Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
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Κυριακή 23 Απριλίου 2017
Editorial Board Page
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
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Vascularized Fascia Lata for Prevention of Postoperative Parotid Fistula Arising From Partial Parotidectomy During Neck Dissection
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
Author(s): Lijuan Zeng, Canhua Jiang, Ning Li, Wen Liu, Fei Wang, Feng Guo
PurposePostoperative parotid fistula can occur after partial parotidectomy, which is a routine surgical procedure during neck dissection of oral cancers arising from or close to the oropharyngeal area. The aim of this study was to evaluate the reliability of vascularized fascia lata for the prevention of postoperative parotid fistula after neck dissection.Materials and MethodsA retrospective review was conducted of patients with oral cancer who underwent ablative resection involving the parotid tail and reconstruction using the anterolateral thigh (ALT) flap with a vascularized fascia lata paddle. The vascularized fascia lata paddle was used to seal off the parotid stump by tightly suturing the edges of the fascia lata and parotid wound together.ResultsTwenty-three patients (18 men and 5 women) with primary oral cancer arising from or close to the oropharyngeal area were enrolled. The mean area of parotid defect was 16.7 cm2 and the mean area of fascia lata harvested was 21.8 cm2. All flaps survived. Pressure dressing or anticholinergic drugs were not used in any case. During the follow-up period, there was no clinical evidence of the development of parotid fistula.ConclusionThe vascularized fascia lata paddle is a reliable option for the prevention of postoperative parotid fistula after neck dissection of oral cancer.
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Table of Contents
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
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AAOMS Author Disclosure forms
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
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Reader's circle
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
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Evidence-Based Practice: Research Opportunities
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
Author(s): James R. Hupp
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Journal of Oral and Maxillofacial Surgery
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
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Regarding “Novel Transoral Approach to the Posterolateral Maxilla and Infratemporal Region”
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
Author(s): Zachary S. Peacock, Leonard B. Kaban
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In Reply
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
Author(s): Marco F. Caminiti, David K. Lam
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News and Announcements
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
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Update on Craniomaxillofacial Trauma
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
Author(s): Edward Ellis
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Evaluation of Stress Response During Mesiodens Extraction Under General Anesthesia Using Heart Rate Variability
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
Author(s): Hye-Won Hwang, Hong-Keun Hyun, Young-Jae Kim, Jung-Wook Kim, Teo Jeon Shin
PurposeStress related to dental treatment can be associated with negative outcomes. Heart rate variability (HRV) is an objective measurement of autonomic nervous system activity. Therefore, HRV was used to identify autonomic nervous system reactions during mesiodens extraction under general anesthesia in children.Materials and MethodsElectrocardiography was performed with customized software during treatment. HRV parameters were analyzed according to time and frequency domains during each dental procedure (local anesthesia, incision, flap, bone removal, extraction of mesiodens, and suturing). The relations of HRV parameters to age also were determined.ResultsTotal autonomic nervous system activity decreased markedly after local anesthesia injection. Depending on the responses of sympathetic nerve activity, patients were categorized in a stress group and a nonstress group. The ratio of low-frequency power (LF) to high-frequency power (HF), an indication of sympathetic and parasympathetic balance, increased in the stress group after incision and flap formation. Conversely, the LF/HF ratio decreased during treatment in the nonstress group. However, HR, widely used to evaluate stress responses, did not change statistically during mesiodens extraction in either group. HRV parameters did not differ statistically according to age.ConclusionsThe internal stress related to mesiodens extraction can be evaluated more objectively with HRV parameters than with conventional methods. Sympathetic nerve activity in the stress group differed from that in the nonstress group during the treatment procedures.
