Head and Neck Medicine by Alexandros G.Sfakianakis: 12/27/17

Τετάρτη 27 Δεκεμβρίου 2017

Editorial Board

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104

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Long-term follow-up with mention of complications in pediatric microvascular mandibular reconstruction

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Kenneth Akakpo, Christopher Iobst, Matthew Old, Jonathan Grischkan
The fibular free flap has become the gold standard for mandibular reconstruction. Despite its vast array of benefits, this procedure has the potential for several complications. In the pediatric setting, the immature skeleton sets the stage for an increased risk of future skeletal abnormalities, both in the jaw, and in the donor site. Herein we describe the case of a toddler who underwent mandibular reconstruction using a fibula free flap and, years later, subsequently developed ankle instability as a result of residual fibula migration. This indicates the need for careful consideration of long-term issues in the growing pediatric skeleton prior to surgery.

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The impact of a resident-run review curriculum and USMLE scores on the Otolaryngology in-service exam

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Andrew J. Redmann, Kareem O. Tawfik, Charles M. Myer
ObjectiveDescribe the association of USMLE Step 1 scores and the institution of a dedicated board review curriculum with resident performance on the Otolaryngology training examination.Study designRetrospective cross sectional study.MethodsWe reviewed American Board of Otolaryngology Training Examination (OTE) scores for an otolaryngology residency program between 2005 and 2016. USMLE Step 1 scores were collected. In 2011 a resident-run OTE review curriculum was instituted with the goal of improving test preparation. Scores were compared before and after curriculum institution. Linear regression was performed to identify predictors of OTE scores.Results47 residents were evaluated, 24 before and 23 after instituting the curriculum. There was a moderate correlation between USMLE step 1 scores and OTE scores for all years. For PGY-2 residents, mean OTE scores improved from 25th percentile to 41st percentile after institution of the review curriculum (p = 0.05). PGY 3–5 residents demonstrated no significant improvement. On multivariate linear regression, after controlling for USMLE step 1 scores, a dedicated board review curriculum predicted a 23-point percentile improvement in OTE scores for PGY-2 residents (p = 0.003). For other post-graduate years, the review curriculum did not predict score improvement.ConclusionUSMLE step 1 scores are moderately correlated with OTE performance. A dedicated OTE review curriculum may improve OTE scores for PGY-2 residents, but such a curriculum may have less benefit for intermediate- and senior-level residents.Level of evidence4.

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Maternal knowledge and attitudes to universal newborn hearing screening: Reviewing an established program

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Maggie Yee Yan Lam, Eddie Chi Ming Wong, Chi Wai Law, Helena Hui Ling Lee, Bradley McPherson
ObjectivesTo facilitate early diagnosis of infants with hearing loss, a universal newborn hearing screening program (UNHS) has been implemented in Hong Kong's public hospitals for over a decade. However, there have been no known studies investigating parent attitudes to, and satisfaction with, UNHS since its launch in Hong Kong. The present study aimed to investigate knowledge of UNHS as well as infant hearing development, and attitudes and satisfaction with UNHS, in Hong Kong mothers with newborns. The study was designed to help evaluate and improve an established UNHS public hospital program, based on the perspectives of service users.MethodsA researcher-developed questionnaire was administered to 102 mothers whose newborn had received UNHS in the postnatal wards of a large public hospital in Hong Kong. The questionnaire considered parental knowledge of UNHS and infant hearing development, attitudes and satisfaction toward public hospital UNHS. In the knowledge dimension, parents' preferred time and location for pre-test information delivery, interpretation of screening results, and knowledge of hearing developmental milestones were surveyed. In addition, maternal attitudes to and satisfaction with UNHS screening services, the potential impact of UNHS on parent emotions and parent-baby bonding, attitudes toward informed consent, and willingness to comply with diagnostic assessment referral were also be surveyed.ResultsMean participant scores on knowledge of infant hearing development were relatively low (M = 2.59/6.0, SD = 0.90). Many mothers also underestimated the potential ongoing risks of hearing impairment in babies. Around 80% of mothers thought an infant could not have hearing impairment after passing the screening. In addition, one-third of mothers thought a baby could not later develop hearing impairment in infancy or childhood. In terms of attitudes and satisfaction, participants gave somewhat negative ratings for questions regarding receiving sufficient information about the screening (M = 2.90/5.0, SD = 1.27), screening procedure (M = 2.20/5.0, SD = 1.08), and sufficiency of information about results (M = 2.87/5.0, SD = 1.14). Nonetheless, participants gave positive ratings concerning whether screening could lead to early diagnosis (M = 4.61/5.0, SD = 0.57) and over 95% of mothers supported UNHS despite potential for false positive results. Mothers reported a high willingness to bring their baby to follow-up assessments if required (M = 4.53/5.0, SD = 0.56). Participants gave positive ratings for their level of satisfaction with the time and location of first UNHS information provision (M = 4.34/5.0, SD = 0.80) and the way permission was asked for screening the baby (M = 4.04/5.0, SD = 0.97) but alternative procedures were also recommended. Most recommendations focused on providing more information about the test and a more detailed explanation of screening results.ConclusionsThe survey results highlighted the need to provide more information to parents about infant hearing development to support home monitoring for signs of hearing loss after UNHS, as well as more detailed explanation and information regarding hearing screening and the implications of results to parents. Regardless of location, surveys of this type may provide valuable support for UNHS program quality assurance.

