Differential expression of transcription factors NF-κB and STAT3 in periodontal ligament fibroblasts and gingiva of healthy and diseased individuals

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): R. Ambili, Prasanthila Janam, P.S. Saneesh Babu, Manu Prasad, D. Vinod, P.R. Anil Kumar, T.V. Kumary, S. Asha Nair
ObjectivePathogens and host mediators can activate transcription factors in periodontal cells to bring about gene level alterations, thereby accentuating the periodontal disease process. Nuclear factor-kappa B (NF-κB) and signal transducers and activators of transcription 3 (STAT3) are two pivotal transcription factors implicated in chronic inflammatory diseases. But their importance in periodontal pathogenesis has not been investigated in detail. The aim of the present study was to evaluate the expression of activated transcription factors and their target genes in healthy and diseased periodontium.DesignPrimary culture of periodontal ligament fibroblasts (PDLF) were established from healthy and diseased periodontium using explant culture methods. NF-κB and STAT3 activation in these cells by Porphyromonas gingivalis LPS (lipopolysaccharide) was demonstrated using confocal microscopy and mRNA expression of target genes were evaluated by quantitative real time PCR. NF-κB and STAT3 expression in diseased and healthy gingival tissues were analyzed using immunohistochemistry.ResultsA basal upregulation of transcription factors and their target genes were noted in diseased PDLF compared to healthy ones. LPS challenge induced differential expression of NF-κB and STAT3 and their target genes in diseased PDLF compared to healthy ones. Immunohistochemical analysis revealed significant activation of transcription factors in diseased gingival tissues.ConclusionThe findings of the present study reveal the role of transcription factors NF-κB and STAT3 in periodontal pathogenesis and disease susceptibility of fibroblast subpopulations in periodontal disease could be mediated through activation of NF-κB and STAT3. Since genetic factors are nonmodifyable, transcription factors are promising targets for future host modulation therapy.



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Differential expression of transcription factors NF-κB and STAT3 in periodontal ligament fibroblasts and gingiva of healthy and diseased individuals

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): R. Ambili, Prasanthila Janam, P.S. Saneesh Babu, Manu Prasad, D. Vinod, P.R. Anil Kumar, T.V. Kumary, S. Asha Nair
ObjectivePathogens and host mediators can activate transcription factors in periodontal cells to bring about gene level alterations, thereby accentuating the periodontal disease process. Nuclear factor-kappa B (NF-κB) and signal transducers and activators of transcription 3 (STAT3) are two pivotal transcription factors implicated in chronic inflammatory diseases. But their importance in periodontal pathogenesis has not been investigated in detail. The aim of the present study was to evaluate the expression of activated transcription factors and their target genes in healthy and diseased periodontium.DesignPrimary culture of periodontal ligament fibroblasts (PDLF) were established from healthy and diseased periodontium using explant culture methods. NF-κB and STAT3 activation in these cells by Porphyromonas gingivalis LPS (lipopolysaccharide) was demonstrated using confocal microscopy and mRNA expression of target genes were evaluated by quantitative real time PCR. NF-κB and STAT3 expression in diseased and healthy gingival tissues were analyzed using immunohistochemistry.ResultsA basal upregulation of transcription factors and their target genes were noted in diseased PDLF compared to healthy ones. LPS challenge induced differential expression of NF-κB and STAT3 and their target genes in diseased PDLF compared to healthy ones. Immunohistochemical analysis revealed significant activation of transcription factors in diseased gingival tissues.ConclusionThe findings of the present study reveal the role of transcription factors NF-κB and STAT3 in periodontal pathogenesis and disease susceptibility of fibroblast subpopulations in periodontal disease could be mediated through activation of NF-κB and STAT3. Since genetic factors are nonmodifyable, transcription factors are promising targets for future host modulation therapy.



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Pharmacotherapy of mast cell disorders.

Purpose of review: Mast cell disorders (MCDs) comprise mastocytosis and disorders referred to as mast cell activation syndrome and are caused by abnormal accumulation and/or activation of mast cells in tissues. Clinical signs and symptoms are protean; therefore, finding suitable treatment options for individual patients entails a challenge for clinicians. The purpose of this manuscript is to review the literature on the available therapeutic interventions in patients with MCD. Recent findings: Pharmacotherapy is mainly directed against the effects of mast cells and their mediators. The current recommendations are exclusively based on expert opinions due to the lack of controlled clinical trials. The targeted therapies aiming at blocking mutant KIT variants and/or downstream signaling pathways are currently being developed and may be considered in severely affected, therapy-refractory patients. Summary: There is currently no method for predicting the best available approach to control symptoms in individual patients with MCD. Therefore, a stepwise, individual-based approach in pharmacotherapy options appears to be most successful strategy and is recommended in all patients. The core component of the treatment in most patients is to control symptoms caused by mast cell mediator release, whereas cytoreductive therapies are mainly reserved for patients with advanced/aggressive systemic mastocytosis. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Coexistence of Lymphoepithelial Carcinoma of the Parotid Gland and Submandibular Gland Pleomorphic Adenoma.

Lymphoepithelial carcinoma is a variant of undifferentiated carcinoma with characteristic dense lymphoid stroma in which nasopharynx is site of predilection. Racial and geographic association and Epstein-Barr virus positivity in endemic areas are other characteristics of this rare neoplasm. Lymphoepithelial carcinoma accounts for only 0.4% of malignant salivary gland tumors. The authors present a patient with Epstein-Barr virus positive lymphoepithelial carcinoma of the parotid gland in a nonendemic region. Besides this, synchronous pleomorphic adenoma in the contralateral submandibular gland caused a challenge in making initial therapeutic decision. (C) 2017 by Mutaz B. Habal, MD.

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Patient With Cleft Maxillary Hypoplasia Who Underwent Distraction Osteogenesis and Conservative Therapies to Postoperative Velopharyngeal Insufficiency.

The authors performed distraction osteogenesis using The Maxillary Distractor System (SYNTHES) to maxillary hypoplasia patient with cleft lip palate, and consequently improved the aesthetic complexion of the patient. Velopharyngeal insufficiency developed after bone elongation; the authors improved the insufficiency with conservative therapies such as articulatory training using the bulb attached palatal lift prosthesis. And then the authors got successful and accepted postoperative speech outcome. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2rLATHx

Canine Eruption After Secondary Alveolar Bone Graft in Unilateral Cleft Lip and Palate Patients.

Purpose: The aim of this article is to analyze dental abnormalities in unilateral cleft lip and palate patients by focusing on the role of the secondary alveolar bone graft (SABG) surgery and its outcomes on canine eruption/inclusion. Materials and Methods: A sample of 24 patients with unilateral cleft lip and palate were selected. Dental anomalies, canine eruption based on the existence of supernumeraries, agenesis elements, inclination of the major canine axis before and after surgery, distance from the occlusal plane before and after surgery, and sector classification were analyzed. Results: Out of the 24 patients, 87.5% presented a canine spontaneously erupted in the dental arch while 12.5% needed surgical-orthodontic traction. There is also no proof that inclination of the canine significantly influenced the eruption before (P = 0.5889) and after (P = 0.4029) surgery. Also, there is no any correlation between the 2 sides (P = 0.1257). The SABG surgery showed a significant correlation with canine eruption (P = 0.009242); moreover, SABG shows a positive relationship with the radicular development of the canine (P = 0.005163). Lateral incisive (P = 0.8493) and second premolar agenesis (P = 1) are not statistically correlated with the eruption of the canine. This does not happen with supernumerary elements that are correlated with the surgical-orthodontic traction (P = 0.0004464). Conclusions: Agenesis does not play any role in the process of canine eruption while supernumeraries do. There is no relationship between the inclination and eruption of the canine. The SABG surgery has a key role because it contributes to create an appropriate support for the erupting canine, the nasal base and the anterior maxilla. (C) 2017 by Mutaz B. Habal, MD.

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Fibrin Tissue Sealant as an Adjunct to Cleft Palate Repair.

Purpose: Fibrin glue is a common tissue sealant used to promote hemostasis, adhere tissues, and accelerate healing. Cleft palate repair can be technically challenging, creating dead space between tissue planes, and can be prone to complications such as would dehiscence or bleeding. The purpose of this study is to assess the role of fibrin glue as an adjunct to cleft palate repair. The authors hypothesize a beneficial impact on complication rates, including bleeding, dehiscence, and fistula formation, among others. Methods: Primary cleft palate repairs using fibrin glue were retrospectively analyzed. Demographic, intraoperative, perioperative, and postoperative data were combed for outcome variables. Complication rates were calculated in percentages and the results were compared to the published literature. Z-test statistics were performed for comparison. Results: A total of 45 patients, 21 females and 24 males, who underwent primary cleft palate repair with fibrin glue between 2011 and 2014, had sufficient data to be reviewed. There were no instances of bleeding, dehiscence, airway obstruction, infection, oronasal fistula, or return to the operating room in any patients. One patient exhibited mild postoperative coughing and secretions that resolved with conservative measures. Another patient displayed postoperative seizure activity due to a pre-existing condition. All complication rates in our fibrin glue series were lower than those reported without the use of fibrin glue. Overall complication rates with fibrin sealant are significantly lower than overall complication rates without. Conclusion: Our data suggest that fibrin sealant is a beneficial adjunct to cleft palate repair. Its application is well-tolerated and the complication profile in our cohort was much less than the reported rates. The results of this preliminary study should be vetted with a prospective analysis involving a control group. (C) 2017 by Mutaz B. Habal, MD.

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Asymmetry of Preoperative Incision Design Markings for Upper Blepharoplasty.

