Πέμπτη 24 Αυγούστου 2017
Re: Mandibular wing osteotomy: technical modification
Publication date: Available online 24 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D. Brusco
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Customised instrument to retract alveolar subperiosteal flap during the placement of dental implants: new technique
Publication date: Available online 24 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Ashwant Kumar Vadepally
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Use and Perceptions of Electronic Cigarettes Among Caregivers of Infants and Children with Bronchopulmonary Dysplasia
Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.
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Characterization of FaDu-R, a radioresistant head and neck cancer cell line, and cancer stem cells
Source:Auris Nasus Larynx
Author(s): Kwang-Jae Cho, Eun-Ji Park, Min-Sik Kim, Young-Hoon Joo
ObjectivesThe aim of this study was to evaluate the impact of CSC on insensitivity to radiotherapy in HNSCC.MethodsA radioresistant cell line, FaDu-R, was established using fractionated ionizing radiation. Cells with high and low CD44/ALDH activity were isolated.ResultsFaDu-R cells demonstrated significantly increased cell viability after radiation exposure compared with parental cells. CD44high/ALDHhigh FaDu-R cells demonstrated significantly faster wound closure (p<0.05) and more efficient invasion (p<0.05) compared to the CD44high/ALDHhigh FaDu cells or the CD44low/ALDHlow FaDu-R cells. There was a significant difference in tumor volume between the CD44high/ALDHhigh FaDu-R cells and the CD44high/ALDHhigh FaDu cells (p<0.05) as well as the CD44low/ALDHlow FaDu-R cells (p<0.05).ConclusionCancer stem cells (CSC) were associated with invasion and tumorigenesis in a radioresistant head and neck squamous cell carcinoma (HNSCC) cell line. This concept might help to improve the understanding of these mechanisms and to develop drugs that can overcome radioresistance during radiotherapy.
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Risk factors for the occurrence of epistaxis: Prospective study
Source:Auris Nasus Larynx
Author(s): Filipa Camacho Côrte, Tiago Orfao, Cláudia Camila Dias, Carla Pinto Moura, Margarida Santos
ObjectiveAnalyse and compare the characteristics of patients with epistaxis admitted to the otolaryngology emergency department with those provided by a control group. Establish a model to identify epistaxis predictive factors.MethodsProspective analysis of 283 consecutive adults, admitted to the otolaryngology emergency department of a tertiary referral centre between 25 January and 25 February 2014. Comparison of gender, age, co-morbidities, usual medication, history of epistaxis or nasal trauma, presence of septal deviation and blood pressure value on admission, between the elements that were admitted to the emergency due to epistaxis (group 1) and a group composed of patients with other symptoms (group 2). Intergroup variations were analyzed using t student and chi-square tests. Multivariate logistic regression and a receiver operating characteristic curve were used to establish a predictive model and test its suitability.ResultsMale gender (OR=2.57, 95% CI 1.1–6.0, p=0.029), older age (OR=1.03, 95% CI 1.0–1.1, p=0.002), existence of peripheral vascular disease (OR=13.47, 95% CI 1.9–95.3, p=0.009), cardiovascular disease (OR=3.91, 95% CI 1.6–9.7, p=0.003) and previous history of epistaxis (OR=5.53, 95% CI 2.5–12.1, p<0.001) were predictors of epistaxis when adjusted for the presence of elevated blood pressure, history of hypertension, cerebrovascular disease and chronic use of anticoagulants or antiplatelet drugs. The model revealed a good applicability (area under the curve of 0.852).ConclusionsThe only predictive factors of admission to the emergency department due to epistaxis were male gender, older age, peripheral vascular disease, cardiovascular disease and history of epistaxis.
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A case of ectopic salivary gland of the larynx
Source:Auris Nasus Larynx
Author(s): Shori Tajima, Kouichi Yamauchi, Ryuzaburo Higo, Katsuhisa Ikeda
A 46-year-old man presented with sore throat. Laryngoscopic findings revealed a smooth yellow mass occupying the anterior portion of the false vocal fold on the left side. The authors performed biopsy under general anesthesia. The histopathological diagnosis was ectopic salivary gland. Because salivary glands are usually not found under the false vocal fold mucosa, ectopic salivary gland of the larynx was diagnosed.It is necessary to consider the possibility of ectopic salivary gland for mass lesions if swelling of the provisional vocal cord is found.
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Characterization of FaDu-R, a radioresistant head and neck cancer cell line, and cancer stem cells
The aim of this study was to evaluate the impact of CSC on insensitivity to radiotherapy in HNSCC.
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Automated anesthesia delivery systems in cardiac surgical patients with left ventricular dysfunction: All systems go?
The interest in the use of automated drug infusion systems to deliver anesthesia has grown amongst both clinicians and researchers since their inception decades ago. Presently, two major types of automated anesthesia delivery systems exist, both of which have been used predominantly to deliver intravenous medications as part of a general anesthetic.
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Otolaryngic manifestations of Cushing disease
Edward C. Kuan, MD, MBA; Kevin A. Peng, MD; Jeffrey D. Suh, MD; Marvin Bergsneider, MD; Marilene B. Wang, MD
Abstract
Cushing disease is a relatively rare cause of Cushing syndrome secondary to a hyperfunctioning pituitary adenoma. In addition to signs and symptoms of hypercortisolism, Cushing disease may present with diverse otolaryngic manifestations, which may guide diagnosis and management. We performed a retrospective chart review of patients who were found to have Cushing disease and who underwent transnasal transsphenoidal surgery for pituitary adenomas between January 1, 2007, and July 1, 2014, at a tertiary academic medical center. There were 37 consecutive patients in this series with Cushing disease caused by a pituitary adenoma. Fifteen (41%) patients complained of visual changes. Five (14%) patients suffered from obstructive sleep apnea. Four (11%) patients had thyroid disease. Other symptoms included hearing loss, vertigo, tinnitus, epistaxis, dysphagia, and salivary gland swelling. Although Cushing disease traditionally presents with classic "Cushingoid" systemic features, it also may present with various otolaryngic manifestations. A thorough workup by otolaryngologists is critical in the comprehensive management of these patients.
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Comparison of clinical outcomes using a Piezosurgery device vs. a conventional osteotome for lateral osteotomy in rhinoplasty
Bulent Koc, MD; Eltaf Ayca Ozbal Koc, MD; Selim Erbek, MD
Abstract
Our aim for this study was to evaluate and compare the clinical outcomes in patients who underwent lateral osteotomy with a Piezosurgery device or a conventional osteotome in open-technique rhinoplasty. This cohort trial involved 65 patients (36 women and 29 men; average age: 23.6 ± 5.71 yr) who underwent surgery between May 2015 and January 2016. Piezosurgery was used for lateral osteotomy in 32 patients, whereas 33 patients underwent conventional external osteotomy. These 2 groups were compared for duration of surgery, perioperative bleeding, postoperative edema, ecchymosis, pain, and patient satisfaction on the first and seventh postoperative days. The Piezosurgery group revealed significantly more favorable outcomes in terms of edema, ecchymosis, and hemorrhage on the first day postoperatively (p < 0.001 for all). Similarly, edema (p = 0.005) and ecchymosis (p < 0.001) on the seventh postoperative day also were better in the Piezosurgery group. Hemorrhage was similar in both groups on the seventh postoperative day (p = 0.67). The Piezosurgery group not only experienced less pain on the first postoperative day (p < 0.001), but these patients also were more satisfied with their results on both the first and seventh postoperative days. Results of the present study imply that Piezosurgery may be a promising, safe, and effective method for lateral osteotomy, a critical step in rhinoplasty. The time interval necessary for the learning curve is counteracted by the comfort and satisfaction of both patients and surgeons.
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Use of sialendoscopy as an aid to identify a large retained foreign body
Christopher J. Britt, MD; David Hyman, MD; Gregory K. Hartig, MD
Abstract
We describe the novel use of sialendoscopy in a 51-year-old man to identify a large and long-standing foreign body (wood) within the facial soft tissues that had eluded detection on previous imaging and surgical exploration. The identification of this foreign body was elusive on both computed tomography and magnetic resonance imaging, illustrating the limitations of imaging in identifying vegetable matter within soft tissues.
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25 years of powered endoscopic transnasal sphenoidotomy
Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS; Eiji Yanagisawa, MD, FACS
Endoscopic transnasal sphenoidotomy requires good hemostasis in the operative field.
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A clinicopathologic and epidemiologic study of chronic white lesions in the oral mucosa
Sampurna Ghosh, MS; Sudipta Pal, MS; Soumya Ghatak, MS; Somnath Saha, MS; Surajit Biswas, MD; Prabha Srivastava, MD
Abstract
Invasive oral squamous cell carcinoma is often preceded by the presence of clinically identifiable premalignant changes of the oral mucosa, including white lesions. We conducted a cross-sectional, observational study to assess the clinicopathologic and epidemiologic aspects of chronic oral mucosal white lesions to determine the necessity of early biopsy in these cases. Our study population was made up of 77 patients-50 males and 27 females, aged 15 to 70 years (mean: 42.9)-who presented with white lesions persisting for at least 4 weeks. All but 3 patients underwent a biopsy; the 3 exceptions were diagnosed with smear-proven candidiasis. Patients with moderate or severe dysplasia underwent an excision biopsy. The buccal mucosa was the single most common site of white lesions, occurring in 15 patients (19.5%), although 21 patients (27.3%) exhibited a diffuse involvement of the oral mucosa. Of the 77 patients, 59 (76.6%) had concerning findings: premalignant lesions in 45 patients (58.4%) and malignant lesions in 14 (18.2%). Also, dysplasia was seen in 8 patients (10.4%), all of whom had premalignant lesions. Tobacco chewing (p = 0.008) and betel quid chewing (p = 0.029) were significantly associated with the development of premalignant and malignant lesions; a longer duration of tobacco chewing (≥10 yr) was significantly associated with a higher risk of malignant but not premalignant lesions (p = 0.031). Finally, illiteracy was a significant risk factor for premalignant and malignant lesions (p = 0.03). Our findings support the necessity of biopsy in every case. Early detection of oral carcinoma by biopsy of all oral white lesions would not only prevent patients from undergoing disfiguring surgery and chemoradiation, but it also would increase the 5-year survival rate.