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Ring a ring o'roses, a patient with Kaposi's? Pazopanib, pazopanib, it might go away. Mediterranean (classic) Kaposi sarcoma responds to the tyrosine kinase inhibitor pazopanib after multiple lines of standard therapy

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Influenza B virus infection and Stevens–Johnson syndrome

Abstract

A 2-year-old boy with influenza B infection and rapidly worsening targetoid skin lesions with mucosal involvement was diagnosed with Stevens–Johnson syndrome (SJS) and treated with oseltamivir and intravenous immunoglobulin, with resolution of illness. Subsequent quadrivalent inactivated influenza vaccine was well tolerated. This case highlights the rarity of SJS in the setting of influenza B infection and addresses the safety of administering subsequent influenza vaccines to such individuals.

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Heparin-induced haemorrhagic bullous dermatosis

Summary

Background

Heparin-induced haemorrhagic bullous dermatosis (HBD) is a rare but probably underdiagnosed reaction to heparin, with 26 cases reported in the English literature. Currently, there is no consensus regarding the treatment.

Aim

To assess our new cases of HBD and review the previously reported cases, in order to draw conclusions about this adverse skin reaction to heparin.

Methods

A PubMed search was performed for articles containing the terms '(heparin-induced AND (blister OR bulla OR bullae)) OR (hemorrhagic bullous dermatosis AND heparin) OR heparin bullous dermatosis'. Descriptive statistical data analysis was performed using Microsoft Excel.

Results

We assessed five new cases of HBD. In addition, our literature search revealed 26 previously reported patients. Combining these, we found that the mean ± SD age of patients with HBD was 71.4 ± 14 years. HBD affects men more commonly than women (men 22/31; P = 0.02). Patients develop tense bullae most frequently on the extremities, approximately 8 days (mean ± SD 7.5 ± 6.4 days) after starting treatment with a heparin product, usually enoxaparin.

Conclusions

The typical clinical course is spontaneous resolution within days to weeks irrespective of continuation of heparin therapy. Because of its self-limiting nature, interruption of heparin therapy may not be required.

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An erythematous raised dermatofibroma-like nodule

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Improving learning and confidence through small group, structured otoscopy teaching: a prospective interventional study

Abstract

Background

Otologic diseases are common and associated with significant health care costs. While accurate diagnosis relies on physical exam, existing studies have highlighted a lack of comfort among trainees with regards to otoscopy. As such, dedicated otoscopy teaching time was incorporated into the undergraduate medical curriculum in the form of a small group teaching session. In this study, we aimed to examine the effect of a small-group, structured teaching session on medical students' confidence with and learning of otoscopic examination.

Methods

Using a prospective study design, an otolaryngologist delivered an one-hour, small group workshop to medical learners. The workshop included introduction and demonstration of otoscopy and pneumatic otoscopy followed by practice with peer feedback. A survey exploring students' confidence with otoscopy and recall of anatomical landmarks was distributed before(T1), immediately after(T2), and 1 month following the session(T3).

Results

One hundred and twenty five learners participated from February 2016 to February 2017. Forty nine participants with complete data over T1-T3 demonstrated significant improvement over time in confidence (Wilk's lambda = .09, F(2,48) = 253.31 p < .001, η ² = .91) and learning (Wilk's lambda = 0.34, F(2,47) = 24.87 p < .001, η ² = .66).

Conclusions

A small-group, structured teaching session had positive effects on students' confidence with otoscopy and identification of otologic landmarks. Dedicated otoscopy teaching sessions may be a beneficial addition to the undergraduate medical curriculum.

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Inflammatory and infectious pathology of the gastrointestinal tract: an introduction

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On the studies of time periods in head and neck cancer diagnosis and treatment

We have read with great interest the valuable paper by Polesel et al. [1] published early this year, where their authors conclude that HNSCC treated within 45 days from diagnosis have increased survival probabilities and also that early-stage patients suffered the most from diagnostic delay.

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Inhalant allergen sensitization is an independent risk factor for the development of angioedema

The etiology and risk factors for angioedema remain poorly understood with causative triggers often going undiagnosed despite repeated reactions. The purpose of this study was to determine the relationship between inhalant allergen sensitization and angioedema.