Purpose: To compare preoperative incision design markings between both eyelids in upper blepharoplasty. Methods: This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. The authors measured medial canthal excision angle, maximal lid excision height, maximal lid excision width, peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software. Results: The mean medial canthal excision angle, maximal lid excision height, and maximal lid excision width for the right side (30.68[degrees] +/- 10.16[degrees], 1.17 +/- 0.24 cm, and 0.72 +/- 0.19 cm) were significantly different from those for the left side (35.39[degrees] +/- 13.82[degrees]; P < 0.001, 1.24 +/- 0.25 cm; P = 0.002, and 0.77 +/- 0.21 cm; P = 0.011). The mean peak point angle and peak point distance for the right side (15.67[degrees] +/- 5.09[degrees], 2.41[degrees] +/- 0.31[degrees]) were significantly different from those for the left side (18.11[degrees] +/- 5.49[degrees]; P = 0.001, 2.22 +/- 0.28 cm; P = 0.001). Conclusions: In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximized by including the asymmetries in the preoperative design. (C) 2017 by Mutaz B. Habal, MD.

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Genetic Factors Involved in Mandibular Prognathism.

Mandibular prognathism is defined as an abnormal forward projection of the mandible beyond the standard relation to the cranial base and it is usually categorized as both a skeletal Class III pattern and Angle Class III malocclusion. The etiology of mandibular prognathism is still uncertain, with various genetic, epigenetic, and environmental factors possibly involved. However, many reports on its coexistence in both twins and segregation in families suggest the importance of genetic influences. A multifactorial and polygenic background with a threshold for expression or an autosomal dominant mode with incomplete penetrance and variable expressivity are the most probable inheritance patterns. Linkage analyses have, thus far, shown the statistical significance of such loci as 1p22.1, 1p22.3, 1p32.2, 1p36, 3q26.2, 4p16.1, 6q25, 11q22, 12pter-p12.3, 12q13.13, 12q23, 12q24.11, 14q24.3 to 31.2, and 19p13.2. The following appear among candidate genes: MATN1, EPB41, growth hormone receptor, COL2A1, COL1A1, MYO1H, DUSP6, ARHGAP21, ADAMTS1, FGF23, FGFR2, TBX5, ALPL, HSPG2, EVC, EVC2, the HoxC gene cluster, insulin-like growth factor 1, PLXNA2, SSX2IP, TGFB3, LTBP2, MMP13/CLG3, KRT7, and FBN3. On the other hand, MYH1, MYH2, MYH3, MYH7, MYH8, FOXO3, NFATC1, PTGS2, KAT6B, HDAC4, and RUNX2 expression is suspected to be involved in the epigenetic regulations behind the mandibular prognathism phenotype. (C) 2017 by Mutaz B. Habal, MD.

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Nasolabial Growth in Individuals With Unilateral Cleft Lip and Palate: A Preliminary Study of Longitudinal Observation Using Three-Dimensional Stereophotogrammetry.

There are limited numbers of studies comparing the preoperative and postoperative facial features of infants with unilateral cleft lip and palate (UCLP) using three-dimensional (3D) stereophotogrammetry. The authors attempted an anthropometric analysis of nasolabial asymmetry 1 year after primary lip repair using a handheld 3D imaging system. Five different nasolabial dimensions in 24 infants with UCLP were measured using 3D images captured during primary lip repair and again, 1 year after the repair. The nasal and upper-lip elements of the cleft side were significantly changed after primary lip repair, and nasolabial asymmetry was anthropometrically improved. This is a preliminary longitudinal observation of nasolabial growth in individuals with UCLP using 3D stereophotogrammetric technique. The authors would like to follow these children until adulthood, capturing 3D images at every intervention. (C) 2017 by Mutaz B. Habal, MD.

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Surrogate Outcome Measures for Corneal Neurotization in Infants and Children.

Background: Corneal anesthesia is a rare and challenging condition, particularly in young children. The insensate cornea leads to abnormal epithelial cell metabolism and loss of trophic influences supplied by the corneal nerve fibers. This results in recurrent spontaneous epithelia erosion and eventual loss of sight. Corneal reinnervation is a definitive treatment option for neuropathic keratitis. The outcome measures in young children following corneal sensitization are different to adults as esthesiometry is unachievable. Methods: The authors have undertaken corneal reinnervation in a young patient using a sural nerve graft. Surrogate measures suitable for pediatric patients were used for assessment of the outcome. Results: Postoperatively there was evidence of improved corneal healing and function after 8 weeks. At 10 months postprocedure, the cornea was completely free of vascularization. Conclusion: Resensitization of the cornea using nerve grafts has previously been reported in older children and adults. This is the first time the procedure has been undertaken in a young child. Although the technique is still in its infancy with only 4 patients reported worldwide including our report, it seems to hold promise of improvement to this challenging cohort of patients. (C) 2017 by Mutaz B. Habal, MD.

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Nasal Root Deviation in Unicoronal Craniosynostosis: A Craniometric Analysis of Early and Late Postoperative Outcomes.

Purpose: Current operative techniques for correcting unicoronal craniosynostosis (UCS) leave the nasal bones untouched, resulting in an unclear long-term impact on nasal root deviation. The purpose of this study is to quantify nasal root deviation in the preoperative and late postoperative setting in patients who have undergone conventional single-staged UCS correction. Methods: The authors performed a retrospective, craniometric analysis of nasal root deviation comparing preoperative computed tomography scans, with those of the early, and late postoperative period. Three vectors were analyzed to measure nasal root deviation, one extending from the nasion to the rhinion (nasal bone vector), the second from the rhinion to the anterior nasal spine (nasal aperture vector), and the third from the nasion to the anterior nasal spine (nasal longitudinal vector). Results: Twenty-five subjects were included in the study. Average ages at the time of preoperative, early, and late postoperative imaging were 0.6 +/- 0.3, 0.9 +/- 0.6, and 9.3 +/- 2.7 years, respectively. Improvement of angular deviation of both the nasal aperture vector and nasal longitudinal vector was observed. Mean angular deviation of the nasal aperture vector was 6.0 +/- 1.9 degrees preoperatively, 6.0 +/- 2.1 degrees early postoperatively (P = 0.952), and 2.4 +/- 2.1 in the late postoperative period (P = 0.013). Mean angular deviation of the nasal longitudinal vector was 5.7+2.0 degrees preoperatively, 5.8 +/- 2.3 degrees early postoperatively (P = 0.948), and 3.7 +/- 1.6 degrees in the late postoperative period (P = 0.019). Conclusion: Nasal root deviation decreased significantly only in the late postoperative period, lending credence to the notion that though UCS correction does not directly address nasal root deviation, this pathology improves significantly over time. (C) 2017 by Mutaz B. Habal, MD.

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Coding Challenges in Craniofacial Surgery.

No abstract available

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A Modified External Fixator System in Treatment of Mandibular Condylar Fractures.

The purpose of this study is to evaluate patient's outcomes after condylar fractures treated with the modified external fixation system from 2008 to 2012. A group of 58 patients with unilateral and bilateral fractures of mandibular condyle was admitted in the authors' study. The final sample included a total of 44 patients, 24 males (54.6%) and 20 females (45.4%). The remaining 14 (24%) patients were excluded because they did not fulfill all the criteria requested. After 12 months from surgery, the functional-clinical evaluation of mouth's maximum opening and mostly extent of lateral excursion and of protrusion showed the following results: 8% of the sample showed a maximum mouth opening 40 mm lateral excursion (contralateral to fracture) and protrusion was respectively of 9.5 and 3.9 mm. Only 2 (4.5%) of the 44 evaluated patients reported headaches. 86.5% of the patients showed no postoperative temporomandibular joint dysfunction; 9% of them reported occasional clicking, while 4.5% reported recurrent disorders. The average satisfaction score of surgery outcome reported by patients was 94.5/100, and it ranged between 50/100 and 100/100. (C) 2017 by Mutaz B. Habal, MD.

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Hidradenoma of the Chin.

Clear cell hidradenoma is a rare skin tumor in the head and neck. Clear cell hidradenoma of skin is an uncommon soft tissue tumor originating from the sweat glands. The authors report a case of clear cell hidradenoma developing in the chin in a 61-year-old woman, which occurred during the course of 8 months. The clinical and histologic findings of the tumor are documented. The lesion was totally removed by excision and revealed no evidence of recurrence. (C) 2017 by Mutaz B. Habal, MD.

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How to Achieve Facial Balance by Mandibular Contouring Ostectomy in Hemimandibular Hyperplasia.

Hemimandibular hyperplasia is a rare type of condylar hyperplasia which leads to facial asymmetry. Its surgical correction may be challenging since it usually requires complex mandibular osteotomies. Mandibular inferior border ostectomy is poorly described in the literature. The aim of this report is to present a new surgical technique guided by a customized surgical splint manufactured using computer-aided design/computer-aided manufacturing technology. Very good aesthetic results are achieved as it is very precise. (C) 2017 by Mutaz B. Habal, MD.

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Microsurgical Decompression of Inferior Alveolar Nerve After Endodontic Treatment Complications.

Iatrogenic injury in oral surgery is the most frequent cause of sensory disturbance in the distribution of the inferior alveolar nerve (IAN) and mental nerve. Inferior alveolar nerve damage can occur during third molar extraction, implant location, orthognathic surgery, preprosthetic surgery, salivary gland surgery, local anesthetic injections or during the resection of benign or malignant tumors. Injuries to the IAN can be caused also by endodontic treatment of mandibular molars and premolars when filling material is forced into the tooth and mandibular canal. The sensory disturbances that could follow a damage of the IAN could be hypoesthesia, dysesthesia, hyperesthesia, anesthesia, and sometimes a painful anesthesia that strike ipsilateral lower lip, chin, and teeth. These can undermine life quality by affecting speech, chewing, and social interaction. Treatment of these complications is sometimes difficult and could consist in observation or in surgical decompression of the involved nerve to relieve the patient's symptoms and improve sensory recovery. The most debated points are the timing of intervention and the effective role of decompression in clinical outcome-improvement. The purpose of this article is to show authors' experience with 2 patients treated with microsurgical nerve decompression to remove endodontic material from the mandibular canal and providing also a comprehensive review of the literature. (C) 2017 by Mutaz B. Habal, MD.

