Digital Workflow for Computer-guided Implant Surgery in Edentulous Patients: A Case Report

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ji-Hyeon Oh, Xueyin An, Seung-Mi Jeong, Byung-Ho Choi
The purpose of this article was to describe a fully digital workflow used to perform computer-guided flapless implant placement in an edentulous patient without the use of conventional impressions, models or a radiographic guide. Digital data for the workflow were acquired using an intraoral scanner and cone-beam computed tomography (CBCT). The image fusion of the intraoral scan data and the CBCT data was performed by matching resin markers placed in the patient's mouth. The definitive digital data were then used to design a prosthetically-driven implant position, surgical template, and computer-aided design/computer-aided manufacturing (CAD/CAM) fabricated fixed dental prosthesis. We believe this is the first published case describing such a technique in computer-guided flapless implant surgery for edentulous patients.



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Benchmarking: an effective tool to demystify the academic career

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gino Inverso, John R. Zuniga, Neeraj H. Panchal




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Does dexamethasone facilitate neurosensory function regeneration after zygomatic fracture? A randomized and controlled trial

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Aleksi Haapanen, Hanna Thorén, Satu Apajalahti, Anna Liisa Suominen, Johanna Snäll
PurposeThis study sought to clarify the rate of neurosensory disturbance (NSD) after zygomatic complex (ZC) fractures in general, and the effect of perioperatively administered dexamethasone on neurosensory recovery.MethodsThis was a single-blinded randomized study aiming to clarify the benefits of perioperative dexamethasone after surgery. The patients were randomly assigned to receive either dexamethasone (up to a total dose of 10 mg or 30 mg) or to act as a control (no glucocorticoid treatment). The outcome variable was NSD, the presence of which was established when patients experienced any sensory disturbance of the infraorbital nerve. Other predictor variables included in the analysis were age, gender, timespan from accident to surgery, surgical approach to the fracture line, and the relation of the fracture to the infraorbital foramen. The statistical significance of associations was evaluated with chi-squared tests.Results64 patients were included in the analyses. Of the patients in the dexamethasone group (either 10 mg or 30 mg), 58.3% had NSD six months post-operatively, whereas in the control group 66.7% of the patients suffered from NSD. This finding was not statistically significant (p=0.565). At the one-month interval, the patients without a fracture through the infraorbital foramen (IOF) had less NSD (p=0.009); this finding was not significant at three and six months postoperatively. Age, gender, injury mechanism, surgical approach, or timespan from accident to surgery were not significant predictors for NSD. In total, 64.4% of the patients still suffered from NSD at six months post operatively.ConclusionThis study showed no benefits of short-term high-dose dexamethasone administration in the neurosensory recovery of patients with ZC fractures. The type of primary trauma is the main cause for NSD, but the precise predictors remain unknown.



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Surgical staples:-A superior alternative to sutures for skin closure after neck dissection:-A single-blindprospective randomized clinical study

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Shrenik Oswal, Rajiv Borle, Nitin Bhola, Anendd Jadhav, Sanidhya Surana, Rajesh Oswal
PurposeTo evaluate the efficacy of staples in skin closure following neck dissection in patients with oral squamous cell carcinoma. We hypothesize that use of staples results in better wound closure, when compared with non-absorbable monofilament sutures.MethodsA prospective single blind, randomized clinical trial was performed to compare various parameters including time taken, inflammatory changes, pain, cost efficacy, complications and esthetic outcome of skin closure with surgical staples and non-absorbable monofilament sutures and to determine its statistical significance using chi- square and Mann Whitney U tests.ResultIn a study of 124 patients the mean skin closure time was 29.2+4 mins with sutures (n=61) and 5.3 + 1.29 mins with staples (n=63), which was significant (p=.01).The mean pain scores during removal using visual analogue scale (VAS) were 5.08+1.29 and 3.15+ 0.89 with sutures and staples, respectively. Post-operative complications, like gaping and stitch abscess with purulent discharge, were noted.ConclusionStaples provided better esthetics with fewer complications, faster closure, minimal pain on removal and faster healing when compared to sutures. The slowest closure time in staples group was four times faster than the fastest closure time in sutures group. However, staples cost five times more than sutures.



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Initial manifestation of acquired hemophilia A (AHA) after a routine tooth extraction. A case report and literature review

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nicholas A. Bennetts, James E. Mergelmeyer, Eric J. Reimer, James C. Melville
Although surgical treatment of patients on anticoagulation regimens is a common practice among oral and maxillofacial surgeons, unexpected and unknown coagulopathies can have devastating and catastrophic consequences for the most routine of procedures. Acquired hemophila A (AHA) is an extremely rare life-threatening bleeding disorder characterized by autoantibodies directed against circulating coagulation factor (F) VIII. The effects of acquired hemophilia A can produce catastrophic bleeding and hematomas. The effect of this uncontrolled hemorrhage post dental-alveolar surgery can mimic severe head and neck infection by causing dysphagia, odynophagia, and acute airway complications. This report describes the case of a 64 year old female who was diagnosed with acquired hemophilia A (AHA) after a routine extraction of tooth #17.



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TheCervicofacialFlapinCheekReconstruction:aGuideforFlapDesign

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): AlHaitham AlShetawi, Anastasiya Quimby, Rui Fernandes
PurposeThecervicofacial(CF)flapisarandompatternflapthatprovidesexcellentmatchforcheekreconstruction.ThedesignoftheCFflapvariesbetweendifferentcheeksubunits.Inthisstudy,wereviewourexperiencewiththisflapandpresentaguideforflapdesignfordifferentcheeksubunits.MaterialsandMethodsPatientswhohadcheekreconstructionwerescreenedusingthedatabaseofthesurgicalproceduresbetween2011-2016.74patientswereidentified.Dataregardingpatientdemographics,diagnosis,defecttypeandoutcomewereretrospectivelyreviewed.Patientswhodidnothavecleardescriptionofthedefectand/orflapdesignwereexcludedfromthestudy.Wedividedthecheekintothreezonesandcreatedaguideforflapdesignforeachzone.Results28patientswithCFflapforcheekreconstructionmettheinclusioncriteria(21males[75%]and7females[25%];meanage57[range8-88years]).57%hadzoneAdefect,18%hadzoneB1defect,14%hadzoneB2defect,and11%hadmultiplezones.Themeanfollow-upwas4.6months(0-17months).93%hadsuccessfuloutcome.Only2patientsexperiencedwoundcomplications.ConclusionTheCFflapisaversatileflapthatprovidesexcellentskincolor,thicknessandtexturematchincheekreconstruction.Planningtheflapdesignisessentialtoachieveagoodoutcome.OuralgorithmprovidesastraightforwardmethodtoreliablydesigntheCFflapforcheekreconstruction.



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A retrospective volume matched analysis of the submental artery island pedicled flap as compared to the forearm free flap: Is it a good alternative choice for the reconstruction of defects of the oral cavity and oropharynx?

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nawaf Aslam-Pervez, Steven J. Caldroney, Amal Isaiah, Joshua E. Lubek
PurposeThe submental artery island pedicled flap (SMIF) is an underutilized alternative for reconstruction of head and neck defects following tumor ablation. The purpose of this study was to perform a comparative evaluation of reconstructive outcomes based on surgical site and ablative defect volume in patients reconstructed with a SMIF versus those reconstructed using the forearm free flap (FFF).MethodRetrospective cohort study of all patients with oral cavity/oropharyngeal defects reconstructed with a SMIF versus a cohort of FFF patients with similar volume defects were compared for oncologic safety and viability of equivalent reconstructive outcomes. All statistical comparisons were assessed by ANOVA and Fisher's exact test.ResultsAverage age was 61.8 years (SMIF) vs. 57.9 years (FFF). Most common defect was located in tongue with squamous cell carcinoma the most common pathology identified. Flap volumes were similar 38.79 (SMIF) vs. 39.77 mL (FFF). Significant comparative outcomes identified with SMIF reconstruction vs. FFF included; shorter anesthesia times (815 vs. 1209 min; P < 0.001), operative times (653 vs. 1031 min; P < 0.001) and blood loss (223 vs. 398 mL; P= 0.04). Post-operative ECOG performance score increased greater for FFF than for SMIF (+0.33 vs. +1.25; P=0.0019). Recipient site complication rates were lower for the FFF (0.17/patient vs. 0.42/patient), but were not statistically significant. There were equal rates of recurrence at the local surgical site and no differences in speech and swallowing function. Mean follow-up was 15.5 months.ConclusionsThis is the first study to compare the submental artery island flap versus the forearm free flap for reconstruction of oral cavity defects based on ablative volume deficit. The SMIF is a viable surgical option as compared to the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time, hospital stay and donor site morbidity.