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VideoEndocrinology™ High-Impact Videos

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Bilateral Axillo-Breast Approach Robot-Assisted Endoscopic Modified Radical Neck Dissection
Hyunsuk Suh, Timo W. Hakkarainen, William B. Inabnet III

Subtotal Thyroidectomy with Local Cervical Block Anesthesia in Rural Uganda
Christine Deyholos, Thanyawat Sasanakietkul, Cathy Kilyewala, Jane O. Fualal, Tobias Carling

Retroperitoneoscopic Excision of Recurrent Paraganglioma
Mark Lansdown, Titus Cvasciuc, Sheila Fraser

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Reanimation of the paralyzed lids by cross-face nerve graft and platysma transfer

Publication date: Available online 27 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Federico Biglioli, Matteo Zago, Fabiana Allevi, Daniela Ciprandi, Giovanni Dell'Aversana Orabona, Valentina Pucciarelli, Dimitri Rabbiosi, Ilaria Pacifici, Filippo Tarabbia, Chiarella Sforza
Alterations of facial muscles may critically humper patients' quality of life. One of the worst conditions is the reduction or abolition of eye blinking. To prevent these adverse effects, surgical rehabilitation of eyelid function is the current treatment choice. In the present paper, we present a modification of the technique devised by Nassif to recover lids from long-standing paralysis. In our modification, the upper lid is rehabilitated by a platisma graft innervated by the contralateral facial nerve branches using a cross-face sural nerve graft. The lower lid is pulled upward by a fascia lata string suspension. Fourteen patients with unilateral facial paralysis were operated on consecutively. For each patient, two sets of frontal photographs with open and closed eyes were available, before and after the surgical rehabilitation. On average, eyelid lumen with closed eyes decreased by 2.6 mm (SD 2.4) after surgical rehabilitation (37% of the initial value). With open eyes, the decrement was 1.5 mm (SD 1.6, 15%). The modifications were highly significant (p < 0.01), with very large effect sizes. Reanimation of the paralyzed eye by mean of cross-face nerve graft followed by platisma neurotization can restore natural eyelid closure and blink reflex.

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The ideal ear position in Caucasian females

Publication date: Available online 26 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): P. Niclas Broer, Aung Thiha, Denis Ehrl, Sammy Sinno, Sabrina Juran, Caroline Szpalski, Reuben Ng, Milomir Ninkovic, Lukas Prantl, Paul I. Heidekrueger
PurposeEar position contributes significantly to facial appearance. However, while objective measurements remain the foundation for aesthetic evaluations, little is known about how an ear should ideally be positioned regarding its rotational axis. This study aimed to further evaluate whether there exists a universally applicable ideal ear axis, and how sociodemographic factors impact such preferences.Materials and MethodsAn interactive online survey was designed, enabling participants to change the axis of a female model's ear in terms of its forward and backward rotation. The questionnaire was sent out internationally to plastic surgeons and the general public. Demographic data were collected and analysis of variance was used to investigate respective preferences.ResultsA total of 1016 responses from 35 different countries (response rate: 18.5%) were gathered. Overall, 60% of survey takers chose the minus 10 or 5 degree angles to be most attractive. Significant differences were found regarding sex, ethnicity, country of residence, profession and respective ear axis preferences.ConclusionAcross multiple countries and ethnicities, an ear position in slight reclination of minus 5 to 10 degrees is considered most pleasing in Caucasian females. However, sociodemographic factors significantly impact individual ear axis preferences and should be taken into consideration when performing reconstructive ear surgery.

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European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases: report of the European Union Parliament Summit (29 March 2017)

On March 29, 2017, a European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases (CRD) was organized by the European Forum for Research and Education in Allergy and Airway Diseases. ...

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Psychosocial health of cochlear implant users compared to that of adults with and without hearing aids: Results of a nationwide cohort study

Abstract

Objectives

This study aimed to examine the psychosocial health status of adult cochlear implant (CI) users, compared to that of hearing aid (HA) users, hearing-impaired adults without hearing aids, and normally hearing adults.

Design

Cross-sectional observational study, using both self-reported survey data and a speech-in-noise test.

Setting

Data as collected within the Netherlands Longitudinal Study on Hearing (NL-SH) between September 2011 and June 2016 were used.

Participants

Data from 1,254 Dutch adults (aged 18 to 70), selected in a convenience sample design, were included for analyses.

Mean outcome measures

Psychosocial health measures included emotional and social loneliness, anxiety, depression, distress, and somatisation. Psychosocial health, hearing status, use of hearing technology, and covariates were measured by self-report; hearing ability was assessed through an online digit-triplet speech-in-noise test.

Results

After adjusting for the degree of hearing impairment, HA users (N=418) and hearing-impaired adults (N=247) had significantly worse scores on emotional loneliness than CI users (N=37). HA users had significantly higher anxiety scores than CI users in some analyses. Non-significant differences were found between normally hearing (N=552) and CI users for all psychosocial outcomes.

