Stickler syndrome is a group of collagenopathies characterized by ophthalmic, skeletal, and orofacial abnormalities, with the degree of symptoms varying among patients. Mutations in the COL2A1, COL11A1, and COL11...
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Παρασκευή 25 Αυγούστου 2017
A novel mutation in the COL2A1 gene in a patient with Stickler syndrome type 1: a case report and review of the literature
Extra-ocular movement restriction and diplopia following orbital fracture repair
To report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used.
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Comment on: “The outcomes of overlay myringoplasty: Endoscopic versus microscopic approach”
We would like to comment on the manuscript titled "The outcomes of overlay myringoplasty: Endoscopic versus microscopic approach" by Plodpai and Paje [1]. Endoscopic techniques have developed rapidly, as has surgical proficiency, and endoscopes are now widely used to perform myringoplasty, replacing traditional operating microscopes. The indications for endoscopic ear surgery have also increased in recent years. The authors compared the outcomes of overlay myringoplasty in patients treated via the endoscopic and microscopic approaches.
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Innovative application of intraoperative laser-assisted fluorescence angiography in resection of an angiosarcoma of the scalp
Cutaneous angiosarcoma is a rare, but aggressive malignant vascular neoplasm arising from endothelial cells. Although it only accounts for less than 2% of soft tissue sarcomas and less than 1% of all head and neck malignancies [1], it is often seen in head and neck regions particularly of the scalp and face in individuals over 60years old. Its clinical presentation varies widely and typically deceiving, from bruise-like macule to benign capillary malformation and hemangioma-like lesion. Prognosis is poor due to its high rate of local recurrence and distant metastasis, with reported 5-year survival rate of approximately 10–34% [2].
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Survival trends in patients with tracheal carcinoma from 1973 to 2011
The prognosis for primary tracheal cancer is dismal. We investigated whether there has been improvement in survival in tracheal cancer patients and how treatment modality affected overall and cancer-specific survival.
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FDA Approves Second Humira Biosimilar, Cyltezo
Adalimumab-adbm Cyltezo, from Boehringer Ingelheim, is approved for multiple indications including treatment of adults with moderate-to-severe active rheumatoid arthritis.
FDA Approvals
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Analysis of the Changing Patterns of Midface Fractures Using 3D Computed Tomography: An Observational Study
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1606250
This article aims to analyze the changing Le Fort fracture patterns using computed tomography (CT) scans with three-dimensional (3D) reconstruction. A prospective observational study was conducted on 60 patients with midface trauma, who had reported to MS Ramaiah Group of Hospitals, Bangalore, between January 2015 and October 2016. CT scans using 1.6 mm axial, sagittal, coronal sections were taken and their 3D reconstruction was made. The images were studied and compared with the standard Le Fort lines. The deviations from the classical Le Fort lines were analyzed and recorded. A note was also made of any additional fixation that was required for these deviations. Descriptive analysis was done and the results expressed in numbers and percentages. Study revealed that the most common cause for the midface fractures was found to be road traffic accidents (81.7%) with a male preponderance (88.3%) and peak incidence in 21 to 30 years of age (40%). Among the 60 patients, 18 (30%) patients had fracture patterns similar to the ideal Le Fort lines, 4 (6.6%) had a combination of Le Fort patterns, and 38 (66.3%) patients had deviations seen from the ideal Le Fort lines. Four types of deviations were recorded, namely, D1(60%), D2(5.4%), D3(10.9%), and D4(23.6%). It was observed that D1 and D3 required additional fixation. Majority of the cases presented as a deviation from ideal Le Fort fractures. CT was a valuable tool in the assessment of these fracture patterns. Deviations, if any, could be better analyzed using the 3D reconstruction images. Proper diagnosis and detection of these deviations make the planning for fixation easier. Repetition of these deviations could propose a newer or modified classification system for Le Fort fractures.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
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Maxillomandibular Syngnathia: 3D Planning and Review of the Literature
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1606248
Congenital maxillomandibular fusion or syngnathia is a rare craniofacial disorder with only 26 cases reported in the literature. We present a case of a congenital complex zygomatico-mandibular syngnathia associated with a palatal cleft, posterior maxilla and turbinate agenesia, mild hemifacial microsomia, and a disordered dental eruption. The patient has the highest age (15 years) at diagnosis described in the literature. 3D planning of the surgery was performed to study the patient's anatomy and design the necessary osteotomies to separate the jaws. En bloc removal of the fused fragment with bilateral coronoidectomy and aggressive long-term physiotherapy for 3 months led to a stable increase in mouth opening from 0 to 21 mm inter-incisor distance. The patient reported an improvement in speech, was able to eat without restriction regarding food consistency, and could maintain a good oral hygiene.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Temporoparietal Fascia Free Flap for Nasoseptal Perforation Repair
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1604425
Nasoseptal perforations can be a challenging defect for the reconstructive surgeon, with repair limited by the surrounding tissue availability and the defect size. In patients with a history of cocaine use, often the integrity of surrounding vasculature is questionable and large defects may not be well suited for local reconstruction. In the otolaryngology literature, several reconstructive options using local tissue and synthetic materials have been described, but there have been no reports of microvascular free flaps utilized in this regard. We present a unique case of a 37-year-old woman with a 3.0 cm × 3.5 cm nasoseptal perforation secondary to cocaine use successfully reconstructed with a temporoparietal fascia free flap anastomosed to the facial artery and vein. Postoperatively, the patient had a well-healed septal defect from the free flap reconstruction This new technique shows promise as a feasible option for patients with large defects and for those with limited local reconstructive options. The ease of harvest and low donor-site morbidity make the temporoparietal fascia flap a suitable option for repair of complex nasoseptal defects.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
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Comparison of Imaging Softwares for Upper Airway Evaluation: Preliminary Study
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1606247
The interest about upper airway evaluation has increased lately. Therefore, many softwares have been developed aiming to improve and facilitate the analysis of airway volume. The objective of this study was to compare two different softwares packages, Mimics and Dolphin, in their accuracy and precision in upper airway space measurements. Preoperative cone beam computed tomography scans of nine nonsyndromic patients submitted to surgically assisted rapid maxillary expansion were included in this study. The imaging exams were converted to DICOM (digital imaging and communications in medicine) files and imported to the softwares. The mean volume for the Dolphin group (G1) was 10.791 cm3 (SD = 4.269 cm3) and for the Mimics group (G2) was 10.553 cm3 (SD = 4.564 cm3). There was no statistically significant difference between the two groups (p = 0.105).
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Glossopharyngeal Nerve Block: The Premolar Approach
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1606249
This is a technical note describing hard tissue landmarks to simplify the intraoral glossopharyngeal nerve block. Our literature review revealed no specific mention of the same procedure in documented data.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anaesthesia in cardiac surgery patients: An observational study.