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Modified two-handed transnasal endoscopic surgery: Innovative instrument design and an experimental canine study
Guodong Feng, MD; Zhiqiang Gao, MD; Xu Tian, MD; Yuan Zhuang, MD; Wei Lv, MD
Abstract
This study was conducted to design new instruments to solve the current issues of one-hand control and the obscuring of the endoscope by blood during transnasal endoscopic surgery. An endoscope holder and an electronically controlled irrigation-suction system were designed and manufactured. The feasibility and effectiveness of the designed instruments and operation models were verified in a model transnasal endoscopic surgery procedure performed on a mongrel dog. During the operation, one hand was used to perform the operation and move the endoscope, and the other hand was used for irrigation and suction to keep the surgical field and the endoscope clear. The combined use of an endoscope holder and an electronically controlled irrigation-suction system facilitates single-surgeon bimanual transnasal endoscopic surgery in a model surgical procedure. The clinical value of this technique warrants further research.
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Paresis podule on a paralyzed vocal fold
Karthik S. Shastri, MD; Aaron J. Jaworek, MD; Robert T. Sataloff, MD, DMA, FACS
Paresis podules are localized areas of Reinke edema that can develop on paretic or paralyzed vocal folds, or on the contralateral vocal fold.
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Nasal cavity tumefactive fibroinflammatory lesion mimicking recurrent mucoepidermoid carcinoma
Daniel Thomas Ginat, MD, MS; Elizabeth Blair, MD
The diagnostic imaging features of tumefactive fibroinflammatory lesions can mimic those of neoplasms.
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Cornelia de Lange syndrome: What every otolaryngologist should know
Michael J. Eliason, MD, USN, LCDR; Jonathan M. Melzer, MD, USN, LCDR; Thomas Q. Gallagher, DO, USN, CDR
Abstract
Cornelia de Lange Syndrome (CdLS) can be expressed in multiple organ systems requiring a variety of specialists, including pediatric otolaryngology. We present the case of a 20-month-old boy with CdLS actively managed by an aerodigestive team consisting of pediatric otolaryngology, pediatric pulmonology, pediatric gastroenterology, with support staff from audiology, speech, and nutrition. His presentation included mixed hearing loss, dysphagia, microaspiration, gastroesophageal reflux, and failure to thrive. We submit this challenging case of CdLS with a review of the literature to focus specific attention on the otolaryngic manifestations of the syndrome and to discuss the benefits of a multidisciplinary approach to these unique patients.
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An incidental thyroid nodule
John P. Flynn, MD; Peter A. Morawiecki, MD; Marco A. Ayala, MD
Preoperative diagnosis of intrathyroidal parathyroid adenomas is essential to determining correct surgical management
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Use and Perceptions of Electronic Cigarettes Among Caregivers of Infants and Children with Bronchopulmonary Dysplasia
Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.
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The Spectrum Of Oral Lesions Presenting Clinically With Papillary- Verrucous Features
Publication date: Available online 24 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Whitefield Sara, Raiser Vadim, Shuster Amir, Kleinman Shlomi, Shlomi Benjamin, Kaplan Ilana
PurposeTo study the spectrum of oral pathologies presenting clinically with papillary-verrucous features.Materials and Methods10-year retrospective study (2007 to 2016) of oral papillary lesions was undertaken. All biopsies which included a clinical description of papillary or verrucous architecture were retrieved. The data collected included clinical features, size, color, location, histopathological diagnosis age and gender.ResultsThe study included 137 patients, with a total of 151 lesions. The ages ranged from 10 weeks to 84 years (mean 49). Histopathologically, 60% of cases were HPV related, 19% showed hyperplasia, 11% hyperplastic candidiasis, 7% dysplastic or malignant and 3% benign of unknown etiology. Of the 7% diagnosed with dysplasia or malignancy, only 60% were suspected for malignancy at the time of biopsy.HPV-related lesions and hyperplasia were most frequently found on the tongue (38% and 41%) and soft palate (21 and 14%), respectively. Hyperplastic candidiasis was most frequent on the buccal mucosa and tongue (35 and 24%, respectively).1.3% of total lesions were found to be squamous cell carcinoma (SCC) and 1.3% verrucous carcinoma. 50% of the verrucous/papillary malignant lesions were found on the gingiva. Most malignant lesions occurred in the 40-60 age group.ConclusionThe results of this study suggest, that due to the wide spectrum of entities presenting clinically as papillary-verrucous architecture, biopsy is necessary for diagnosis. The clinical presentations allowed for overall accurate diagnosis in only 47% of cases and 60% accuracy in dysplastic or malignant cases. It is of significant importance to correctly identify those lesions which are HPV-related, but at the same time to rule-out those lesions which are unrelated to HPV, to help alleviate a patient's anxiety. Most importantly, biopsy is mandatory for recognition of the malignant lesions with a papillary verrucous architecture, which may mimic other benign entities in the group of papillary verrucous lesions.
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Biological effects of orthodontic tooth movement into the grafted alveolar cleft
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jian Sun, Xiaoyue Zhang, Renmei Li, Zhengxi Chen, Yuanliang Huang, Zhenqi Chen
ObjectiveFunctional stimulus as orthodontic tooth movement into the grafted bone can lead to better ABG outcomes. The aim of this study was to analyze the biological effects of orthodontic tooth movement in the grafted alveolar cleft area using histological staining, fluorescence staining, and Real-time PCR.MethodThe animal model of orthodontic tooth movement into the grafted alveolar cleft area was established in 8-week-old SD rats. Animals were divided into the experimental group and the control group. Four checkpoints were observed as follows: before orthodontic stimuli, day 1 after orthodontic stimuli, day 3 after orthodontic stimuli, and day 5 after orthodontic stimuli. The cleft bone formation conditions, including the collagen fibers and the activities of the osteoclasts and osteoblasts were evaluated by histological staining respectively. The expression of TRAP / RANKL / RUNX2 were detected by Real-time PCR in both groups.ResultHE staining showed that the remodeling process of iliac autografts was completed when the orthodontic stress was applied whilst the bone tissues first revealed osteoclastogenesis and then osteogenesis. On the basis of TRAP staining, the osteoclasts increased to the maximal amount on Day 3 before it decreased afterwards. Evidence from the tetracycline fluorescence staining indicated that no obvious changes in the osteoblast activity were detected at the early stage, however, it gradually increased, especially in the region close to the root surface. According to Real-time PCR, the expression of TRAP increased in both the early and middle stages, RANKL increased at the early stage while RUNX2 increased at the late stage. Moreover, the results revealed significant differences between the experimental and control groups.ConclusionOrthodontic tooth movement into the alveolar cleft bone graft area promoted bone remodeling of embedded bone, thus induced bone resorption and subsequent deposition.
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Definitive abutments placed at implant insertion and never removed: is it an effective approach? A systematic review and meta-analysis of randomized controlled trials
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Marco Tallarico, Martina Caneva, Silvio Mario Meloni, Erta Xhanari, Ugo Covani, Luigi Canullo
Purposeto assess whether repeated abutment dis/reconnections has any impact on peri-implant bone resorption and on soft-tissue healing.MethodsElectronic and manual searches were conducted for English articles published up to March 2017, to identify whether there is a relationship between repeated disconnections of implant abutments (PA group) and prosthetic/implant failures, complications, marginal bone loss (MBL), soft tissue healing and esthetic evaluation (PES), after at least 1 year of function, compared to implants receiving a final abutment at the time of implant placement (DA group).ResultsFourteen articles (535 patients with 994 implants) were selected in the qualitative analysis. Six of these were included in the meta-analysis. Five prosthesis failed in the PA group and one in the DA group (P=0.1047). Seven biologic complications were experienced in the PA group and six in the DA group (P=0.8121). MBL was statistically lower in the DA group (difference 0.279mm; P=0.000). Higher buccal recession was experienced in the PA group (difference 0.198mm; P=0.0004). The PES evaluation showed no differences between groups (P=0.289).ConclusionsRepeated abutment dis/reconnections significantly increased MBL and buccal recession. Further studies are needed to confirm these results.
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A comparison of clinical follow-up of different total temporomandibular joint replacement prostheses：a systematic review and meta–analysis
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Luxiang Zou, Dongmei He, Edward Ellis
BackgroundThere are different total TMJ prostheses on the market today but no comparison of the efficacy. The purpose of this meta-analysis was to evaluate the effectiveness of different temporomandibular joint replacement (TJR) systems.MethodsA systematic review and meta-analysis was performed using the Pubmed, Embase, Medline and Cochrane Library search engines in May 2017 to identify qualified studies. The outcome measures were the changes between the pre- and postoperative maximal incisal opening (MIO), the level of pain relief, diet limitations and function deficiencies. Analyses of heterogeneity, sensitivity and publication bias were performed. A fixed-effects model was used in the meta-analysis of pooled weighted mean difference (WMD) in the MIO pre- and post-operation, pain changes, diet changes and functional improvement.ResultTwenty studies with 1262 patients were included into the meta-analysis. There was no real difference in the comparison of MIO and pain, diet, function changes pre- and post-operation of three different brands of TJR systems. The MIO and function efficiency decreased gradually with time, but the effectiveness of pain relief and improvements in diet limitation were stable with no significant differences over the follow-up period. In the comparison of the custom and stock devices, both types of prostheses performed similarly in MIO, pain, function and diet changes between pre- and post-operation.ConclusionThe analysis showed that there was no significant difference in treatment outcomes among the different brands of TJR systems.
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Surgeon’s Guide to Facial Soft Tissue Filler Injections: Relevant Anatomy and Safety Considerations
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Elie M. Ferneini, Steven Hapelas, James Watras, Antoine M. Ferneini, Drew Weyman, Jenna Fewins
The purpose of this study is to provide a review of the relevant facial anatomy related to soft tissue filler injections. Facial fillers are used daily in our clinical practice. Although safe and predictable, adverse events do occur. Some of these dire events include vascular complications leading to blindness, ischemia, and even stroke. Proper knowledge and understanding of the anatomic landmarks can minimize the risk of these vascular events. Additionally, early recognition and treatment are necessary in order to prevent permanent complications.