Conclusions

Psychosocial health of CI-users is not worse than that of hearing-impaired adults with or without hearing aids. CI users' level of emotional loneliness is even lower than that of their hearing impaired peers using hearing aids. A possible explanation is that CI-patients receive more professional and family support, and guidance along their patient journey than adults who are fitted with hearing aids.

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Local Anesthetic Systemic Toxicity in Total Joint Arthroplasty: Incidence and Risk Factors in the United States From the National Inpatient Sample 1998–2013

Background Local anesthetic systemic toxicity (LAST) is a rare and potentially devastating complication of regional anesthesia. Single-institution registries have reported a decreasing incidence, but these results have limited broad applicability. A recent study using a US database found a relatively high incidence of LAST. We used the National Inpatient Sample, a US database of inpatient admissions, to identify the national incidence and associated risk factors for LAST in total joint arthroplasties. Methods In this retrospective study, we studied patients undergoing hip, knee, or shoulder arthroplasty, from 1998 to 2013, with an adjunct peripheral nerve blockade. We used a multivariable logistic regression to identify patient conditions, hospital level variables, and procedure sites associated with LAST. Results A total of 710,327 discharges met inclusion criteria. The average adjusted incidence was 1.04 per 1000 peripheral nerve blocks, with decreasing trend over the 15-year study period (odds ratio [OR], 0.90; P = 0.002). Shoulder arthroplasty (OR, 4.35; P = 0.0001) compared with knee or hip arthroplasty and medium-size (OR, 3.34; P = 0.003) and large-size (OR, 2.40; P = 0.025) hospitals as compared with small hospitals were associated with increased odds of LAST. Conclusions The incidence of LAST nationally in total joint arthroplasty with adjunct nerve blocks is similar to recent estimates from academic centers, with a small decreasing trend through the study period. Despite an overall low incidence rate, practitioners should continue to maintain vigilance for manifestations of LAST, especially as the use of regional anesthesia continues to increase. Accepted for publication June 29, 2017. Address correspondence to: Daniel S. Rubin, MD, Department of Anesthesia and Critical Care, University of Chicago Medicine, 5841 S Maryland, Box MC 4028, Chicago, IL 60637 (e-mail: drubin@dacc.uchicago.edu). Funding was provided by National Institutes of Health (Bethesda, Maryland) grant UL1 RR024999 to the University of Chicago Institute for Translational Medicine. G.W. is an officer, director, shareholder and paid consultant of ResQ Pharma, Inc. He also created and maintains www.lipidrescue.org, an educational web site. The other authors declare no potential conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org). Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Common BP Drug Tied to Increased Risk of Skin Cancer

People who take a certain diuretic prescribed to control fluid retention and treat high blood pressure may be more likely to get skin cancer than other individuals, a Danish study suggests.
Reuters Health Information

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Tortuous internal carotid artery in the oropharynx: a rare cause of a mass

Publication date: Available online 26 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A. Vural, E. Gülmez, H. Yurdakul

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17,18-EpETE–GPR40 axis ameliorates contact hypersensitivity by inhibiting neutrophil mobility in mice and cynomolgus macaques

Publication date: Available online 27 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Takahiro Nagatake, Yumiko Shiogama, Asuka Inoue, Junichi Kikuta, Tetsuya Honda, Prabha Tiwari, Takayuki Kishi, Atsushi Yanagisawa, Yosuke Isobe, Naomi Matsumoto, Michiko Shimojou, Sakiko Morimoto, Hidehiko Suzuki, Soichiro Hirata, Pär Steneberg, Helena Edlund, Junken Aoki, Makoto Arita, Hiroshi Kiyono, Yasuhiro Yasutomi, Masaru Ishii, Kenji Kabashima, Jun Kunisawa
BackgroundMetabolites of eicosapentaenoic acid (EPA) exert various physiological actions. 17,18-epoxyeicosatetraenoic acid (17,18-EpETE) is a recently identified new class of anti-allergic and anti-inflammatory lipid metabolite of EPA, but its effects on skin inflammation and the underlying mechanisms remain to be investigated.ObjectiveWe evaluated the effectiveness of 17,18-EpETE for the control of contact hypersensitivity in mouse and cynomolgus macaques. We further sought to reveal underlying mechanisms by identifying the responsible receptor and cellular target of 17,18-EpETE.MethodsContact hypersensitivity was induced by topical application of 2,4-dinitrofluorobenzene. Skin inflammation and immune cell populations were analyzed by flow cytometric, immunohistologic and quantitative RT-PCR analyses. Neutrophil mobility was examined by imaging analysis in vivo and neutrophil culture in vitro. The receptor for 17,18-EpETE was identified by using the TGFα-shedding assay and receptor's involvement in the anti-inflammatory effects of 17,18-EpETE was examined by using KO mice and specific inhibitor treatment.ResultsWe found that preventive or therapeutic treatment with 17,18-EpETE ameliorated contact hypersensitivity by inhibiting neutrophil mobility in mice and cynomolgus macaques. 17,18-EpETE was recognized by GPR40 (also known as free fatty acid receptor 1) and inhibited chemoattractant-induced Rac activation and pseudopod formation in neutrophils. Indeed, the anti-allergic inflammatory effect of 17,18-EpETE was abolished in the absence or inhibition of GPR40.Conclusion17,18-EpETE inhibits neutrophil mobility through the activation of GPR40, which is a potential therapeutic target to control allergic inflammatory diseases.

