDAGS), is an infrequent autosomal recessive entity with only 10 cases reported; no associated gene has been identified so far.

Case Report

The proband is a 2-year-old Mexican female with brachycephaly, cleft palate, anal malformation with rectovestibular fistula, and clinodactyly of the third toe overlapping the second. At 4 months of age, she developed a disseminated dermatosis with erythematous scaly nummular plaques, elevated keratotic sharp borders with thin to broad flaking, hematic crusts, and keratotic surface in others. The lesions were slightly pruritic and began at the lower limbs with posterior dissemination to the upper limbs, head, and trunk; palms and soles were unaffected. A skin biopsy showed hyperkeratosis, parakeratosis, acanthosis, and perivascular inflammatory infiltration in the upper reticular dermis among other alterations. She also presented mild bilateral neurosensory hypoacusia and enamel dysplasia. Her karyotype was normal. Treatment with topical hydrating creams partially improved the skin lesions at their center, while the sharply keratotic borders remained, giving a clinical resemblance to porokeratosis.

Discussion

The patient suffers from CDAGS syndrome but has normal development, and feet abnormality was described in only one other patient. The treatment with topical hydrating creams improved the skin lesions at their center, while porokeratotic characteristics persisted. CDAGS remains a diagnostic challenge; a comparison with previously reported cases is discussed. The timely detection of the syndrome will allow early treatment that may improve the condition of the patients.

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Evidence for the association of Hashimoto's thyroiditis with psoriasis: a cross-sectional retrospective study

Abstract

Background

Current information indicates that psoriasis is a metabolic disorder with systemic manifestations. Reports have revealed an association between psoriasis and several chronic autoimmune disorders. For one of these disorders, Hashimoto's thyroiditis (HT), there are scarce, and relatively unconfirmed, reports of an association with psoriasis. We sought to determine if such an association is detectable in a large medical record data repository.

Methods

We searched one institution's electronic medical record data repository from January 2010 to December 2013. Patients were identified by ICD-9 codes (psoriasis: 696.0; 696.1, HT: 245.2). Only data from patients with laboratory-confirmed HT (anti-thyroid peroxidase [anti-TPO] antibodies; thyroglobulin antibodies; serum thyroid-stimulating hormone; and free T3) were eligible for inclusion. Logistic regression analysis was used to obtain an odds ratio (OR) to establish an association between psoriasis and HT. Stratified analyses were performed to test for confounding variable and effect modification.

Results

Medical records for 856,615 individuals with documented encounters between January 1, 2010, and December 31, 2013, were detected. A total of 9654 had a diagnosis of psoriasis, and 1745 had a diagnosis of HT. Of these, 41 subjects were diagnosed with both conditions. A significant association existed for psoriasis and HT, even after adjusting for confounding variables that included gender, age, psoriatic arthropathy, and the use of systemic anti-psoriatic agents (OR = 2.49; 95% CI 1.79–3.48; P < 0.0001).

Conclusions

This association has broad clinical impact and deserves further attention with regard to patient care, clinical research, and developmental therapeutics.

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A Rare Cause of Childhood Cerebellitis-Influenza Infection: A Case Report and Systematic Review of Literature

Acute cerebellitis is a benign neurologic condition generally caused by viral or bacterial infections. Influenza associated cerebellitis is extremely rare; a 6-year-old boy with acute cerebellitis, who presented with fever, vomiting, weakness, febrile seizure, and acute cerebellar features, is discussed in this article.

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Airborne bacterial contamination during orthopedic surgery: A randomized controlled pilot trial

Several factors such as lack of unidirectional, turbulent free laminar airflow, duration of surgery, patient warming system, or the number of health professionals in the OR have been shown or suspected to increase the number of airborne bacteria. The objective of this study was to perform a multivariate analysis of bacterial counts in the OR in patients during minor orthopedic surgery.

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Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial

To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population.

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What's in a dose? Advantages and disadvantages of reducing local anesthetic requirements in children

Prior to the widespread use of ultrasound guidance in regional anesthesia, higher volumes of local anesthetic were often required to achieve reliable blockade with landmark and neurostimulation techniques. The ability to clearly visualize neural structures with ultrasound guidance has resulted in more precise delivery of local anesthetic around the target nerve or plexus, which should theoretically reduce the risk of complications such as local anesthetic systemic toxicity (LAST) as well as tissue toxicity to nerves and surrounding muscle.

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The impact of the fabrication method on the three-dimensional accuracy of an implant surgery template

The use of a surgical template is a well-established method in advanced implantology. In addition to conventional fabrication, computer-aided design and computer-aided manufacturing (CAD/CAM) work-flow provides an opportunity to engineer implant drilling templates via a three-dimensional printer. In order to transfer the virtual planning to the oral situation, a highly accurate surgical guide is needed. The aim of this study was to evaluate the impact of the fabrication method on the three-dimensional accuracy.