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Condyle Excursion Angle, Articular Eminence Inclination, and Temporomandibular Joint Morphologic Relations With Disc Displacement
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
Author(s): Katharina Alves Rabelo, Saulo Leonardo Sousa Melo, Marianna Guanaes Gomes Torres, Paulo Sérgio F. Campos, Patrícia Meira Bento, Daniela Pita de Melo
PurposeThe aim of this study was to evaluate the relations of the condyle excursion angle (CEA) and the morphology and morphometry of the articular eminence to disc displacement (DD) using magnetic resonance imaging (MRI) of symptomatic patients.Materials and MethodsMRIs of 199 temporomandibular joints (TMJs) were evaluated. Qualitative and quantitative morphologic analyses were performed with tools available in PACS 11.0 (Carestream Health, Inc, Rochester, NY). The articular eminence inclination (AEI), eminence height (EH), CEA, and articular eminence morphologic shape were evaluated. Statistical analyses were used to evaluate any possible association of the variables with DD in the closed- and open-mouth positions, age, and gender. The significance level was set at .05.ResultsElderly women (>60 yr) presented higher prevalence values (43.26%). There was no statistical correlation between DD and gender (P = .4290). Higher mean values of the AEI and EH were associated with box-shaped eminences. The EH, AEI, and CEA were not related to the presence or absence of DD and the different types of DD. The AEI (P = .002) and CEA (P < .001) values were higher for TMJs with disc reduction in the open-mouth position.ConclusionDisc position in the closed- and open-mouth positions is not influenced by articular eminence morphology; however, the AEI and CEA have an influence on disc reduction.
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Comprehensive Genomic Profiling of Central Giant Cell Lesions Identifies Clinically Relevant Genomic Alterations
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 5
Author(s): Brett Bezak, Heidi Lehrke, Julia Elvin, Laurie Gay, David Schembri-Wismayer, Christopher Viozzi
PurposeComprehensive genomic profiling (CGP) can simultaneously detect clinically relevant genomic alterations (CRGAs) in hundreds of cancer-related genes and direct treatment toward patient-specific therapy options for many tumors. This pilot study aimed to use CGP to describe CRGAs present in central giant cell lesions (CGCLs) to characterize any possible underlying genomic drivers of CGCLs.Materials and MethodsWith institutional review board approval, electronic medical records were searched for patients with histologically confirmed CGCLs who underwent biopsy at Mayo Clinic from 2000 through 2014. Clinical characteristics were recorded from the medical records. At least 50 ng of DNA was extracted from formalin-fixed paraffin-embedded archival CGCL specimens by use of hybridization-capture, adaptor ligation–based libraries targeting all exons from 315 cancer-related genes plus select introns from 28 genes commonly rearranged in cancer. Samples were sequenced to high, uniform coverage and assessed for all 4 classes of genomic alterations: base substitutions, small insertions and deletions, rearrangements, and copy number alterations.ResultsOf 8 CGCL specimens, 3 (37.5%) harbored CRGAs, including base substitutions in BRAF, GNAS, and KRAS that are predicted to be oncogenic. In 1 sample, focal high-level amplification of the MITF gene was detected. Rearrangement in the PDGFRB gene was identified in a fourth sample, although the significance of this alteration is uncertain.ConclusionsThis pilot study shows that a relatively high frequency of CRGAs (37.5%) can be identified in CGCLs by use of CGP. Furthermore, 25% of CGCLs analyzed had somatic mutations predicted to activate the mitogen-activated protein kinase signaling pathway, suggesting it may be a driver of the aggressive behavior of these lesions. On the basis of this study, genomic profiling of a larger cohort of CGCLs to validate these observations, as well as correlate mutations with aggressive versus nonaggressive biological behavior and therapeutic responses, appears warranted.
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Hair diameter evaluation in different regions of the safe donor area in Asian populations
Abstract
Background
There is little information about how hair diameter differences within the safe donor area. Thicker or thinner hair may be needed depending on the recipient area, hairline design, and surgical purpose.