Graphical abstract

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Congenital basal meningoceles with different outcomes: a case series

Basal meningoceles are rare congenital defects and often clinically occult until they result in life-threatening complications. Therefore, it is important to know the diagnostic clues to early diagnosis.

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Association of Uterine Leiomyomas With Central Centrifugal Cicatricial Alopecia

This cohort study examines the risk of uterine leiomyomas in black women with central centrifugal cicatricial alopecia.

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Nongenital Molluscum Contagiosum in Persons Without Immune Deficiency

This Clinical Evidence Synopsis summarizes an updated Cochrane review that assessed effectiveness and safety of treatments for nongenital molluscum contagiosum in persons without immune deficiency.

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Diameter of Skin Lesions With and Without a Ruler

This analysis of survey results examines the accuracy with which medical students, internal medicine residents, and dermatology residents, fellows, and faculty can estimate the diameter of skin lesions in clinical photographs.

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Cutaneous Diphtheria Mimicking Pyoderma Gangrenosum

This case report describes a patient with cutaneous diphtheria mimicking pyoderma gangrenosum.

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Standardized Screening for Depression and Suicidal Ideation

This Viewpoint examines the role of the Patient Health Questionnaire-2 in dermatology concerning secondary psychiatric disorders that involve emotional disturbances and manifest in response to the psychologic stress caused by dermatologic conditions.

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Body balance at static posturography in vestibular migraine

Publication date: Available online 27 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Leslie Palma Gorski, Adriana Mendes Marques, Flávia Salvaterra Cusin, Suelen Cesaroni, Mauricio Malavasi Ganança, Heloisa Helena Caovilla
IntroductionMigraine is one of the most frequent and incapacitating headaches, with a high degree of impairment in quality of life. Its association with vestibular symptoms is common, including imbalance and postural instability.ObjectiveTo evaluate the body balance of patients with vestibular migraine through a static posturography test.MethodsAn experimental group of 31 patients with a medical diagnosis of vestibular migraine in the intercritical period of the disease, and a control group of 31 healthy individuals, matched for age and gender, were submitted to the eight sensory conditions of the Tetrax Interactive Balance System. The parameters analyzed were: stability index, which measures the amount of sway, global stability and ability to compensate postural modifications; weight distribution index, which compares deviations in weight distribution; synchronization index, which measures the symmetry in the weight distribution; postural sway frequency, which indicates the frequency range with more sway; and fall risk index, which expresses the probability of falls.ResultsThe stability index was higher in the experimental group in all eight sensory conditions, with a significant difference between the groups in six of them. The weight distribution index was higher in the experimental group in all conditions, with a significant difference in three of them. The number of cases with preferential sway in F2–F4 was significantly higher in the experimental group in three conditions, and in F5–F6 in two, while the fall risk was significantly higher in the experimental group than in the control group.ConclusionPatients with vestibular migraine showed compromised body balance at the static posturography test.

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The anatomic analysis of the vidian canal and the surrounding structures concerning vidian neurectomy using computed tomography scans

Publication date: Available online 26 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Gülay Açar, Aynur Emine Çiçekcibaşı, İbrahim Çukurova, Kemal Emre Özen, Muzaffer Şeker, İbrahim Güler
IntroductionThe type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures.ObjectiveThe variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning.MethodsThis study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625mm of 250 adults.ResultsThe distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p<0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p<0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p<0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05±7.71°.ConclusionsPreoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to insure predictable postoperative outcomes.

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Electroacoustic verification of frequency modulation systems in cochlear implant users