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Nasal Soft Tissue Change Following Bimaxillary Orthognathic Surgery.

Objective: The purpose of this study is to identify the correlation between maxillary movement and nasal soft tissue changes on three-dimensional reconstructed cone beam computed tomography (CBCT) images after Le Fort I osteotomy. Materials and Methods: The authors also investigate the long-term change of alar base width (ABW) to determine the effect of cinch suture. The authors retrospectively studied 52 subjects (14 males and 38 females) who were treated by bimaxillary orthognathic surgery including Le Fort I osteotomy and mandibular ramus surgery. The landmarks and planes were established on three-dimensional reconstructed CBCT images. The authors measured each parameters preoperatively, 1 month postoperatively, and 1 year postoperatively. Results: There was no significant correlation between the horizontal movement of A-point and the widening of ABW (P

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Review of "Medical Error-the Third Leading Cause of Death in the US" by Makary MA and Daniel M in BMJ 353: i2139, 2016.

No abstract available

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Cutaneous T pseudolymphoma on the red pigmented areas of a tattoo

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Revision Rhinoplasty: Retrospective Chart Review Analysis of Deformities and Surgical Maneuvers in Patients with Nasal Airway Obstruction—Five Years of Experience

Facial plast Surg 2017; 33: 334-338
DOI: 10.1055/s-0037-1598041

Nasal airway obstruction is one of the most frequent causes of revision rhinoplasty in patients after previous rhinoplasty procedure. Purpose of this study is to present the deformities and the surgical maneuvers conducted in revision rhinoplasty patients with functional complaint, anatomical sites at risk, and potential prophylactic maneuvers. This study is a retrospective chart review analysis of 46 consecutive revision rhinoplasty procedures in patients with nasal airway obstruction. Inclusion criteria were at least one previous rhinoplasty and nasal airway obstruction as the epicenter of patients' complaint. Thorough clinical examination to certify the obstruction was performed. Deformities noted were separated in three categories according to functional, cosmetic, and combination of functional and cosmetic implications. Surgical maneuvers conducted were reviewed. Deformities found were checked for statistically significant coexistences. The average patient age was 34.9 years. The mean number of previous septorhinoplasties was 1.33. Nasal ventilation obstruction mainly caused either by septum deviation or nasal valve dysfunction was identified in 91.3% of our patients. Surgical maneuvers conducted included placement of grafts in 89.1% of all cases, septoplasty in 76.1%, lateral wall support in 47.8%, and placement of spreader grafts in 39.1% of patients. The average preoperative Nasal Obstruction Symptom Evaluation (NOSE) score was 61 ± 15 and it improved substantially, even from month 1, postoperatively. Owing to high prevalence of nasal airway obstruction after primary or secondary rhinoplasty, we conducted the first retrospective chart review study to identify the most common deformities in revision rhinoplasty patients with nasal airway obstruction and the appropriate surgical maneuvers to address them. Septum deviation and nasal valve dysfunction were the two pillars of nasal airway obstruction in those patients.
[...]

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Rhytidectomy: Analysis of Videos Available Online

Facial plast Surg 2017; 33: 311-315
DOI: 10.1055/s-0037-1602163

The objective of this study was to examine YouTube videos related to rhytidectomy created by both physicians and nonphysicians to determine the content of the videos, the selected topics of discussion, and other important parameters using a cross-sectional analysis study design. A YouTube search result for the keyword "facelift" was performed. Videos pertaining to the rhytidectomy procedure were included in this analysis. Authorship, length of video, primary objective, and total views were recorded. Total 80 videos (81%) were authored by physicians, 14 (14%) were authored by patients, and 5 (5%) were authored by a third party. Fifty-eight (59%) videos were shorter than 5 minutes, and 41 videos (41%) were longer than 5 minutes. Fifty-two (53%) videos were viewed fewer than 10,000 times, and 47 videos (47%) were viewed more than 10,000 times. Forty (40%) videos had a primary objective of providing information, 13 (13%) had a primary objective of providing the patient's perspective, and 46 (46%) had a primary objective of advertising a physician's practice. A chi-square test for independence with threshold of significance < 0.05 was used to compare whether or not the primary objective of the videos depended on the type of authorship. A significant difference was found between physician- and patient-authored videos. In addition, the 12 (12%) videos with the most views of videos included in this study were responsible for 75% of the total views of videos included in this study. Advertising was a goal of both physician- and patient-based videos, but physician-based videos were more likely to provide information about the procedure whereas patient-based videos more commonly presented a patient's personal perspective. The most popular 12% of videos were responsible for 75% of total views in this analysis, indicating that a small minority of perspectives dominates the YouTube viewership regarding rhytidectomy. The general public may be misled by information found by viewing these videos as the Internet generally lacks safeguards for quality or accuracy. It may be prudent for academic or professional organizations to provide videos intended to achieve a more neutral, well-informed perspective.
[...]

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The History of Rhytidectomy

Facial plast Surg 2017; 33: 247-249
DOI: 10.1055/s-0037-1603347

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Beyond the Facelift: Procedures to Enhance Rhytidectomy

Facial plast Surg 2017; 33: 245-246
DOI: 10.1055/s-0037-1603348

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Surgical Anatomy for Facelift

Facial plast Surg 2017; 33: 250-251
DOI: 10.1055/s-0037-1603528

Knowledge of surgical anatomy is of paramount importance during surgical dissection for facelift surgery, regardless of the type of facelift procedure performed. This article reviews the relevant surgical anatomy for facelift, including the superficial musculoaponeurotic system (SMAS), and course of the facial nerve relative to the SMAS, zygomatic arch, and mandible. Also, this article reviews the various retaining ligaments, and some types of facelift procedures recommend release of these ligaments to achieve a more effective aesthetic result.
[...]

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Preoperative Simulation in Planning Rhinoplasty: Evaluation from Patients' and Surgeons' Perspectives

Facial plast Surg 2017; 33: 324-328
DOI: 10.1055/s-0037-1601419

Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulations have become increasingly commonplace through the recent years along with a controversy regarding their use. Although capable of building a solid rapport between the surgeon and the patient by visualizing the end result, it can also prove to be a liability for a surgeon who is not confident about delivering the result which has been put on screen. The objective of this study is to evaluate the outlook of the surgeons and patients on preoperative simulations. Plastic surgeons who perform rhinoplasty and individuals who consider rhinoplasty were surveyed via an online questionnaire system. Their opinions about the practice of simulation were questioned and they were asked to distinguish between simulated and actual postoperative results. Statistical analyses were performed using SPSS software. Major factors influencing the decision-making process of patients were the availability of preoperative simulation, being shown appealing results of the surgeon's previous work and a personal reference from a patient with an appealing result. Within the health care professionals, it has been observed that experienced surgeons are more confident about using simulations, while inexperienced ones are daunted by being bound with a visual contract (p < 0.05). However, it has been noted that the preference of withholding the simulation or providing a copy to the patient was similar in all experience levels (p > 0.05). In conclusion, our findings suggest that the patients' self-consciousness regarding preoperative simulations seem to grow faster than the surgeons' confidence in their use. Level of evidence is Level V.
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Psychology of the Facelift Patient

Facial plast Surg 2017; 33: 252-259
DOI: 10.1055/s-0037-1598071

This paper presents an extensive literature review of the psychology of facelift patients as it has evolved over the past 50 years. Earlier studies revealed significant levels of pre and perioperative depression. Facelift patients generally exhibit emotional and social concerns about facial appearance that are higher than the general population. Many are undergoing midlife situational stresses and may lack the positive characteristics to deal with them. The most common diagnoses seen include depression, impulsivity, unstable personality, and passive dependence, albeit not necessarily serious. Improvement in body image is the major driver for surgery. Characteristics of female patients as defined by their age are described. These include the younger emotionally dependent group, the worker group of middle age, and the older grief group. Male patients are seen to have a higher level of psychological dysfunction, but a higher improvement in postoperative quality of life. Motivations for surgery include increasing self-esteem, making new friends, improving relationships, and getting better jobs. Overall patient satisfaction is more than 95%, with improvement seen in positive changes in their life, increased self-confidence and self-esteem, decreased self-consciousness about their appearance, and overall improvement in quality of life. Postoperative psychological reactions are seen in about half the patients, these primarily being anxiety and depression of varying degrees. Predictors of patient satisfaction include the desire for self-image improvement in contradistinction to a change in life situation. Negative predictors include male sex, young age, unrealistic expectations, relationship disturbances, and preexisting psychological pathology. The importance of good patient selection in achieving a satisfied patient is outlined and emphasized.
[...]

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Prophylactic Midface Lift in Midfacial Trauma

Facial plast Surg 2017; 33: 347-351
DOI: 10.1055/s-0037-1602165

The objective was to review our favorable experience in the use of prophylactic midface lifts in the setting of severe midfacial trauma. A retrospective review of a consecutive series of patients undergoing prophylactic midface lifts at the time of definitive fracture repair in a County Hospital Level 1 trauma center was done. All patients undergoing midface lifts at the time of fracture repair by the senior author from July 1998 to July 2012 were included in this review. A total of 72 patients (58 males, 14 females, average age: 36.2 years) were available for review. Sixty-three patients had a minimal follow-up of at least 3 months. No complications felt to be related to the midfacial suspension were noted. There were no instances of frontal nerve paralysis or palsy. There were no patients with ectropion. Patient midfacial symmetry was evaluated by two blinded facial plastic surgeons. It was felt to be excellent in 53 patients, good in 9, fair in 1, and poor in none. The force of trauma necessary to elicit a severe midfacial fracture and the subsequent subperiosteal dissection required to expose the fractures for rigid fixation result in severe laxity of the midfacial soft tissue envelope. Failure to suspend and support these soft tissues will result in significant facial asymmetry. Prophylactic endoscopic midface suspension appears to be a safe and effective method of largely eliminating this problem and should be considered in the setting of severe midfacial fractures.
[...]