BACKGROUND: Induction of anaesthesia causes significant macrohaemodynamic changes, but little is known about its effects on the microcirculation. However, alterations in microvascular perfusion are known to be associated with impaired tissue oxygenation and organ dysfunction. Microvascular reactivity can be assessed with vascular occlusion testing, which evaluates the response of tissue oxygen saturation to transient ischaemia and reperfusion. OBJECTIVE: The aim of the current study was to evaluate the effects of an opioid-based anaesthesia induction on microvascular reactivity. We hypothesised that despite minimal blood pressure changes, microvascular function would be impaired. DESIGN: Prospective, observational study. SETTING: Single-centre, tertiary university teaching hospital, Belgium. PATIENTS: Thirty-five adult patients scheduled for elective coronary artery bypass grafting surgery. INTERVENTION: Microvascular reactivity was assessed before and 30 min after anaesthesia induction by means of vascular occlusion testing and near-infrared spectroscopy. MAIN OUTCOME MEASURES: Tissue oxygen saturations, desaturation rate, recovery time (time from release of cuff to the maximum value) and rate of recovery were determined. RESULTS: Data are expressed as median (minimum to maximum). Tissue oxygen saturation was higher after induction of anaesthesia [70 (54 to 78) vs. 73 (55 to 94)%, P = 0.015]. Oxygen consumption decreased after induction, appreciable by the higher minimum tissue oxygen saturation [45 (29 to 69) vs. 53 (28 to 81)%, P
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Research ethics committee approval as reported for abstracts submitted to the annual Euroanaesthesia meeting.
BACKGROUND: The annual congress of the European Society of Anaesthesiology (ESA) is one of the largest anaesthesia congresses in the world and exhibits more than 1200 abstracts annually. OBJECTIVES: The aims of this study were to quantify the frequency of inadequate evidence of ethical approval for abstracts submitted to the ESA congress and to examine whether abstracts without appropriate ethical approval were subsequently accepted. DESIGN AND SETTING: All abstracts submitted in 2015 were adjudicated according to European ethical criteria. MAIN OUTCOME MEASURE: The proportion of submitted abstracts that lacked evidence of appropriate ethics committee approval. Secondary outcomes included the proportion of accepted abstract that lacked evidence of appropriate ethical approval; the proportion of correctly identified case reports; the proportion of accepted abstracts that lacked evidence of appropriate ethics committee approvals corresponding to location (within/outside Europe); and the proportion of accepted abstracts that lacked evidence of appropriate ethics committee approvals corresponding to a specific area of research. RESULTS: In total, 1792 abstracts were reviewed and 1572 (87.7%) involved humans. In 527 (29.4%), the authors failed to demonstrate adequate ethical approval with higher rates in abstracts submitted from Europe (32.1%) than the rest of the world (23.5%), P
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Repair of Craniomaxillofacial Traumatic Soft Tissue Defects With Tissue Expansion in the Early Stage.
Background: Craniomaxillofacial traumatic soft tissue defects severely affect the function and appearance of the patients. The traditional skin grafting or free flap transplantation can only close the defects in the early stage of operation but cannot ensure similar color, texture, and relative aesthetic contour. In the present study, the authors have explored a novel strategy to repair craniomaxillofacial traumatic soft tissue defects by tissue expansion in the early stage and have obtained satisfactory results. Methods: Eighteen patients suffering large craniomaxillofacial traumatic soft tissue defects were treated by thorough debridement leaving the wounds unclosed or simply closed with thin split-thickness scalp grafts, adjacent expander implantation in the first stage, and expanded flap transposition in the second stage. Results: There were 11 male patients and 7 female patients ranging in age from 3.5 to 40 years (mean, 19.4 +/- 12.2 years), with average 15 months follow-up (range, 3-67 months). The average expansion time was 74.3 days (range, 53-96 days). The 18 patients with a total of 22 expanders were treated with satisfactory results. All the flaps survived and the skin color, texture, and contour well matched those of the peripheral tissue. Only 1 complication of infection happened in the 18 cases (5.56%) and the 22 expanders (4.55%), which was similar to the rate reported in the literature. No other complications related to the expanders occurred. Conclusion: Debridement and tissue expansion in the early stage has been proved to be a more effective strategy to repair craniomaxillofacial traumatic soft tissue defects. This strategy can not only achieve satisfactory color, unbulky and well-matched texture similar to normal, but also avoid unnecessary donor site injuries. (C) 2017 by Mutaz B. Habal, MD.
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http://ift.tt/2wFYfAI
Comprehensive Treatment of Primary Orbital Arteriovenous Malformation.
Primary orbital arteriovenous malformations are a rare kind of vascular malformation lesions. The authors present a 17-year-old man presented with swelling and pulsation in the left upper eyelid. The angiogram of the left internal carotid artery showed that arteriovenous malformations at the left upper eyelid area were supplied with one of the branches of ophthalmic artery. In this report, the authors elaborated the comprehensive treatments of primary arteriovenous malformation. (C) 2017 by Mutaz B. Habal, MD.
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Evaluation of Palatal Bone thickness for Insertion of Orthodontic Mini-Implants in Adults and Adolescents.
Objective: The aim of this study was to measure palatal bone thickness and select relatively safe regions for mini-implant insertion, and to determine the effect of age and sex on palatal bone thickness and whether there is any difference between right and left sides. Materials and Methods: Cone beam computed tomographic (CBCT) evaluation was used on 107 healthy orthodontic patients, including 51 adolescents (12.90 +/- 1.71 years) and 56 adults (26.09 +/- 4.35 years), who were selected from the Zhongshan Hospital, Fudan University (Shanghai, China). Seventy-two sites of bone thickness were measured in the palate. Intragroup, intergroup, and sex differences were analyzed by repeated measures analysis of variance. Results: Palatal bone thickness exhibited significant differences in 3 anteroposterior areas of the 2 groups. From anterior to posterior region, palatal bone thickness gradually decreased. Meanwhile, on the sagittal plane, palatal bone thickness decreased gradually from reference line 0 to 9 mm among adults, and from reference line 0 to 12 mm among adolescents posterior to the level of the posterior rim of the incisive foramen. However, on the coronal plane, no significant differences were found in the palatal bone thickness among reference lines 2, 4, 6, and 8 mm lateral to the midpalatal suture. Nor were there differences between right and left sides, between adults and adolescents or between males and females. Conclusions: In terms of bone thickness, the anterior region is relatively safe for orthodontic mini-implant insertion. However, since subjects vary greatly, CBCT scans are needed before undertaking mini-implant insertion. (C) 2017 by Mutaz B. Habal, MD.