Publication date: Available online 26 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Vanessa Luisa Destro Fidêncio, Regina Tangerino de Souza Jacob, Liége Franzini Tanamati, Érika Cristina Bucuvic, Adriane Lima Mortari Moret
IntroductionThe frequency modulation system is a device that helps to improve speech perception in noise and is considered the most beneficial approach to improve speech recognition in noise in cochlear implant users. According to guidelines, there is a need to perform a check before fitting the frequency modulation system. Although there are recommendations regarding the behavioral tests that should be performed at the fitting of the frequency modulation system to cochlear implant users, there are no published recommendations regarding the electroacoustic test that should be performed.ObjectivePerform and determine the validity of an electroacoustic verification test for frequency modulation systems coupled to different cochlear implant speech processors.MethodsThe sample included 40 participants between 5 and 18 year's users of four different models of speech processors. For the electroacoustic evaluation, we used the Audioscan Verifit device with the HA-1 coupler and the listening check devices corresponding to each speech processor model. In cases where the transparency was not achieved, a modification was made in the frequency modulation gain adjustment and we used the Brazilian version of the "Phrases in Noise Test" to evaluate the speech perception in competitive noise.ResultsIt was observed that there was transparency between the frequency modulation system and the cochlear implant in 85% of the participants evaluated. After adjusting the gain of the frequency modulation receiver in the other participants, the devices showed transparency when the electroacoustic verification test was repeated. It was also observed that patients demonstrated better performance in speech perception in noise after a new adjustment, that is, in these cases; the electroacoustic transparency caused behavioral transparency.ConclusionThe electroacoustic evaluation protocol suggested was effective in evaluation of transparency between the frequency modulation system and the cochlear implant. Performing the adjustment of the speech processor and the frequency modulation system gain are essential when fitting this device.

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Endoscopic surgery of the frontoethmoidal osteomas

Publication date: Available online 26 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Tomasz Gotlib

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Expanding the limits of endoscopic intraorbital tumor resection using 3-dimensional reconstruction

Publication date: Available online 26 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Luciano Lobato Gregorio, Nicolas Y. Busaba, Marcel M. Miyake, Suzanne K. Freitag, Benjamin S. Bleier
IntroductionEndoscopic orbital surgery is a nascent field and new tools are required to assist with surgical planning and to ascertain the limits of the tumor resectability.ObjectiveWe purpose to utilize three-dimensional radiographic reconstruction to define the theoretical lateral limit of endoscopic resectability of primary orbital tumors and to apply these boundary conditions to surgical cases.MethodsA three-dimensional orbital model was rendered in 4 representative patients presenting with primary orbital tumors using OsiriX open source imaging software. A 2-Dimensional plane was propagated between the contralateral nare and a line tangential to the long axis of the optic nerve reflecting the trajectory of a trans-septal approach. Any tumor volume falling medial to the optic nerve and/or within the space inferior to this plane of resectability was considered theoretically resectable regardless of how far it extended lateral to the optic nerve as nerve retraction would be unnecessary. Actual tumor volumes were then superimposed over this plan and correlated with surgical outcomes.ResultsAmong the 4 lesions analyzed, two were fully medial to the optic nerve, one extended lateral to the optic nerve but remained inferior to the plane of resectability, and one extended both lateral to the optic nerve and superior to the plane of resectability. As predicted by the three-dimensional modeling, a complete resection was achieved in all lesions except one that transgressed the plane of resectability. No new diplopia or vision loss was observed in any patient.ConclusionThree-dimensional reconstruction enhances preoperative planning for endoscopic orbital surgery. Tumors that extend lateral to the optic nerve may still be candidates for a purely endoscopic resection as long as they do not extend above the plane of resectability described herein.

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A comparative study of osteopontin and MMP-2 protein expression in peripheral and central giant cell granuloma of the jaws

Publication date: Available online 27 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Nooshin Mohtasham, Nasrollah Saghravanian, Bahareh Fatemi, Mehdi Vahedi, Monavar Afzal-Aghaee, Hamideh Kadeh
IntroductionOral peripheral and central giant cell granulomas are lesions with little-known etiology and pathogenesis.ObjectiveThe aim of this study was to compare matrix metalloproteinases-2 and osteopontin protein expression in the multinucleated giant cells and mononuclear cells of the peripheral and central giant cell granuloma lesions.MethodsIn this retrospective study, the presence of matrix metalloproteinases-2 and osteopontin in 37 cases of central giant cell granuloma and 37 cases of peripheral giant cell granuloma paraffin blocks were assessed by streptavidin-biotin immunohistochemistry. Independent sample t-test, Chi-square, Mann–Whitney tests and Spearman's rank correlation coefficient were used.ResultsThe osteopontin was expressed in both multinucleated giant cells and mononuclear cells in all cases of peripheral and central giant cells granulomas. However, the matrix metalloproteinases-2 expression was positive in 86.5% of giant cells and it was positive in all of mononuclear cells in peripheral giant cells granuloma. In central giant cells granulomas, 91.8% of giant cells and all mononuclear cells were positive for matrix metalloproteinases-2 marker. Percentage and Intensity of staining were significantly higher in central than peripheral giant cells lesions, for both markers (p˂0.05).ConclusionThis study showed that the expression of osteopontin in giant cells supports the theory of osteolcastic nature of these cells. Also, the presence of osteopontin and matrix metalloproteinases-2 in mononuclear cells may indicate the monocyte-macrophage origin of these cells, as the differentiation of the precursors of the mononuclear stromal monocyte/macrophage to osteoclasts is possibly affected by the expression of osteolytic factors. Also, may be differences in biological behaviors of these lesions are associated with the level of osteopontin and matrix metalloproteinases-2 expression.