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Editorial Board/Reviewing Committee

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Preoperative Signs and Symptoms as Prognostic Markers in Nasal Septoplasty

Identification of preoperative signs and symptoms that may predict the outcome of surgery is important, for both patient selection and the development of interventions for improving outcomes. The purpose of this study was to assess the value of some selected preoperative signs and symptoms for predicting outcomes of nasal septoplasty. Patients undergoing septoplasty with or without turbinoplasty responded to the Nasal Surgical Questionnaire (NSQ) preoperatively and six months postoperatively. The questionnaire contains visual analogue scales (VAS) for nasal obstruction during the day and at night. We compared preoperative and postoperative VAS scores in patients with unilateral versus bilateral septal deviation and patients with low versus high preoperative scores. Of 446 patients undergoing septoplasty from September 2014 to December 2015 who had responded to the preoperative NSQ, 286 (64.1%) also returned the postoperative version. There was greater improvement in obstruction in patients with preoperative unilateral compared to bilateral septal deviation (day scores, ). The grade of deviation and the presence of concomitant bony conchal hypertrophy did not influence results. Patients with lower preoperative VAS scores obtained better end results than those with higher scores (). Type of septal deviation and preoperative VAS scores may aid in predicting outcome of nasal surgery.

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Malignant transformation of oral leukoplakia in a patient with dyskeratosis congenita

Publication date: Available online 12 August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Michelle Bongiorno, Shayna Rivard, Daniel Hammer, Joshua Kentosh
Dyskeratosis congenita (DC) is a rare, inherited, bone marrow failure syndrome caused by premature telomere shortening. The classic mucocutaneous triad of clinical features is reticulated skin pigmentation, nail dysplasia, and oral leukoplakia. Multiple somatic features are also common including bone marrow failure, pulmonary fibrosis, and liver disease. DC significantly increases the risk for malignant transformation, including myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), head and neck squamous cell carcinoma (HNSCC), and anogenital cancer. This case describes a 23 year old female with malignant transformation of oral leukoplakia to squamous cell carcinoma (SCC) demonstrated in a series of biopsies of the same site. Increased surveillance, proper biopsy technique, and a multi-disciplinary approach are critical in DC patients to ensure rapid diagnosis and treatment.



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Comparaison des effets des corticostéroïdes par voie nasale et du montélukast sur les fonctions olfactives chez les patients atteints de rhinite allergique

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): A. Dalgic, M.E. Dinc, S. Ulusoy, D. Dizdar, A. Is, M. Topak
ObjectifLe dysfonctionnement olfactif est l'une des comorbidités associées à la rhinite allergique (RA) et celle-ci est l'une des causes les plus fréquentes de troubles olfactifs. Notre objectif était d'évaluer les effets des corticostéroïdes par voie nasale et des antagonistes des leucotriènes utilisés dans la rhinite allergique, sur les fonctions olfactives à l'aide du test Sniffin' Sticks.MéthodesTrente patients atteints de rhinite saisonnière ont été inclus dans cette étude. Les patients ont été randomisés en trois groupes de 10 patients ; le groupe 1 a été traité par montélukast sodique et furoate de mométasone, le groupe 2 a été traité uniquement par montélukast, et le groupe 3 uniquement par furoate de mométasone. Les fonctions olfactives des patients ont été déterminées à l'aide du test olfactif Sniffin' Sticks avant et après un mois de traitement.RésultatsLes valeurs de seuil, de discrimination, d'identification et de TDI (somme du seuil, de la discrimination et de l'identification) n'étaient pas significativement différentes entre les groupes avant le traitement. Pour les patients du groupe 1 et du groupe 3, des différences statistiquement significatives ont été observées en termes de valeurs de seuil, de discrimination, d'identification et de TDI avant et après le traitement (p<0,05) (test des rangs signés de Wilcoxon). Pour les patients du groupe 2, aucune différence significative n'a été observée concernant les valeurs de seuil, de discrimination, d'identification et de TDI avant et après le traitement (p>0,05).ConclusionLes résultats de notre étude montrent que le furoate de mométasone (FM) est plus efficace que le montélukast en terme d'amélioration de la fonction olfactive. Bien que le montélukast se soit avéré efficace pour traiter les symptômes de RA, son effet sur la fonction olfactive n'a pas été démontré dans cette étude.



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La chondroplastie par injection : remodelage enzymatique des greffes de cartilage

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): J.R. Gandy, A. Foulad, K.K. Chao, B.J.F. Wong
ObjectifDévelopper une technique d'injection d'enzymes assouplissant sélectivement le tissu cartilagineux pour le remodelage des structures cartilagineuses de la tête et du cou.Matériel et méthodesÀ partir d'oreilles de lapin, deux groupes ont été formés : (1) le groupe « oreille de lapin entière » et (2) le groupe « greffon composite » (échantillons de 2,5mm×3,0cm prélevés dans la région centrale du pavillon). Des injections séquentielles sous-périchondrales utilisant trois enzymes (hyaluronidase, pronase et collagénase de type II) ont été réalisées sur les échantillons de chaque groupe. Dans les échantillons témoins, une solution saline tamponnée au phosphate a été injectée de la même façon. Les oreilles entières ont ensuite été photographiées, maintenues en position anatomique verticale, pour évaluer leur déformation lors d'une compression afin de juger de l'intégrité du cartilage. De plus, une photographie à contre-jour a été réalisée pour tous les échantillons afin d'évaluer davantage les effets des enzymes, de manière à ce qu'une zone d'intensité lumineuse plus forte représente une augmentation du remodelage cartilagineux.RésultatsL'application des enzymes digestives a entraîné une réduction marquée de la résistance de la matrice des tissus cartilagineux, tout en préservant les couches superficielles sus-jacentes. Les pavillons entiers traités par les enzymes ont été remodelés au niveau du site d'injection des enzymes. Les images à contre-jour ont révélé une augmentation de l'intensité lumineuse locale dans les zones de digestion enzymatique. Il n'y a pas eu de destruction évidente de la peau sus-jacente lors de l'inspection visuelle.ConclusionCette étude démontre la faisabilité de la chondroplastie par injection comme une potentielle méthode alternative à la chirurgie conventionnelle pour le remodelage du cartilage auriculaire. Les injections séquentielles de hyaluronidase, de pronase et de collagénase de type II dans l'espace sous-périchondral peuvent être réalisées pour remodeler et assouplir les structures cartilagineuses avec une atteinte minimale des tissus environnants. Les études futures devront inclure des tests de viabilité des chondrocytes et l'optimisation des techniques d'injection.



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Images et comptes cellulaires de cochlées intactes et transparentes de gerbille de Mongolie par microscopie confocale à balayage laser

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): M. Risoud, J. Sircoglou, G. Dedieu, M. Tardivel, C. Vincent, N.-X. Bonne
ObjectifsRéaliser le protocole de clarification sur des cochlées de gerbilles de Mongolie et évaluer la possibilité de quantifier et d'analyser la cytoarchitecture tri-dimensionelle (3D) de ces cochlées transparisées.Matériels et méthodesLes oreilles internes fraîchement disséquées étaient préparées suivant un protocole de 13jours : fixation, microdissection, post-fixation, décalcification, pré-traitement (amplification du signal, perméabilisation et blocage), marquage fluorescent (immunomarquage indirect et marquage direct), déshydratation, transparisation en solution de Spalteholz (méthyl salicylate et benzoate de benzyl [MSBB]) et montage. L'acquisition des images était réalisée par microscopie confocale à balayage laser. Le logiciel ImageJ était utilisé pour mesurer la longueur analysée de l'organe de Corti analysée et compter les cellules ciliées internes et externes.RésultatsQuatre cochlées ont été imagées. Les reconstructions 3D permettaient l'analyse de grandes longueurs d'organes de Corti. La longueur moyenne d'organe de Corti analysée était de 1269 (±346) μm. Le nombre moyen de cellules ciliées par longueur d'organe de Corti était : 142 (±44) cellules ciliées internes et 400 (±122) cellules ciliées externes.ConclusionLa transparisation cochléaire par le MSBB peut être réalisée chez la gerbille de Mongolie, permettant d'obtenir des images en haute résolution d'oreilles internes marquées en immunofluorescence. Ceci constitue, à notre connaissance, la première application de cette technique dans cette espèce. Elle permet ainsi des comptes cellulaires, sans dissection traumatique, sur de grandes longueurs d'organe de Corti.