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Intracranial Enterogenous Cysts Close to the Brainstem Treated Through the Nerve Endoscope.
Enterogenous cysts (ECs) are rare, inborn lesions of central nervous system, which mostly occurred in the ventral side of the spinal cord as well as common in children; adult intracranial cysts are rare. Although the morbidity of intracranial ECs is quite low, we also can make a preliminary diagnosis of those patients with the help of imaging examination. In this article, we introduced 1 case of ECs ventral to the brainstem, which present images on magnetic resonance imaging as hypointense lesions on T1-weighted and high-intensity mass on T2-weighted image. In consideration of the difficulty of the surgical approach and the surgical visual field exposure, we use microscope and nerve endoscope to design personalized surgical approach to minimize the surgical injury. Pathologic examination showed that it was typical EC. Not only is the location extremely rare, but also the surgical method is uncommon in this disease. We not only study the intracranial ECs' manifestations, but also discuss the surgical approach and the application of nerve endoscope of our choice,which aims to provides a new surgical therapeutic approach for these lesions. (C) 2017 by Mutaz B. Habal, MD.
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Editorial Board Page
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
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Table of Contents
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
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AAOMS Author Disclosure forms
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
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For Every Manuscript, a Journal?
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): Thomas B. Dodson
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Treatment of Temporomandibular Joint Disorders: The Unwanted Stepchild
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): Roger A. Meyer
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Masthead
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
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Does Administration of Oral Versus Intravenous Antibiotics for Third Molar Removal Have an Effect on the Incidence of Alveolar Osteitis or Postoperative Surgical Site Infections?
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): Matthew D. Reiland, Kyle S. Ettinger, Christine M. Lohse, Christopher F. Viozzi
PurposeTo compare the incidence of postoperative alveolar osteitis (AO) and surgical site infections (SSIs) in 2 separate cohorts of patients undergoing elective third molar removal: those who received postoperative oral (PO) antibiotics and those who received perioperative intravenous (IV) antibiotics.Materials and MethodsA retrospective cohort study of all patients 14 to 30 years old undergoing elective outpatient third molar removal under a single surgeon's service over a 12-year period was completed. Patients undergoing third molar removal during the first 72 months received postoperative PO antibiotics alone. Patients undergoing third molar removal during the second 72 months received perioperative IV antibiotics alone. The primary predictor variable for the study was the antibiotic regimen used at the time of third molar removal. The primary outcome variable was the postoperative development of AO or SSI. Covariates included age and gender. Univariable and multivariable regression models assessed for associations between the antibiotic regimen used and the presence of AO and SSI.ResultsThe study sample consisted of 1,895 patients (1,020 patients receiving postoperative PO antibiotics and 875 patients receiving perioperative IV antibiotics). Of patients receiving postoperative PO antibiotics, 6.4% developed AO an average of 5.7 days after the procedure and 2.6% developed an SSI an average of 23.2 days after the procedure. Of patients receiving perioperative IV antibiotics, 5.5% developed AO an average of 6.2 days after the procedure and 3.3% developed an SSI an average of 18.2 days after the procedure. No statistically significant associations between the antibiotic regimen used and the presence of AO or SSI were identified in univariable (P = 0.42 for AO, P = 0.32 for SSI) or multivariable (P = 0.65 for AO, P = 0.26 for SSI) analyses. In the postoperative PO antibiotic cohort, older age (P < .001) and female gender (P < .001) were significantly associated with the development of AO, and female gender (P = .015) was significantly associated with the presence of an SSI. In the perioperative IV antibiotic cohort, female gender was significantly associated with the development of AO (P = .011), and younger age was significantly associated with the presence of an SSI (P = .011).ConclusionThe use of a postoperative PO versus a perioperative IV antibiotic regimen does not significantly alter the incidence of AO or SSI after elective third molar removal. If the surgeon chooses to use antibiotics in the setting of third molar surgery, then perioperative IV antibiotics are preferable over postoperative PO antibiotics because they obviate any issues with patient compliance and might be less costly.
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News and Announcements
Publication date: September 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
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Does Orthognathic Surgery Cause or Cure Temporomandibular Disorders? A Systematic Review and Meta-Analysis
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): Essam Ahmed Al-Moraissi, Larry M. Wolford, Daniel Perez, Daniel M. Laskin, Edward Ellis
PurposeThere is still controversy about whether orthognathic surgery negatively or positively affects temporomandibular disorders (TMDs). The purpose of this study was to determine whether orthognathic surgery has a beneficial or deleterious effect on pre-existing TMDs.Materials and MethodsA systematic review and meta-analysis were conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 major databases to locate all pertinent articles published from 1980 to March 2016. All subjects in the various studies were stratified a priori into 9 categories based on subdiagnoses of TMDs. The predictor variables were those patients with pre-existing TMDs who underwent orthognathic surgery in various subgroups. The outcome variables were maximal mouth opening and signs and symptoms of a TMD before and after orthognathic surgery based on the type of osteotomy. The meta-analysis was performed using Comprehensive Meta-Analysis software (Biostat, Englewood, NJ).ResultsA total of 5,029 patients enrolled in 29 studies were included in this meta-analysis. There was a significant reduction in TMDs in patients with a retrognathic mandible after bilateral sagittal split osteotomy (BSSO) (P = .014), but no significant difference after bimaxillary surgery (BSSO and Le Fort I osteotomy) (P = .336). There was a significant difference in patients with prognathism after isolated BSSO or intraoral vertical ramus osteotomy and after combined BSSO and Le Fort I osteotomy (P = .001), but no significant difference after BSSO (P = .424) or bimaxillary surgery (intraoral vertical ramus osteotomy and Le Fort I osteotomy) (P = .728).ConclusionsOrthognathic surgery caused a decrease in TMD symptoms for many patients who had symptoms before surgery, but it created symptoms in a smaller group of patients who were asymptomatic before surgery. The presence of presurgical TMD symptoms or the type of jaw deformity did not identify which patients' TMDs would improve, remain the same, or worsen after surgery.