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The Application of Real Time Surgical Navigation for Zygomatic Implant Insertion in Severely Atrophic Maxilla Patients
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Feng Wang, Michael M. Bornstein, Kuofeng Hung, Shengchi Fan, Xiaojun Chen, Wei Huang, Yiqun Wu
PurposeComputer-aided treatment technology has extended its applications to oral implantology. In this study, our initial clinical experience on the application of a commercially available navigation system (the VectorVision®) in zygomatic implant (ZI) insertion in severely atrophic maxilla was presented.Materials and MethodsIt was a retrospective longitudinal study. Eligible maxillary edentulous patients who were treated with ZI were enrolled. Treatment planning was performed on the computer based on previously obtained 3-dimensional imaging data. The surgical procedure was carried out under the guidance of a surgical navigation system. The outcome variable was safety and additional variables were ZI survival rate and radiological bone-to-implant contact (rBIC) area in the zygoma. Statistical analysis was performed with SPSS for Windows (Version 16.0, SPSS Inc., Chicago, IL, USA).ResultsA total of 15 patients (male: 8, female: 7; age: 30-69 y, average: 43±3.5 y) were eligible for the study and enrolled between May 2015 and September 2016. Of the included patients, 4 received one ZI on each side of the zygomatic bone and 2 to 4 standard implants in the edentulous anterior maxilla, and the other 11 received a ZI 'quad approach' without standard implant insertion. All ZIs were anchored in the site of the maxillary alveolar process and zygomatic bone, and no critical anatomical structure injuries occurred during insertion and post-operative radiographic examination. All ZIs that achieved osseointegration resulted in an overall survival rate of 100% after early healing. The overall rBIC area of ZIs in the study was between 4.1 mm and 24.7 mm with an average of 14.5± 4.6 mm.DiscussionFor the limited clinical cases treated in the study, our procedure for ZI placement was feasible and reliable with the guidance of the surgical navigation system. In addition, the potential risk of complications was minimized and ZIs were placed making the best possible use of the available bone volume.
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Are wireless electronic stethoscopes useful for respiratory rate monitoring during intravenous sedation?
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Keiko Morimoto, Yukako Tsutsui, Shin Ogura, Katsuhisa Sunda
PurposeWireless stethoscopes can measure the respiratory rate non-invasively and continuously, but there are no reports of their use during dental treatment. We aimed to evaluate the usefulness of wireless stethoscopes during dental procedures requiring intravenous sedation (IVS).MethodsThis study was a prospective cohort study. The study sample consisted of dental patients who received IVS via propofol or midazolam administration at Nippon Dental University Hospital. The predictor was BrRR (respiratory rate measured using wireless stethoscope), and the outcome variable was RR (respiratory rate measured during capnography). We used Pearson's correlation coefficients paired-samples t-tests for data analysis. P < 0.05 was considered statistically significant.ResultsThe study sample consisted of 12 patients. BrRR and RR were significantly positively correlated (r = 0.93, P < 0.01). The mean ± standard deviation of BrRR was 14.16 ± 2.67, and that of RR was 14.32 ± 2.77. There was no significant difference between the two groups (p = 0.27).ConclusionsThe results of this study suggest that wireless stethoscopes are suitable for monitoring the respiratory rate during dental procedures requiring intravenous sedation, as their use is as accurate as capnography.
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The correlation between periodontal health status and suspectibility to infections associated with craniomaxillofacial osteosynthesis plates
Publication date: Available online 24 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yahya Açil, Marie-Annett Heitzer, Aydin Gülses, Hendrik Naujokat, Rainer Podschun, Jörg Wiltfang, Christian Flörke
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Clinical study of splint therapeutic efficacy for the relief of temporomandibular joint discomfort
Publication date: Available online 24 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yoko Hasegawa, Naoya Kakimoto, Seiki Tomita, Masanori Fujiwara, Reichi Ishikura, Hiromitsu Kishimoto, Kosuke Honda
PurposeThis study aimed to evaluate the relationship between displacement of the mandibular condyle/disc due to occlusal splint insertion with splint therapy and changes in discomfort of the temporomandibular joint (TMJ), and to clarify the relationships between the outcomes over time of temporomandibular discomfort and TMJ magnetic resonance imaging (MRI) findings at the initiation of splint therapy.Materials and MethodsA total of 75 patients admitted to hospital with discomfort around the TMJ were evaluated. A visual analogue scale for TMJ discomfort was administered during visits for approximately 3 months following the initiation of splint therapy. At the start of splint therapy, magnetic resonance imaging (MRI) was performed with and without splint insertion, and condyle and disc movements were evaluated. Disc balance, disc position and function, disc configuration, joint effusion, osteoarthritis, and bone marrow were evaluated. Linear regression and multiple regression analyses were used to clarify relationships between changes in discomfort and the factors evaluated.ResultsThere was no significant correlation between TMJ discomfort and condyle/disc movement with splint insertion. TMJ discomfort was significantly relieved by splint therapy regardless of temporomandibular MRI findings. Unilateral anterior disc displacement and marked or extensive joint effusion fluid were significantly improved with splint therapy.ConclusionDiscomfort tended to remit with splint therapy regardless of temporomandibular MRI findings. Improvement of TMJ discomfort appears more likely to occur in patients with unilateral anterior disc displacement and with an apparent organic disorder, such as a joint effusion.
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Utility of Tc-99m MDP bone SPECT in evaluation of osseous involvement in craniofacial malignancies
Publication date: Available online 24 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Shabana Saeed, Saif-ul-Haq, Muhammad Sohaib, Ali Nawaz Khan
PurposeTo assess the role of technetium-99m methoxy diphosphonate (Tc-99m MDP) single photon emission tomography (SPECT) imaging for the detection of osseous invasion in craniofacial malignancies.Material and MethodsThe study was performed in 45 subjects using Tc-99m MDP (740 MBq). Out of 45 subjects, 30 were patients had different craniofacial malignancies, and 15 subjects who did not have any malignancy served as controls. Planar imaging was performed. Anterior, lateral and oblique lateral views of the skull were obtained. SPECT imaging was done taking 64 views of the skull in a 360° circular path, each 40 seconds with 128 × 128 matrices. Scans were visually interpreted using a score of 0, 1, and 2, representing a lesion as definitely absent, doubtful, and definitely present, respectively. Planar scans were compared with the SPECT images.ResultsBone SPECT detected more lesions as compared to planar bone scan and plain radiographs. SPECT was found to be superior to planar imaging and radiographs in the detection and efficient demonstration of the extent of osseous invasion of craniofacial cancer. Sensitivity was 100% for SPECT and 83.33% for planar bone scan.ConclusionSPECT imaging of the skull is a very beneficial complementary form of investigation in patients with craniofacial malignancies for the assessment of osseous invasion, particularly in tumors likely to invade the skull base.
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Acute hypopituitarism associated with periorbital swelling and cardiac dysfunction in a patient with pituitary tumor apoplexy: a case report
Pituitary tumor apoplexy is a rare clinical syndrome caused by acute hemorrhage or infarction in a preexisting pituitary adenoma. It typically manifests as an acute episode of headache, visual disturbance, men...
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Extensive intramuscular manifestation of sarcoidosis with initially missed diagnosis and delayed therapy: a case report
Sarcoidosis is a multisystemic granulomatous disorder, which in nearly all cases involves the lungs and other organs. Isolated forms of sarcoidosis within the muscles, but without lung involvement, are extreme...
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Association Between BKPyV Serotype I Antibody Level and Natalizumab-Associated Progressive Multifocal Leukoencephalopathy
Viral Immunology , Vol. 0, No. 0.
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Interactions Between Chronic Viral Infections and the Host Immune System
Viral Immunology , Vol. 0, No. 0.
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Therapeutic antibodies against cancer stem cells: a promising approach
Abstract
Monoclonal antibodies have been extensively used to treat malignancy along with routine chemotherapeutic drugs. Chemotherapy for metastatic cancer has not been successful in securing long-term remission of disease. This is in part due to the resistance of cancer cells to drugs. One aspect of the drug resistance is the inability of conventional drugs to eliminate cancer stem cells (CSCs) which often constitute less than 1–2% of the whole tumor. In some tumor types, it is possible to identify these cells using surface markers. Monoclonal antibodies targeting these CSCs are an attractive option for a new therapeutic approach. Although administering antibodies has not been effective, when combined with chemotherapy they have proved synergistic. This review highlights the potential of improving treatment efficacy using functional antibodies against CSCs, which could be combined with chemotherapy in the future.
http://ift.tt/2vjRX5E
Comparison of Output Volume Thresholds for Drain Removal After SLND
This randomized clinical trial compares 2 output volume thresholds for drain removal in patients undergoing selective lateral neck dissection for head and neck cancer.
http://ift.tt/2iu88LT
http://ift.tt/2iu88LT
Hearing Loss and Patient-Physician Communication
Communication is essential in the patient-physician relationship. A report published in 2001 by The Institute of Medicine highlighted that effective communication is necessary for patient-centered care because it facilitates knowledge transfer and shared decision making. What impact does hearing loss have on communication and health? The work of Lin et al and The Health ABC Study have examined the long-term effects on health with the association with dementia and cognitive decline. But what about the short-term effects?
http://ift.tt/2g9qWz8
http://ift.tt/2g9qWz8
Typographical Data Error in Abstract
In the Original Investigation titled "Objective and Subjective Measures of Simultaneous vs Sequential Bilateral Cochlear Implants in Adults: A Randomized Clinical Trial," published online June 22, 2017, a typographical data error occurred in the Results section of the abstract. For the difference of 0.9 dB, the upper limit of the 95% CI should have been reported as 4.4 dB, not −4.4 dB (ie, difference, 0.9 dB [95% CI, –3.1 to 4.4 dB], not [95% CI, –3.1 to –4.4 dB]). This article was corrected online.
http://ift.tt/2iu7Ww9
http://ift.tt/2iu7Ww9
Age-Related Hearing Loss and Communication Breakdown
This cohort study calculates baseline prevalence of communication breakdown in hospital and primary care settings among older adult patients reporting hearing loss.
http://ift.tt/2g8qUrl
http://ift.tt/2g8qUrl
Functional outcomes and quality of life after total laryngectomy with noncircumferential radial forearm free tissue transfer
Abstract
Background
The purpose of this study was to compare long-term functional and quality of life (QOL) outcomes after total laryngectomy with primary closure and those who underwent reconstruction with noncircumferential radial free forearm tissue transfer (RFFTT).