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The Superficial Musculoaponeurotic System Facelift: A Prudent Balance of Risks and Benefits

Facial plast Surg 2017; 33: 260-265
DOI: 10.1055/s-0037-1603316

Over the decades, facelifting has not escaped the natural history of trends and fads. And, as a profession, facial plastic surgery has not avoided falling into the trap of following corporate initiated technology, rather than leading common-sense methodologies to rejuvenating the aging face. The author is often reminded of a truism to which he was introduced in the 1980s. "When there are many ways of doing things, all of them work; or none of them work." Undeniably, any procedure that lifts and removes excessive skin of the face and neck "works." However, the questions that must be answered by leading teachers of facelifting surgery are: How well does a given technique work? How long-lasting are the results? Where does the risk–benefit curve cross over from optimal benefits to unacceptable risks? At what stage in a given patient's aging process are more aggressive techniques called for? At what stage in a surgeon's career should more invasive techniques be attempted, if ever? This article addresses the preceding questions as they relate to the contribution made by the superficial musculoaponeurotic fascia in repositioning sagging tissues of the face and neck.
[...]

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Skin Resurfacing in Combination with Facelift Surgery

Facial plast Surg 2017; 33: 299-310
DOI: 10.1055/s-0037-1602742

Facial aging is a combination of descent of facial tissues, atrophy of fat compartments, bony remodeling, and chronological and photoaging changes of the skin. A rhytidectomy will address the aging changes due to gravity on facial tissues but will do little to improve skin texture, thickness, and pigmentation. To address collagen loss, rhytids, and dyspigmentation, surgeons are incorporating resurfacing techniques including carbon dioxide/erbium ablative and fractionated lasers, 35% trichloroacetic acid chemical peel pretreated with Jessner's solution, phenol 88% chemical peel, Baker's solution chemical peel, and dermabrasion. More recently, surgeons are approaching facial aging with a more comprehensive approach to address both gravity and collagen changes by a combination of rhytidectomy with resurfacing. Technique and modality selection are keys to maximum single treatment results and therefore the greatest patient satisfaction.
[...]

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The Horizontal Neck Lift

Facial plast Surg 2017; 33: 266-270
DOI: 10.1055/s-0037-1598054

The horizontal neck lift is a procedure involving direct excision of a horizontally oriented ellipse of skin from the neck. This procedure was developed for neck rejuvenation in patients with significant horizontal creases and excess skin of the middle and lower neck, areas that often cannot be adequately addressed with traditional techniques. This article describes the procedure, indications, patient counseling, and postoperative care in detail from the senior author's (H. M.) experience.
[...]

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Lateral Crural Tensioning for Refinement of the Nasal Tip and Increasing Alar Stability: A Case Series

Facial plast Surg 2017; 33: 316-323
DOI: 10.1055/s-0037-1602143

The objective of this study was to discuss the technical details and our experiences with lateral crural tensioning (LCT) in both functional and aesthetic rhinoplasties. A retrospective medical review was completed for all patients who underwent rhinoplasty with LCT from the years 2011 to 2014. The indications for LCT included correction of lateral crural convexity, boxy tip geometry, and dynamic collapse of the external nasal valve. The details of the rhinoplasty procedure and complications were evaluated. A total of 114 LCT rhinoplasty cases were included in this series. The most common adjunctive maneuvers included placement of spreader grafts (92% of cases) and alar rim grafts (78% of cases). Conventional classic cephalic trim was not performed in any subjects and conservative paradomal cephalic trim was performed in 48% of cases. As experience with the technique progressed, the use of onlay tip grafts decreased and the use of articulated rim grafts increased. Indications for revision were dissatisfaction with cosmetic outcome (4.4% of cases) and nasal obstruction (0.9% of cases). LCT combines traditional lateral crural steal with the use of a caudal septal extension graft to refine the broad tip and increase stability of the alar lobule. This maneuver is essentially cartilage sparing and does not rely on extensive grafting maneuvers that can reduce airway area.
[...]

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The Difficult Neck in Facelifting

Facial plast Surg 2017; 33: 271-278
DOI: 10.1055/s-0037-1598073

As the popularity and acceptance of facial and cervical rejuvenation procedures grows, surgeons are increasingly encountering patients with less favorable anatomical characteristics for rhytidectomy. These patients will typically display an obtuse cervicomental angle, underprojected chin, excess cervical adiposity, and platysmal banding, in addition to ptotic submandibular glands, tenacious jowls, and prejowl volume deficits. Recognition of these problems and the correct application of available techniques to address the difficult neck in facelifting are critical in maximizing success.
[...]

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V-Y Advancement Flap for Defects of the Lid–Cheek Junction

Facial plast Surg 2017; 33: 329-333
DOI: 10.1055/s-0037-1602144

We report a series of 10 patients who underwent inferolaterally based V-Y advancement flaps for reconstruction of defects involving the lower eyelid and infraorbital cheek junction. Defects ranged from 1.7 to 2.9 cm in largest diameter, and patients ranged from 59 to 84 years of age. All patients had excellent functional and cosmetic outcomes without subsequent surgical or laser revision. There were no instances of flap necrosis, hematoma, or ectropion. Vertically oriented V-Y flaps are often underused in this setting largely due to the perceived increase risk of ectropion. We describe a modification of the flap with lateral orientation that both diminishes the downward tension vector, which threatens ectropion, and conceals incision scars within resting tension lines, providing superior functional and aesthetic outcomes. Our series demonstrates that a properly designed and well-executed inferiorly based V-Y advancement flap can be used as a safe reconstructive modality for defects involving the lid–cheek junction.
[...]

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Cheek and Chin Implants to Enhance Facelift Results

Facial plast Surg 2017; 33: 279-284
DOI: 10.1055/s-0037-1598055

The traditional rhytidectomy addresses facial and neck aging as it relates to soft tissue laxity. The modern volumetric facelift provides optimal results by addressing not only skin laxity but also the loss of volume secondary to tissue atrophy and bony resorption. While multiple techniques including fat grafting, dermal fillers, and tissue resuspension are used to correct the tissue loss, alloplastic midface augmentation remains the most permanent method. In our practice we often address midface cheek hollowness or atrophy with the placement of submalar implants at the time of rhytidectomy. In addition to midface volumetric rejuvenation, alloplastic chin implantation can help strengthen and further define a retrusive chin and weak jawline. In this article we discuss technique, indications, and benefits of performing alloplastic augmentation as an adjunct to rhytidectomy.
[...]

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Effects of Tumescent Solution on Fat Survival

Facial plast Surg 2017; 33: 339-346
DOI: 10.1055/s-0037-1602164

Autologous fat transfer is a commonly used procedure in plastic surgery practice. The long-term survival rate of fat grafts is the most important issue for satisfactory results. The presented study includes the effects of different tumescent solutions on long-term fat graft survival. A total of 24 rats were divided into four groups: sham, lidocaine, adrenaline, and lidocaine + adrenaline groups. In all groups except the sham group, right inguinal fat pad was harvested 10 minutes after injecting 5 cc of the appropriate tumescent solution. The fat pad was trimmed and reimplanted to the interscapular area. After 3 months, fat pad was reharvested and sent for histopathologic evaluation. The harvested fat grafts were weighted in both surgical sessions. A significant difference was observed in comparison of fat grafts weights between the initial operation and the postoperative third month (p = 0.002). By intergroup comparisons, a significant difference was observed between sham and adrenaline groups (p = 0.002) and between sham and lidocaine + adrenaline groups (p = 0.007). No statistical difference was observed by the comparison of TUNNEL results (p = 0.663). The histopathologic evaluation of the specimens revealed similar results between groups. The injection of tumescent solutions containing only lidocaine before fat harvesting yields similar long-term fat graft survival rates in comparison to the conduction of surgical procedure without injecting any tumescent fluid. However, the injection of solutions containing adrenaline with or without lidocaine may decrease the long-term survival rates of fat autografts.
[...]

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Autologous Fat Grafting Combined with Facelifting

Facial plast Surg 2017; 33: 285-298
DOI: 10.1055/s-0037-1598072

There are multiple factors contributing to facial aging. Rejuvenation of the aging face, therefore, requires a multimodal approach to attain an overall natural and uniform result that is long lasting. Fat grafting has become a very important method for restoring facial soft-tissue atrophy, while facelifting procedures address the ptosis and descent of facial and neck tissue. These modalities performed together offer the patient a comprehensive approach to attain a more attractive and youthful facial appearance.
[...]

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Erratum: Rhytidoplasty: SMAS Imbrication Vector Comparison

Facial plast Surg 2017; 33: 352-352
DOI: 10.1055/s-0037-1602171

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Erratum: Absorbable Implant to Treat Nasal Valve Collapse

Facial plast Surg 2017; 33: 353-354
DOI: 10.1055/s-0037-1603201

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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A Study of the Combination of Cetuximab and Methotrexate in Recurrent or Metastatic Cancer of the Head and Neck

Condition:   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Drug: Cetuximab;   Drug: Methotrexate
Sponsors:   Radboud University;   Merck Serono International SA;   Leiden University Medical Center;   Academisch Ziekenhuis Maastricht;   Erasmus Medical Center;   Medisch Spectrum Twente;   Medical Center Haaglanden;   Elisabeth-TweeSteden Ziekenhuis;   Medical Centre Leeuwarden;   Erasmus Medical Center, Rotterdam
Recruiting - verified May 2017

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Predictive validity of the GOSLON Yardstick index in patients with unilateral cleft lip and palate: A systematic review

by Cindy Buj-Acosta, Vanessa Paredes-Gallardo, José María Montiel-Company, Alberto Albaladejo, Carlos Bellot-Arcís

Among the various indices developed for measuring the results of treatment in patients born with unilateral cleft lip and palate (UCLP), the GOSLON Yardstick index is the most widely used to assess the efficacy of treatment and treatment outcomes, which in UCLP cases are closely linked to jaw growth. The aim of this study was to conduct a systematic review to validate the predictability of growth using the GOSLON Yardstick in patients born with UCLP. A systematic literature review was conducted in four Internet databases: Medline, Cochrane Library, Scopus and Embase, complemented by a manual search and a further search in the databases of the leading journals that focus on this topic. An electronic search was also conducted among grey literature. The search identified a total of 131 articles. Duplicated articles were excluded and after reading titles and abstracts, any articles not related to the research objective were excluded, leaving a total of 21 texts. After reading the complete text, only three articles fulfilled the inclusion criteria. The results showed a predictive validity of between 42.2% and 64.7%, which points to a lack of evidence in the literature for the predictive validity of the GOSLON Yardstick index used in children born with UCLP.