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Lobectomie thyroïdienne en ambulatoire ? Analyse rétrospective de faisabilité

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): H. Yakhlef, Y. Marboeuf, A. Piquard, O. Saint Marc
ButsLa prise en charge en ambulatoire constitue un enjeu majeur de la politique de santé publique. La réalisation des thyroïdectomies totales en ambulatoire reste discutée, mais qu'en est-il pour les hémi-thyroïdectomies ? Le but de notre étude est d'évaluer notre expérience concernant la prise en charge ambulatoire des hémi-thyroïdectomies.Matériels et méthodesIl s'agit d'une étude analytique rétrospective multicentrique, réalisée sur deux centres hospitaliers entre le premier janvier 2009 et le 31 décembre 2013. La prise en charge ambulatoire des hémi-thyroïdectomies n'était pas permise si : le score ASA était supérieur à 2, le patient était sous anticoagulant, le risque de totalisation était présent et en cas d'association d'un autre acte chirurgical nécessitant une surveillance>12h. Les critères suivants ont été recensés : âge, poids, sexe, complications postopératoires, taux d'admission et d'hospitalisation non programmés.ObjectifsAnalyser le taux de reprise pour hématome ainsi que le taux d'admission et d'hospitalisation non programmés.RésultatsSur 294 hémi-thyroïdectomies réalisées durant cette période, 130 l'ont été en ambulatoire (soit environ 44 %). Nous n'avons pas retrouvé d'obstacle médical à la prise en charge ambulatoire chez environ 64 % des patients pris en charge en hospitalisation conventionnelle. L'âge moyen en ambulatoire était de 44 ans. Huit totalisations ont été réalisées en ambulatoire. Seuls 2 patients initialement prévus en ambulatoire ont finalement passé une nuit d'hospitalisation pour surveillance, sans aucune reprise. Tous les patients étaient satisfaits voire très satisfaits de la prise en charge ambulatoire.ConclusionDans notre pratique, la réalisation d'une hémi-thyroïdectomies en ambulatoire est une procédure fiable et sûre.



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Dysplasie fibreuse osseuse cranio-faciale : à propos de 10 cas

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): A. Couturier, O. Aumaître, L. Gilain, B. Jean, T. Mom, M. André
ObjectifsLa dysplasie fibreuse osseuse (DFO) est une maladie osseuse bénigne, congénitale, sporadique et rare dans laquelle l'os est remplacé par du tissu fibro-osseux renfermant une ostéogenèse immature. Une évolution sarcomateuse est exceptionnelle. Les lésions sont soit uniques (forme monostotique), soit multiples (forme polyostotique). La DFO peut être associée à une hyperpigmentation maculaire cutanée et à une endocrinopathie dans le cadre du syndrome de McCune-Albright ou à des myxomes dans le syndrome de Mazabraud.MéthodesNous rapportons dix observations de patients suivis pour une DFO cranio-faciale dans notre centre entre 2010 et 2015.RésultatsL'âge moyen était de 43 ans (10–72 ans). Les symptômes cliniques étaient des céphalées (n=3), et des troubles neurosensoriels (uvéite antérieure à répétition [n=1], une baisse progressive de l'acuité visuelle épiphora et syndrome vestibulaire [n=1] et hypoacousie [n=1]). Tous présentaient une forme monostotique. La lésion de DFO était frontale (n=1), fronto-ethmoïdale (n=1), ethmoïdale (n=1), sphénoïdale (n=5), temporale (n=1) et étendue (fronto-ethmoïdo-sphénoïdale ; n=1). Cinq patients ont été traités par pamidronate, un bisphosphonate injectable : trois ont évolué favorablement entre 1 et 6 mois après le début du traitement (disparition des céphalées ou du syndrome vestibulaire), les 2 autres étaient cliniquement stables. Deux patients ont été opérés.ConclusionLe diagnostic de DFO cranio-faciale doit être évoqué devant des céphalées, des névralgies faciales, des atteintes sensorielles, des troubles fonctionnels ou des complications infectieuses de la sphère ORL. Une approche médico-chirurgicale est utile à la prise en charge de ces patients.



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Editorial Board

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4





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Mélanomes muqueux des cavités nasosinusiennes : revue de la littérature à propos d’une série de 44 cas

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): M. Dréno, M. Georges, F. Espitalier, C. Ferron, A. Charnolé, B. Dréno, O. Malard
ObjectifsLes mélanomes muqueux des fosses nasales et des sinus sont des tumeurs rares : ils représentent 4 % des tumeurs des cavités nasosinusiennes. L'objectif de cette étude est d'évaluer les caractéristiques cliniques de cette pathologie, ses modalités d'évolution, sa prise en charge thérapeutique et d'identifier des facteurs pronostiques.Matériel et méthodesÉtude rétrospective à partir d'une série de 44 patients traités pour un mélanome muqueux des cavités nasosinusiennes, dans le service d'ORL et de chirurgie cervicofaciale du CHU de Nantes entre 1988 et 2015.RésultatsL'âge moyen des patients était de 71,2 ans. Les 2 principaux signes rhinologiques lors du diagnostic étaient l'épistaxis et l'obstruction nasale unilatérale. Au moment de la prise en charge, 25 % des patients étaient classés T4. Un traitement chirurgical a été effectué chez 42 patients. Une radiothérapie postopératoire a été délivrée dans 19 cas et une immunothérapie adjuvante dans 14 cas. La durée moyenne de suivi était de 50 mois. Le taux de survie globale cumulée était de 71,5 % à 1 an, 33 % à 5 ans. Cliniquement, la présence de céphalées, d'algies faciales ou d'anesthésie du V2 étaient des facteurs significatifs de mauvais pronostic. L'atteinte exclusive des fosses nasales était également de meilleur pronostic sur la survie globale que l'atteinte sinusienne. La réalisation d'une radiothérapie adjuvante augmentait de façon non significative le contrôle local.ConclusionsLes mélanomes muqueux des cavités nasosinusiennes sont des tumeurs de mauvais pronostic en raison de leur potentiel métastatique élevé. L'exérèse chirurgicale suivie d'une radiothérapie est le traitement principal. Il n'existe pas actuellement de consensus concernant l'intérêt des nouveaux traitements adjuvants médicamenteux dans cette indication contrairement au traitement du mélanome cutané primitif.



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Imagerie morphologique et fonctionnelle des paragangliomes cervicaux

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): J.-P. Guichard, N. Fakhry, J. Franc, P. Herman, C.-A. Righini, D. Taieb
ObjectifFaire une mise au point sur les techniques d'imagerie dans la localisation et la caractérisation des paragangliomes (PGL) cervicaux.Matériel et méthodesAnalyse de la littérature à partir de la base de données PubMed/Medline.RésultatsLes PGL cervicaux sont des tumeurs hypervasculaires provenant essentiellement des paraganglions situés au niveau de la bifurcation carotidienne (glomus carotidien) et ou associés au nerf vague. L'imagerie morphologique est indiquée pour confirmer le diagnostic, rechercher une multifocalité et évaluer l'extension locorégionale. L'angio-IRM est la technique non invasive de choix. Le scanner et notamment l'angioscanner constitue une excellente alternative pour le diagnostic et le bilan d'extension. L'artériographie conventionnelle reste utile en préopératoire pour l'embolisation et le test de clampage. L'imagerie fonctionnelle permet la localisation et la caractérisation des PGL. La scintigraphie des récepteurs à la somatostatine constitue l'imagerie de référence dans le bilan des PGL sporadiques. Ces dernières années, les indications de la TEP se sont étendues parallèlement au développement des nouveaux traceurs telle que la TEP à la [18F]-FDOPA ou utilisant des analogues de la somatostatine marqués au gallium-68.ConclusionL'imagerie est fondamentale dans bilan des PGL du cou et combine des examens d'imagerie morphologique et fonctionnelle.



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La chirurgie ambulatoire en otologie

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): A. Uziel
L'auteur fait une mise au point sur la chirurgie ambulatoire en otologie qui s'est considérablement développée dans le monde et en France ces dernières années. La chirurgie de l'oreille se prête bien à une hospitalisation de courte durée en raison de la rapidité des actes et des possibilités de contrôle de la douleur. L'article discute de l'intérêt de ce mode de prise en charge (pour le patient, le chirurgien et l'établissement de santé), des contraintes organisationnelles et de sécurité, et des critères de non-éligibilité. La chirurgie ambulatoire en otologie est maintenant passée du stade d'alternative au stade de règle.



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L’immunotherapie antiallergenique dans la rhinite allergique

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): G. Mortuaire, J. Michel, J.-F. Papon, O. Malard, D. Ebbo, L. Crampette, R. Jankowski, A. Coste, E. Serrano
La rhinite allergique (RA) est une pathologie fréquente dont la sévérité ou le mauvais contrôle peut aboutir à une altération significative de la qualité de vie des patients. L'immunothérapie antiallergénique (ITA) constitue à l'heure actuelle le seul traitement étiologique susceptible de modifier l'histoire naturelle de la maladie allergique. Bien connue des allergologues, cette option thérapeutique est encore insuffisamment maîtrisée par les ORL. Cette mise au point basée sur les méta-analyses et les essais les plus récents souligne l'efficacité de l'ITA sur l'amélioration des symptômes de la RA et sur la réduction de la consommation des traitements médicaux (corticoïdes, antihistaminiques). L'ITA serait aussi susceptible de réduire le risque d'apparition d'un asthme et de nouvelles sensibilisations lorsqu'elle est introduite suffisamment précocement. Les analyses immunobiologiques montrent bien une modification du profil inflammatoire après ITA en faveur d'une immunotolérance impliquant les lymphocytes T régulateurs et la production d'IgG. La voie sublinguale en gouttes apporte des résultats comparables à ceux de la voie sous-cutanée tout en proposant une utilisation plus simple réduisant le risque anaphylactique. Une standardisation des protocoles d'étude en termes de mesure de l'effet thérapeutique et de gradation des effets indésirables est néanmoins nécessaire pour améliorer les études comparatives. Les formes sublinguales en comprimés plus récemment introduites constituent une réelle opportunité pour ouvrir le champ de l'ITA aux ORL dans la RA pollinique et prochainement la RA aux acariens.