Methods
Sixty-seven patients were identified by chart review and underwent long-term follow-up using QOL surveys and standardized interviews.
Results
The RFFTT group had significantly higher rates of chemotherapy, gastric tube (G-tube) at surgery, and postoperative stricture. At follow-up, most patients (88%) had a tracheoesophageal prosthesis (TEP) and were using it as their primary communication method. Diet and swallowing outcomes were comparable and no one had a G-tube. Device life and TEP complications did not differ significantly. Only voice-related QOL differed significantly between the RFFTT group and those who had undergone total laryngectomy without adjuvant treatment.
Conclusion
Despite more extensive treatment, the reconstructed group achieved comparable outcomes to those who had undergone total laryngectomy with adjuvant treatment.
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Characterization of patients with suspected hypersensitivity to cervico-vaginal fluid
Abstract
Background
Allergic reaction to seminal plasma was described decades ago. In USA only tens of thousands women are estimated to be affected. Not only seminal plasma, but also cervico-vaginal fluid contains sex-restricted antigens, yet allergy to cervicovaginal fluid has never been reported in medical literature. We came to a suspicion that because immunologic tests required to prove such a diagnosis, allergy to cervicovaginal fluid has never been reported yet it is not uncommon.
Objective
The objective of this study was to use an Internet-based questionnaire to characterize the population of men with suspected hypersensitivity to cervico-vaginal fluid.
Methods
A questionnaire designed to cover localized and systemic symptoms of hypersensitivity reaction was made available via the Internet. Respondents with post-coital adverse reactions were invited to participate. Only respondents who presented with at least two symptoms suggestive to hypersensitivity to seminal plasma or cervicovaginal fluid and were negative for STI and known hypersensitivity reactions such as latex allergy were a subject for further analysis. Board-certified dermatologists were surveyed for seeing bona fide cases of cervicovaginal fluid hypersensitivity.
Results
We have identified 52 cases of suspected hypersensitivity to CVF. Both localized and systemic types of hypersensitivity were identified. A substantial number of dermatologists admitted to witnessing cases of hypersensitivity to CVF
Conclusion
Based on data from affected individuals as well as the opinions of dermatologists worldwide we believe that allergic reaction to cervicovaginal fluid is at least as common as seminal plasma allergy. However, remains unreported due to technical difficulties in diagnosis and dermatologists' disbelief in its actual existence.
This article is protected by copyright. All rights reserved.
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Correction to: Thyroid 2017;27:315–389. DOI: 10.1089/thy.2016.0457
Thyroid , Vol. 0, No. 0.
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Management of chronic spontaneous urticaria (CSU): a treat to target approach using a patient reported outcome
Treat-to-target therapy approaches are established for chronic diseases such as diabetes, hypertension, and more recently rheumatoid arthritis, resulting in improved patient outcomes. These approaches do not u...
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Case 26-2017: A 63-Year-Old Woman with Fever, Hypotension, and Hypoxemia
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Nestle Impact Advanced Recovery in Improving Surgery Recovery in Patients With Head and Neck Cancer
Condition: Head and Neck Carcinoma
Interventions: Other: Best Practice; Other: Laboratory Biomarker Analysis; Dietary Supplement: Nutritional Intervention
Sponsors: OHSU Knight Cancer Institute; National Cancer Institute (NCI)
Not yet recruiting - verified August 2017
http://ift.tt/2wARD6O
Interventions: Other: Best Practice; Other: Laboratory Biomarker Analysis; Dietary Supplement: Nutritional Intervention
Sponsors: OHSU Knight Cancer Institute; National Cancer Institute (NCI)
Not yet recruiting - verified August 2017
http://ift.tt/2wARD6O
Phase Ib/II of TG4001 and Avelumab in HPV16 Positive R/M Cancers and Expansion Cohort to Oropharyngeal SCCHN
Conditions: Head and Neck Squamous Cell Carcinoma; HPV Positive Oropharyngeal Squamous Cell Carcinoma; HPV-Related Carcinoma
Interventions: Biological: TG4001; Drug: Avelumab
Sponsors: Transgene; Merck KGaA; EMD Serono Research & Development Institute, Inc.; Pfizer
Not yet recruiting - verified August 2017
http://ift.tt/2xvMfyp
Interventions: Biological: TG4001; Drug: Avelumab
Sponsors: Transgene; Merck KGaA; EMD Serono Research & Development Institute, Inc.; Pfizer
Not yet recruiting - verified August 2017
http://ift.tt/2xvMfyp
Ptosis, miosis and cats
Horner's syndrome (HS) is caused by a disruption in the oculosympathetic pathway. Both congenital and acquired HS are unusual in children. Acquired HS can be caused by trauma, surgical intervention, tumours, vascular malformations or infection.
We describe the case of a 6-year-old boy who was brought to our emergency department with ptosis, miosis, painful cervical lymphadenopathy and a cat scratch on a hand. The diagnosis of a cat scratch disease was confirmed by serology. A full recovery was observed on antibiotic treatment and cervical lymphadenomegaly reduction 3 weeks later.
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The F0F1 ATP synthase regulates human neutrophil migration through cytoplasmic proton extrusion coupled with ATP generation
Source:Molecular Immunology, Volume 90
Author(s): Jun Gao, Tian Zhang, Zhanfang Kang, Weijen Ting, Lingqing Xu, Dazhong Yin
Cytoplasmic alkalinization and extracellular adenosine triphosphate (ATP) signals are required for migration of chemokineactivated neutrophils, but the precise functions remain unclear. In this work, the effect of the plasma membrane-expressed F0F1-ATP synthase (FATPase) on human neutrophils was examined. We found F-ATPase to be involved in cytoplasm proton extrusion and extracellular ATP generation. Oligomycin A, an F-ATPase inhibitor that blocks proton transfer, inhibited cytoplasmic alkalinization, extracellular ATP generation, adhesion and chemotaxis in N-formyl-Met-Leu-Phe (fMLP)-stimulated neutrophils; however, adenosine diphosphate (ADP), a substrate and activator of F-ATPase, had the opposite effect. Further analysis revealed that cell surface F-ATPase can translocate to the leading edge of directional fMLP-stimulated neutrophils toward ADP hydrolyzed from pannexin 1 channel-released ATP, followed by F-ATPase-catalyzed ATP regeneration using ADP and protons transferred from the cytoplasm. Therefore, the membrane-expressed F-ATPase regulates human neutrophil migration via cytoplasm proton extrusion and extracellular ATP generation.
http://ift.tt/2g7x2jt
Temporomandibular disorder: otologic implications and its relationship to sleep bruxism
Publication date: Available online 23 August 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Bruno Gama Magalhães, Jaciel Leandro de Melo Freitas, André Cavalcanti da Silva Barbosa, Maria Cecília Scheidegger Neves Gueiros, Simone Guimarães Farias Gomes, Aronita Rosenblatt, Arnaldo de França Caldas Júnior
IntroductionTemporomandibular disorder (TMD) is an umbrella term for various clinical problems affecting the muscles of mastication, temporomandibular joint (TMJ) and associated structures. This disorder has a multifactor etiology, with oral parafunctional habits considered an important co-factor. Among such habits, sleep bruxism is considered a causal agent involved in the initiation and/or perpetuation of TMD. That condition can result in pain otologic symptoms.ObjectiveThe aim of the present study was to investigate the relationship between temporomandibular disorder (TMD) and both otologic symptoms and bruxism.MethodsA total of 776 individuals aged 15 years or older from urban areas in the city of Recife (Brazil) registered at Family Health Units were examined. The diagnosis of TMD was determined using Axis I of the Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD), addressing questions concerning myofascial pain and joint problems (disk displacement, arthralgia, osteoarthritis and osteoarthrosis). Four examiners had previously undergone training and calibration exercises for the administration of the RDC/TMD. Intra-examiner and inter-examiner agreement was determined using the Kappa statistic. Individuals with a diagnosis of at least one of these conditions were classified as having TMD. The diagnosis of otologic symptoms and bruxism was defined using the RDC/TMD and a clinical exam.ResultsAmong the individuals with TMD, 58.2% had at least one otologic symptom and 52% exhibited bruxism. Statistically significant associations were found between TMD and both otologic symptoms and bruxism (p<0.01 for both conditions; OR=2.12 and 2.3 respectively). Otologic symptoms and bruxism maintained statistical significance in the binary logistic regression analysis, which demonstrated a 1.7 fold and twofold greater chance of such individuals have TMD, respectively.ConclusionThe logistic regression analysis demonstrated strong associations between TMD and both otologic symptoms and bruxism when analyzed simultaneously, independently of patient age and gender.
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Ethical and legal aspects in the care of singers and actors
Publication date: Available online 23 August 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Gustavo Polacow Korn, Carlos Michaelis, Vania Rosa Moraes
http://ift.tt/2v9koHe
Retro- and orthonasal olfactory function in relation to olfactory bulb volume in patients with hypogonadotrophic hypogonadism
Publication date: Available online 24 August 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Murat Salihoglu, Onuralp Kurt, Seyid Ahmet Ay, Kamil Baskoy, Aytug Altundag, Muzaffer Saglam, Ferhat Deniz, Hakan Tekeli, Arif Yonem, Thomas Hummel
IntroductionIdiopathic hypogonadotrophic hypogonadism (IHH) with an olfactory deficit is defined as Kallmann syndrome (KS) and is distinct from normosmic IHH.ObjectiveBecause olfactory perception not only consists of orthonasally gained impressions but also involves retronasal olfactory function, in this study we decided to comprehensively evaluate both retronasal and orthonasal olfaction in patients with IHH.MethodsThis case-control study was included 31 controls and 45 IHH patients. All participants whose olfactory and taste functions were evaluated with orthonasal olfaction (discrimination, identification and threshold), retronasal olfaction, taste function and olfactory bulb volume (OBV) measurement. The patients were separated into three groups according to orthonasal olfaction: anosmic IHH (aIHH), hyposmic IHH (hIHH) and normosmic IHH (nIHH).ResultsDiscrimination, identification and threshold scores of patients with KS were significantly lower than controls. Threshold scores of patients with nIHH were significantly lower than those of controls, but discrimination and identification scores were not significantly different. Retronasal olfaction was reduced only in the aIHH group compared to controls. Identification of bitter, sweet, sour, and salty tastes was not significantly different when compared between the anosmic, hyposmic, and normosmic IHH groups and controls. OBV was lower bilaterally in all patient groups when compared with controls. The OBV of both sides was found to be significantly correlated with TDI scores in IHH patients.Conclusion1) There were no significant differences in gustatory function between controls and IHH patients; 2) retronasal olfaction was reduced only in anosmic patients but not in orthonasally hyposmic participants, possibly indicating presence of effective compensatory mechanisms; 3) olfactory bulb volumes were highly correlated with olfaction scores in the HH group. The current results indicate a continuum from anosmia to normosmia in IHH patients.