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Overexpression of CDC7 in malignant salivary gland tumors correlates with tumor differentiation

Publication date: Available online 26 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Zohreh Jaafari Ashkavandi, Mohammad Javad Ashraf, Ali Asghar Abbaspoorfard
IntroductionCell division cycle-7 protein is a serine/threonine kinase that has a basic role in cell cycle regulation and is a potential prognostic or therapeutic target in some human cancers.ObjectivesThis study investigated the expression of cell division cycle-7 protein in benign and malignant salivary gland tumors and also its correlation with clinicopathologic factors.MethodsImmunohistochemical expression of cell division cycle-7 was evaluated in 46 cases, including 15 adenoid cystic carcinoma, 12 mucoepidermoid carcinoma, 14 pleomorphic adenoma, and 5 normal salivary glands. Cell division cycle-7 expression rate and intensity were compared statistically.ResultsThe protein was expressed in almost all tumors. The intensity and mean of cell division cycle-7 expression were higher in malignant tumors in comparison with pleomorphic adenomas (p=0.000). The protein expression was correlated with tumor grades (p=0.000).ConclusionsThe present study demonstrated cell division cycle-7 overexpression in malignant salivary gland tumors in comparison with pleomorphic adenomas, and also a correlation with tumor differentiation. Therefore, this protein might be a potential prognostic and therapeutic target for salivary gland tumors.

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Septum pyramidal adjustment and repositioning – a conservative and effective rhinoplasty technique

Publication date: Available online 26 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Vanessa Lunelli, Nedio Atoloni, Gustavo Pereira Lang, Luís Fernando Melotti, Tatiany Tiemi Yamamoto, Emílio Jonatas Munerolli
IntroductionIn rhinoplasty, the nasal dorsum has important relevance regarding the esthetic and functional aspects of the surgery. Its reduction should be performed with maximum accuracy and controlled resection to prevent or minimize potential complications. The acronym S.P.A.R. (Septum Pyramidal Adjustment and Repositioning) consists of a conservative surgical technique of the nasal dorsum, which does not require the detachment of the upper lateral cartilages of the nasal septum, allowing the remodeling of the nasal dorsum while maintaining esthetic lines and nasal function, potentially reducing frequent complications in more traditional surgeries.ObjectiveTo describe the S.P.A.R. technique in detail, presenting its advantages and disadvantages in relation to the other surgical approaches, as well as to disclose results of this surgical procedure in patients submitted to primary rhinoplasty in a specific hospital.MethodsThe medical records of all patients submitted to surgery from 2011 to 2015 through this surgical technique were evaluated by the same team. Of these cases, certain variables were analyzed such as gender, age, indication for reoperation and surgical complications.Results153 patients underwent rhinoplasty through S.P.A.R. Of these, 13 patients experienced an indication for a second surgery and four had some type of postoperative complication.ConclusionThe S.P.A.R. surgical technique is a simple procedure, as it does not require the reconstruction of the nasal dorsum. It has a low number of complications and preserves the anatomical structures.

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Factors associated with voice disorders among the elderly: a systematic review

Publication date: Available online 26 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Amanda Cibelly Brito Gois, Leandro de Araújo Pernambuco, Kenio Costa de Lima
IntroductionDuring the aging process, natural modifications occur in the larynx and the structures involved in phonation which explain the specific characteristics found in the voices of elderly persons. When, at any moment, a voice fails and there is interference with communication, a voice disorder has occurred. This can generate disadvantages in communicative efficiency and have a negative impact on quality of life, compromising mechanisms of socialization, the maintenance of autonomy, and the sense of well-being. Nevertheless, there appears to be little clarity about which factors are associated with voice disorders in this population, especially from an epidemiological perspective.ObjectiveThe present study is a literature review to identify factors associated with voice disorders among the elderly described in population-based studies.MethodsA systematic review of electronic databases was carried out. The methodological quality of the studies was analyzed with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The research was conducted independently by two researchers.ResultsAlthough two articles met the eligibility criteria, none fulfilled all the criteria for the evaluation of methodological quality. According to the two studies selected for this review, factors associated with voice disorders among the elderly included both physical and psychosocial aspects. However, the methodological discrepancies between the studies, particularly in relation to sample selection and the instruments used indicate great variability and compromise the reliability of the results.ConclusionFurther prevalence studies and investigations of factors associated with voice disorders in the elderly from an epidemiological perspective, and which involve different cultures, should be carried out.