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Dentigerous cysts associated with impacted third molars in adults after decompression: a prospective survey of reduction in volume using computerised analysis of cone-beam computed tomographic images

We prospectively investigated in adults the decompression of dentigerous cysts associated with impacted third molars at high risk of iatrogenic damage during extraction. The computerised calculated volumetric postoperative reductions measured by cone-beam computed tomography at four and eight months were correlated with the duration of treatment, initial volume, and patient's age. We prospectively monitored 14 adult patients with 14 dentigerous cysts that were associated with impacted third molars, for eight months after decompression.

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Neocondylar formation after resection of the mandible and reconstruction with a vascularised iliac crest free flap: rare case

Tumours in the mandible often necessitate the removal of both mandibular and condylar bone. A free vascularised bone flap is a common choice for reconstruction, but it is rare for adults to form a new condyle after it. We describe a patient in whom a new condyle did form after reconstruction with a vascularised iliac crest free flap.

http://ift.tt/2rL5hls

Setting up a successful special interest study group: five-year reflection

Continuing medical education (CME), which helps clinicians maintain competence and learn about new and developing areas of their specialty, is required by the General Medical Council (GMC) to meet the standard for good medical practice. We describe our experience of establishing an orthognathic study group, and identify factors relevant to its success.

http://ift.tt/2skjvGX

Anchors for sutures to fix pedicled flaps to the floor of the mouth in reconstructions for cancer

We have already described the use of minisized Mitek® suture anchors (Depuy Mitek Surgical Products, Inc. Raynham, Mass, USA) to fix free flaps in the reconstructions of oral and oropharyngeal defects after resections for cancer.1,2 The anchors are available in different sizes: micro, mini, GII, and super. The minisized ones require that a hole 1cm deep be placed in the recipient bone, but the thickness and quality of the bone may be insufficient to fulfill this requirement. Recently, we tested the microsized anchors for fixing regional pedicled flaps, which are typically used in the reconstruction of the floor of the mouth when the tumour has spared both the mylohyoid muscle and the mandible, and when harvesting nasolabial,3 intraoral facial artery musculomucosal,4 or submental flaps.

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Phosphaturic mesenchymal tumor of the nasal cavity and paranasal sinuses: A clinical curiosity presenting a diagnostic challenge

Phosphaturic mesenchymal tumor (PMT) is a rare mesenchymal neoplasm associated with tumor-induced osteomalacia (TIO) and elevated serum FGF-23. Common in extremities, PMT rarely occurs in sinonasal region. We report a series of sinonasal PMT diagnosed at our institute over a 6-year period.Six cases of sinonasal PMT were identified during this period, of which five presented with features of TIO. Median age of patients was 45.5 years. All six tumors were composed of stellate to spindled cells, with prominent staghorn vasculature in four cases.

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Utility and tolerability of the long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet (LP Nd:YAG) laser for treatment of symptomatic or disfiguring vascular malformations in children and adolescents

Vascular malformations manifest with pain, bleeding, disability, and disfigurement in a subset of children. There are scant data available on the utility and tolerability of laser surgery for symptomatic or disfiguring non–port-wine stain vascular malformations in children.

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Importance of chewing, saliva, and swallowing function in patients with advanced oral cancer undergoing preoperative chemoradiotherapy: a prospective study of quality of life

The primary objective of this study was to investigate the quality of life (QOL) of patients with oral squamous cell carcinoma (OSCC) undergoing curative neoadjuvant chemoradiotherapy followed by radical tumour resection and simultaneous oral cavity reconstruction, using two validated questionnaires. A secondary objective was to assess clinical variables predicting post-treatment dysfunction in chewing, saliva, and swallowing. Thirty-five patients with locally advanced OSCC who underwent preoperative chemoradiotherapy were recruited prospectively.

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A longitudinal study of changes in psychosocial well-being during orthognathic treatment

The aim was to evaluate changes in the psychosocial well-being of orthognathic surgery patients (n=22) during treatment and to compare results with those of adults not requiring orthognathic treatment (n=22). Patient data were collected before treatment (T0), after the first orthodontic examination (T1), three times during treatment (T2–T4), and 1 year after surgery (T5). In this article, only data corresponding to patient stage T5 are reported for the control subjects. Participants filled in a structured diary and the modified version of the Secord and Jourard body image questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Acceptance and Action Questionnaire II.

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Is centrally induced alveolar bone loss in a large animal model preventable by peripheral hormone substitution?

Abstract

Objectives

Alveolar bone structures are mostly investigated in small animal models. The majority of these studies examined local influences on the alveolar bone, but only a few examined systemic influencing factors. The hypothalamic-pituitary axis is known to be essential for a vital bone balance. The aim of this study was to analyse the effects that selective hormone treatments have on alveolar bone structure and quality in a sheep model for alveolar bone loss, induced by hypothalamic-pituitary disconnection (HPD).

Methods

Thirty sheep were randomly selected into six groups of five each: control (C), ovariectomy—OVX (O), O + HPD (OH), OH with oestrogen treatment (OHE), OH with thyroxine (T4) treatment (OHT), and OH with a combined treatment of oestrogen and thyroxine (OHTE). After OVX and HPD procedures and an additional 9-month observation/treatment period, structural bone analyses of the mandible were performed by contact radiography, micro-CT, and static histomorphometry.

Results

The HPD procedure caused structural alveolar bone parameters to decrease significantly compared to controls (C). Treatment with oestrogen (OHE) was protective and bone structure was maintained at baseline levels. Thyroxine treatment (OHT) promoted significant bone loss, but the combined treatment (OHTE) improved bone structure and volume parameters even above baseline levels.

Conclusions

Alveolar bone homeostasis significantly underlies systemic regulatory systems. Centrally induced (HPD) bone loss can be prevented by combined peripheral treatment with oestrogen and thyroxine.

Clinical relevance

These results demonstrate the significance of a balanced hormonal regulatory system for steady bone remodelling and maintenance of healthy alveolar bone.

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Systemic Embolization from an Unusual Intracardiac Mass in the Left Ventricular Outflow Tract

Endocarditis can affect any endocardial surface; in the vast majority of cases, the cardiac valves are involved. It is exceedingly rare to develop infective endocarditis on the endocardium of the left ventricular outflow tract due to the high velocity of blood that traverses this area. Herein, we present a rare case of left ventricular outflow tract endocarditis that likely occurred secondary to damage to the aortic valve leaflets (from healed prior aortic valve endocarditis) causing a high velocity aortic valve regurgitant jet that impinged upon the interventricular septum which damaged the endocardium and resulted in a fibrotic "jet lesion." This fibrous jet lesion served as a nidus for bacterial proliferation and vegetation formation. The high shear stress (due to high blood flow velocity through the left ventricular outflow tract) likely promoted the multiple embolic events observed in this case. Our patient was successfully treated with aortic valve replacement, vegetation resection, and antibiotics.

http://ift.tt/2rgBjUV

Rising atmospheric CO 2 concentration may imply higher risk of Fusarium mycotoxin contamination of wheat grains

Abstract

Increasing atmospheric CO₂ concentration not only has a direct impact on plants but also affects plant–pathogen interactions. Due to economic and health-related problems, special concern was given thus in the present work to the effect of elevated CO₂ (750 μmol mol⁻¹) level on the Fusarium culmorum infection and mycotoxin contamination of wheat. Despite the fact that disease severity was found to be not or little affected by elevated CO₂ in most varieties, as the spread of Fusarium increased only in one variety, spike grain number and/or grain weight decreased significantly at elevated CO₂ in all the varieties, indicating that Fusarium infection generally had a more dramatic impact on the grain yield at elevated CO₂ than at the ambient level. Likewise, grain deoxynivalenol (DON) content was usually considerably higher at elevated CO₂ than at the ambient level in the single-floret inoculation treatment, suggesting that the toxin content is not in direct relation to the level of Fusarium infection. In the whole-spike inoculation, DON production did not change, decreased or increased depending on the variety × experiment interaction. Cooler (18 °C) conditions delayed rachis penetration while 20 °C maximum temperature caused striking increases in the mycotoxin contents, resulting in extremely high DON values and also in a dramatic triggering of the grain zearalenone contamination at elevated CO₂. The results indicate that future environmental conditions, such as rising CO₂ levels, may increase the threat of grain mycotoxin contamination.

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Prognostic impact of HER-2 Subclonal Amplification in breast cancer

Abstract

The presence of a limited number of cells with HER-2 amplification (Subclonal Amplification) in breast carcinomas is occasionally encountered, but its prognostic impact is poorly known. The purpose of this study is to evaluate the prognostic impact of HER-2 Subclonal Amplification in a retrospective series of breast cancers. Accordingly, 81 consecutive breast carcinomas showing HER-2 Subclonal Amplification were obtained from the histology files (case series). These cases were subdivided into two groups: (a) those cases in which the HER-2 Subclonal Amplification was consonant to the accepted criteria for amplification, showing clusters of amplified cells, and (b) those cases with rare HER-2 Subclonal Amplification that did not reflect the accepted criteria for amplification, showing scattered amplified cells only. The incidence of metastases and late recurrences of the case series was compared with a series composed of 109 consecutive cases, being HER-2 homogeneous (comprising 14 Amplified and 95 Non-Amplified cases), matched for grade and stage (control series). It appeared that cases showing Subclonal Amplification had an incidence of metastases intermediate between the cases Amplified and Non-Amplified. Specifically, Subclonal Amplification with clustered cells had a lower incidence of metastases than Amplified cases (12.9 versus 21.4%). On the contrary, Subclonal Amplification with scattered cells showed an incidence of metastases higher than Non-Amplified cases (14 versus 9.47%). In addition, patients Subclonal Amplification with clustered cells, who were treated with the specific monoclonal antibody, had a lower incidence of metastases than patients showing Subclonal Amplification with scattered cells, who did not receive target therapy. These data, together with those recently published, indicate that Subclonal Amplification has an impact on prognosis and should be taken into consideration to correctly plan the treatment of breast cancer patients.