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Effect of hyaluronic acid on the regulation of inflammatory mediators in osteoarthritis of the temporomandibular joint: a systematic review

Osteoarthritis is one of the most frequent pathologies affecting the temporomandibular joint (TMJ). There is evidence that the use of intra-articular hyaluronic acid (HA) for the treatment of this disorder achieves positive effects through a reduction in inflammatory mediators. A systematic review of the available evidence regarding the regulation of inflammatory mediators when applying HA in osteoarthritis of the TMJ in humans was performed. The Web of Science, Embase, ScienceDirect, MEDLINE, Scopus, EBSCOhost, and LILACS databases, SciELO library, and search engine Trip Database were searched systematically.

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The Inferior Turbinate in Rhinoplasty

There is controversy regarding optimum treatment of the hypertrophied inferior turbinate. Patients undergoing rhinoplasty will likely need treatment of bony hypertrophy as well as possibly soft tissue hypertrophy. Although inferior turbinate hypertrophy is a heterogeneous entity, future studies should standardize outcome measures and compare treatment methods with rigorous clinical trials.

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Osteotomies Demystified

Osteotomies are critical techniques in rhinoplasty. There are a variety of approaches, trajectories, and tools used with no widely standardized classification or nomenclature. Percutaneous osteotomies are gaining in popularity, and picture framing the nasomaxillary bone is crucial for predictable fracture and reproducible results. This is best accomplished with medial, lateral, and transverse osteotomies. Intermediate osteotomies are used less frequently, but provide more mobility. With a detailed understanding of anatomy and a thorough approach to nasal osteotomies, the contour and function of the bony vault can be reshaped with a successful outcome for both the surgeon and patient.

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Advances in Technology for Functional Rhinoplasty

Advances in computer modeling and simulation technologies have the potential to provide facial plastic surgeons with information and tools that can aid in patient-specific surgical planning for rhinoplasty. Finite element modeling and computational fluid dynamics are modeling technologies that have been applied to the nose to study structural biomechanics and nasal airflow. Combining these technologies with patient-specific imaging data and symptom measures has the potential to alter the future landscape of nasal surgery.

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Management of Pediatric Nasal Surgery (Rhinoplasty)

Nasal surgery in children, most often performed after trauma, can be performed safely in selected patients with articulate, deliberate, and conscientious operative plan. All nasal surgery in children seeks to avoid disruption of the growth centers, preserving and optimizing nasal growth while improving the form and function of the nose. A solid appreciation of long-term outcomes and effects on growth remain elusive.

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Revision Functional Surgery

Reduction rhinoplasty techniques include maneuvers that weaken the nasal osseocartilaginous framework. The structurally compromised anatomy remaining after reductive surgery may be left with inadequate strength to withstand postoperative contractile forces. Significant aesthetic and functional deformities requiring revision rhinoplasty may develop. This article reviews common causes of nasal obstruction after primary rhinoplasty. The discussion of etiology is based on both the anatomic description of nasal subsites (middle vault and lateral walls) as well as an explanation of why certain techniques lead to functional problems in these areas. Revision rhinoplasty techniques for correcting these problems are discussed in detail.

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Functional Rhinoplasty

Understanding nasal anatomy and physiology are the most important points for successful functional rhinoplasty. Anatomic structures playing major roles in nasal breathing functions include the septum, and internal and external nasal valves, so physical examination of these regions is essential. Planning for functional rhinoplasty involves the identification of the sites of nasal airway obstruction or old trauma, and addressing those regions during the operation with a number of different techniques that have been described.

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Septoplasty

Nasal septal deviation is a prevalent problem that can have significant quality of life ramifications. Septoplasty is commonly performed to provide qualitative and quantitative benefit to those who with nasal obstruction owing to septal deviation. Although a standard, basic technique is often adequate for individuals with mild to moderate mid to posterior septal deviation, unique challenges arise with caudal septal deviation. Herein, multiple strategies that attempt to address anterior septal deviation are discussed. Anterior septal reconstruction has been shown to be a safe and effective means by which to address severe caudal septal deviation and long-term reduction in preoperative symptoms.

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The External Nasal Valve

The external nasal valve is a complex entity comprised of multiple structures and tissue types. As such, there is no single operation that can address all problems of the external valve. This article reviews the relevant anatomy, pathologic conditions, and treatments for external nasal valve dysfunction, including a detailed review of the nasal muscles and their contribution to external nasal valve patency. Surgical and nonsurgical options for treatment and the evidence supporting the importance of proper external nasal valve function on quality-of-life measures are discussed.