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Treatment outcomes of recurrent respiratory papillomatosis
Abstract
Background
Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease of viral etiology which is characterized by multiple, recurrent growth of papillomas in the aerodigestive tract.
Materials and methods
The surgical outcomes and the recurrence rates of 106 patients with RRP of the larynx were analyzed. The patients were treated at the University of Magdeburg between 1983 and 2014. The surgical outcomes of conventional and laser surgery regarding time to relapse and complications were compared. In addition, the influence of the quadrivalent vaccine Gardasil® on the disease was analyzed in 10 patients.
Results
Children with RRP had a statistically significant greater number of surgeries throughout their lifetimes compared to adult patients. There were no differences between the adult (n = 79) and juvenile (n = 27) groups in the time to relapse and the number of surgeries/year. The time to relapse and number of procedures/year were not influenced by the various surgical methods. Complications after conventional and laser surgery were not statistically different between the two groups. Serious complications and the need for a tracheotomy were only reported after conventional surgery. In the 10 patients who were immunized with Gardasil®, a statistically significant lower number of surgeries/year after vaccination was achieved.
Conclusion
RRP is a rare disease. Treatment requires experience and may be very difficult. The analysis of the course of the disease has shown that the treatment of choice is surgical excision with the CO2 laser combined with the quadrivalent or polyvalent vaccine. Consequent vaccination of both boys and girls has the potential to reduce the occurrence of RRP.
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Case of steroid-responsive encephalopathy from hypoglycaemia
Hypoglycaemic encephalopathy is a feared complication in the management of patients with diabetes mellitus. We report on a 73-year-old woman with type 1 diabetes managed with an insulin pump who presented unresponsive after an inappropriate insulin bolus. The patient had minimal improvement in her neurological status over 8 days. After administration of 1 g intravenous methylprednisolone, she had dramatic neurological improvement including successful extubation and discharge from the intensive care unit. Steroid responsive encephalopathy is increasingly recognised in practice and literature. However, to the best of our knowledge, this is the first case of hypoglycaemic encephalopathy that responded to high-dose steroids.
http://ift.tt/2wqclFY
Primary renal echinococcosis with gross hydatiduria
Renal echinococcosis is a rare disease. It is usually asymptomatic but may present with pain, lump or in rare cases hydatiduria. Diagnosis is mainly by imaging but serology is usually false negative. We present a patient of renal echinococcosis who presented with passing of grape skin like structures in urine and was diagnosed to be a case of renal echinococcosis on the basis of positive serology, ultrasonographic and CT findings. The patient underwent a nephroureterectomy and was given albendazole preoperatively and postoperatively.
http://ift.tt/2w78v1O
Hepatic artery aneurysm: an unusual cause of upper gastrointestinal bleed
An 86-year-old woman presented to hospital with melaena. This was her third presentation with the same symptom. There was no obvious source of bleeding on her oesophagogastroduodenoscopy; however, it did show a previously clipped Dieulafoy lesion. CT angiography showed an aneurysm arising from the hepatic artery. Selective coeliac artery angiogram showed aneurysmal dilatation of the distal part of the coeliac trunk and confirmed the presence of the common hepatic artery aneurysm. The aneurysm was coiled by the interventional radiologist. Final angiogram showed good flow through the hepatic artery with obliteration of the inferior patch. The procedure was uncomplicated and the patient was discharged shortly afterwards.
http://ift.tt/2wq7jJr
Elephantiasis nostras verrucosa secondary to recurrent erysipelas
Description
A 79-year-old man presented with worsening lower leg oedema, nausea, prostration, fever and chills. He had history of several episodes of erysipelas during 10 years, chronic venous insufficiency and type 2 diabetes mellitus. Physical examination revealed lesions of a mossy and verrucose appearance, with exophytic and agglomerated lesions on the left lower limb (figure 1). The dermatological findings of epidermal thickening, lymphoedema and fibrosis of the dermis and subcutaneous tissue were consistent with the final stage of erysipelas in the rare form of elephantiasis nostras verrucosa (ENV). The patient received intravenous furosemide and heparin to control oedema and to prevent deep vein thrombosis and antibiotic therapy.
Figure 1
Detailed view of verrucose and exophytic lesions on the left lower limb of the patient.
ENV is a serious complication of chronic lymphoedema that causes progressive cutaneous hypertrophy.1 Lymphoedema, if left untreated,...
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Expression of neurotensin receptor 1 in endometrial adenocarcinoma is correlated with histological grade and clinical outcome
Abstract
The promalignant effects of neurotensin (NTS) are sustained in many solid tumors, including hormone-dependent cancers. As the endometrium is also subjected to hormonal regulation, we evaluated the contribution of NTS to endometrial carcinogenesis. Neurotensin receptor 1 (NTSR1) expression and NTSR1 promoter methylation (HM450) were analyzed in 385 cases of endometrial carcinoma from The Cancer Genome Atlas (TCGA). Additionally, from a series of 100 endometrial carcinomas, and 66 benign endometrium samples, NTS and NTSR1 labeling was evaluated by immunohistochemistry. Using TCGA series, NTSR1 messenger RNA (mRNA) level was negatively correlated with overall survival (OS) and progression-free survival (PFS) (p = 0.0012 and p = 0.0116, respectively), and positively correlated with the grade (p = 0.0008). When including only endometrioid carcinomas, NTSR1 mRNA level continued to be negatively correlated with OS (log-rank: p < 0.0001) and PFS (log-rank: p = 0.002). A higher NTSR1 mRNA level was significantly associated with a loss of NTSR1 promoter methylation. Immunohistochemical expression of NTS and NTSR1 was significantly increased in adenocarcinoma (n = 100), as compared to benign endometrium (p < 0.001). NTSR1 expression was positively correlated with grade (p = 0.004). High immunohistochemical expression of cytoplasmic NTSR1 was significantly correlated with a shorter OS and PFS (p < 0.001 and p = 0.001, respectively). This correlation remained significant when excluding non-endometrioid subtypes (p = 0.04 and p = 0.02, respectively). In multivariate analysis, the expression of NTSR1 was an independent prognostic factor (p = 0.004). NTSR1 overexpression is a poor prognostic factor in endometrial cancer, highlighting the contribution of NTS in endometrial cancer progression and its uses as a prognostic marker, and as a potential therapeutic target.
http://ift.tt/2vih09e
Emergency Operative Airway Techniques
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Tom Shokri, David Goldenberg
The Otolaryngologist-Head and Neck surgeon must be adept at providing assistance and intervening surgically in airway management when adequate ventilation becomes challenging. A step-wise and logical approach to airway emergencies can prevent poor outcomes. It is therefore important to have both a strong understanding of airway anatomy as well as an armamentarium of strategies or techniques in securing the airway if ones initial approach is problematic. The present article discusses several surgical approaches to the patient with a difficult airway.
http://ift.tt/2xuP2I5
Management of Parapharyngeal and Retropharyngeal Space Infections
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Jo-Lawrence Martinez Bigcas, Kunal Sudhir Jain
Deep neck space infection is a relatively common condition with potentially catastrophic, life-threatening complications. A detailed understanding of the topography of the neck, relationships between compartments of the neck, and the propagation of infection is essential for accurate assessment and formulation of a propitious and timely treatment plan. This chapter focuses on approaches to the deepest spaces in the anterior neck – the parapharyngeal space (PPS) and retropharyngeal space (RPS). Treatment starts with assessment and assurance of a safe, stable airway, broad spectrum intravenous antibiotics, and contrasted imaging to formulate a surgical plan. The PPS and RPS may be approached transorally or transcervically. Sound surgical principles, namely wide incision and dependent drainage, may prevent the further spread and associated morbidity.
http://ift.tt/2wAXetI
Endoscopic management of anterior and posterior epistaxis
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Kent Lam, Amber Luong, William C. Yao
The current management for epistaxis encompasses a wide variety of options that include pressure and intranasal decongestants, nasal packing, chemical and electrical cauterization, endovascular embolization, and surgical ligation of offending vessels. For episodes of epistaxis refractory to the more conservative measures, the use of the rigid endoscope has significantly increased the efficacy of therapeutic techniques by improving visualization of and access to intranasal bleeding sites. This review highlights the endoscopic approach to manage cases of severe epistaxis through direct cauterization, ligation of the sphenopalatine artery, and ligation of the anterior ethmoid artery.
http://ift.tt/2xuZbEv
Operative management of catastrophic bleeding in the head and neck
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Christopher Pool, Neerav Goyal
The otolaryngologist commonly performs several procedures in close proximity to the carotid and innominate arterial systems. In this chapter, we will discuss the management of catastrophic bleeding following adult tonsillectomy and tracheostomy, as well as the management of carotid blowout syndrome in head and neck cancer patients. While the bleeding risk from tonsillectomy is considered very low, the acceptance of transoral robotic surgery (TORS) as a treatment modality of oropharyngeal head and neck carcinomas makes the specter of catastrophic oropharyngeal bleeding more real. Aggressive resection in this area can leave minimal parapharyngeal fat over the carotid artery and damage from manipulation of smaller vessels can lead to pseudoaneurysms. Tracheostomy also carries a very low but real risk of trachea-innominate artery fistula which have devastating consequences. Finally, we will discuss how to identify head and neck cancer patients who are at-risk for carotid blowout syndrome as well as appropriate interventions to manage this condition.
http://ift.tt/2wAGz9D
Pediatric Airway Foreign Body
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Stephanie E. Ambrose, Nikhila P. Raol
Foreign body aspiration in the pediatric population is a potentially life-threatening emergency that carries both diagnostic and management challenges. Children often present after a witnessed aspiration or choking event. For those children who are asymptomatic or have nonspecific findings, clinical symptoms, chest radiography and a thorough physical examination are critical for diagnosis. A reasonable suspicion of foreign body aspiration warrants a bronchoscopy. This article focuses on the management of pediatric airway foreign bodies, including the initial evaluation, preparation and treatment approach.