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Early detection: the impact of genomics

Abstract

The field of genomics has shifted our view on disease development by providing insights in the molecular and functional processes encoded in the genome. In the case of cancer, many alterations in the DNA accumulate that enable tumor growth or even metastatic dissemination. Identification of molecular signatures that define different stages of progression towards cancer can enable early tumor detection. In this review, the impact of genomics will be addressed using early detection of colorectal cancer (CRC) as an example. Increased understanding of the adenoma-to-carcinoma progression has led to the discovery of several diagnostic biomarkers. This combined with technical advancements, has facilitated the development of molecular tests for non-invasive early CRC detection in stool and blood samples. Even though several tests have already made it to clinical practice, sensitivity and specificity for the detection of precancerous lesions still need improvement. Besides the diagnostic qualities, also the accuracy of the intermediate endpoint is an important issue on how the effectiveness of a novel test is perceived. Here, progression biomarkers may provide a more precise measure than the currently used morphologically based features. Similar developments in biomarker use for early detection have taken place in other cancer types.

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Decisional regret following ventilation tube insertion

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Michele M. Carr, Jillian Printz, Shreya Thakur
ObjectiveThe purpose of this study was to see if parental regret following ventilation tube (VT) insertion was related to non-resolution of ear infections and thus ongoing need for otolaryngological care and VT reinsertion.Materials and methodsAll consecutive parents presenting with children who had VT in place were given a validated regret survey and asked the reason for their visit. Chart review was used for medical history.ResultsTwo hundred and ten respondents were included. The children involved had a mean age of 5.2 years, 63.3% were male, and mean number of years since first VT insertion was 1.12 with a range of 0.04–9.28 years. 70.5% had a regret score of 0, with mean score 6.98 (95%CI 5.11–8.85). Scores were significantly higher for parents who presented their child with an ear complaint such as otorrhea (15.52, 95%CI 7.67–23.37, p = 0.004). Parents whose children had a history of reflux had significantly lower regret scores than parents whose children did not have a history of reflux (3.33 versus 7.89, p = 0.007). Parental regret was unrelated to patient age, other comorbidities, indication for initial tube insertion, hearing status on the day of inquiry, number of sets of tubes, visits for otorrhea, prescriptions given for eardrops, clinic visits, or length of follow-up.ConclusionTransient factors may influence decisional regret at any given time. For parents whose children receive VT, regret is not related to prolonged specialized ear care and need for VT reinsertion.



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Non-coeliac gluten sensitivity: A review of the literature

Publication date: Available online 1 June 2017
Source:Trends in Food Science & Technology
Author(s): Joana Clímaco Henggeler, Manuel Veríssimo, Fernando Ramos
BackgroundNon-coeliac gluten sensitivity (NCGS) is an emerging and still poorly defined clinical entity, which is part of the spectrum of gluten-related disorders (along with coeliac disease and wheat allergy) but also closely related to irritable bowel syndrome. It is characterised by a wide array of both gastrointestinal and extra-intestinal symptoms. NCGS was first defined in the 1970s, but has gained critical relevance in recent years.Scope and ApproachThis review covers the existing definitions, documented symptoms and methods of diagnosis, treatment via a gluten-free diet, history, prevalence in the general population and possible mechanisms for NCGS. It also looks into recent studies and their findings. All information is relative to studies published in the last 6 years (2011-present).Key Findings and ConclusionsDespite recent advances in characterising NCGS as a clinical entity and gaining novel insights into its pathogenesis, further studies are needed to better understand its etiology and mechanism and to establish specific biomarkers.



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Editorial Board/ Publication Information

Publication date: July 2017
Source:Molecular Immunology, Volume 87





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B cell lymphomas with discordance between pathological features and clinical behavior

Abstract

B-cell lymphomas encompass a large number of disease entities clinically ranging from indolent to aggressive. The defining pathological features usually predict clinical course, with small and large B-cell lymphomas correlating to low-grade vs high-grade features, but discordant situations may be encountered. Two sessions of the workshop of the XVIII meeting of the European Association for Haematopathology (EAHP) held in Basel in 2016 addressed this topic. One session illustrated various facets of "aggressiveness" in indolent lymphomas, either peculiar clinical manifestations, cytological variants, or unusual genetic features, as well as several examples of progression or transformation to a more aggressive disease. Another session exemplified large B-cell lymphomas with unexpected indolent behavior including cases arising in well-defined body compartments or in sanctuary sites. This paper describes the features of the cases presented in both groups, highlights the most salient points of discussion raised by the submitters and the panel, and summarizes current knowledge and recommendations relevant to diagnostic pathology practice.

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Functional and cosmetic outcomes of robot-assisted neck dissection by a postauricular facelift approach for head and neck cancer

Publication date: July 2017
Source:Oral Oncology, Volume 70
Author(s): Yong Bae Ji, Chang Myeon Song, Hyang Sook Bang, Hae Jin Park, Ji Young Lee, Kyung Tae
ObjectivesThe purpose of this study was to compare the functional and cosmetic outcomes of robot-assisted neck dissection with those of conventional neck dissection.Materials and methodsWe prospectively analyzed 113 patients with head and neck cancer who underwent unilateral neck dissection by a robot-assisted postauricular facelift approach (38 patients) or conventional trans-cervical approach (75 patients). Postoperative functional outcomes such as edema, sensory loss, pain, and fibrosis in the neck, and limitations of neck and shoulder motion, and cosmetic satisfaction scored by questionnaire were evaluated serially up to 1year postoperatively, and compared between the two groups.ResultsThere were differences at baseline clinicopathologic characteristics including age, T classification and stage between the two groups. The mean score of neck edema was lower in the robotic group than that of the conventional group at 1day and 3days postoperatively, and sensory loss was also lower in the robotic group at 1day, 3days and 1week postoperatively (P<0.05). The postoperative cosmetic satisfaction were significantly higher in the robotic group than the conventional group at 1month, 3, 6, and 12months postoperatively. Transient marginal nerve palsy was higher in the robotic group than the conventional group (P=0.043).ConclusionPostoperative neck edema and sensory loss were lower in the robotic group in the early postoperative period although its clinical significance is not clear. Cosmetic satisfaction was superior in the robotic group.



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Gender Disparities in Financial Relationships Between Industry and Academic Otolaryngologists

This study evaluates the existence of gender disparities in industry relationships with academic otolaryngologists.

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An HIV-Positive Child With Gingival Mass

A young girl diagnosed as having varicella zoster encephalitis, cytomegalovirus retinitis, and HIV/AIDS had facial swelling and a violaceous, vascular-appearing lesion involving the left maxillary gingiva with numerous surrounding loose teeth.What is your diagnosis?

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Opsoclonus Recorded by a Smartphone

This is the report of a case wherein an acute attack of idiopathic opsoclonus was recorded in real time on a smart phone.

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Free Flap Monitoring Techniques and Frequency

This multi-institutional review characterizes various techniques and frequencies of free flap monitoring by nurses and resident physicians and seeks to determine if adapted resident monitoring frequency is associated with recognition of flap compromise and outcome.

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Assumptions of Quality Medicine

This Viewpoint discusses the increasing pressure on physicians to provide safe, effective, patient-centered, timely, efficient, and equitable care to all patients and the potentially incorrect assumptions of the economic policies influencing decision making.

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Novel function of Porphyromonas gingivalis gingipains in the PI3K/Akt signaling pathway

Publication date: Available online 31 May 2017
Source:Journal of Oral Biosciences
Author(s): Masaaki Nakayama, Naoya Ohara
BackgroundPorphyromonas gingivalis is s major oral bacterium closely associated with periodontal diseases including periodontitis and directly affects host cellular signaling. The phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway plays multiple roles in various cell functions including cell survival and glucose metabolism. In this review, we describe the effect of gingipains on the PI3K/Akt signaling pathway in P. gingivalis infection.HighlightGingipains inactivate PI3K and Akt in gingival epithelial cells infected with P. gingivalis. These events occur independently of invasion of this organism into the cells and are required for the enzymatic activity of gingipains. Furthermore, 3-Phosphoinositide-dependent protein kinase-1 (PDK1) failed to translocate to the plasma membrane from the cytosol following PI3K inactivation.Additionally, dephosphorylation of Akt downstream proteins, including glycogen synthase kinase 3 (GSK3), mammalian target of rapamycin (mTOR), and Bad, occurs in parallel with the dysregulation of PI3K/PDK1/Akt cascades.ConclusionThis review describes the biological characterization of gingipains, which inactivate PI3K and Akt, and disorder the PI3K/Akt signaling pathway. Hence, gingipains may decrease cellular physiological functions, eventually disrupting the gingival epithelium and causing development of periodontal diseases.