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Les clés du traitement « conservateur » des carcinomes épidermoïdes de stade « précoce » de la région amygdalienne

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): O. Laccourreye, P. Castelnau-Marchand, F. Rubin, C. Badoual, P. Halimi, P. Giraud
Analyse de la littérature médicale scientifique consacrée au bilan, à l'épidémiologie, au contrôle local, à la survie ainsi qu'aux complications et séquelles après traitement conservateur des carcinomes épidermoïdes de stade « précoce » de la région amygdalienne. Analyse de la base de données PubMed (1975–2016) avec les mots clés et les associations qui suivent : « amygdale/loge amygdalienne/oropharynx » et « cancer épidermoïde » et « stade précoce (I–II ; T1-T2N0M0) » et « radiothérapie » ou « chirurgie conservatrice/oropharyngectomie/chirurgie transorale/amygdalectomie radicale ». Cette recherche électronique trouvait dix articles rétrospectifs qui analysaient spécifiquement survie et contrôle local au sein de séries de plus de 50 patients avec un recul minimum de 2 ans après traitement conservateur et aucun article prospectif, méta-analyse et/ou étude Cochrane. L'imagerie par résonance magnétique nucléaire est l'examen radiologique clef du bilan d'extension locale. L'infestation par l'human papilloma virus est un facteur de risque à rechercher systématiquement, car il favorise la radiosensibilité tumorale et expose à des secondes localisations synchrones et métachrones spécifiques. Quel que soit le traitement conservateur réalisé, des taux de contrôle local et de survie supérieure à 85 % étaient notés. La modulation d'intensité réduisait la morbidité de la radiothérapie. La chirurgie transorale avait une faible morbidité/mortalité tout en permettant la réalisation d'un évidement ganglionnaire ipsilatéral et en préservant la radiothérapie pour le traitement des secondes localisations métachrones. La chirurgie transorale semble l'option thérapeutique à privilégier dans la majorité des cas. Un suivi à vie adapté au statut HPV doit être réalisé. La mise en place de vaccination anti-HPV ne doit pas faire perdre de vue l'importance de la lutte contre le tabagisme et l'énolisme.



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Rédaction du compte-rendu opératoire après chirurgie otorhinolaryngologique et cervico-faciale

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): O. Laccourreye, F. Rubin, A. Villeneuve, P. Bonfils
Une dizaine d'articles, seulement, consacrés au compte-rendu opératoire, sont publiés dans la littérature médicale scientifique indexée alors que ce document est indispensable, tant au plan médical qu'au plan légal, à la prise en charge optimale de la personne malade opérée. Dans cette note technique, construite à partir des travaux publiés sur ce sujet, les auteurs détaillent les points clés de la rédaction de ce document après chirurgie en otrorhinolaryngologie et soulignent la nécessité de rédiger ce document dans les minutes qui suivent la fin de l'intervention, l'apport de sa standardisation, et l'importance de son enseignement lors de la formation chirurgicale.



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Sténose bilatérale des artères linguales – une complication rare et tardive de la chimio-radiothérapie

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): F. Holtz, Y. Monnier, U. Borner, L. Nisa
IntroductionL'atteinte des artères carotides suite à la radiothérapie (RT) est un facteur de risque établi pour le développement d'atteintes cérébro-vasculaires avec risque ultérieur d'accident vasculaire cérébral ou accident vasculaire cérébral transitoire. En comparaison, l'atteinte de petits vaisseaux cervicaux suite à la RT est une complication plus rarement décrite.Présentation de casNous rapportons le cas d'un patient de 61 ans qui a développé une nécrose linguale partielle 4 ans après chirurgie et radio-chimiothérapie postopératoire pour un carcinome épidermoïde du plancher buccal. Un CT-scan avec injection de contraste a confirmé l'occlusion totale à subtotale des deux artères linguales. Le débridage chirurgical de la nécrose a permis une guérison complète des lésions.DiscussionL'atteinte des petits vaisseaux est une complication possible chez les patients irradiés pour des carcinomes de la région cervico-faciale. Bien que le risque de développement de telles complications n'ait pas de rapport direct avec la dose totale de RT, de plus hautes doses semblent accélérer le développement de lésions vasculaires. Les praticiens devraient garder en tête la possibilité de telles complications, surtout auprès des survivants au-delà de 5 ans.



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Exérèse par voie endonasale d’un neurofibrome solitaire de la portion externe du nez

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): H.J. Min, K.S. Kim
IntroductionLe neurofibrome solitaire développé dans la portion externe du nez est extrêmement rare et, à notre connaissance, seuls 3 cas ont été rapportés dans la littérature anglophone. Il peut se développer à partir des branches ophtalmique (V1) et maxillaire (V2) du nerf trijumeau.Cas cliniqueNous présentons un cas rare de neurofibrome solitaire développé à partir de la portion externe du nez dont l'exérèse complète a été réalisée par voie endonasale après incision cartilagineuse.ConclusionCe cas met en lumière deux points importants. Tout d'abord, nous devons garder à l'esprit que cette entité clinique est incluse dans le diagnostic différentiel des masses tissulaires développées à partir de la portion externe du nez. Ensuite, nous devons choisir la meilleure approche chirurgicale pour l'exérèse complète avec préservation de l'aspect cosmétique.



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Fracture du stapes évoquée devant une tympanométrie anormale

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): C. Aussedat, C. Bobiller, K. Gaillot, E. Lescanne, D. Bakhos
IntroductionLes fractures de l'os temporal sont fréquemment associées à des disjonctions ou des fractures ossiculaires. L'osselet le plus fréquemment impliqué est l'incus. À notre connaissance, le cas d'une fracture isolée de la branche postérieure du stapes n'a pas été rapporté.Résumé du cas cliniqueUn patient de 20 ans a consulté pour une hypoacousie gauche persistante plusieurs mois après un traumatisme crânien. Une tomodensitométrie initiale de l'os temporal montrait une fracture de l'os temporal simple, sans autre anomalie détectée. Le diagnostic a été évoqué sur les résultats de l'impédancemétrie. L'aspect de compliance augmentée a conduit à réaliser une nouvelle tomodensitométrie temporale en coupes fines, évoquant une fracture de la branche postérieure du stapes. Une exploration chirurgicale par voie endaurale a permis de confirmer le diagnostic et a permis la mise en place de ciment ionomère au niveau de la branche postérieure.DiscussionUne fracture ou une disjonction ossiculaire doit être évoquées s'il persiste une surdité de transmission associée à un aspect de compliance augmentée sur la tympanométrie, même si la tomodensitométrie de l'os temporal ne montre pas de rupture de chaîne ou une fracture ossiculaire. La réhabilitation de l'audition peut être réalisée par la mise en place d'audioprothèse ou par reconstruction ossiculaire chirurgicale.



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Une tuméfaction parotidienne

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): C.A. Righini, A. Baguant, I. Atallah




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Une tumeur rare du pavillon de l’oreille

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): M. Volkan Akdoğan, O. Topal, H. Erinanç




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État de mal convulsif révélant une tumeur naso-sinusienne chez l’enfant

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): H. Dimassi, S. Kedous, I. Ben Said




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Maladie de Kimura orbitaire : un défi diagnostique moderne

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): P. Clarós, J.V. Fokouo, F. Nyada, A. Clarós




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Hidradénocarcinome du cuir chevelu d’évolution fatale : une nouvelle observation

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): J. Elbenaye, M. Moumine, M. Sinaa, M. Elhaouri




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Submucosal injection of dexamethasone and methylprednisolone for the control of postoperative sequelae after third molar surgery: randomized controlled trial

Pain, swelling, and trismus are known sequelae of third molar surgery that can significantly affect the individual's quality of life (QOL). These should be minimized to improve QOL. The purpose of this study was to compare the effects of the preoperative submucosal administration of equivalent doses of two commonly used steroids on these postoperative sequelae. A randomized controlled clinical trial was conducted involving 60 subjects requiring the removal of impacted mandibular third molars. Extraction cases with a similar difficulty index were included.

http://ift.tt/2uyZSQ6

Significance of Frequencies, Compositions, and/or Antileukemic Activity of (DC-stimulated) Invariant NKT, NK and CIK Cells on the Outcome of Patients With AML, ALL and CLL