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Association of Temporomandibular Joint Pain According to Magnetic Resonance Imaging Findings in Temporomandibular Disorder Patients
Publication date: September 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): Namiaki Takahara, Satoshi Nakagawa, Kanako Sumikura, Yuji Kabasawa, Ichiro Sakamoto, Hiroyuki Harada
PurposeThis study investigated the associations between magnetic resonance imaging (MRI) findings and pain in the temporomandibular joint (TMJ).Materials and MethodsThe study included 646 TMJs of 323 consecutive patients with temporomandibular disorders; of these, 222 (34.4%) had TMJ pain whereas 424 (65.6%) had no TMJ pain. MRIs were used to evaluate disc position, osteoarthritis, joint fluid, and bone marrow edema. Internal derangement was classified as normal, anterior disc displacement with reduction, and anterior disc displacement without reduction (ADDWOR); condylar morphology was classified as normal, moderate bony change, and severe bony change. The odds ratio (OR) for each MRI variable for nonpainful versus painful TMJs was computed using logistic regression analysis.ResultsCompared with joints with normal disc position, the OR of those with ADDWOR was 2.74 (P < .001) for TMJ pain. Similarly, compared with joints with normal condylar morphology, the OR of those with severe bony change was 4.62 (P = .02) for TMJ pain. In addition, the risk of TMJ pain increased by 2.37 in joints with joint fluid (P < .001) and by 2.34 in joints with bone marrow edema (P = .006). The risk of TMJ pain increased significantly with ADDWOR in combination with severe bony change, joint fluid, and bone marrow edema.ConclusionsThese results suggest an association between TMJ pain and ADDWOR, severe bony change, joint fluid, and bone marrow edema. Thus, combining various MRI variables may improve the diagnostic accuracy of TMJ pain.
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Can a 10-Minute Questionnaire Identify Significant Psychological Issues in Patients With Temporomandibular Joint Disease?
Publication date: September 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): Shang-Lun Lin, Shang-Liang Wu, Hsien-Te Huang, For-Wey Lung, Tzong-Cherng Chi, Jung-Wu Yang
PurposesFor patients with disc displacement disorders (DDDs), psychiatric illness increases the risk of worsening postsurgical pain, postoperative delirium, postoperative incomplete recovery, and worse postoperative life quality. This study provides a fast and practical protocol to evaluate psychological conditions of patients with DDDs of the temporomandibular joint (TMJ) in clinical care.Materials and MethodsThe populations under investigation in this cross-sectional study included patients with DDD who received treatment from October 2012 through June 2016. Variables included age, gender, education level, and TMJ (Axis I) and psychological (Axis II) evaluations. The 13-item protocol of Axis II evaluations contained a 5-item Brief Symptom Rating Scale (BSRS-5), a pain visual analog scale (VAS; 1 item), major life events (3 items), suicidal risk (3 items), and substance use (1 item). Analysis of variance, χ2 test, and multivariate logistic regression were used for analyses.ResultsOf 177 patients, 75.14% were women (mean age, 37.46 ± 14.06 yr). Pain VAS scores clearly supported the following ranking of psychosocial discomforts: disc displacement without reduction with limited opening (DDWORWLO) > disc displacement without reduction without limited opening > disc displacement with reduction. Pain VAS and BSRS-5 correlated with 5 variables in Axis I (trismus, acute TMJ pain, chronic awake bruxism, chronic sleep bruxism, and deep bite). The DDD study indicated that 9.6% of patients required urgent referrals to mental health resources (MHRs) for their moderate and high suicidal risk DDD and 77% required nonurgent referrals to MHRs for their psychiatric morbidity.ConclusionsThis study found that patients with DDD showed a prevalence of suicidal ideation and mean BSRS scores that were higher for anxiety, hostility, depression, interpersonal hypersensitivity, and insomnia than in the general population. Patients with trismus or acute TMJ pain could have a higher pain VAS score; chronic awake bruxism could involve greater hostility and lower depression; chronic sleep bruxism could increase sensitivity to interpersonal interactions; and deep bite could involve a higher anxiety level. DDWORWLO produced the highest pain VAS score in patients with DDD. The 13-item Axis II evaluations can offer useful clues for oral and maxillofacial surgeons and other specialists to collaborate with MHRs.
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Multistage Sclerotherapy for Extensive Lymphatic Malformations With Airway Involvement in Infant: A Protocol to Prevent Tracheotomy
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): An-Wei Chen, Tao Wang, Ying-Ying Huang, Shao-Hua Liu
PurposeThe management of extensive head and neck lymphatic malformations (LMs) in infants is challenging because of life-threatening upper airway compression. The aim of this study was to present a management protocol and evaluate the clinical outcomes for preventing tracheotomy in these patients.Materials and MethodsFifteen infants with extensive head and neck LMs and airway involvement were enrolled from August 2010 through September 2015 at the Qilu Hospital of Shandong University (Jinan, China). According to various key factors associated with airway compression of patients in the perioperative period, different anesthesia types, treatment times, sclerosant concentrations, and sclerotherapy protocols were used. Multistage sclerotherapy was performed with bleomycin A5. All patients were followed at 1, 3, 6, and 12 months. More extended follow-up was offered if patients had a residual lesion requiring supplementary sclerotherapy. Reviews on the site and size of the lesion, times and durations of treatments, therapeutic response, airway complications, and conduction of tracheotomy were performed.ResultsLM lesions in the head and neck were located in the floor of the mouth, tongue, and neck. An overall average of 5 treatments was required; a lesion volume decrease of more than 50% was achieved in all patients. For efficacy, morphologic resolution was achieved in 3 of 15 cases (20%), and there was a substantial response in 12 of 15 cases (80%). Eight of 15 patients (53.3%) with microcystic LMs exhibited immediate swelling and had more serious upper airway symptoms than preoperatively, and 2 of 15 patients (13.3%) had feeding difficulty. No upper airway obstruction occurred and no tracheotomy was performed in the patients in this study.ConclusionsMultistage sclerotherapy with bleomycin A5 is a safe and effective treatment for extensive head and neck LMs in infants with airway involvement. A routine perioperative protocol is essential for decreasing airway complications.
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Erratum
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
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Restricted Mandibular Movement Attributed to Ossification of Mandibular Depressors and Medial Pterygoid Muscles in Patients With Fibrodysplasia Ossificans Progressiva: A Report of 3 Cases
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): Tetsuko Okuno, Hitoshi Suzuki, Akio Inoue, Jingo Kusukawa
Fibrodysplasia ossificans progressiva (FOP) is an extremely rare genetic condition characterized by congenital malformation and progressive heterotopic ossification (HO) caused by a recurrent single nucleotide substitution at position 617 in the ACVR1 gene. As the condition progresses, HO leads to joint ankylosis, breathing difficulties, and mouth-opening restriction, and it can shorten the patient's lifespan. This report describes 3 cases of FOP confirmed by genetic testing in patients with restricted mouth opening. Each patient presented a different onset and degree of jaw movement restriction. The anatomic ossification site of the mandibular joint was examined in each patient using reconstructed computed tomographic (CT) images and 3-dimensional reconstructed CT (3D-CT) images. A 29-year-old woman complained of jaw movement restriction since 13 years of age. 3D-CT image of the mandibular joint showed an osseous bridge, formed by the mandibular depressors that open the mouth, between the hyoid bone and the mentum of the mandible. A 39-year-old man presented with jaw movement restriction that developed at 3 years of age after a mouth injury. 3D-CT image of the jaw showed ankylosis of the jaw from ossification of the mandibular depressors that was worse than in patient 1. CT images showed no HO findings of the masticatory muscles. To the authors' knowledge, these are the first 2 case descriptions of the anatomic site of ankylosis involving HO of the mandibular depressors in the jaw resulting from FOP. In contrast, a 62-year-old bedridden woman with an interincisal distance longer than 10 mm (onset, 39 years of age) had no HO of the mandibular depressors and slight HO of the medial pterygoid muscle on the right and left sides. These findings suggest that restricted mouth opening varies according to the presence or absence of HO of the mandibular depressors.