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A novel germline gain-of-function variant in PIK3CD

Publication date: Available online 31 May 2017
Source:Clinical Immunology
Author(s): William Rae, Yifang Gao, Daniel Ward, Christopher J. Mattocks, Efrem Eren, Anthony P. Williams




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Multimarker risk stratification approach at multiple sclerosis onset

Publication date: Available online 31 May 2017
Source:Clinical Immunology
Author(s): Lidia Fernández-Paredes, Armanda Casrouge, Jérémie Decalf, Clara de Andrés, Luisa Maria Villar, Rebeca Pérez de Diego, Bárbara Alonso, José Carlos Álvarez Cermeño, Rafael Arroyo, Marta Tejera-Alhambra, Joaquín Navarro, Celia Oreja-Guevara, Margarita López Trascasa, Ansgar Seyfferth, Maria Angel García Martínez, Roberto Álvarez Lafuente, Matthew L. Albert, Silvia Sánchez-Ramón
Delay in the diagnosis of multiple sclerosis (MS) stems from the lack of specific clinical and analytical markers to assist in the early diagnosis and prediction of progressive course. We propose a decision-tree model that better defines early at onset MS patients and those with the progressive form by analysing a 12-biomarkers panel in serum and CSF samples of patients with MS, other neurological diseases (OND) and healthy contols. Thus, patients at onset of neurological disease were first classified by serum IL-7 levels <141pg/ml (OR=6.51, p<0.001). Combination of IL-7 and IP-10 indicated risk for a specific MS clinical form, where IL-7<141 and IP-10<570pg/ml were associated with the highest risk for PP-MS (OR=22, p=0.01). Unexpectedly, both PP-MS and RR-MS patients shared significantly decreased prototypical biomarkers of inflammation and tissue regeneration in CSF than OND suggesting a defective intrinsic immune response playing a role at the beginning of the disease.



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Hexamerization-enhanced CD20 antibody mediates complement-dependent cytotoxicity in serum genetically deficient in C9

Publication date: Available online 31 May 2017
Source:Clinical Immunology
Author(s): Ronald P. Taylor, Margaret A. Lindorfer, Erika M. Cook, Frank J. Beurskens, Janine Schuurman, Paul W.H.I. Parren, Clive S. Zent, Karl R. VanDerMeid, Richard Burack, Masashi Mizuno, B. Paul Morgan
We examined complement-dependent cytotoxicity (CDC) by hexamer formation-enhanced CD20 mAb Hx-7D8 of patient-derived chronic lymphocytic leukemia (CLL) cells that are relatively resistant to CDC. CDC was analyzed in normal human serum (NHS) and serum from an individual genetically deficient for C9. Hx-7D8 was able to kill up to 80% of CLL cells in complete absence of C9. We conclude that the narrow C5b-8 pores formed without C9 are sufficient for CDC due to efficient antibody-mediated hexamer formation. In the absence of C9, we observed transient intracellular increases of Ca²⁺ during CDC (as assessed with FLUO-4) that were extended in time. This suggests that small C5b-8 pores allow Ca²⁺ to enter the cell, while dissipation of the fluorescent signal accompanying cell disintegration is delayed. The Ca²⁺ signal is retained concomitantly with TOPRO-3 (viability dye) staining, thereby confirming that Ca²⁺ influx represents the most proximate mediator of cell death by CDC.



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Recurrent deep vein thrombosis with a protein S Tokushima mutation

Deep vein thrombosis (DVT) is multifactorial disease caused by acquired risk factors such as bed rest, surgery and malignancies as well as genetic factors. Regarding the genetic factors, factor V Leiden (c.1601G>A, p.R534Q) and the prothrombin G20210A mutations are well-known risk factors for DVT in Caucasians.¹ However, these two mutations do not exist in Japanese populations. A missense mutation (c.586A>G, p. K196E) in protein S gene, known as the protein S (PS) Tokushima mutation, was identified as a genetic risk factor for DVT in Japanese populations.² We herein report a young Japanese patient with recurrent DVT in whom a PS Tokushima mutation was detected.

This article is protected by copyright. All rights reserved.

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Lymphomatoid papulosis associated with chronic lymphocytic leukemia/small lymphocytic lymphoma: 3 cases

Lymphomatoid papulosis (LyP) is considered as an indolent CD30+ lymphoproliferative cutaneous disorder. ^1,2 Nevertheless, 10%–20% up to 50% of patients with LyP have coexistent lymphoma. ^{1, 3–7} The most frequently associated malignancies are mycosis fungoides, primary cutaneous anaplastic large cell lymphoma, or Hodgkin's disease. There are only seven reported cases of an association between LyP and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). ^{5, 7-9} Herein, we report and analyze three new cases.

This article is protected by copyright. All rights reserved.

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Morphological and molecular characterization of actinic lentigos reveals alterations of the dermal extracellular matrix

Abstract

Background

Actinic lentigos (AL) are benign hyperpigmented skin lesions associated with photoageing. Despite their high prevalence, biological mechanisms driving their formation remain unclear.

Objectives

To provide new insights about the physiopathology of AL through a comprehensive description of their histological and molecular features.

Methods

Quantitative analysis of dermoscopic images was used to select AL containing elongated patterns, predicted to display a highly deformed dermal-epidermal junction (DEJ), on the back of hands of 15 Caucasian women. Biopsies from lesional and adjacent non-lesional (NL) areas were processed for histological analysis or gene expression profiling.

Results

Histological staining confirmed a drastic deformation of the DEJ in AL, with deep epidermal invaginations into the dermis. Although the melanin content was significantly higher in AL compared to NL epidermis, the distribution of melanocytes along the DEJ was unchanged.

Transcriptomic analysis revealed a signature of 529 genes differently expressed in AL versus NL skin. Alteration of epidermal homeostasis was confirmed by the dysregulation of keratinocyte proliferation and differentiation markers. Surprisingly, canonical genes involved in melanogenesis were not significantly modulated in AL. A striking finding was the overexpression of a large group of genes involved in dermal extracellular matrix organization and remodelling. Dermal alterations were confirmed by immunolabellings on AL and NL sections.

Conclusions

Drastic disorganization of the cutaneous structure in AL is accompanied by a specific molecular signature revealing alterations in both epidermal and dermal compartments. Particularly, our results suggest that local modifications of the dermal extracellular matrix might contribute to hyperpigmentation in AL.

This article is protected by copyright. All rights reserved.

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A pretrained neural network shows similar diagnostic accuracy to medical students in categorising dermatoscopic images after comparable training conditions

Automated image classification by machine vision is evolving, largely because of the increasing efficiency of neural networks with special architectures such as convolutional neural networks (CNN)¹. A recent study comparing board certified dermatologists with CNN suggested that CNN may achieve diagnostic accuracies similar to human experts². We demonstrated that medical students without prior knowledge of dermatoscopy learn equally well from an analytic or heuristic teaching approach³.

This article is protected by copyright. All rights reserved.

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Effect of transcervical arterial ligation on the severity of postoperative hemorrhage after transoral robotic surgery

ABSTRACT

Background

The value of transcervical arterial ligation during transoral robotic surgery (TORS) as a measure to decrease postoperative bleeding incidence or severity is unclear.

Methods

A retrospective single institution study was performed to identify risk factors for hemorrhage after TORS for oropharyngeal squamous cell carcinoma (SCC).

Results

Overall, 13.2% of patients (35/265) experience postoperative hemorrhage. T classification, perioperative use of anticoagulants, surgeon experience >50 cases, and tumor subsite were not predictors of postoperative hemorrhage. Of this cohort, 28% underwent prophylactic arterial ligation. The overall incidence of bleeding was not significantly decreased in patients who underwent arterial ligation (12.1% vs 13.6%; p = .84). However, arterial ligation significantly reduced the incidence of major and severe bleeding events (1.3% vs 7.8%; p = .04). Radiation before TORS was a risk factor for major and severe postoperative hemorrhage (p < .02).

Conclusion

Transcervical arterial ligation during TORS may reduce the severity of postoperative hemorrhagic events. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Study of Nivolumab Plus Ipilimumab in Patients With Salivary Gland Cancer

Condition:   Salivary Gland Cancer
Interventions:   Drug: Nivolumab;   Drug: Ipilimumab
Sponsors:   Memorial Sloan Kettering Cancer Center;   Bristol-Myers Squibb
Recruiting - verified May 2017

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Videolaryngoscopy during Conscious Sedation in Patients Not Suitable for Phonosurgery by Microlaryngoscopy: A Pilot Study

Background: Microlaryngoscopy is the preferred and most widely used technique in phonosurgery for the treatment of benign and early malignant glottic lesions. However, the procedure may be technically difficult or impossible due to alterations of the cervical spine that may not allow hyperextension of the head or may present general anesthesia contraindications. The aim of this study is to evaluate the efficacy and safety of our surgical approach for lesions of the vocal folds in patients who are not suitable for phonosurgery by microlaryngoscopy. This approach applies videolaryngoscopy during conscious sedation, which combines local anesthesia with moderate analgosedation by using midazolam and fentanyl with premedication. Methods: A total of 235 patients affected by benign diseases or suspicious cancerous lesions of the vocal folds were retrospectively evaluated. Results: The method has shown a success rate of 95.5, 89, 52.3, and 86.7% in cases of polyps of the vocal folds, Reinke's edema, cysts of the vocal folds, and suspicious lesions of the larynx, respectively. Only 3 patients (1.27%) have been reported to experience adverse events. Conclusion: The results suggest that the method is an effective and safe procedure without relevant local and/or general complications.
ORL 2017;79:185-190

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Lebensqualität von Patienten mit Vestibularisschwannom

Zusammenfassung

Hintergrund

Das Vestibularisschwannom (VS) ist eine Erkrankung, die die gesundheitsbezogene Lebensqualität („health-related quality of life", HR-QOL) negativ beeinflussen kann. Nachdem viele Jahre nur allgemeine Lebensqualitätsmessinstrumente wie der SF-36 zur Messung der gesundheitsbezogenen Lebensqualität zur Verfügung standen, existiert seit einigen Jahren mit dem Penn Acoustic Neuroma Quality Of Life (PANQOL) ein krankheitsspezifisches Messinstrument. Es ist zu erwarten, dass die Anwendung dieses Instruments in der Zukunft wichtige Aspekte der HR-QOL bei VS besser herausarbeiten kann. Eine validierte deutsche Version des Instruments existiert noch nicht.

Die von den Patienten am häufigsten beklagten Symptome im Rahmen der Erkrankung sind Kopfschmerzen und Schwindel.