Invariant natural killer T (iNKT)/natural killer (NK)/cytokine-induced killer (CIK) cells are important for immune surveillance. (I) Novel combinations of antibody 6B11 (targeting the Vα24-Jα18-invariant T-cell receptor) with CD4/CD8/CD1d/Vα24 for iNKT subset detection and "T/NK cell-like"-iNKT subsets were defined. Compared with healthy peripheral blood mononuclear cells (MNC) (significantly) lower proportions of iNKT cells (6B11+/6B11+CD3+/6B11+CD161+), NK cells (CD3−CD56+/CD3−CD161+), and CIK cells (CD3+CD56+/CD3+CD161+) were found in peripheral blood MNC from acute myeloid (AML)/acute myeloid, lymphoid (ALL)/chronic lymphoid leukemia (CLL) patients in acute disease stages. Subtyping of iNKT cells revealed (significantly) higher proportions of CD3+ T cells and CD161+ NK cells in AML/ALL/CLL expressing 6B11 compared with healthy MNC. Prognostic evaluations showed higher proportions of iNKT/NK/CIK cells in favorable AML subgroups (younger age, primary, no extramedullary disease, achievement/maintenance of complete remission) or adult ALL and CLL patients. (II) iNKT/NK/CIK cell frequencies increased after (vs. before) mixed lymphocyte cultures of T-cell–enriched immune reactive cells stimulated with MNC/whole blood with or without pretreatment with "cocktails" (dendritic cells generating methods/kits inducing blasts' conversion to leukemia-derived dendritic cells from AML patients). Individual "cocktails" leading to "highest" iNKT cell frequencies could be defined. Antileukemic blast lytic activity correlated significantly with frequencies of iNKT/NK/CIK cells. In summary healthy MNC show significantly more iNKT/NK/CIK cells compared with AML/ALL/CLL MNC, a shift in the iNKT cell composition is seen in healthy versus leukemic samples and iNKT/NK/CIK cell-proportions in AML/ALL/CLL MNC samples correlate with prognosis. "Cocktail"-treated AML blasts lead to higher iNKT/NK/CIK cell frequencies and samples with antileukemic activity show significantly higher frequencies of iNKT/NK/CIK cells. Proportions of iNKT/NK/CIK cells should regularly be evaluated in AML/ALL/CLL diagnosis panels for quantitative/prognostic estimation of individual patients' antileukemic potential and their role in dendritic cells/leukemia-derived dendritic cells triggered immune surveillance.

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Zebularine Treatment Induces MAGE-A11 Expression and Improves CTL Cytotoxicity Using a Novel Identified HLA-A2-restricted MAGE-A11 Peptide

Melanoma-associated antigen-A11 (MAGE-A11) is frequently expressed in breast cancer and is associated with poor prognosis. Therefore, MAGE-A11 is a potential immunotherapy target in breast cancer. MAGE-A11 expression, however, is downregulated in many patients, thus constraining the application of immunotherapy. The induction of MAGE-A11 expression is crucial for the recognition and killing of breast cancer cells by cytotoxic T lymphocytes (CTL). In this study, a series of HLA-A2-restricted candidate MAGE-A11 peptides were predicted, synthesized, and tested. Of the selected peptides, p350 (FLFGEPKRL) elicited peptide-specific CTLs from healthy HLA-A*0201-positive donors. The induced CTLs can lyse MAGE-A11-expressing breast cancer cells but not MAGE-A11-negative tumor cells. To improve antitumor immune response, zebularine, a DNA methyltransferase inhibitor, was used to induce MAGE-A11 expression and upregulate the cytotoxicity of antigen-specific T cells in breast cancer cell lines and primary breast cancer cells. The present findings suggested that peptide p350 induces peptide-specific cytolytic activity and is thus a potential candidate for tumor vaccination or T-cell therapy. Epigenetic modulation by zebularine can induce MAGE-A11 expression in breast cancer cells and facilitate cytotoxicity via MAGE-A11-specific CTL.

http://ift.tt/2wESjVG

Antigen Presentation by Individually Transferred HLA Class I Genes in HLA-A, HLA-B, HLA-C Null Human Cell Line Generated Using the Multiplex CRISPR-Cas9 System

Human leukocyte antigens (HLAs) are essential immune molecules that affect transplantation and adoptive immunotherapy. When hematopoietic stem cells or organs are transplanted with HLA-mismatched recipients, graft-versus-host disease or graft rejection can be induced by allogeneic immune responses. The function of each HLA allele has been studied using HLA-deficient cells generated from mutant cell lines or by RNA interference, zinc finger nuclease, and the CRISPR/Cas9 system. To improve HLA gene editing, we attempted to generate an HLA class I null cell line using the multiplex CRISPR/Cas9 system by targeting exons 2 and 3 of HLA-A, HLA-B, and HLA-C genes simultaneously. Multiplex HLA editing could induce the complete elimination of HLA class I genes by bi-allelic gene disruption on target sites which was defined by flow cytometry and target-specific polymerase chain reaction. Furthermore, artificial antigen-presenting cells were generated by transfer of a single HLA class I allele and co-stimulatory molecules into this novel HLA class I null cell line. Artificial antigen-presenting cells showed HLA-restricted antigen presentation following antigen processing and were successfully used for the efficient generation of tumor antigen-specific cytotoxic T cells in vitro. The efficient editing of HLA genes may provide a basis for universal cellular therapies and transplantation.

http://ift.tt/2wEE17j

Inflammatory Myopathy and Axonal Neuropathy in a Patient With Melanoma Following Pembrolizumab Treatment

Immune-mediated adverse effects of immune checkpoint inhibitors are rather common, but neuromyopathic immune-related adverse events are very rare. In this report, we present a unique case of a patient with a complex neuromyopathic syndrome with axonal neuropathy and inflammatory myopathy after a single dose of pembrolizumab. An 82-year-old patient with a previously untreated stage IIIc melanoma developed ptosis in the left eye, generalized weakness, and neck and shoulder pain 15 days after pembrolizumab administration. He had left-sided ptosis and miosis, with a normal pupillary light reflex, horizontal diplopia, and voice hoarseness, along with weakness of the neck muscles and a hypokinetic right vocal cord at laryngoscopy. The laboratory evaluation was remarkable for the marked increase in the serum lactate dehydrogenase and creatine phosphokinase levels. Further evaluation revealed findings compatible with axonal neuropathy and inflammatory myopathy. The patient was treated with corticosteroids, immunoglobulin, and plasmapheresis, with a minor response; the patient eventually died. This case represents a newly described syndrome probably associated with pembrolizumab administration.

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Diabetic Ketoacidosis as an Immune-related Adverse Event from Pembrolizumab in Non–Small Cell Lung Cancer

Programmed cell death protein 1 pathway inhibitors are now routinely administered to patients with non–small cell lung cancer, and prompt recognition of immune-related adverse events is critical to managing serious drug toxicities. Here, we describe a 66-year-old man with no known history of diabetes who presented with diabetic ketoacidosis after receiving 3 doses of pembrolizumab for lung adenocarcinoma. Autoimmune diabetes is a rare but potentially life-threatening complication of programmed cell death protein 1 inhibitors

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Oral immunization with Porphyromonas gingivalis outer membrane protein and CpG oligodeoxynucleotides attenuates P. gingivalis-accelerated atherosclerosis and inflammation

Publication date: Available online 12 August 2017
Source:Journal of Oral Biosciences
Author(s): Takashi Takeuchi, Tomomi Hashizume-Takizawa, Ryoki Kobayashi
ObjectiveIt has previously been shown that oral immunization with the 40-kDa outer membrane protein of Porphyromonas gingivalis (40k-OMP) and CpG oligodeoxynucleotides (ODN) as an adjuvant elicits protective antibody responses against alveolar bone loss caused by P. gingivalis infection. The objective of the present work was to assess the efficacy of this same oral vaccine on prevention of P. gingivalis-accelerated atherosclerosis.MethodsApolipoprotein E-deficient spontaneously hyperlipidemic (Apoe^shl) mice were orally immunized with 40k-OMP plus CpG ODN and subsequently challenged intravenously with P. gingivalis. The mice were euthanized 15 weeks later, and atheromatous lesions in the proximal aorta of each mouse were analyzed histomorphometrically. Serum concentrations of 40k-OMP-specific antibodies and cytokines as well as levels of proatherogenic factors in the aorta were determined.ResultsP. gingivalis challenge resulted in an increase in the areas of the aortic sinus covered with atherosclerotic plaque, as well as in the levels of high-sensitive C-reactive protein (hsCRP) and some cytokines and chemokines, when compared with sham-treated mice. In contrast, oral immunization with 40k-OMP plus CpG ODN induced 40k-OMP-specific serum IgG responses, and significantly reduced atherosclerotic plaque accumulation in the aortic sinus, along with hsCRP and the cytokine and chemokine levels.ConclusionsThese results suggest that oral administration of 40k-OMP plus CpG ODN may be an effective vaccine for the prevention of accelerated atherosclerosis caused by P. gingivalis infection.



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Duration of tracheostomy dependence and development of tracheocutaneous fistula in children

Objective

To determine whether the risk of developing a tracheocutaneous fistula (TCF) increases with longer tracheostomy dependence times in children.

Study Design

Retrospective review of medical records.

Method

A retrospective chart review was conducted for all children who both underwent tracheotomy and were decannulated between 2002 and 2011 at a tertiary children's hospital. Charts were analyzed for duration of tracheostomy and evidence of TCF up to 12 months. Data for these criteria was available on 164 out of 182 patients.