http://ift.tt/2xv6VWZ
Bleeding After Tonsillectomy
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Zi Yang Jiang
Oropharyngeal hemorrhage after tonsillectomy is one of the most common post-procedural ENT emergencies which require immediate attention. Management choices depend on the severity of bleeding, underlying platelet/coagulation disorders, and the patient′s maturity and age. Treatment range from simple observation to an emergent need to both secure the airway and stop the hemorrhage. The work up of the hemorrhagic patient will be discussed from the pre-operative to post-operative time period. Surgical techniques in response to various acuity will be discussed to fully elucidate options to control the hemorrhage.
http://ift.tt/2wAtgGm
Coalescent Mastoiditis
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Tanner Fullmer, Alex D. Sweeney
Coalescent mastoiditis occurs as bone is remodeled and resorbed from pressure necrosis, inflammation, and increased osteoclastic activity in the setting of an acute otologic infection. This finding necessitates treatment with antibiotics and surgery, which typically involves pressure equalizing tube placement and mastoidectomy. Herein, we review diagnostic and treatment considerations as well as surgical technique in the management of acute coalescent mastoiditis.
http://ift.tt/2xuZ9MT
Epinephrine use as a measure of successful food allergy management
Source:Journal of Allergy and Clinical Immunology
Author(s): Lara S. Ford, Briony K. Tyquin, Margot J. Treloar, Alyson M. Kakakios, Dianne E. Campbell
http://ift.tt/2w6Xy0r
Reply
Source:Journal of Allergy and Clinical Immunology
Author(s): Lisa M. Bartnikas, Michael C. Young, Wanda Phipatanakul
http://ift.tt/2wqtpM5
Methotrexate, but not narrowband ultraviolet B radiation, suppresses interleukin-33 mRNA levels in psoriatic plaques and protein levels in serum of patients with psoriasis
Abstract
Interleukin (IL)-33 can function both as a conventional cytokine and as a nuclear factor regulating gene transcription. IL-33 expression is strongly upregulated in the nucleus of keratinocytes and serum of patients with psoriasis. However, the role of IL-33 in psoriasis is unclear, and IL-33 expression in the lesional psoriatic skin after conventional systemic treatments has not been investigated. In this study, we aimed to compare IL-33 mRNA in patients' lesional skin samples and IL-33 protein expression in patients' serum before and after treatment with methotrexate (MTX) and narrowband ultraviolet B (NB-UVB). IL-33 mRNA levels in lesional skin and IL-33 protein levels in serum were downregulated after treatment with MTX. Results revealed a significant decrease in IL-33 protein expression (P = 0.028). IL-33 expression increased after NB-UVB treatment. IL-33 production is associated with inflammatory skin in psoriasis, possibly through its cytokine function. However, high expression of IL-33 after NB-UVB treatment suggests the occurrence of unknown functions to alleviate psoriatic lesions without IL-33 involvement.
http://ift.tt/2wqdWeU
Disseminated cutaneous Mycobacterium kansasii infection presenting with Rosai–Dorfman disease-like histological features in a patient carrying anti-interferon-γ autoantibodies
Abstract
Typical cutaneous non-tuberculous mycobacteria (NTM) infections show a histopathology pattern of granulomas with admixed Langhans giant cells, and abscesses may be observed in acute lesions. Herein, we describe a patient carrying a high titer of autoantibodies to interferon (IFN)-γ with disseminated Mycobacterium kansasii infection presenting with emperipolesis and Rosai–Dorfman disease (RDD)-like histopathological features characterized by remarkable, large, pale-staining "RD cells", which were CD68 and S100 positive and CD1a negative. The patient was misdiagnosed with RDD initially, but exhibited a poor response to all interventions. A re-biopsy revealed Langhans-type multinucleated giant cells; multiple definite acid-fast bacilli were also found. M. kansasii was isolated from cultured tissues. Anti-NTM treatment was initiated. After treatment, all lesions resolved almost completely within the following month. High-titer anti-IFN-γ autoantibodies were detected during follow up, leading to the diagnosis of adult-onset immunodeficiency syndrome. In conclusion, patients carrying high-titer autoantibodies to IFN-γ who also have a disseminated cutaneous M. kansasii infection may present with RDD-like histopathological features, which may be a pitfall in the diagnosis of disseminated cutaneous NTM infections.
http://ift.tt/2w6Xeic
New photobiomodulation protocol prevents oral mucositis in hematopoietic stem cell transplantation recipients—a retrospective study
Abstract
Oral mucositis (OM) is an adverse side effect among hematopoietic stem cell transplantation (HSCT) recipients. The objective of this retrospective study was to evaluate the preventive effect of photobiomodulation (PBM) applied three times per week versus seven times per week in patients undergoing HSCT. The risk factors related to the incidence and severity of OM were also assessed. This was a retrospective study that evaluated 99 HSCT recipients who received different PBM protocols. Group I received three sessions per week, and group II received daily treatment. PBM was applied using a continuous-wave diode laser (InGaAlP; MM Optics, São Carlos, SP, Brazil) at a wavelength of 660 nm (visible-red) and a total radiant energy of 0.24 J per point. The baseline disease, type of transplant, type of conditioning, prophylaxis against graft-versus-host disease, OM grade, absolute leukocyte and platelet counts, and levels of liver and renal function markers were collected from medical records. The patients' age ranged from 13 to 71 years (mean/SD, 40.54 ± 16.45). No significant difference was observed between groups I and II regarding sex, age, ethnic, diagnosis, donor type, and conditioning treatment. Both PBM protocols were equally efficient in preventing OM (p = 0.34, ANOVA). Independent of the PBM protocol used, patients who received allogeneic transplant (p < 0.01—Fischer's exact test), total body irradiation (TBI-12Gy) (p = 0.01—chi-square test), busulfan + cyclophosphamide (p < 0.01—chi-square test), or methotrexate-containing regimens (p < 0.01—Fischer's exact test) demonstrated higher OM incidence and severity. Myelosuppression (p < 0.01—Mann-Whitney test) and impaired renal function (p = 0.02—Mann-Whitney test) were also considered risk factors for OM. Based on this retrospective data, PBM was effective in preventing OM in patients undergoing HSCT even when it was applied three times a week. A prospective study might be necessary to confirm these findings.
http://ift.tt/2xvhQAi
cDNA microarray analysis of human keratinocytes cells of patients submitted to chemoradiotherapy and oral photobiomodulation therapy: pilot study
Abstract
Oral mucositis is an acute toxicity that occurs in patients submitted to chemoradiotherapy to treat head and neck squamous cell carcinoma. In this study, we evaluated differences in gene expression in the keratinocytes of the oral mucosa of patients treated with photobiomodulation therapy and tried to associate the molecular mechanisms with clinical findings. From June 2009 to December 2010, 27 patients were included in a randomized double-blind pilot study. Buccal smears from 13 patients were obtained at days 1 and 10 of chemoradiotherapy, and overall gene expression of samples from both dates were analyzed by complementary DNA (cDNA) microarray. In addition, samples from other 14 patients were also collected at D1 and D10 of chemoradiotherapy for subsequent validation of cDNA microarray findings by qPCR. The expression array analysis identified 105 upregulated and 60 downregulated genes in our post-treatment samples when compared with controls. Among the upregulated genes with the highest fold change, it was interesting to observe the presence of genes related to keratinocyte differentiation. Among downregulated genes were observed genes related to cytotoxicity and immune response. The results indicate that genes known to be induced during differentiation of human epidermal keratinocytes were upregulated while genes associated with cytotoxicity and immune response were downregulated in the laser group. These results support previous clinical findings indicating that the lower incidence of oral mucositis associated with photobiomodulation therapy might be correlated to the activation of genes involved in keratinocyte differentiation.
http://ift.tt/2wAoPLJ
Piezoelectric vibrator-stimulated potential and heart rate accelerations detected from the fetus
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Rina Matsuoka, Sinyoung Lee, Miho Sato, Remi Hibiya, Yota Shimanuki, Misato Kasai, Kazusaku Kamiya, Atsuo Itakura, Takuji Koike, Katsuhisa Ikeda
ObjectivesThe fetus is well known to have a substantial capacity for sound recognition in the uterine environment. The aim of this study was to develop a sound stimulus system equipped with a piezoelectric vibrator (PV), record the PV-stimulated potential (PVSP) of the fetus and monitor changes of the fetal heart rate (FHR) under PV stimulation.MethodsThe relationship between the input voltage applied to a piezoelectric vibrator and the sound pressure generated in the uterus was calibrated based on a model of the maternal abdomen. Fourteen fetuses for the measurement of the PVSP and 22 fetuses for the measurement of the heart rate changes from low-risk pregnant women were recruited.ResultsThe PVSP responses were obtained in 9 out of 14 fetuses. All the tested fetuses accelerated the FHR after the 2 kHz tone stimulation at 70 dB intensity generated by PV from 32 to 37 weeks gestational age.ConclusionsUsing a newly developed sound stimulus system equipped with PV, the electric responses of a fetus recorded from electrodes placed on the mother's abdomen may be closely related to the auditory evoked response. Significant accelerations of FHR were objectively, accurately and readily obtained after the sound stimulation.
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Paediatric endonasal dacryocystorhinostomy using an otology set: How I do it
Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Hetal Marfatia, Keya Shah, Asmita Madhavi, Yogesh Parmar
IntroductionEndonasal DCR is safely performed in children presenting with persistent epiphora, not responding to conservative management. The surgical technique of endoscopic DCR in the paediatric age group essentially remains the same as that performed in adults, but children have narrower nasal passages and relatively larger inferior turbinates which limit the surgeon's working space. The standard 2.7 mm paediatric nasal endoscope gives a smaller surgical work field as compared to the 4 mm adult endoscope. Hence, we have used the otology set of instruments for performing endoscopic DCR in children to allow the negotiation of a wider 4 mm scope which gives a larger field of surgery and better illumination.Materials and methodsIt is a prospective study of 23 children done over the last 5 years at our tertiary care hospital. We have successfully used this less invasive technique of endoscopic dacryocystorhinostomy who didn't respond to conservative management.ResultsThe overall success rate was 95.65% without any major complications.ConclusionUsing the fine delicate otology set for endonasal DCR is advantageous as it not only allows the use of a 4 mm endoscope but also allows the surgeon to perform a more meticulous surgery by preventing unnecessary mucosal abrasions and creation of raw areas thereby improving surgical outcome. It thus combines a high success rate with a lesser invasive technique. At the same time, it is important to have an experienced surgeon due to the variable anatomy and technical accuracy required in children.