Ergebnisse und Diskussion

Die bisher vorliegende Literatur zeigt, dass die therapeutischen Verfahren die HR-QOL unterschiedlich beeinflussen. Insbesondere die Strahlentherapie hat bei kleinen und mittelgroßen Tumoren keine ausgeprägten negativen Effekte auf die HR-QOL. Die Bewertung operationsbedingter Einschränkungen gleicht sich aber über den Verlauf einiger Jahre den Bewertungen nach Strahlentherapie an. Für große VS mit einem Durchmesser >3 cm liegen diesbezüglich noch keine richtungweisenden Daten vor. Wünschenswert für die Zukunft wären prospektive Studien mit einer Langzeitnachbeobachtung von 10 Jahren und mehr, um die offenen Fragen zu klären.

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Turkish validity and reliability of Eustachian Tube Dysfunction Questionnaire-7

Publication date: Available online 31 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Erdoğan Özgür, Cem Bilgen, Beyhan Cengiz Özyurt
IntroductionDuring clinical evaluations, in order to interpret patients' complaints caused by Eustachian Tube Dysfunction (ETD) and to monitor the success of the treatment, standardized and disease-related scales are necessary.ObjectiveThe aim of this study was to investigate the validity and reliability of the Turkish version of Eustachian Tube Dysfunction Questionnaire-7.MethodsForty patients diagnosed with ETD and 40 healthy individuals were enrolled for the study. After language validation of the ETDQ-7 for Turkish, a scale was completed by the both ETD and control groups. Two weeks after the first evaluation, 15 of the cases filled out the scale again without any treatment intervention. Known-groups method was used in validity analysis. Floor-ceiling effect, test–retest method, item-total score correlation and internal consistency analysis were used in reliability analyses.ResultsCronbach's alpha coefficient was 0.714 for the entire questionnaire. The test–retest reliability coefficient for the total scale was determined as 0.792, indicating correlation between the two questionnaires completed by the same patient over time. In the ETD group, total and each item scores were found significantly higher than the control group (p<0.001).ConclusionThe Turkish version of ETDQ-7 was found to be highly valid and reliable. This scale is recommended to use for screening of ETD and evaluating treatment outcome.



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Evaluating the ototoxicity of a antiMRSA peptide KR-12-a2

Publication date: Available online 31 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Chung Man Sung, Hyung Chae Yang, Yong Beom Cho, Song Yub Shin, Chul Ho Jang
IntroductionMethicillin-Resistant Staphylococcus Aureus (MRSA) is an emerging problem for the treatment of chronic suppurative otitis media, and also for pediatric tympanostomy tube otorrhea. To date, there are no effective topical antibiotic drugs to treat MRSA otorrhea.ObjectiveIn this study, we evaluated the ototoxicity of topical KR-12-a2 solution on the cochlea when it applied topically in the middle ear of guinea pigs.MethodsThe antimicrobial activity of KR-12-a2 against MRSA strains was examined by using the inhibition zone test. Topical application of KR-12-a2 solution, Gentamicin (GM) and Phosphate Buffered Saline (PBS) were applied in the middle ear of the guinea pigs after inserting ventilation tubes. Ototoxicity was assessed by Auditory Brainstem Evoked Response (ABR) and Scanning Electron Microscope (SEM) examination.ResultsKR-12-a2 produced an inhibition zone against MRSA from 6.25 μg. Hearing threshold in the KR-12-a2 and PBS groups were similar to that before ventilation tube insertion. However, the GM group showed elevation of the hearing threshold and there were statistically significant differences compared to the PBS or the KR-12-a2 group. In the SEM findings, the KR-12-a2 group showed intact outer hair cells. However, the GM group showed total loss of outer hair cells. In our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs.ConclusionIn our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs. The KR-12-a2 solution can be used as ototopical drops for treating MRSA otorrhea; however, further evaluations, such as the definition of optimal concentration and combination, are necessary.



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Update HNO

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Evaluation of retromolar canals on cone beam computerized tomography scans and digital panoramic radiographs

Abstract

Purpose

The purpose of this study was to carry out morphologic and topographic analyses of retromolar canals on cone beam computerized tomography (CBCT) scans, comparing findings to others obtained from the corresponding digital panoramic radiographs.

Methods

Sixty-one CBCT scans were analysed digitally, as well as their corresponding digital panoramic radiographs. The prevalence and distribution of these canals, foramen diameters, and intraosseous communications were also evaluated.

Results

On CBCT scans, we found that 24.6% of individuals had at least one retromolar canal. The mean foramen diameter was slightly higher than 1 mm and we could not determine the intraosseous anatomical connections in most cases. The morphology and topography of the retromolar canals were not affected by gender and antimere. In addition, only 22.2% of all tomographically identified canals could be confirmed on digital panoramic radiographs (26.7% of such patients). Regarding all sample, 6.6% of individuals showed retromolar canals on digital panoramic radiographs.

Conclusion

We may consider that these structures are clinically relevant findings and, due to the low accuracy of the panoramic radiographs, high-quality tomographic exams should always be asked for presurgical treatment planning.

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Large schwannoma of the femur – a common tumor at an unusual site: a case report and review of the literature

Schwannomas are benign nerve sheath tumors and are most frequently encountered as soft tissue tumors of peripheral nerves of the head and neck or the extensor extremities. Osseous involvement is very uncommon ...

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Evaluation of retromolar canals on cone beam computerized tomography scans and digital panoramic radiographs

Abstract

Purpose

The purpose of this study was to carry out morphologic and topographic analyses of retromolar canals on cone beam computerized tomography (CBCT) scans, comparing findings to others obtained from the corresponding digital panoramic radiographs.

Methods

Sixty-one CBCT scans were analysed digitally, as well as their corresponding digital panoramic radiographs. The prevalence and distribution of these canals, foramen diameters, and intraosseous communications were also evaluated.

Results

On CBCT scans, we found that 24.6% of individuals had at least one retromolar canal. The mean foramen diameter was slightly higher than 1 mm and we could not determine the intraosseous anatomical connections in most cases. The morphology and topography of the retromolar canals were not affected by gender and antimere. In addition, only 22.2% of all tomographically identified canals could be confirmed on digital panoramic radiographs (26.7% of such patients). Regarding all sample, 6.6% of individuals showed retromolar canals on digital panoramic radiographs.

Conclusion

We may consider that these structures are clinically relevant findings and, due to the low accuracy of the panoramic radiographs, high-quality tomographic exams should always be asked for presurgical treatment planning.

http://ift.tt/2sh04Pg

A systematic review to uncover a universal protocol for accuracy assessment of 3D virtually planned orthognathic surgery

Publication date: Available online 1 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ramy M. Gaber, Eman Shaheen, Bart Falter, Sebastian Araya, Constantinus Politis, Gwen R.J. Swennen, Reinhilde Jacobs
PurposeThe aim of this study was to systematically review methods used for assessing the accuracy of 3D virtually planned orthognathic surgery, in an attempt to reach an objective assessment protocol that could be universally used.MethodsA systematic review of the current available literature, till 12/9/2016, was conducted using PubMed as the primary search engine. Secondary searches were performed in the Cochrane database, Clinical trial registries, Google scholar, EMBASE and a bibliography search. Included articles should state clearly that 3D virtual planning was used and accuracy assessment performed, along with validation of the planning and/or assessment method. Descriptive statistics as well as quality assessment of included articles were also performed.ResultsInitial search yielded 1461 study. Only 7 studies were included in the current review. There was found to be an important variability as regards methods used for i) accuracy assessment of virtually planned orthognathic surgery or ii) validation of the used tools. Included studies were found to be of moderate quality, reviewers agreement regarding quality was calculated to be 0.5 using Cohen's Kappa test.ConclusionBased on the findings of the current review, it is evident that the literature lacking consensus regarding the accuracy assessment. Hence, a protocol was suggested for accuracy assessment of the virtually planned orthognathic surgery with the least margin of error.



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Comorbidity assessment in patients with oral squamous cell carcinoma: can imaging techniques (18FDG PET/CT and contrast - enhanced CT) provide additional information?

Publication date: Available online 31 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Matthias Troeltzsch, Florian Andreas Probst, Axel Rominger, Ulrich Müller - Lisse, Monika Probst, Katharina Obermeier, Michael Ehrenfeld, Sven Otto
PurposeTo evaluate the role of imaging staging examinations (PET/CT and contrast - enhanced [ce]CT) for the assessment of the comorbidity status of patients with oral squamous cell carcinoma (OSCC). A binary null hypothesis was drafted: (1) imaging staging examinations do not augment knowledge about the comorbidity status of OSCC patients and (2) there is no difference between PET/CT and ceCT in this matter.MethodsA retrospective cohort study design was selected to address the research question. Patients with histologically confirmed OSCC who underwent whole - body staging either by PET/CT or ceCT between 2012 and 2015 were considered for inclusion with respect to predefined criteria. The data collection was performed by review of patient charts, histology, radiology and nuclear medicine reports. The Charlson Comorbidity Index (CCI) was chosen to quantify comorbidity and was calculated before and after staging and then compared. The type of the imaging staging examination (PET/CT or ceCT) served as the predictor variable and the CCI was determined as the primary outcome variable. Descriptive and inferential statistics were computed with respect to the variable scale. The significance level was set at p ≤ 0.05.ResultsThe sample was composed of 178 patients (female: 71, male: 107; average age 64.2) of whom 109 (61%) underwent PET/CT and 69 (39%) ceCT staging. The pre - and post - staging CCI differed significantly. Neither of the imaging techniques showed superior results.ConclusionRelevant and otherwise covert comorbidity can be revealed by the performance imaging staging examinations. This enables clinicians to better assess the peritherapeutic risk and prognosis of OSCC patients. A detailed evaluation of incidental findings in imaging studies is therefore warranted and recommended.



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Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report

This report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is t...

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Spiraling Out of Control

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 22-year-old man presented to the…

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