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Acute Facial Nerve Palsy With Ipsilateral Soft Palate Ulcers
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): Cédric Mauprivez, Clément Comte, Marc Labrousse, Roman H. Khonsari
Ramsay-Hunt syndrome (RHS) is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus (VZV) infection occurs in the geniculate ganglion. Major clinical findings are peripheral facial nerve palsy accompanied by ipsilateral ear pain and erythematous vesicular rash on the external ear (herpes zoster oticus) and in the mouth. Thus, diagnosis of RHS is usually clinical. However, auricular herpetic eruption is not always present, making diagnosis more difficult. This report describes a case of RHS with left facial palsy without skin lesions in 60-year-old woman. Multiple ulcers were found on her left soft palate. Polymerase chain reaction analysis on oral mucosa biopsy samples and serologic assays allowed the identification of VZV as the causal agent. Knowledge of the anatomy of the facial nerve is important for oral and maxillofacial surgeons when dealing with patients with RHS, especially in unusual and clinically misleading forms of this syndrome.
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Tube Decompression for Staged Treatment of a Calcifying Odontogenic Cyst—A Case Report
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 9
Author(s): Hany A. Emam, Judson Smith, Ashleigh Briody, Courtney A. Jatana
The calcifying odontogenic cyst is a rare developmental odontogenic lesion with a distinguishing cystic lining containing "ghost" epithelial cells. The variation in clinical, radiographic, and histologic findings makes the treatment decision difficult for these lesions. There are very few reports on treatment, with enucleation and curettage being the standard surgical method of choice for the cystic type and excision of the tumor for the solid type. A 2-stage surgical approach consisting of initial decompression with tube placement followed by a secondary procedure of enucleation and curettage is common for other large odontogenic cysts, such as dentigerous and odontogenic keratocysts. To the authors' knowledge, this is the first case managed with an intended 2-stage approach in the form of decompression followed by enucleation and curettage.
http://ift.tt/2wOfZJD
Association Between Obesity and Migraine in Women
Abstract
Purpose of Review
Migraine is a common and highly disabling condition that is particularly prevalent among women and especially women of reproductive age. The tremendous rise in adiposity in the Western world has led to an epidemic of obesity in women. The particular effects of obesity on women with migraine of various ages are the focus of this review.
Recent Findings
Conflicting findings from various studies with different approaches and populations have made challenging definitive conclusions about associations between migraine and obesity. While the association between obesity and migraine frequency has been consistently demonstrated and obesity is considered a risk factor for progression from episodic to chronic migraine, the association between obesity and migraine prevalence is still somewhat debated and appears to be dependent on gender and age, with the most consistent effects observed in women younger than 55 years of age.
Summary
Association between migraine and obesity is most commonly observed in women of reproductive age. The multimodal changes associated with age and hormonal change in women likely play a role in this relationship, as obesity does not appear to be related to migraine in women over 55 years of age. Future studies focusing on the migraine-obesity relationship in women should examine the effects of age, endogenous hormonal state, and exogenous hormones on migraine and obesity.
http://ift.tt/2w3V9VP
Specific mutations of penicillin-binding protein 1A in 77 clinically acquired amoxicillin-resistant Helicobacter pylori strains in comparison with 77 amoxicillin-susceptible strains
Abstract
Background
Amoxicillin (Amx) is one of the most important antibiotics for eradication of Helicobacter pylori (H. pylori). Main determinants of genetically stable Amx resistance are mutations in the C-terminus of penicillin-binding protein 1A (pbp1A). However, contribution of individual mutation remains unclear.
Methods
77 Amx-resistant (AmxR) and 77 Amx-susceptible (AmxS) H. pylori strains were isolated from gastric tissues, and DNA sequencing was performed to compare C-terminus sequences of pbp1A gene between AmxR and AmxS strains. Natural transformation of these mutated genes into amoxicillin-susceptible strains was performed.
Results
Among many mutations in pbp1A, D479E (OR: 37.4, 95% CI: 5.53-252.49, P < .001), and T593 mutation (OR: 32.0, 95% CI: 4.04-252.86, P < .001) independently contributed to Amx resistance in H. pylori strains. In the transformation experiment, T593 mutations were identified in their transformants showing Amx resistance. However, PCR product of D479E was not inserted into recipient (ATCC 43504) resulting in transformation failure.
Conclusion
Amx resistance is associated with various substitutions in pbp1A and T593 mutation contributes to Amx resistance of H. pylori.
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Huge buccal angiomyolipoma: a rare entity
Publication date: Available online 24 August 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Siew Chung Cheah, Rohaizam Jaafar, Murni Hartini Jais
http://ift.tt/2gbmRu9
Incidence of bifid uvula and its relationship with submucous cleft palate and a family history of oral cleft in the Brazilian population
Publication date: Available online 24 August 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Sizina Aguiar G. Sales, Maria Luiza Santos, Renato Assis Machado, Verônica Oliveira Dias, Jairo Evangelista Nascimento, Mario Sérgio Oliveira Swerts, Hercílio Martelli Júnior, Daniella Reis Barbosa Martelli
IntroductionBifid uvula is a frequently observed anomaly in the general population and can be regarded as a marker for submucous cleft palate.ObjectiveIn this study aimed to determine the frequency of bifid uvula and submucous cleft palate and their relationship with oral clefts in a Brazilian population.MethodsWe conducted a transversal, descriptive and quantitative study of 1206 children between August 2014 and December 2015. A clinical examination of the children was conducted by means of inspection of the oral cavity with the aid of a tongue depressor and directed light. After the clinical examination in children, parents answered a questionnaire with questions about basic demographic information and their family history of oral clefts in their first-degree relatives. After application of the questionnaires, the information collected were archived in a database and analyzed by the statistical program SPSS® version 19.0, by applying Chi-Square tests. Values with p<0.05 were considered statistically significant.ResultsOf the 1206 children included in this study, 608 (50.40%) were female and 598 (49.60%) were male (p=0.773). The average age of children was 3.75 years (standard deviation±3.78 years). Of the 1206 children studied, 6 (0.5%) presented with bifid uvula. Submucosal cleft palate was not found in any child. When the family histories of children were examined for the presence of nonsyndromic cleft lip and/or cleft palate, no first degree relatives presented with the congenital anomaly.ConclusionThis study revealed that the incidence of bifid uvula and submucous cleft palate in this population was quite similar to previously reported incidence rates. Our study suggests an intensification of new reviews, with broader and diverse populations, seeking to associate the occurrence of bifid uvula, submucous cleft palate and oral clefts.