Results

A significant difference in the duration of tracheostomy dependence between children with and without resultant TCF was determined by the Wilcoxon signed rank test (P = 0.0003). The relative risk (RR) of a persistent TCF was significantly increased when the duration of tracheostomy dependence was greater than 24 months (RR = 2.5217, P < 0.005) when compared to those decannulated before 12 months. The mean tracheostomy dependence times for children with and without TCF were 33.1 and 23.4 months, respectively. Overall, 94 children (57.3%) developed a TCF.

Conclusion

To our knowledge, this study represents the largest collection of data for children who have been decannulated following tracheostomy placement. These data demonstrate that the risk of developing a TCF increases with longer tracheostomy dependence times in children.

Level of Evidence

4. Laryngoscope, 2017

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Measurements of ionic concentrations along with endocochlear potential in wild-type and claudin 14 knockout mice

To examine whether the changes in endolymphatic ion concentrations were involved in hair cells degeneration in claudin-14 knockout (KO) mice (Cldn14−/−), we measured the endocochlear potential (EP) along with concentrations of K+, Na+, H+, or Ca2+ ([K]e, [Na]e, pHe, [Ca]e) in Cldn14−/−, in which hair cells were selectively damaged, and compared with measurements in wild type mice (Wt).

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Calendrier

Publication date: August–September 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issues 8–9





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Editorial board

Publication date: August–September 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issues 8–9





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Erratum de l’article « Encore un “dernier mot” sur le syndrome de Rowell » [Ann. Dermatol. Venereol. 144 (2017) 247–249]

Publication date: August–September 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issues 8–9





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Artery of Percheron infarction: a case report

The artery of Percheron is a rare anatomic variant of arterial supply to the paramedian thalamus and rostral midbrain, and occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts...

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Snail and Axin2 expression predict the malignant transformation of oral leukoplakia

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Xianglan Zhang, Ki-Yeol Kim, Zhenlong Zheng, Hyun Sil Kim, In Ho Cha, Jong In Yook
ObjectivesOral leukoplakia (OL) has a well-documented potential risk of malignant transformation into oral squamous cell carcinoma (OSCC), although biomarker(s) predicting malignant potential are limited in capability. The aim of this cross-sectional and retrospective cohort study was to investigate the predictive role of canonical Wnt genes Axin2 and Snail (SNAI1) expression in the malignant transformation of OL lesions.Materials and methodsThe expression of epithelial-mesenchymal transition (EMT) genes Snail and Axin2, which are regulated by the canonical Wnt pathway, were determined using immunohistochemical staining in an OL cohort consisting of 154 samples of patients with long-term follow-up and then evaluated as risk factors for malignant transformation of OL.ResultsIncreased Axin2 and Snail abundance were found in 107 (69.5%) and 58 (37.7%) of OL patients, respectively. In a multivariate analysis using gender, age, lesion site, Axin2, and Snail as cofactors, both Axin2 and Snail were independent risk factors for malignant transformation with a hazard ratio of 7.47 (95% confidence interval, 2.23–25.02; P=0.001) and 4.41 (95% confidence interval, 1.78–10.93; P=0.001), respectively. A nomogram for predicting 5-, 10-, and 15-year cancer-free survival probability was developed in patients with OL by including gender, age, lesion site, Axin2, and Snail expression with ac-index of 0.760.ConclusionThe increased abundance of Snail and Axin2 is highly correlated to malignant transformation of OL, making them novel biomarker(s) predicting oral cancer development.



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Genomic characterization of tobacco/nut chewing HPV-negative early stage tongue tumors identify MMP10 asa candidate to predict metastases

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Pawan Upadhyay, Nilesh Gardi, Sanket Desai, Pratik Chandrani, Asim Joshi, Bhaskar Dharavath, Priyanca Arora, Munital Bal, Sudhir Nair, Amit Dutt
ObjectivesNodal metastases status among early stage tongue squamous cell cancer patients plays a decisive role for choice of treatment, wherein about 70% patients may be spared from surgery with accurate prediction of negative pathological lymph node status. However, there is an unmet need for prognostic biomarkers to stratify the patients who are likely to develop metastases.Materials and methodsWe performed high throughput sequencing of fifty four samples derived from HPV negative early stage tongue cancer patients habitual of chewing betel nuts, areca nuts, lime or tobacco using whole exome (n=47) and transcriptome (n=17) sequencing. Additionally the relevant alterations were validated using orthologous methods in extended early stage TSCC cohort.Results and conclusionSomatic analysis revealed a classical tobacco mutational signature C:G>A:T transversion in 53% patients that were mutated in TP53, NOTCH1, CDKN2A, HRAS, USP6, PIK3CA, CASP8, FAT1, APC, and JAK1. Similarly, significant gains at genomic locus 11q13.3 (CCND1, FGF19, ORAOV1, FADD), 5p15.33 (SHANK2, MMP16, TERT), and 8q24.3 (BOP1); and, losses at 5q22.2 (APC), 6q25.3 (GTF2H2) and 5q13.2 (SMN1) were observed in these samples. Furthermore, an integrated gene-expression analysis of 253 tongue tumors suggested an upregulation of metastases-related pathways and over-expression of MMP10 in 48% tumors that may be crucial to predict nodal metastases in early tongue cancer patients. In overall, we present the first descriptive portrait of somatic alterations underlying the genome of tobacco/nut chewing HPV-negative early tongue cancer, and identify MMP10 asa potential prognostic biomarker to stratify those likely to develop metastases.



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Transient receptor potential vanilloid 4–expressing macrophages and keratinocytes contribute differentially to allergic and nonallergic chronic itch

Publication date: Available online 11 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jialie Luo, Jing Feng, Guang Yu, Pu Yang, Madison R. Mack, Junhui Du, Weihua Yu, Aihua Qian, Yujin Zhang, Shenbin Liu, Shijin Yin, Amy Xu, Jizhong Cheng, Qingyun Liu, Roger G. O'Neil, Yang Xia, Liang Ma, Susan M. Carlton, Brian S. Kim, Kenneth Renner, Qin Liu, Hongzhen Hu
BackgroundChronic itch is a highly debilitating symptom that underlies many medical disorders with no universally effective treatments. Although unique neuronal signaling cascades in the sensory ganglia and spinal cord have been shown to critically promote the pathogenesis of chronic itch, the role of skin-associated cells remains poorly understood.ObjectiveWe sought to examine the cutaneous mechanisms underlying transient receptor potential vanilloid 4 (TRPV4)–mediated allergic and nonallergic chronic itch.MethodsExpression of TRPV4 in chronic itch and healthy control skin preparations was examined by using real-time RT-PCR. Trpv4^eGFP mice were used to study the expression and function of TRPV4 in the skin by means of immunofluorescence staining, flow cytometry, calcium imaging, and patch-clamp recordings. Genetic and pharmacologic approaches were used to examine the role and underlying mechanisms of TRPV4 in mouse models of dry skin–associated chronic itch and spontaneous scratching associated with squaric acid dibutylester–induced allergic contact dermatitis.ResultsTRPV4 is selectively expressed by dermal macrophages and epidermal keratinocytes in mice. Lineage-specific deletion of TRPV4 in macrophages and keratinocytes reduces allergic and nonallergic chronic itch in mice, respectively. Importantly, TRPV4 expression is significantly increased in skin biopsy specimens from patients with chronic idiopathic pruritus in comparison with skin from healthy control subjects. Moreover, TRPV4-dependent chronic itch requires 5-hydroxytryptamine (5-HT) signaling secondary to activation of distinct 5-HT receptors in both patients with allergic and those with nonallergic chronic itch conditions.ConclusionOur study reveals previously unrecognized mechanisms by which TRPV4-expressing epithelial and immune cells in the skin critically and dynamically mediate chronic itch and unravels novel targets for therapeutics in the setting of chronic itch.

Graphical abstract

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Neutralization of interferon-γ reverts clinical and laboratory features in a mouse model of macrophage activation syndrome

Publication date: Available online 12 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Giusi Prencipe, Ivan Caiello, Antonia Pascarella, Alexei A. Grom, Claudia Bracaglia, Laurence Chatel, Walter G. Ferlin, Emiliano Marasco, Raffaele Strippoli, Cristina de Min, Fabrizio De Benedetti
BackgroundThe pathogenesis of macrophage activation syndrome (MAS) is not clearly understood: a large body of evidence supports the involvement of mechanisms similar to those implicated in primary hemophagocytic lymphohistiocytosis.ObjectiveTo investigate the pathogenic role of interferon-γ (IFNγ) and the therapeutic efficacy of IFNγ neutralization in an animal model of macrophage activation syndrome.MethodsWe used a MAS model established in mice transgenic for human interleukin-6 (IL-6TG) challenged with LPS (MAS mice). Levels of IFNγ and IFNγ-inducible chemokines were evaluated by real-time PCR in liver and spleen and by ELISA in plasma. IFNγ neutralization was achieved using the anti-IFNγ antibody XMG1.2 in vivo.ResultsMAS mice showed a significant upregulation of the IFNγ pathway, as demonstrated by increased mRNA levels of Ifnγ and by higher levels of phospho-STAT1 in liver and spleen and by increased expression of IFNγ-inducible chemokines Cxcl9 and Cxcl10 in liver and spleen as well as in plasma. A marked increase in Il-12a and Il-12b expression was also found in liver and spleen from MAS mice. In addition, MAS mice showed a significant increase in liver CD68 positive macrophages. MAS mice treated with an anti-IFNγ antibody showed a significant improvement in survival and in body weight recovery, associated to a significant amelioration of ferritin, fibrinogen and alanine aminotransferase levels. In MAS mice, treatment with the anti-IFNγ antibody significantly decreased circulating levels of CXCL9, CXCL10 and downstream proinflammatory cytokines. The decrease in CXCL9 and CXCL10 levels paralleled the decrease in the serum levels of proinflammatory cytokines and ferritin.ConclusionThese results provide evidence for a pathogenic role of IFNγ in MAS.