Methods
Thirty-eight non-alopecic subjects (19 males and 19 females) were evaluated. The safe donor area was defined as the area contained within 28 cm from the horizontal plane of the upper border of the hair rim to the vertical line of the bilateral external acoustic meatus. Seven zones were defined starting 2 cm on each side (bilateral 4 cm) from the mid-occiput to the temporal side. The diameters of 10 randomly selected anagen hairs were measured from each of the seven zones.
Results
The results showed significant differences in hair diameter by zone between males and females (P < 0.0001). In general, hair diameter tended to decrease from zone 3 to 7.
Conclusion
Our results suggest that safe donor areas between zones 4 and 7 could be useful for specific hair transplantation surgeries requiring thinner hair, such as eyebrows, eyelashes, and female hairline correction surgery, whereas hair from zones 1–3 could be more useful for those requiring thicker hair, such as male and female pattern hair loss. Our data could be clinically valuable for planning hair transplant surgery and choosing the most optimal donor region.
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Early clinical presentations and progression of calciphylaxis
Abstract
Background
Untreated calciphylaxis is a fatal disease of intra- and extravascular calcification, most commonly presenting in end-stage renal disease (ESRD) patients. While early identification is critical for timely treatment, early-stage clinical and histopathological descriptions have not, to our knowledge, been elucidated. As early clinical recognition is essential to prompt definitive histopathological diagnosis, this study describes a range of clinical and histopathological manifestations of early-stage calciphylaxis.
Methods
Five patients with clinical photographs of lesions of early-phase calciphylaxis were chosen from a recent database of 101 patients. Their clinical histories were reviewed and correlated with their respective clinical and histopathological images of early-stage disease and progression of the disease.
Results
Two of the five patients were identified early to have calciphylaxis and were promptly initiated on aggressive, multimodal therapy, resulting in complete resolution and remission of calciphylaxis. The other three patients were also recognized in early stages, one without renal disease, although the disease had progressed to more advanced stages associated with greater morbidity and mortality.
Conclusions
These cases demonstrate that calciphylaxis may be clinically misdiagnosed due to ill-defined presentations, particularly in the early stages without the characteristic features of livedo racemosa and ulceration. However, recognition in the early stages is critical to implement timely treatment. As such, definitively diagnostic skin biopsy should be considered early in suspected cases to confirm the diagnosis of calciphylaxis and ensure prompt management of this lethal disease.
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The use of topical minoxidil to accelerate nail growth: a pilot study
Abstract
Linear nail growth rate is affected by various conditions, one of which is the level of blood flow. Our supposition was that topical minoxidil, which has vasodilatory properties, can increase the rate of nail growth. The aim of this study was to determine the impact of topical minoxidil on nail growth. A 5% topical minoxidil solution was applied twice daily to the fingernails of 32 participants. Two groups of 16 participants were randomly chosen. In one group, the applications were made to the right index and left ring fingernails, and, in the other, the left index and right ring fingernails. During each visit (weekly during the first month and every 2 weeks during the second month), the nail length of six fingernails (index, middle, and ring of both hands) was measured using a digital caliper. Beginning in the first week, the mean nail length of the treated nails was greater than that of nails in the untreated group with statistical significance. There were no systemic or cutaneous side effects. During the first month, the mean growth of the treated nails was 4.27 mm/month compared with 3.91 mm/month in the untreated nails (P = 0.003). These findings suggest that a 5% concentration of topical minoxidil can stimulate nail growth with increased growth beginning in the first week of application. The results may have important implications for the treatment of nail disorders; however, a comparable study involving participants with nail disorders is highly recommended.
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Burning mouth syndrome: results of screening tests for vitamin and mineral deficiencies, thyroid hormone, and glucose levels—experience at Mayo Clinic over a decade
Abstract
Background
Burning mouth syndrome (BMS) is a disorder characterized by chronic mouth pain in the absence of objective clinical abnormalities. Vitamin or mineral deficiencies may have a role in BMS, but data regarding the prevalence and relevance of hematinic deficiencies are conflicting. We aimed to determine the frequency of specific laboratory abnormalities in patients with BMS.