http://ift.tt/2iwrpvT
Multidimensional effects of voice therapy in patients affected by unilateral vocal fold paralysis due to cancer
Publication date: Available online 24 August 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Camila Barbosa Barcelos, Paula Angélica Lorenzon Silveira, Renata Lígia Vieira Guedes, Aline Nogueira Gonçalves, Luciana Dall'Agnol Siqueira Slobodticov, Elisabete Carrara-de Angelis
IntroductionPatients with unilateral vocal fold paralysis (UVFP) may demonstrate different degrees of voice perturbation depending on the position of the paralyzed vocal fold. Understanding the effectiveness of voice therapy in this population may be an important coefficient to define the therapeutic approach.ObjectiveTo evaluate the voice therapy effectiveness in the short, medium and long-term in patients with UVFP and determine the risk factors for voice rehabilitation failure.MethodsProspective study with 61 patients affected by UVFP enrolled. Each subject had voice therapy with an experienced speech pathologist twice a week. A multidimensional assessment protocol was used pre-treatment and in three different times after voice treatment initiation: short-term (1–3 months), medium-term (4–6 months) and long-term (12 months); it included videoendoscopy, maximum phonation time (MPT), GRBASI scale, acoustic voice analysis and the portuguese version of the voice handicap index (VHI).ResultsMultiple comparisons for GRBASI scale and VHI revealed statistically significant differences, except between medium and long term (p<0.005). The data suggest that there is vocal improvement over time with stabilization results after 6 months (medium term). From the 28 patients with permanent UVFP, 18 (69.2%) reached complete glottal closure following vocal therapy (p=0.001). The logistic regression method indicated that the Jitter entered the final model as a risk factor for partial improvement. For every unit of increased jitter, there was an increase of 0.1% (1.001) of the chance for partial improvement, which means an increase on no full improvement chance during rehabilitation.ConclusionVocal rehabilitation improves perceptual and acoustic voice parameters and voice handicap index, besides favor glottal closure in patients with UVFP. The results were also permanent during the period of 1 year. The Jitter value, when elevated, is a risk factor for the voice therapy success.
http://ift.tt/2gc9070
Complement as a regulator of adaptive immunity
Abstract
The complement system is an ancient and evolutionarily conserved effector system comprising in mammals over 50 circulating and membrane bound proteins. Complement has long been described as belonging to the innate immune system; however, a number of recent studies have demonstrated its key role in the modulation of the adaptive immune response. This review does not set out to be an exhaustive list of the numerous interactions of the many complement components with adaptive immunity; rather, we will focus more precisely on the role of some complement molecules in the regulation of antigen presenting cells, as well as on their direct effect on the activation of the core adaptive immune cells, B and T lymphocytes. Recent reports on the local production and activation of complement proteins also suggest a major role in the control of effector responses. The crucial role of complement in adaptive immunity is further highlighted by several examples of dysregulation of these pathways in human diseases.
http://ift.tt/2wauJjF
Comparison of Output Volume Thresholds for Drain Removal After Selective Lateral Neck Dissection: A Randomized Clinical Trial.
Comparison of Output Volume Thresholds for Drain Removal After Selective Lateral Neck Dissection: A Randomized Clinical Trial.
JAMA Otolaryngol Head Neck Surg. 2017 Aug 24;:
Authors: Tamplen ML, Tamplen J, Shuman E, Heaton CM, George JR, Wang SJ, Ryan WR
Abstract
Importance: Limited evidence is available to guide drain removal after selective lateral neck dissection (SLND). Patients may have drains left in longer than necessary, leading to patient discomfort, longer hospitalizations, and increased costs.
Objective: To compare 2 output volume thresholds for drain removal after SLND.
Design, Setting, and Participants: This single-blind randomized clinical trial included a consecutive sample of all adult patients undergoing unilateral or bilateral SLND of levels I to III, I to IV, II to III, or II to IV from March 1, 2015, to December 1, 2016, at a tertiary academic medical center. Eligible patients had at least 30 days of follow-up. Patients undergoing a parotidectomy, a level V lymphadenectomy, or an SLND that communicated with the upper aerodigestive tract or who had a suspected chylous fistula on the first postoperative day were excluded from enrollment. Sixty-five patients were offered enrollment and 12 refused. Fifty-three patients who underwent 67 SLNDs were included in the final analysis, with no patients lost to follow-up. Analysis was based on intention to treat.
Interventions: On the first postoperative day, patients were randomized to either a drain removal threshold of less than 30 mL or less than 100 mL during a 24-hour period.
Main Outcomes and Measures: Duration of drain use, hospital length of stay, and wound complications for both groups.
Results: Among the 53 patients with 67 SLNDs included in the analysis (45 men [85%] and 8 women [15%]; mean age, 58.5 years [95% CI, 53.2-64.5 years]), 32 SLNDs were randomized to the 100-mL group and 35 were randomized to the 30-mL group. No meaningful differences in preoperative characteristics were noted between groups. Two seromas occurred in the 100-mL group (2 of 32 [6.3%; 95% CI, 0%-13.5%]) and in the 30-mL group (2 of 35 [5.7%; 95% CI, 0%-14.6%]). No hematomas, chylous fistulas, or wound infections occurred. The 100-mL group had a 1.87-day reduction in mean hospital length of stay (95% CI, 0.66-3.10 days).
Conclusions and Relevance: A volume threshold for drain removal of 100 mL during a 24-hour period after SLNDs appears to be safe and may significantly reduce duration of drain use and hospital length of stay.
Trial Registration: clinicaltrials.gov Identifier: NCT03113526.
PMID: 28837725 [PubMed - as supplied by publisher]
http://ift.tt/2xye6xK
Typographical Data Error in Abstract.
Typographical Data Error in Abstract.
JAMA Otolaryngol Head Neck Surg. 2017 Aug 24;:
Authors:
PMID: 28837724 [PubMed - as supplied by publisher]
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Hearing Loss and Patient-Physician Communication: The Role of an Otolaryngologist.