Teaser

In a murine model of MAS, the IFNγ pathway is activated and has a pathogenic role, as neutralization of IFNγ reverts the disease. These results provide the rationale for the therapeutic targeting of IFNγ in MAS.


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Overcoming severe adverse reactions to venom immunotherapy by using anti-IgE antibodies in combination with a high maintenance dose

Abstract

Background

An omalizumab treatment and a high maintenance venom dose may both help to prevent recurrent systemic allergic reactions (SAR) to venom immunotherapy (VIT). The effectiveness of this combination therapy, however, is unclear.

Objective

We wanted to explore the possibility whether a temporary treatment with the anti-IgE antibody omalizumab, combined with a VIT using an elevated maintenance dose of >100 μg venom may establish a permanent tolerance of maintenance VIT.

Methods

For this retrospective case series, we scoured our institutional data base for patients who had had an insect venom allergy, and in whom it had not been possible to continue VIT because of repeated unstoppable SAR during maintenance VIT. Patients were divided into those who had received the combination therapy (omalizumab group), and those who had not received omalizumab because its costs could not be covered (controls). Guided by the total IgE level and by body weight, omalizumab had been given subcutaneously 5, 3 and 1 week before VIT had been restarted. Three to six months after an elevated maintenance dose (200 – 300 μg venom) had been reached, omalizumab had been stopped.

Results

Between 2006 and 2011 15 patients had qualified for an off-label use of omalizumab. 10 patients had received the combination therapy, five patients had remained without such a therapy. The combination therapy lead to a durable tolerance of VIT in all patients even after omalizumab had been discontinued (median of follow-up time 5.8 years, IQR 2.7-8.6 years). Sting challenge tests were tolerated by all of the re-stung omalizumab patients (n=8). In all controls VIT had to be stopped permanently due to repeated SARs (p<0.001 vs. omalizumab group).

Conclusions

Combining a temporary omalizumab therapy with an elevated maintenance dose seems a promising approach to achieve a tolerance of treatment in patients with a recurrent SAR to VIT.

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Helicobacter pylori and its secreted immunomodulator VacA protect against anaphylaxis in experimental models of food allergy

Summary

Background

Food allergy is an increasingly common health problem in Western populations. Epidemiological studies have suggested both positive and negative associations between food allergy and infection with the gastric bacterium Helicobacter pylori.

Objective

The objective of this work was to investigate whether experimental infection with H. pylori, or prophylactic treatment with H. pylori-derived immunomodulatory molecules, affects the onset and severity of food allergy, either positively or negatively.

Methods

We infected neonatal C57BL/6 or C3H mice with H. pylori or treated animals with H. pylori components (bacterial lysate or the immunomodulator VacA) and subsequently subjected them to four different protocols for food allergy induction, using either ovalbumin or peanut extract as allergens for sensitization and challenge. Readouts included anaphylaxis scoring, quantification of allergen-specific serum IgE and IgG1 and of the mast cell protease MCPT1, as well as splenic T-helper-2 cell-derived cytokine production. Mesenteric lymph node CD4⁺FoxP3⁺ regulatory T-cells were subjected to flow cytometric quantification and sorting followed by qRT-PCR, and to DNA methylation analyses of the Treg-specific demethylated region (TSDR) within the FOXP3 locus.

Results

Mice that had been infected with H. pylori or treated with H. pylori-derived immunomodulators showed reduced anaphylaxis upon allergen sensitization and challenge, irrespective of the allergen used. Most of the immunologic assays confirmed a protective effect of H. pylori. CD4⁺FoxP3⁺ T-cells were more abundant in protected mice and exhibited a stable Treg phenotype characterized by FOXP3 TSDR demethylation.

Conclusions and Clinical Relevance

H. pylori confers protection against the anaphylaxis associated with ovalbumin and peanut allergy and affects the epigenome of T-cells, thereby promoting stable Treg differentiation and functionality. Prophylactic treatment with H. pylori-derived immunomodulators appears to be a promising strategy for food allergy prevention.

This article is protected by copyright. All rights reserved.

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Evaluation of nonablative fractional laser treatment in scar reduction

Abstract

Fractional lasers have been used for the improvement of scar tissue in the recent years but there has not been extensive research on their impact. The purpose of this study was to evaluate the efficacy of nonablative fractional laser (NAFL) on acne, burn, and surgery/traumatic scar. The scars were also categorized as atrophic, hypertrophic, and keloid, and treatment efficacy was investigated accordingly. This is a retrospective, single-center study. Scar tissues were treated using a nonablative fractional 1550-nm Erbium glass laser in high-energy parameters at 4-week interval for 4–8 sessions. The scar regression score (SRS) was used to determine the decrease in scar appearance. Forty-six patients with acne (n:18), burn (n:13), or surgery/traumatic (n:15) scar were included. The number of sessions was higher for burn patients while SRS in burn patients was lower than in patients with acne or a surgical/traumatic scar. Evaluation according to scar types showed that atrophic scars had a significantly better response to NAFL treatment. This study indicates that NAFL treatment with the high-energy parameters has better outcomes in atrophic acne scars, while the success rate is considerably low in post-burn and keloid scars.

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The Effect of Ondansetron on Acute Opioid Tolerance in Patients Receiving Intrathecal Opioids Prior to Cesarean Delivery.

Background: Multiple animal studies suggest that ondansetron ameliorates opioid-induced hyperalgesia and tolerance. In this study, we aimed to determine if the administration of ondansetron prior to spinal anesthesia would have an effect on intrathecal opioid-induced acute opioid tolerance, postoperative pain, and analgesic requirements in patients undergoing cesarean delivery with spinal anesthesia. Methods: Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (n = 44) or placebo (n = 42) in a prospective, double-blind design. All patients received spinal anesthesia consisting of 15 mg bupivacaine, 20 [mu]g of fentanyl, and 100 [mu]g of preservative-free morphine. We used linear mixed-effects models to assess the difference in pain and opioid consumption in the first 24 hours after surgery between the 2 groups. Results: No differences between the 2 groups were found in age, body mass index, American Society of Anesthesiologists physical status scores, duration of surgery, or sensory and motor block characteristics. There was no difference between the 2 groups in postoperative pain scores (P = 0.95) or opioid consumption (P = 0.68). Conclusions: In patients undergoing cesarean delivery under spinal anesthesia with intrathecal opioids, the administration of ondansetron prior to spinal anesthesia did not significantly affect postoperative pain scores or opioid consumption. Thus, the administration of ondansetron did not have an effect on acute opioid tolerance in our study. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Psoas Versus Femoral Blocks: A Registry Analysis of Risks and Benefits.

Background and Objectives: Psoas blocks are an alternative to femoral nerve blocks and have the potential advantage of blocking the entire lumbar plexus. However, the psoas muscle is located deeply, making psoas blocks more difficult than femoral blocks. In contrast, while femoral blocks are generally easy to perform, the inguinal region is prone to infection. We thus tested the hypothesis that psoas blocks are associated with more insertion-related complications than femoral blocks but have fewer catheter-related infections. Methods: We extracted 22,434 surgical cases from the German Network for Regional Anesthesia registry (2007-2014) and grouped cases as psoas (n = 7593) and femoral (n = 14,841) blocks. Insertion-related complications (including single-shot blocks and catheter) and infectious complications (including only catheter) in each group were compared with [chi]2 tests. The groups were compared with multivariable logistic models, adjusted for potential confounding factors. Results: After adjustment for potential confounding factors, psoas blocks were associated with more complications than femoral blocks including vascular puncture 6.3% versus 1.1%, with an adjusted odds ratio (aOR) of 3.6 (95% confidence interval [CI], 2.9-4.6; P

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Classification of the Residual Cranial Defects and Selection of Reconstruction Materials.