Methods
We retrospectively reviewed the results of screening blood tests in patients with BMS at our institution between January 2003 and December 2013.
Results
Among 659 patients with BMS, the most common decreased values or deficiencies were vitamin D3 (15%), vitamin B2 (15%), vitamin B6 (5.7%), zinc (5.7%), vitamin B1 (5.3%), thyrotropin (TSH) (3.2%), vitamin B12 (0.8%), and folic acid (0.7%). Laboratory values for fasting blood glucose and TSH were increased in 23.7% and 5.2%, respectively.
Conclusions
In patients with symptoms of BMS, our results suggest it is reasonable to screen for fasting blood glucose, vitamin D (D2 and D3), vitamin B6, zinc, vitamin B1, and TSH. Deficiencies of vitamin B12 and folic acid were rare (<1% abnormal).
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IgG4-related disease presenting as posterior scleritis and vitritis, progressing to multifocal orbital involvement
IgG4-related disease (IgG4-RD) is a rare, chronic inflammatory condition that may involve nearly every organ system. Originally identified as a cause of autoimmune pancreatitis, its characteristic histological and clinical features have been found in a wide variety of inflammatory presentations, including the eye and orbit. Here we describe an example of a case of IgG4-RD initially presenting as scleritis and vitritis, with further progression to multifocal bilateral orbital involvement. Tissue biopsy of an orbital mass was highly characteristic of IgG4-RD histology and a rapid clinical response to corticosteroids was observed. This case highlights IgG4-RD as a rare cause of intraocular inflammation that may progress to involve the orbit.
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Intradiaphragmatic hybrid lesion: surgical decision-making and value of minimal invasive surgery
Hybrid lesions (HLs) have elements of congenital pulmonary airway malformation and extrapulmonary sequestration (EPS) and belong to the congenital lung lesions. EPS usually arises in the thorax or the abdomen but rarely in the diaphragm. The preoperative diagnostic work-up based on chest radiograph, ultrasound (US) and CT often shows imprecise results. Therefore, the exact localisation of the lesion can only be ascertained intraoperatively. Here we present a patient, with an intradiaphragmatic HL, and demonstrate the difficulties of surgical decision making regarding the localisation of the lesion and discuss the value of minimal invasive surgery.
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An unusual cause for diffuse pulmonary nodules
Description
We present the case of a 67-year-old woman with a 3-week history of dysphagia in the absence of any respiratory or constitutional symptoms. A lifelong non-smoker with no significant medical comorbidities, it was thought unusual that a routine chest radiograph (figure 1) demonstrated diffuse, small, irregular nodules throughout her lung fields. The diagnosis of primary lung adenocarcinoma was made on the basis of a CT-guided biopsy (figure 2). It is likely that this atypical presentation and radiological appearance of primary malignancy is related to the erosion of tumour into one of the pulmonary arteries thus disseminating the neoplasm throughout the lungs. The cause for the patient's symptoms was attributed to malignant involvement of the central nervous system.
Figure 1
Chest X-ray.
Figure 2
CT scan of the chest.
To distinguish between...
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Complicated small bowel diverticular disease: a case series
Small bowel diverticulosis of the jejunum and ileum is an uncommon finding with a prevalence rate of 0.2% to 1.3% at autopsy and 0.3% to 1.9% on small bowel studies. Diagnosis can be difficult because there are no pathognomonic features or clinical symptoms that are specific for small bowel diverticulosis. Though rare, it is critical to keep the possibility of small bowel diverticulosis in mind when evaluating cases of malabsorption, chronic abdominal pain, haemorrhage, perforation and intestinal obstruction, especially in patients with connective tissue disorders, a family history of diverticula and a personal history of colonic diverticulosis. Guidelines for the treatment of complicated small bowel diverticulosis are not clearly defined. However, the consensus in treatment is to do a small bowel resection with primary anastomosis. We report three interesting cases of jejunoileal diverticula that presented in an occult manner and later progressed to more emergent manifestations.