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Transtympanic pseudoaneurysm of the internal carotid artery complicating a myringotomy in a four-year old child: Case report and literature review
Publication date: Available online 24 August 2017
Source:American Journal of Otolaryngology
Author(s): Damien Bonnard, Erwan de Monès, Thomas Sagardoy, Valérie Franco-Vidal, Vincent Darrouzet, Sylvestre Fierens
We report the first case of a transtympanic iatrogenic internal carotid artery (ICA) pseudoaneurysm diagnosed in a 4-year-old child following a myringotomy. An endovascular treatment with a covered-stent was decided; spontaneous thrombosis was found during the therapeutic arteriography, and the procedure was aborted. Otoscopy and computed tomography (CT) scan monitoring showed a prolonged thrombosis and the disappearance of the pseudoaneurysm 18months after the diagnostic arteriography. Based on literature review, endovascular techniques seem to be preferred to the surgical approach for treatment of intrapetrous ICA pseudoaneurysm, however clinical and CT scan monitoring may also be a valid option.
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Analysis of Orbital Volume Measurements Following Reduction and Internal Fixation Using Absorbable Mesh Plates and Screws for Patients With Orbital Floor Blowout Fractures.
Introduction: Hinge-shaped fractures are common type of orbital floor blowout fractures, for which reduction and internal fixation is ideal. Nonetheless, orbital floor reconstruction using alloplastic materials without reducing the number of bone fragments is the most frequently used procedure. Therefore, this study analyzed and compared the outcomes between open reduction and internal fixation using absorbable mesh plates and screws, and orbital floor reconstruction, by measuring the orbital volume before and after surgery. Method: Among patients with orbital floor blowout fractures, this study was conducted on 28 patients who underwent open reduction and internal fixation, and 27 patients who underwent orbital floor reconstruction from December 2008 to September 2015. The mechanism of injury, ophthalmic symptoms before and after surgery, and the degree of enophthalmos were examined; subsequently, the volumes of the affected and unaffected sides were measured before and after surgery based on computed tomography images. This study compared the degree of recovery in the correction rate of the orbital volume, ophthalmic symptoms, and enophthalmos between the 2 groups. Result: The patients who underwent open reduction and internal fixation, and the patients who underwent orbital floor reconstruction showed average correction rates of 100.36% and 105.24%, respectively. Open reduction and internal fixation showed statistically, significantly superior treatment outcomes compared with orbital floor reconstruction. The ophthalmic symptoms and incidence of enophthalmos completely resolved in both groups. Conclusion: For orbital floor blowout fractures, open reduction and internal fixation using absorbable mesh plates and screws was a feasible alternative to orbital floor reconstruction. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2xeniYF
http://ift.tt/2xeniYF
The New Anatomical Classification System for Orbital Exenteration Defect.
Background: The unique anatomy of the orbita and the different behavior of each malignant tumor cause us to perform the various types of orbital exenteration that yields to varying defect each of which has own specific demands in terms of the reconstruction. Current classification of orbital exenteration defects seems not to be adequate to provide detailed description. This study reviews 50 exenteration defects to offer a more effective anatomical classification system. Methods: Over a 15 years period, 50 orbital exenteration defects in 47 patients were reconstructed. Defects were categorized according to the resected orbital wall, dura, and ethmoid resection. If the maxillectomy was performed, A or B was added to define the type of maxillectomy as partial (intact palate) or total maxillectomy, respectively. According to these criteria, 4 types of defect patterns were determined including Type 0 (n = 5) with intact orbital wall, Type I (n = 9) with sino-orbital fistula, Type II (n = 4) with crania-orbital fistula with intact dura, Type III (n = 6) with crania-orbital fistula associated with dura defect, and Type IV (n = 8) with cranio-nasal-orbital fistula. There were 12 partial (A) and 6 total maxillectomy (B) defects along with the orbital exenteration. Results: There was no major complication except one. The minor wound-healing problems occurred in 7 patients. Nine patients (19%) used prosthesis. Twenty-two (46.8%) patients chose a patch to cover the area. The remaining 16 patients were not able to use any type of prosthesis because of the reconstruction methods. Conclusion: The authors believe that the authors' anatomical classification system provides more precise description of the defect which eventually enhances the success rate of both reconstruction and resection. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2xf97Tm
http://ift.tt/2xf97Tm
An Epithelioid Hemangioendothelioma of the Head and Neck.
An epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of the head and neck region, which carries a risk of recurrence and metastasis. Its etiology is still unclear. It frequently involves the lungs, liver, and bones. Rarely, it may manifest in other parts of the body. Pathologic immunohistochemical investigations are essential to make the definite diagnosis. As it is uncommon, there is no standardized protocol for the treatment of EHE. Herein, the authors report a rare patient with of an EHE localized in the head and neck region. (C) 2017 by Mutaz B. Habal, MD.
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http://ift.tt/2w0x0iX
Differential Diagnosis Between Nasal Septal Schwannoma and Nasal Septal Neurofibroma.
Recently, as the authors experienced nasal septal schwannoma and nasal septal neurofibroma with similar clinical symptoms but different endoscopic findings, the authors tried to review all the literatures previously reported on the "Nasal septal schwannoma and Nasal septal neurofibroma." The aim of this study is to thoroughly review previously reported patients with nasal septal schwannomas and neurofibromas and to describe similar and different features focusing on the differential diagnosis between the 2 entities. On the basis of our review, the authors made some important conclusions. First, benign peripheral nerve tumors originating from the nasal septum are uncommon. Especially, nasal septal neurofibroma is extremely rare that only 5 patients were reported. So, more clinical reports of benign peripheral nerve tumors are necessary to elucidate the differences between nasal septal schwannoma and nasal septal neurofibroma. Second, there are some similar features between nasal septal schwannoma and nasal septal neurofibroma such as clinical symptoms, endoscopic findings, and treatment strategy. However, since there seem to be some differences in nasal endoscopic findings, they may be helpful for the provisional diagnosis, and so more patients should be reported to verify that point. Third, image study, especially magnetic resonance imaging (MRI), is considered to be a useful tool for differential diagnosis of benign peripheral nerve tumors originating from the nasal septum. So, more clinical reports reporting MRI findings are needed to verify the differences. Last, because of distinctive histologic appearances of benign peripheral nerve tumors, it is usually not difficult to make the distinction between nasal septal schwannoma and nasal septal neurofibroma. However, immunohistochemical stains including S-100 protein, calretinin, CD 34, factor XIIIa, and CD56 are necessary when it is difficult to differentiate between 2 disease entities. (C) 2017 by Mutaz B. Habal, MD.
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http://ift.tt/2xeT0oW
Three-Dimensional Analysis of Midfacial Soft Tissue Changes After Maxillary Posterior Impaction and Intraoral Vertical Ramus Osteotomy for Mandibular Setback in Class III Patients.
This study investigated the correlation between the 3-dimensional changes in midfacial soft tissues, including the parasagittal area and maxilla-mandible complex, after Le Fort I maxillary posterior impaction and bilateral intraoral vertical ramus osteotomy (B-IVRO), using cone-beam computed tomography (CBCT). This retrospective study included 22 skeletal Class III patients (6 men and 16 women; mean age 21.6 years) who underwent orthognathic surgery. Three-dimensional CBCT images taken before and 1 year after surgery were superimposed based on the cranial base. Midfacial soft tissues, including those in the parasagittal area (paranasal area, anterior cheek area, lateral cheek area) and midsagittal areas of the face, were evaluated using reconstructed CBCT images. Correlations and the ratios between soft tissue and hard tissue movement were calculated. After surgery, both paranasal areas showed significant forward movement (about 2.0 mm) and the largest upward movement (about 0.15 mm) among the 3 areas. The paranasal areas moved forward with a ratio of 0.5, according to vertical movement of B. Orthognathic surgery using Le Fort I maxillary posterior impaction with B-IVRO mandibular setback results in forward movement of midfacial soft tissues, even though sagittal movement of the maxilla is limited because facial muscles and retaining ligaments pull the redundant soft tissues, which are caused by vertical movement of the maxilla-mandible. This midfacial soft tissue change with maxillary posterior impaction could be advantageous to patients who have paranasal depression and protrusion of the upper lip owing to proclined upper incisors, which are prevalent among Asian Class III patients. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2vZJS8Y
http://ift.tt/2vZJS8Y
Esophageal Stricture in a Child With Habit of Acidic Drinks.
A 12-year-old boy with Down syndrome referred to the authors' department with dysphagia and growth retardation. Dysphagia was especially with solid foods and had a 12-month history. When he was 7, he had started to drink Coke and from that time he had a Coke drinking habit. Every day he was drinking more than 2 L Coke and was eating meals in small amounts. Investigations of the patient revealed esophageal stricture related to acidic drink habit and gastro-oesephageal reflux. The patient was treated with recurrent bouginage, antireflux medication, and nutrional support. The patient became symptom free from 13 months and gained weight. The clinicians should take the nutrition habits into consideration when evaluating the esophageal stricture patients. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2xey69j
http://ift.tt/2xey69j
Prediction of Late Enophthalmos Using Preoperative Orbital Volume and Fracture Area Measurements in Blowout Fracture.
Enophthalmos caused by orbital volume expansion is the traditional indication for blowout fracture operation, but it may not appear immediately after orbital trauma due to periorbital swelling. The purpose of this study was to investigate the correlations of the orbital volume ratio (OVR) and, orbital fracture area (OFA) with the late enophthalmos measurement in unilateral pure blowout fracture. Seventy-two patients who had experienced a blowout fracture were divided into 2 groups, the conservative treatment group (n = 40) and the operative treatment group (n = 32). The authors measured the preoperative OVR and OFA using three-dimensional facial bone computed tomography and investigated their relationship with late enophthalmos that obtained 6 months after orbital trauma. In both conservative and operative groups, there were significant positive correlations between the OVR and OFA (P
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http://ift.tt/2w0mWGO
Open Versus Closed Reduction of Maxillary Fractures: Complications and Resource Utilization.