The cranial defects are complex in nature and are due to various causes. Therefore, there is a need for a common term of reference to these defects. This requirement stood as a prime reason for proposing a classification system for cranial defects. The classification is based on 2 decades of experience in cranioplasty. This efficient and simple way of representation would fill the existing lacunae for a systematic communication on cranial defects. Over the ages the evolution of reconstruction and grafting had undergone a massive progress. Therefore, it is essential to enumerate all available graft and bio-materials for restoring the cranial defects. The aetiology for these defects, age and sex of the patient, site and size of the defect, associated systemic conditions, cost factor, and operator's choice are the factors that play key role in the selection of the reconstructive material. This article discusses on these factors in cranioplasty. High success rate with excellent function and cosmetic outcome in using a variety of materials, as shared in this article. The advantages of autografts cannot be matched by any existing alloplast. However, in case of larger defects, for a better cosmetic outcome and to reduce the donor site morbidity, alloplasts are the most widely preferred material of choice. (C) 2017 by Mutaz B. Habal, MD.

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The Double Intravenous Catheter Technique for Single-Puncture Arthrocentesis.

Traditionally, arthrocentesis involves insertion of 2 needles into the joint space of which one acts as an inflow port and the other as the outflow port. These 2 needles must triangulate and be exactly placed in the upper joint space for the procedure to be effective. Due to the difficulty in maintaining the needle position, single-puncture arthrocentesis is gaining popularity. It is relatively easier to perform and less traumatic to the joint. The authors describe a simple technique of single-puncture arthrocentesis using parts of 2 peripheral intravenous catheters of different gauges. The outflow port is formed by the catheter tube of 1 cannula while the inflow port is formed by the needle of the second cannula. Besides beings easy to perform and cost-effective, our technique provides predictable joint lavage of the joint with minimal trauma to the tissues. (C) 2017 by Mutaz B. Habal, MD.

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Gummy Smile Correction Using Lingual Orthodontics and Augmented Corticotomy in Extremely Thin Alveolar Housing.

Background: Tooth movement out of anatomic limitations was assisted by augmented corticotomy using deproteinized bovine bone mineral. Methods: Lip protrusion can be reduced by premolar extraction followed by retraction of the anterior teeth. Surgical intervention is appropriate when the alveolar bone housing of the anterior region is insufficient for the tooth movement. In this patient, corticotomy in upper palatal area and anterior segmented osteotomy in the mandible were performed. Anatomic limitation to the retraction was expanded by xenograft. An antero-posterior lingual appliance was used to bodily retract the upper anterior teeth. The gummy smile was resolved by intrusion of upper entire arch using 2 mid-palatal temporary skeletal anchorage devices. Results: New bone formation was observed on palatal side of upper anterior teeth. The teeth were moved into augmented area without fenestration or vitality loss. Lip protrusion was resolved, and the gummy smile was effectively improved. Conclusions: Orthodontic tooth movement beyond the limitation of the alveolar bone housing can be achieved with surgical assistance, which can be performed under local anesthesia. Without orthognathic surgery, the gummy smile can be reduced using an antero-posterior lingual retractor with mid-palatal skeletal anchorage. (C) 2017 by Mutaz B. Habal, MD.

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Eyelid and Periorbital Surgery, Second Edition, edited by Mark A. Codner and Clinton D. McCord, Jr Boca Raton, FL: CRC Press, 2016.

No abstract available

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Evaluation of Protraction Face-Mask Therapy on the Craniofacial and Upper Airway Morphology in Unilateral Cleft Lip and Palate.

Introduction: The aim of the authors' study was to evaluate the effects of protraction face-mask therapy on the craniofacial and upper airway morphology in patients with unilateral cleft lip and palate (UCLP). Methods: Twenty-three growing UCLP patients (mean age: 8.3 + 2.4) were enrolled in the study group. Protraction face-mask in combination with Hyrax appliance was applied for the correction of anterior crossbite and maxillary insufficiency. Twenty-six patients with maxillary retrusion (mean age: 8.1 + 2.5) were evaluated as the control group. The pharyngeal airway morphology was assessed via the area measurements of upper airway structures on the lateral cephalometric radiographs. Results: The upper airway morphology was similar compared with the control group subjects at the beginning of the treatment. The pharyngeal airway area was increased significantly following the maxillary expansion and protraction. Nasopharyngeal area increased and the oropharyngeal area decreased significantly. There was an increase in the sagittal and vertical dimensions after the protraction therapy. Conclusion: The pharyngeal morphology in both UCLP patients and control group patients was similarly improved with the protraction face-mask therapy. (C) 2017 by Mutaz B. Habal, MD.

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Formation of the Philtral Column Using a Dermal Graft in Secondary Unilateral Cleft Lip.

Introduction: The philtral column has an important aesthetic significance and is especially important in patients with cleft lip. If the integrity of the philtrum cannot be preserved in patients of unilateral clefts, these patients will have profound abnormalities in their facial musculature. The purpose of this study was to analyze the effects of dermal grafting on the philtral column in patients with a unilateral alveolar cleft. Methods: The authors retrospectively studied dermal grafts performed in Konkuk University Medical Center between January 2009 and January 2015. A total of 26 patients with unilateral cleft lip were included in this study; the authors measured philtral symmetry based on differences in convexity and angle using clinical photos. Additionally, panel evaluation was performed. Results: Of 26 patients enrolled, 21 completed follow-up and had adequate photographs. Five patients who were lost to follow-up were excluded. The difference in convexity decreased from 0.25 to 0.15 (P

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Congenital Salivary Fistula From Parotid Main Gland.

Congenital parotid fistulas are extremely rare diseases. Herein, the authors report a patient with congenital salivary fistula from parotid main gland in a 15-year-old boy. Therefore, clinicians should consider the possibility of congenital parotid fistula form parotid main gland. Surgical excision of the fistula and parotid gland can be effective treatment option of congenital parotid fistula. (C) 2017 by Mutaz B. Habal, MD.

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Orbital Cellulitis Following Orbital Blow-out Fracture.

Orbital cellulitis and abscess have been described in the literature as complication that usually occur secondary to infection in the maxillary, ethmoidal, and frontal sinuses. If left untreated, it can lead to blindness, cavernous sinus thrombosis, meningitis, or cerebral abscess. Orbital fractures are a common sequela of blunt orbital trauma, but are only rarely associated with orbital cellulitis. So, the authors present rare orbital cellulitis after orbital blow-out fracture. A 55-year-old Asian complains of severe orbital swelling and pain on the left side. These symptoms had started 2 days earlier and worsened within the 24 hours before hospital admission resulting in visual disturbances such as diplopia and photophobia. Contrast-enhanced computed tomography scan showed considerable soft tissue swelling and abscess formation on the left side. Patient was subjected to surgical drainage under general anesthesia in the operation room. In this case, the postoperative period was uneventful and the rapid improvement of symptoms was remarkable. In conclusion, the abscess of the orbit is a surgical emergency in patients whose impairment of vision or ocular symptoms cannot be controlled with medical therapy using antibiotics. In our case, orbital cellulitis can occur after blunt orbital trauma without predisposing sinusitis. Early and prompt diagnosis and surgical drainage before severe loss of visual acuity rescue or recover the vision in case of orbital cellulitis. (C) 2017 by Mutaz B. Habal, MD.

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Subependymal Heterotopia Mimicking Mass in Conventional Magnetic Resonance Imaging: Demonstration With 3T Advanced Neuroimages.

The authors reported a rare patient with large subependymal heterotopia mimicking cerebral neoplasia. A 22-year-old female was admitted with a history of right-sided paresthesia accompanied by progressive headache. Cerebral magnetic resonance (MR) imaging showed a large solid lesion in the left frontal lobe. Advanced MR images proved that the lesion was compatible with subependymal heterotopia. Large subependymal heterotopia may mimick cerebral neoplasia. (C) 2017 by Mutaz B. Habal, MD.

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Transient Amaurosis and Diplopia After Inferior Alveolar Nerve Block.

A 40-year-old female patient was admitted to the authors' oral and maxillofacial clinic for removal of her lower left second molar under local anesthesia. The patient's medical history revealed that she had cardiac arhythmia and hypertension. Inferior alveolar nerve block was achieved using 2 mL of sefacaine (%3 mepivacaine HCL, without epinephrine). The patient complained of loss of vision in her left eye. All procedures were stopped immediately. Within 2 minutes the patient reported diplopia. All of the symptoms disappeared about 5 minutes after initial observation. Follow-up after 1 day revealed no complications. The procedure was then performed uneventfully. (C) 2017 by Mutaz B. Habal, MD.

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Physics and Histologic Evaluation of Rotary, Ultrasonic, and Sonic Instruments.

Rotary instruments (RIs) are the most commonly used to perform osteotomies in many fields of medicine. Owing to a new interest in performing a minimally invasive surgery, over last fifteen years new devices have been used in oral surgery such as ultrasonic instruments (UIs) and, lately, sonic instruments (SIs). Nowadays, bone preservation and regeneration are paramount in many clinical situations and, consequently, it is crucial to rely upon instruments, which cause the least tissue damage during the surgery. Concerning SIs, there is still few information about workload to be applied and related temperature increases; furthermore, there are no comparative in-vivo studies, which analyze the thermal and mechanical effects on bone. Thus, SIs have been compared with UIs and RIs in terms of heat generation, operating time, accuracy, and tissue damage. Decalcification and sectioning procedure resulted in no significant differences between the applied instruments in terms of bone damage. RIs resulted more efficient than UIs (P

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