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Respiratory difficulty with palatal, laryngeal and respiratory muscle tremor in adult-onset Alexanders disease
Sleep apnoea and respiratory difficulties are reported in adult-onset Alexander's disease (AOAD), an autosomal-dominant leukodystrophy that presents mainly with progressive ataxia. We demonstrate for the first time that the respiratory symptoms can result from association of palatal tremor with a similar tremor of laryngeal and respiratory muscles that interrupts normal inspiration and expiration.
A 60-year-old woman presented with progressive ataxia, palatal tremor and breathlessness. MRI revealed medullary atrophy, bilateral T2 hyperintensities in the dentate nuclei and hypertrophic olivary degeneration (HOD). AOAD was confirmed genetically with a positive glial fibrillary acidic protein (GFAP) mutation. Electrophysiological study revealed 1.5 Hz rhythmic laryngeal and respiratory muscle activity. Her respiratory symptoms were significantly improved at night with variable positive pressure ventilation.
This case illustrates that palatal tremor in AOAD, and potentially in other conditions, may be associated with treatable breathlessness due to a similar tremor of respiratory muscles.
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Efficiency of Ustekinumab in Crohn's Disease with Severe Psoriasiform Rash Induced by Biotherapies in an Adolescent
Abstract
Ustekinumab is approved for the treatment of psoriasis in adolescents and for the treatment of moderate to severe Crohn's disease (CD) in adults, but data are lacking in pediatric CD. We report a case of severe psoriasis induced by biotherapies in an adolescent with CD that improved after switching to ustekinumab (90 mg at weeks 0, 2, and 4 and then every 8 weeks). The patient had not experienced CD relapse after 1 year of follow-up. Ustekinumab can be an alternative therapy for psoriasis induced by biotherapies when conventional treatment fails and can maintain remission of CD.
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Duplicated internal auditory canal with inner ear malformation: Case report and literature review
Source:Auris Nasus Larynx
Author(s): Yoshitaka Takanashi, Tetsuaki Kawase, Yasuko Tatewaki, Jun Suzuki, Izumi Yahata, Yuuri Nomura, Kazuha Oda, Hiromitsu Miyazaki, Yukio Katori
Internal auditory canal anomalies are rare. Narrow internal auditory canal is believed to occur as a result of aplasia or hypoplasia of the vestibulocochlear nerve. Narrow duplication of the internal auditory canal is considered to be very rare. Narrow duplication of the internal auditory canal with inner ear malformation has been reported in only 3 cases. We present 2 cases of narrow duplication of the internal auditory canal with inner ear malformation. The first case had inner ear malformation on only one side and the second case had inner ear malformation on both sides. The embryogenesis may be different between internal auditory canal and inner ear.
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Duplicated internal auditory canal with inner ear malformation: Case report and literature review
Internal auditory canal anomalies are rare. Narrow internal auditory canal is believed to occur as a result of aplasia or hypoplasia of the vestibulocochlear nerve. Narrow duplication of the internal auditory canal is considered to be very rare. Narrow duplication of the internal auditory canal with inner ear malformation has been reported in only 3 cases. We present 2 cases of narrow duplication of the internal auditory canal with inner ear malformation. The first case had inner ear malformation on only one side and the second case had inner ear malformation on both sides.
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Ipsilateral sagittal split ramus osteotomy to facilitate reconstruction of the temporomandibular joint after resection of condylar osteochondroma
We report the outcomes of 12 patients with osteochondroma of the mandibular condyle who were treated by condylectomy with sagittal split ramus osteotomy (SSRO) between January 2011 and October 2015. Variables assessed before and after operation were imaging, appearance, maximum mouth opening, maximum mandibular protrusion, lateral excursion, and function of the temporomandibular joint (TMJ). Patients were followed up for a mean (range) of 21 (13 - 30) months. Outcomes were satisfactory with no complications or recurrence.