Hearing Loss and Patient-Physician Communication: The Role of an Otolaryngologist.
JAMA Otolaryngol Head Neck Surg. 2017 Aug 24;:
Authors: Weinreich HM
PMID: 28837710 [PubMed - as supplied by publisher]
http://ift.tt/2xxXM05
Age-Related Hearing Loss and Communication Breakdown in the Clinical Setting.
Age-Related Hearing Loss and Communication Breakdown in the Clinical Setting.
JAMA Otolaryngol Head Neck Surg. 2017 Aug 24;:
Authors: Cudmore V, Henn P, O'Tuathaigh CMP, Smith S
PMID: 28837709 [PubMed - as supplied by publisher]
http://ift.tt/2vvcHXi
Use of an endotracheal tube for surgical abortion complicated by a leiomyomatous uterus: a case report
Abnormal uterine anatomy, especially leiomyomas, can significantly impact the difficulty and potential morbidity of surgical uterine evacuation. To avoid hysterotomy and/or hysterectomy, limited evidence exist...
http://ift.tt/2vmwR6I
Anesthetic management during adenotonsillectomy for twins with congenital insensitivity to pain with anhidrosis: two case reports
Congenital insensitivity to pain with anhidrosis is a rare autosomal recessive disorder characterized by hyperpyrexia, anhidrosis, pain insensitivity, self-inflicted injuries, and intellectual disability. The ...
http://ift.tt/2wMhGqU
Regulation of epithelial cell expressed C3 in the intestine – Relevance for the pathophysiology of inflammatory bowel disease?
Publication date: October 2017
Source:Molecular Immunology, Volume 90
Author(s): Annika Sünderhauf, Kerstin Skibbe, Sophie Preisker, Karen Ebbert, Admar Verschoor, Christian M. Karsten, Claudia Kemper, Markus Huber-Lang, Marijana Basic, André Bleich, Jürgen Büning, Klaus Fellermann, Christian Sina, Stefanie Derer
The complement system not only plays a critical role in efficient detection and clearance of bacteria, but also in intestinal immune homeostasis as mice deficient for key complement components display enhanced intestinal inflammation upon experimental colitis. Because underlying molecular mechanisms for this observation are unclear, we investigated the crosstalk between intestinal epithelial cells (IEC), bacteria and the complement system in the course of chronic colitis.Surprisingly, mouse intestinal epithelial cell lines constitutively express high mRNA levels of complement component 3 (C3), Toll-like receptor 2 (Tlr2) and Tlr4. Stimulation of these cells with lipopolysaccharide (LPS), but not with flagellin, LD-muramyldipeptide or peptidoglycan, triggered increased C3 expression, secretion and activation. Stimulation of the C3aR on these cell lines with C3a resulted in an increase of LPS-triggered pro-inflammatory response. Tissue biopsies from C57BL/6J mice revealed higher expression of C3, Tlr1, Tlr2 and Tlr4 in colonic primary IECs (pIECs) compared to ileal pIECs, while in germ-free mice no differences in C3 protein expression was observed. In DSS-induced chronic colitis mouse models, C3 mRNA expression was upregulated in colonic biopsies and ileal pIECs with elevated C3 protein in the lamina propria, IECs and the mucus. Notably, increased C3b opsonization of mucosa-attached bacteria and decreased fecal full-length C3 protein was observed in DSS-treated compared to untreated mice. Of significant interest, non-inflamed and inflamed colonic biopsy samples from CD but not UC patients displayed exacerbated C3 expression compared to controls.These findings suggest that a novel TLR4-C3 axis could control the intestinal immune response during chronic colitis.
http://ift.tt/2w3j5Zh
Multisite tumor sampling enhances the detection of intratumor heterogeneity at all different temporal stages of tumor evolution
Abstract
Intratumor heterogeneity (ITH) is an inherent process of tumor development that has received much attention in previous years, as it has become a major obstacle for the success of targeted therapies. ITH is also temporally unpredictable across tumor evolution, which makes its precise characterization even more problematic since detection success depends on the precise temporal snapshot at which ITH is analyzed. New and more efficient strategies for tumor sampling are needed to overcome these difficulties which currently rely entirely on the pathologist's interpretation. Recently, we showed that a new strategy, the multisite tumor sampling, works better than the routine sampling protocol for the ITH detection when the tumor time evolution was not taken into consideration. Here, we extend this work and compare the ITH detections of multisite tumor sampling and routine sampling protocols across tumor time evolution, and in particular, we provide in silico analyses of both strategies at early and late temporal stages for four different models of tumor evolution (linear, branched, neutral, and punctuated). Our results indicate that multisite tumor sampling outperforms routine protocols in detecting ITH at all different temporal stages of tumor evolution. We conclude that multisite tumor sampling is more advantageous than routine protocols in detecting intratumor heterogeneity.
http://ift.tt/2wapzEr
Laryngeal trauma with and without tracheal separation
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Charissa N. Kahue, Alexander Gelbard
External laryngotracheal trauma is a rare occurrence and requires specialized evaluation and management. Airway compromise from laryngotracheal injury can be catastrophic. The stability of an airway must be ensured with rapid and repeated clinical evaluation. Additionally, bedside and operative endoscopy combined with radiographic studies should guide treatment planning. Repair may include open reduction and internal fixation of laryngeal fractures, endolaryngeal mucosal repair (via either endoscopic or open approaches), endoluminal stenting or open repair of laryngotracheal separation.
http://ift.tt/2wu4FTk
Introduction
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): William Yao
http://ift.tt/2wafwyT
Management of Retrobulbar Hematoma
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Matthew A. Tyler, Martin J. Citardi, William C. Yao
Retrobulbar hemorrhage is regarded as one of the most feared conditions in otolaryngology -- its onset can be rapid and can result in irreversible blindness. While a rare occurrence, the otolaryngologist should be compulsive about recognizing this entity, as he or she may be faced with managing this condition either as a consultant, or as one of his or her personal surgical complications. Regardless, prompt recognition and swift action can prevent catastrophic visual loss. This article presents a stepwise discussion of the surgical management of retrobulbar hematoma. Specifically, we discuss lateral canthotomy, cantholysis, and endoscopic orbital decompression.