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Myopericytoma in urinary bladder: a case report

Myopericytoma is reported to occur mainly in the skin and superficial soft tissue of the extremities. In contrast, occurrence in the urinary bladder is extremely rare.

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Head and neck surgery: tracheostomy or not?

We commend Singh et al1 on an informative paper and the production of an excellent algorithm for the provision of a tracheostomy. The paper immediately opened the debate about tracheostomies in maxillofacial surgery in our region and probably further afield.

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Preliminary evidence of improved cognitive performance following vestibular rehabilitation in children with combined ADHD (cADHD) and concurrent vestibular impairment

Balance function has been reported to be worse in ADHD children than in their normal peers. The present study hypothesized that an improvement in balance could result in better cognitive performance in children with ADHD and concurrent vestibular impairment. This study was designed to evaluate the effects of comprehensive vestibular rehabilitation therapy on the cognitive performance of children with combined ADHD and concurrent vestibular impairment.

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Quantitative representation of Eustachian tube component movements during swallowing

Describes a method of dynamic video-endoscopy of the Eustachian tube (ET) orifice at the nasopharynx to quantitatively represent ET component movements during swallowing using a graphic function and analyze their importance to its opening mechanics.

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Liquor legislation, last drinks, and lockouts: the Newcastle (Australia) solution

The aim of this study was to determine whether the regional implementation of prohibitive liquor legislation, introduced in order to limit the sale of and access to alcohol, can lead to a sustained reduction in the incidence of assault occasioning facial injury, as seen in patients presenting to a level 1 trauma hospital. A retrospective observational cohort study was conducted to document patients who were identified as an acute hospital presentation of assault occasioning facial injury. The period of study was 2003–2015; this ensured a similar period of time before and after the implementation of the legislation in 2008.

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Is the intake of selective serotonin reuptake inhibitors associated with an increased risk of dental implant failure?

The aim of this retrospective study was to investigate the association between the intake of selective serotonin reuptake inhibitors (SSRIs) and the risk of dental implant failure. Patients were included if they were taking SSRIs only and no other medication, did not present any other systemic condition or compromising habits (bruxism, smoking, snuff), and complied with the use of prophylactic antibiotics for implant surgery. The multivariate generalized estimating equation (GEE) method and multilevel mixed-effects parametric survival analysis were used to test the association between SSRI exposure (predictor variable) and the risk of implant failure (outcome variable), adjusting for several potential confounders (other variables).

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Maxillary sinus floor elevation with simultaneous implant placement without grafting materials: a systematic review and meta-analysis

The present study aimed to conduct a systematic review and meta-analysis on the effectiveness of maxillary sinus floor elevation and immediate implant installation without the use of grafting material. An electronic search without date or language restriction was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and the grey literature, to May 2016. Eligibility criteria encompassed prospective and retrospective cohort studies, controlled clinical trials, and randomized clinical trials.

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Comparison of the effectiveness of three different treatment methods for temporomandibular joint disc displacement without reduction

The aim of this study was to compare the effectiveness of three treatment methods for unilateral temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). One hundred and twenty patients with unilateral TMJ DDwoR were assigned randomly to one of three treatment groups (40 patients in each): group 1 received arthrocentesis, group 2 received stabilization splint therapy following arthrocentesis, and group 3 received splint therapy only. The groups were compared in terms of pain (visual analogue scale), joint function (maximum mouth opening and laterotrusive movements), disability and psychological status (validated questionnaire), and success rates.

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Eosinophilia associated with Strongyloides infection, severe asthma, and central bronchiectasis

The primary causative agent of human strongyloidiasis is Strongyloides stercoralis, a soil-transmitted helminth of the Strongyloides genus.1 Although strongyloidiasis characteristically occurs through contact with contaminated soil, rare cases of human transmission have also been documented.1 The nematode can be found globally; however, its prevalence is higher in tropical and subtropical regions.1 Within the United States, the highest rates of strongyloidiasis are seen in immigrants, especially those coming from Latin American countries where intestinal parasites, such as S stercoralis, are endemic.

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Factors associated with poor controller medication use in children with high asthma emergency department use

Understanding health and social factors associated with controller medication use in children with high-risk asthma may inform disease management in the home and community. Objective: To examine health and social factors associated with the Asthma Medication Ratio (AMR), a measure of guideline-based care and controller medication use, in children with persistent asthma and frequent emergency department (ED) use.

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Predictors of granulomatous lymphocytic interstitial lung disease in common variable immunodeficiency

A subset of patients with common variable immunodeficiency (CVID) develop granulomatous lymphocytic interstitial lung disease (GLILD), which is associated with early mortality.

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