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Point-of-care ultrasound for oral and maxillofacial surgeons
Publication date: Available online 22 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): F.M. Ryba, K. George
Point-of-care ultrasound is an ultrasound examination that is made at the bedside by the examining clinician in the Accident and Emergency department, clinic, ward, or operating theatre, and it has been growing in popularity since it was first introduced in the 1990s. It is used as an adjunct to clinical examination to aid diagnosis or treatment. We have carried out a pilot survey to assess whether oral and maxillofacial surgeons in the United Kingdom either need or desire to make such an examination. We present the results of our survey and discuss the uses and benefits of point-of-care ultrasound in oral and maxillofacial surgery.
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Ipsilateral sagittal split ramus osteotomy to facilitate reconstruction of the temporomandibular joint after resection of condylar osteochondroma
Publication date: Available online 23 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): X. Luo, X. Ren, T. Li, Y. Li, B. Ye, S. Zhu
We report the outcomes of 12 patients with osteochondroma of the mandibular condyle who were treated by condylectomy with sagittal split ramus osteotomy (SSRO) between January 2011 and October 2015. Variables assessed before and after operation were imaging, appearance, maximum mouth opening, maximum mandibular protrusion, lateral excursion, and function of the temporomandibular joint (TMJ). Patients were followed up for a mean (range) of 21 (13 - 30) months. Outcomes were satisfactory with no complications or recurrence. Patients regained good occlusion and facial symmetry, and satisfactory function of the TMJ. Our results suggest that SSRO is a good option for condylar reconstruction after resection of mandibular condylar osteochondroma.
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Comparative study of three kinds of fibula cutting guides in reshaping fibula for the reconstruction of mandible: An accuracy simulation study in vitro
Publication date: Available online 22 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Zhiwei Dong, Bei Li, Rui Xie, Qin Wu, Li Zhang, Shizhu Bai
ObjectivesIn order to get predictable reassembling and higher accuracy in the reconstruction of the mandible, we designed three kinds of fibula cutting guides: (1) two-edge wide groove guide (WGG); (2) two-edge narrow groove guide (NGG); and (3) one-edge guide (OEG). The purpose of this study was to compare the accuracy of fibula remodelling using the three kinds of fibula cutting guides above in a simulation procedure in vitro.Materials and MethodsCutting and reshaping of fibula analogs were guided by the three kinds of guides mentioned above. Then the fibula segments were glued together and scanned with CT, and finally the 3D accuracy of fibula reshaping was compared to the virtual plan.ResultsComparisons were made with regard to planned versus actual fibula segment length and angle projections in 3 planes. There were no significant differences in length change among the WGG group, NGG group and OEG group. There were very significant differences in angle projections in 3 planes between every 2 of the 3 groups.Conclusions3 kinds of guides do not affect the length of fibula segments. Two-edge narrow groove guides (NGG) caused the smallest error among the 3 kinds of guides. The error caused by two-edge wide groove guide (WGG) was similar to that caused by one-edge guide (OEG). The conclusion was in consistent with the referred groove-restriction-effect in the section of discussion.Clinical RelevanceWe suggest that the two-edge narrow groove guide (NGG) is the superior choice for fibula cutting in reconstruction of the mandible.
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Parotid gland involvement as an initial presentation of papillary thyroid carcinoma
Publication date: Available online 22 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): K. Kilic, M.S. Sakat, M.S. Gozeler, E. Demirci
Papillary thyroid carcinoma (PTC) is the most differentiated malignant thyroid neoplasm. Local metastases of PTC commonly occur in the regional lymph nodes, while distant metastases are mainly to the lung and bone. The case of a patient with PTC who presented with swelling of the parotid gland and neck, mimicking a primary parotid neoplasm, is presented herein. This case is unique due to the unexpected initial presentation of PTC with no signs of disease in the thyroid gland.