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Increased SOX2 expression in salivary gland carcinoma ex pleomorphic adenoma progression: an association with adverse outcome
Abstract
SOX2 is a regulatory factor of embryonic stem cells that has been implicated in carcinogenesis and cancer progression. We aimed to investigate the potential role of SOX2 in the stepwise progression from pleomorphic adenoma (PA) to invasive carcinoma ex pleomorphic adenoma (CXPA), evaluating its prognostic significance as well. Thirty PAs without malignant transformation and 25 CXPAs presenting both luminal or myoepithelial differentiation (7 intracapsular and 18 extracapsular) were evaluated immunohistochemically for SOX2 expression. Of these, 24 CXPAs (96%) were positive to SOX2, being 6 intracapsular carcinomas (85.7%) and all the 18 extracapsular carcinomas (100%). Residual PA areas and PA without malignant transformation were negative. High SOX2 expression levels (> 50% of positive cells) were correlated with high histological grade (p = 0.02), brisk mitotic activity (p = 0.01), advanced pT stage (p = 0.01), tumor recurrence (p = 0.01), and development of distant metastasis (p = 0.004). Still, overall survival rates were shorter in patients with extracapsular CXPA exhibiting diffuse SOX2 expression. These results suggest that SOX2 may play an important role in carcinogenesis and progression of CXPA and is also related with prognostic indicators in CXPAs with extracapsular invasion. Although direct therapeutic intervention in SOX2 may result in unwanted complications due to its constitutive functions, strategic approach to SOX2-related pathways may provide new therapeutic opportunities for patients with invasive CXPA.
http://ift.tt/2gb22z1
Implementation of a perioperative surgical home protocol for pediatric patients presenting for adenoidectomy
Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Vidya T. Raman, Dmitry Tumin, Joshua Uffman, Arlyne K. Thung, Candice Burrier, Kris R. Jatana, Charles Elmaraghy, Joseph D. Tobias
IntroductionThe perioperative surgical home (PSH) is a patient-centered model designed to improve health, streamline the delivery of health care, and reduce the cost of care. Following the national introduction of PSH in 2014 by the ASA, adult hospitals have reported success with this model, with studies validating the benefits of PSH including reducing length of stay, lowering costs, and improving patient satisfaction.MethodsEligible patients, ranging in age from 16-35 months of age, were identified by the pre-admission testing (PAT) registered nurses (RNs) and faculty anesthesiologists upon review of the patient history. Participation in Pediatric PSH (PPSH) was introduced to the families by the pediatric otolaryngologists. Either the patient's family or physician team could elect to decline participation in the PPSH model. On the day of surgery, the PPSH protocol included a paper checklist to ensure that all patients met eligibility standards. A standardized order-set was implemented in the electronic medical record (EMR) for pre-operative and post-operative nursing instructions and eligible medications. Patients received at least 3 hours of postoperative monitoring prior to discharge home to address postoperative issues. Prior to discharge, caregivers watched a standard teaching video, available on YouTube, which was developed in conjunction with the hospital educational and technical support staff. An attending anesthesiologist made a postoperative followup phone call on the evening of surgery to ensure no untoward events were experienced by the patient as well as elicit caregiver feedback concerning the discharge process. The protocol was discontinued if at any time family members, physicians, or nurses were uncomfortable with completing the protocol or felt that the patient did not meet discharge criteria.ResultsOne hundred sixty-six patients were evaluated for PPSH inclusion. Forty patients were excluded (23 did not meet inclusion criteria, 5 had viral upper respiratory infections, and 10 for other non specified reasons such as tonsillectomy added, sibling with surgery, and incorrect documentation). Therefore, a total of 126 were eligible for PPSH (male/female = 69/57; age 22 ± 4 months). The comparison group included 1,029 children (male/female = 645/384; age 22 ± 7 months of age) undergoing adenoidectomy who were not evaluated for PPSH inclusion. Of the 126 PPSH participants included in the analysis, 27 were excluded at some point during the pathway. Nine cases experienced oxygen desaturation, laryngospasm, or required supplemental oxygen. Noncompliance with the protocol was noted in 5 cases, parental concerns were noted in 17 cases, and there were concerns from the pediatric anesthesiologist or otolaryngologist in 5 cases. In the comparison group, hospital length of stay was significantly longer than in the PSH group (p<0.001), with 524 (51%) patients discharged on the day of service compared to 99 (79%) in the PSH group. No major morbidity or mortality occurred. There was no difference between the two groups in return to the emergency department (ED) visits within 30 days (PSH: 7/126, 6%; control: 59/1,029, 6%; p=0.935). Within 14 days of the procedure, 4 PPSH patients visited urgent care or a primary care physician; 4 visited the ED; and 1 was readmitted to the hospital. Twenty families contacted the otorhinolaryngology triage phone line primarily related to pain and fever.ConclusionWe present our experience and success in developing a PPSH for patients, ranging in age from 16 to 35 months of age, undergoing adenoidectomy either alone or with tympanostomy tube insertion by protocolizing care, collaborating among care providers, and educating families. With this process in place, a significant percentage of these patients who were previously admitted were discharged home the same day of surgery.
http://ift.tt/2vuOQaa
Temporomandibular joint reconstruction after condylar fracture complication related to osteosynthesis material
Publication date: Available online 24 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.F.C. Dantas, J.N. Nogueira Neto, V.A. Sarmento, P.S.F. Campos
Total condylar resorption and the failure of bone synthesis material as postoperative complications of condyle fracture are seldom reported in the literature. When these occur, they may severely limit temporomandibular joint (TMJ) function. In such cases, a reconstruction of the joint is indicated, which can be achieved by means of an alloplastic prosthesis. This article reports a rare case of impaction of osteosynthesis material in the region of the base of the skull associated with a mandibular condyle fracture treated with rigid internal fixation, which resulted in complications. There was progression to condylar resorption, requiring an alloplastic TMJ reconstruction, which was performed in a single surgical session.
http://ift.tt/2vlDbvm
The impact of treatment for head and neck cancer on positive psychological change within a year of completing treatment
Publication date: Available online 24 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Harding, T.P. Moss
Head and neck cancer carries a high level of morbidity and mortality. So why could anyone find having such a disease a positive event? The adversity hypothesis of "what doesn't kill you makes you stronger" suggests that people can use adversity to develop as human beings. This positive psychological change has received little attention in relation to head and neck cancer. Responses to the Silver Lining Questionnaire, University of Washington Quality of Life Questionnaire, and Short-Form 12 were collected from a postal survey, 3 to 12 months after the completion of treatment for head and neck cancer. Fifty-two (63%) people returned the survey and were included in the analysis. Time since completion of therapy did not show any relationship with positive psychological change. Tumour stage and treatment regimen both had a relationship with positive change. Participants with lower stage tumours had higher levels of positive change than those with tumours of higher stages. Participants who had surgery alone reported more positive change than those who had surgery with radiotherapy. A social factor related to greater change was being married or living with a partner when compared to living alone. Further research would aid the identification of bio-psychosocial factors that influence the development of positive psychological change and inform the development of rehabilitation interventions.
http://ift.tt/2wLU4Tp
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