Introduction: Maxillary fractures are frequently managed depending on the surgeon's preferences, nature of the injury, presence of associated injuries, and comorbidities. Current literature advocates open reduction with plating versus closed techniques. However, data defining associated costs and complications comparing the 2 approaches remains lacking. Methods: National Inpatient Sample (2006-2011) was examined for patients undergoing closed or open (76.73-76.74) reduction of maxillary fractures. Treatment-related complications were regarded as re-exploration of surgical site, hemorrhage, hematoma, seroma, wound infection, and dehiscence. Results: Overall, 22,157 patients were identified. There were 18,874 closed and 3283 open procedures. Median age was 35 (interquartile range 27). Median length of stay (LOS) was 4 days. Median total charges were reported as 51486.80 USD. Males comprised 77% of the cohort. 68% of patients were Caucasian. Private payer/HMO accounted for the largest source of health care coverage (43.5%). On risk-adjusted multivariate analysis, there was no difference in surgical approach regarding incidence of postoperative complications. Males (2.73), nonprivate insurer payer (P = 0.002), South region (2.49), and transferred patients (2.55) had higher incidence of complications. Presence of chronic pulmonary disease (2.87) and coagulopathy (6.62) also increased risk of complications. Length of stay was shorter for open reduction (0.68) versus closed. Total charges were also less for open approach (0.37). Conclusion: While surgical approach did not affect complications, open approach favorably affected LOS and total charges. Future studies should focus on comorbidities, demographics, and associated injuries in relation to resource utilization for maxillary fractures. In current economic environment, such information might further dictate management options. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2xeFuBq
http://ift.tt/2xeFuBq
Anatomical Relationship of the Inferior Bundle of the Incisivus Labii Inferioris With the Depressor Labii Inferioris and the Platysma.
The current study examined the inferior bundle of the incisivus labii inferioris muscle (ILI) and its morphologic and spatial relationships with regard to the depressor labii inferioris muscle (DLI) and the platysma. Incisivus labii inferioris muscles and their inferior bundles were investigated in 50 specimens from embalmed Korean adult cadavers. The inferior bundle of the ILI was divided from the originating fibers of the ILI, and it was present in all specimens (100%). The inferior bundle of the ILI could be distinguished into the transverse and inferolateral slips according to their courses and locations. The inferior bundle of the ILI was classified into 3 types according to the presence of the transverse and inferolateral slips. In Type I (44%), the inferior bundle of the ILI had both the transverse and inferolateral slips. In Type II (48%), the inferior bundle of the ILI had only the transverse slip. In Type III (8%), the inferior bundle of the ILI had only the inferolateral slip. The transverse and inferolateral slips were usually attached to the deep fibers of both the platysma lateral to the DLI and the lateral portion of the DLI via aponeurosis, just below the ILI and above the inferior margin of the mandible, respectively. The new anatomical findings of the present study might contribute to the understanding of the detailed movements required to raise the lower lip. This knowledge will be useful for botulinum toxin type A therapies, various facial surgeries, orthodontic treatment, and electromyographic analyses in this area. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2w0tPb9
http://ift.tt/2w0tPb9
Line Laser as an Assistance for Facial and Dental Midlines Evaluation in Single-Splint Orthognathic Surgery.
Coincidence of facial and dental midlines is one of the important goals in orthognathic-orthodontic treatment to achieve optimum facial aesthetics and good occlusal functions. Tools assisting diagnosis of facial midline are usually ruler or dental floss. These tools are usually hand held and hinder the global sight required in facial evaluation. Line laser device projects a steady narrow laser line and is commonly used in construction and carpentry to replace traditional chalk line tool. The authors take the advantages of line laser and incorporate it into facial evaluation in the authors' practice of single-splint orthognathic surgery. During June 2013 to May 2015, the authors used line laser device to evaluate facial and dental midlines in 28 patients of facial asymmetry requiring orthognathic surgery during consultation in office and intraoperative evaluation. The details of integrating this device to practice are described. All the patients showed improved facial symmetry and coincidence of facial and dental midlines after operation. Postoperative orthodontics were finished smoothly. Line laser is available from general utility stores and is safe to use according to laser safety regulation. From the authors' experiences, it is burden free to apply in facial and dental midlines evaluation and improves the practice. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2xfeGB5
http://ift.tt/2xfeGB5
Use of Acellular Allogenic Dermal Matrix (MegaDerm) in Orbital Wall Reconstruction: A Comparison With Absorbable Mesh Plate and Porous Polyethylene.
The selection of materials for orbital wall reconstruction has been a matter of debate. This study aimed to evaluate the effectiveness of an acellular allogenic dermal matrix (ADM) as an orbital wall reconstruction material and to compare the results of orbital wall reconstruction with the ADM to those of reconstruction with the more widely used absorbable mesh plate and porous polyethylene. We retrospectively reviewed the clinical charts and computed tomography images of 73 patients who underwent orbital reconstruction at 1 institution between March 2013 and February 2014. In the ADM group, the mean defect size of 29 patients was 2.89 cm2. After orbital wall reconstruction with ADM, patients with preoperative enophthalmos (7 patients), limited range of eyeball movement (6 patients), and diplopia (12 patients) showed improvements. In the comparative study, the 3 groups showed no significant differences with respect to age distribution (P = 0.522), defect size (P = 0.455), and preoperative findings such as enophthalmos (P = 0.811), diplopia (P = 0.357), and limited range of eyeball movement (P = 0.795). All the preoperative symptoms improved in every group, and in the ADM group, no complication was observed during the postoperative follow-up. ADM is a biocompatible material that combines the flexibility and rigidity required to support the orbital soft tissue. Therefore, it could be an excellent alternative material for orbital wall reconstruction. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2xeQeQf
http://ift.tt/2xeQeQf
Osseous Flap of Galea and Periosteum Filled With Mesenchymal Stem Cells, Platelet-Rich Plasma, Bone Dust, and Hyaluronic Acid.
Reconstructive surgery to craniofacial deformities caused by tumor ressections, traumas or congenital malformation are frequent in medicine practice. It aims to provide the patients with better quality of life and functional improvement of speech, breathing, chewing, and swallowing. Many are the techniques described in the literature to recover bone defects. This study evaluated a vascularized galeal and periosteum flap in rabbits, which could possibly substitute the bone graft in reconstructive surgery, especially for facial defects. It involved rabbits, divided into 12 groups, submitted to a surgical procedure to construct the galea and periosteum cranial flap filled with fragments of cranial bone, platelet-rich plasma, mesenchimal stem cells, and hyaluronic acid. The evaluation methods included image examinations and histological analysis. The results demonstrated bone formation with the use of platelet-rich plasma, mesenchimal stem cells, and bone fragments. The use of several enrichment materials of osseous cellular stimulation improved the quality and bone tissue organization. The more enrichment factor used, the better the tissue quality result was. Much research should be done to improve the methods and to analyze if results in human have the same bone formation as it happened in rabbits. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2vZJNCc
http://ift.tt/2vZJNCc
Lymphatic Malformation Architecture: Implications for Treatment With OK-432.
Purpose: Herein, the authors aim to describe their findings of novel architectural types of lymphatic malformations (LM) and explain the relationship between these architectures and OK-432 treatment outcomes. Methods: A retrospective review was conducted of all patients diagnosed with a LM treated with OK-432 at the Vascular Anomalies Clinic at BC Children's Hospital from December 2002 to January 2012. Results: Twenty-seven patients were included in the study. Sixty percent of lesions were present by 2 years of age with the majority located in the head and neck (59%). The average number of sclerotherapy procedures was 1.4 per patient. Treatment under fluoroscopic guidance revealed 3 new LM architectures: open-cell microcystic, closed-cell microcystic, and lymphatic channel. Response to treatment was complete or good for 14/19 macrocystic and for 1/2 mixed lesions. Open-cell microcystic LMs gave a complete or good response for 3/3, which was attributed to OK-432 freely communicating between cysts. Closed-cell microcystic LM had localized cysts that did not allow OK-432 to freely communicate and were associated with partial responses, 2/2. The lymphatic channel had a partial response. There were 2 minor complications and 1 instance of recurrence. Conclusions: The identification of 3 new LM architectures expands the current accepted classification to include: open-cell microcystic, closed-cell microcystic, and lymphatic channels. The majority of complete responses to OK-432 were found with macrocystic lesions. Open-cell microcystic lesions respond better to OK-432 than closed-cell microcystic lesions, and lymphatic channels may respond to OK-432. These key architecture-response relationships have direct clinical implications for treatment with OK-432 sclerotherapy. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2xeQH50
http://ift.tt/2xeQH50
Effect of atopic dermatitis on quality of life and its psychosocial impact in Asian adolescents
Abstract
Background/Objectives
Atopic dermatitis (AD) is a common condition affecting up to 20% of the paediatric population in Singapore. It is often associated with significant psychosocial morbidity and can affect patients' quality of life (QOL) tremendously. This study investigated the varying lifestyle impacts, and psychosocial domains most affected by AD in adolescent children in Singapore.
Methods
A prospective study evaluating the impact of AD on the QOL of adolescents was conducted over a 6-month period from July to December 2014. Adolescents aged 11–16 years with varying eczema severity were recruited. Eczema severity was determined by using the eczema area and severity index (EASI) scores. Lifestyle impact of AD was evaluated using patient-reported children's dermatology life quality index (CDLQI) scores. Statistical analysis was performed using an analysis of one-way variance and Student's t-test.
Results
A total of 50 patients were enrolled and divided into three groups: mild (<10.3), moderate (10.3–20.9) and severe (>20.9) eczema based on EASI scores. Patients with mild and moderate eczema had lower CDLQI scores. Adolescents were most affected by the disruption that their symptoms had on their leisure and physical activities and sleep as a result of itch and scratching, respectively.
Conclusion
Chronic sufferers of severe eczema experience poorer QOL than those with mild or moderate eczema. They also experience significant psychosocial impact as a consequence of their condition.
http://ift.tt/2irEkPT
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