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The effect of parotid gland-sparing IMRT on salivary composition, flow rate and xerostomia measures
Abstract
Objectives
To describe parotid gland (PG) saliva organic and inorganic composition and flow rate changes, after curative intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC) and analyse the relationship between PG saliva analytes and xerostomia measures.
Methods and Materials
Twenty-six patients recruited to five prospective phase 2 or 3 trials which assessed toxicity and efficacy of IMRT by HNC subsite, provided longitudinal PG salivas. Salivary flow rate, subjective and objective xerostomia measures were prospectively collected and salivas tested for inorganic and organic analytes. Statistical comparisons of longitudinal analyte changes and analysis for a relationship between dichotomised xerostomia score and saliva analytes were performed.
Results
One-hundred and forty-two PG saliva samples from twenty-six patients were analysed. At 3-6 months after IMRT, stimulated and unstimulated salivas showed significantly decreased flow rate, total protein (TP) secretion rate, phosphate concentration and increased lactoferrin (LF) concentration. Stimulated salivas alone had elevated LF secretion rate and beta-2-microglobulin (B2M) concentration with decreased Calcium (Ca2+) and Magnesium (Mg2+) concentrations and Ca2+ secretion rate. At >12 months, under stimulated and unstimulated conditions, increased LF concentration and decreased Mg2+ and phosphate concentration persisted and, in stimulated saliva, there was decreased potassium (K+) and Mg2+ concentration. Unstimulated TP secretion rate was lower in the presence of high grade xerostomia. Otherwise, no relationship between xerostomia grade and PG salivary flow rate, TP and Ca2+ secretion rate was found.
Conclusion
Fewer significant differences in PG saliva analytes >12 months after IMRT indicate good functional recovery. Residual xerostomia after IMRT will only be further reduced by addressing the sparing of subsites of the PG or other salivary gland tissues, in addition to the PG.
This article is protected by copyright. All rights reserved.
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Sinonasal mucosal melanoma: A 44-case study and literature analysis
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Dréno, M. Georges, F. Espitalier, C. Ferron, A. Charnolé, B. Dréno, O. Malard
ObjectivesSinonasal mucosal melanoma is a rare disease, representing 4% of nasal cavity and paranasal sinus malignancies. The aim of this study was to assess the clinical characteristics, progression and treatment of this disease and to identify prognostic factors.Material and methodsThis retrospective review presents a cohort of 44 patients treated for a melanoma arising from the nasal cavity and paranasal sinuses, in the ENT Head and Neck Surgery Department of the University Hospital of Nantes (France) between 1988 and 2015.ResultsMean age at diagnosis was 71.2 years. The main signs at diagnosis were epistaxis and unilateral nasal obstruction. 25% of patients were initially classified as T4. Surgical treatment was performed in 42 patients. Postoperative radiotherapy was performed in 19 cases and adjuvant immunotherapy in 14 cases. Mean follow-up was 50 months. Cumulative overall survival was 71.5% at 1 year and 33% at 5 years. Clinically, headache, facial pain and trigeminal V2 nerve anesthesia were significant factors for poor prognosis. Exclusively nasal involvement was a factor for better overall survival than sinus involvement. Adjuvant radiation therapy showed a non-significant trend toward improved local control.ConclusionsMucosal melanoma of the sinonasal cavities has poor prognosis due to high metastatic potential. Surgical resection followed by radiation therapy is the main treatment. There is no consensus regarding new systemic adjuvant treatments in this indication, unlike for primary cutaneous melanoma.
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Modified Ipswich Procedure: patient-perceived benefit and surgical outcomes in a series of ten patients
Abstract
Acquired nasolacrimal duct obstruction (NLO) causes symptoms of epiphora which can be associated with stickiness, dacryocystitis and interference with tear film causing visual blurring [1]. The annual incidence rate of NLO is 20 per 100,000, with the majority of patients being females above the age of 66 years [2]. While the aetiology is usually unknown, the site of obstruction is more commonly distal and invariably amenable to treatment by DCR surgery [3-4]. Proximal NLO at the level of the cancaliculi is less common but may still be treatable by extended DCR techniques including canalulostomy. In patients with upper system atresia, or who have acquired obstruction unresponsive to DCR techniques, a conjunctival DCR (CDCR) may be the only other option.
This article is protected by copyright. All rights reserved.
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Left and right reaction time differences to the sound intensity in normal and AD/HD children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Golnaz Baghdadi, Farzad Towhidkhah, Reza Rostami
ObjectivesRight hemisphere, which is attributed to the sound intensity discrimination, has abnormality in people with attention deficit/hyperactivity disorder (AD/HD). However, it is not studied whether the defect in the right hemisphere has influenced on the intensity sensation of AD/HD subjects or not. In this study, the sensitivity of normal and AD/HD children to the sound intensity was investigated.MethodsNineteen normal and fourteen AD/HD children participated in the study and performed a simple auditory reaction time task. Using the regression analysis, the sensitivity of right and left ears to various sound intensity levels was examined.ResultsThe statistical results showed that the sensitivity of AD/HD subjects to the intensity was lower than the normal group (p < 0.0001). Left and right pathways of the auditory system had the same pattern of response in AD/HD subjects (p > 0.05). However, in control group the left pathway was more sensitive to the sound intensity level than the right one (p = 0.0156).ConclusionsIt can be probable that the deficit of the right hemisphere has influenced on the auditory sensitivity of AD/HD children. The possible existent deficits of other auditory system components such as middle ear, inner ear, or involved brain stem nucleuses may also lead to the observed results. The development of new biomarkers based on the sensitivity of the brain hemispheres to the sound intensity has been suggested to estimate the risk of AD/HD. Designing new technique to correct the auditory feedback has been also proposed in behavioral treatment sessions.
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Prevention of post-operative pediatric tracheotomy wounds: A multidisciplinary team approach
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Timothy P. McEvoy, Nolan B. Seim, Abdullah Aljasser, Charles A. Elmaraghy, Brenda Ruth, Leslie Justice, Sarah Begue, Kris R. Jatana
ObjectiveTracheotomy-related pressure wounds have been reported as high as 29%. All advanced stage (stage 3 or 4) wounds are reported by hospitals, and CMS will no longer reimburse healthcare costs to manage them. We present the results of an intensive, multidisciplinary wound prevention strategy starting in the operating room at the time of tracheotomy placement.MethodsProspective analysis of a tracheostomy wound care protocol at an academic, tertiary-care pediatric hospital from September 2012 to February 2016. Participants include all patients having undergone tracheostomy placement followed by protocoled daily dressing changes until the first tracheostomy tube change by team consisting a senior level otolaryngology resident or pediatric otolaryngology fellow, certified wound care specialist, respiratory therapist, and bedside nurse.ResultsPost-operative tracheostomy-related wound data from 3 years prior to clinical intervention was obtained and compared to the intervention cohort. From March 2010–August 2012, 161 tracheotomy procedures were performed with 36 (22.4%) subsequent pressure wounds; 31% of these were stage 3 or 4 wounds. After multidisciplinary protocol implementation, there have been 121 additional tracheotomy procedures with reduction to 12 (9.9%) total tracheotomy-related wounds (p = 0.0064) and none (0%) were stage 3 or 4 (p = 0.0014). All stage 1 and 2 wounds were identified early, underwent appropriate intervention, and avoided further progression.ConclusionsThis protocol was successful in the elimination of all tracheostomy-related advanced stage, hospital-acquired pressure injuries and led to prompt identification of early stage wounds post-operatively.
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