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The Portuguese version of “The Utrecht Questionnaire for outcome assessment in aesthetic rhinoplasty”: validation and clinical application

Publication date: Available online 26 December 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Francisco Rosa, Miguel Ferreira, João Almeida, Mariline Santos, Jorge Oliveira, Cecília Almeida e Sousa
IntroductionThe evaluation of surgical outcomes measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery.ObjectiveThe aim of this study was to perform the translation, cross-cultural adaptation and validation of "The Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty" from English to Portuguese.MethodsRetrospective study involving 50 patients undergoing to rhinoplasty comparing the preoperative period with the current postoperative situation (minimum 6 months and maximum 24 months postoperatively). Statistical analysis was performed to assess internal consistency, test–retest reliability, validity and responsiveness.ResultsNo patients received a negative score on the visual analogue scale comparing preoperative and postoperative appearance. The postoperative improvement on the visual analogue scale revealed a Gaussian curve of normal distribution with a mean improvement of 4.44 points. The test–retest reliability showed a positive correlation between the postoperative response and the same questionnaire repeated ninety-six hours later. The internal consistency was high (Cronbach's alpha value: Preoperative=0.88; Postoperative=0.86). The authors observed a significant improvement in response for all individual questions in the postoperative phase as compared with preoperative situation (t-student test – p<0.05).ConclusionThe Portuguese version of "The Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty" is a valid instrument to assess patients' outcomes following rhinoplasty surgery.

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Successful Treatment of Refractory Vitiligo with a Combination of Khellin and 308-nm Excimer Lamp: An Open-Label, 1-Year Prospective Study

Abstract

Introduction

Phototherapy is the cornerstone of treatment of vitiligo. The 308-nm excimer lamp (EL) induces T cell apoptosis and the stimulation of melanocyte proliferation. Khellin is a furanochromone with a chemical structure close to psoralens. The objective of the study was to evaluate the safety and efficacy of 1-year treatment of recalcitrant vitiligo with a combination of 308-nm EL and khellin.

Methods

Twenty patients with resistant vitiligo were included. Khellin was applied 45 min before irradiation with EL, twice a week, at a dose of 250 mJ/cm². The repigmentation was assessed in four categories: excellent repigmentation (ER) (> 75% repigmentation), good repigmentation (GR) (50–75% repigmentation), moderate repigmentation (MR) (25–50% repigmentation), and poor repigmentation (PR) (< 25% repigmentation).

Results

An ER was observed in 45% of patients (9/20), 5/20 (25%) achieved a GR, 3/20 (15%) an MR, and 3/20 (15%) a PR. Better response was observed on the face, neck, upper limb, hands, and abdomen. The mean number of procedures was 54.1 and the mean cumulative dose was 2967.5 mJ/cm². Six months after the last session no recurrences were observed.

Conclusion

The combination of 308-nm EL and khellin is a safe and effective treatment and represents a new alternative therapy for vitiligo. Further comparative controlled randomized investigations are needed to confirm these promising results with the appropriate therapeutic protocols.

http://ift.tt/2zEuP3i

Summary

Background

Quantitative assessment of possible linkages between skin's firmness and water content is useful for cosmetic and clinical purposes and to better understand features of advancing age.

Objectives

Our goals were to characterize age-related differential features in skin firmness in women and determine the relationship between skin firmness and indices of skin water.

Methods

Skin firmness was quantified using handheld devices that measure the force to indent skin 0.3 and 1.3 mm (F0.3 and F1.3). Skin hydration was quantified using handheld devices that measured tissue dielectric constant (TDC) at 300 MHz to skin depths of 0.5 and 2.0-2.5 mm. All parameters were measured bilaterally in the jowl area and volar forearm of 60 women grouped by age <45 years (YOUNG) and ≥45 years old (MATURE).

Results

All measured parameters were bilaterally symmetrical at jowl and forearm. Forearm and jowl indentation forces were greater in YOUNG with statistically significant declines with advancing age with regression relations most evident at shallower indentation depths (P < .001). Quantitative relations for arm and jowl were F_0.3 = 0.256 × AGE + 32.7 mN and F_0.3 = −0.07 × AGE + 17.7 mN. Firmness was related to TDC values only when indentation force and TDC were assessed on the arm at the shallowest skin depths, as weakly related to firmness and was observed to change with age only when measured to a depth of 0.5 mm represented by TDC5 = 0.096 × AGE + 32.7.

Conclusions

Experimental finding show clear differences in skin firmness between age-groups with skin hydration playing a minor role. Possible explanations and suggestions for further studies are provided.

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Announcement

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Public perception of dermatology and dermatologists: a very relevant but untapped issue

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Depression and suicidality in psoriasis patients: emotional needs to discover

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Psoriasis and multiple sclerosis – hidden link?

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Issue Information

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Forthcoming Events

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JEADV on the rise

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Reviewers who have performed more than three reviews in 2017 A big thank you to our most active reviewers

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Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review

Objective

Opioid abuse is a common disorder affecting over 2 million Americans. Intranasal tissue necrosis is a previously described sequela of nasal opioid inhalation, with a similar presentation to invasive fungal rhinosinusitis (IFRS). The goal of this case report and systematic review is to evaluate the evidence supporting this uncommon disease, with qualitative analysis of the presentation, management and treatment outcomes.

Data Sources

MEDLINE, EMBASE, Google Scholar, Scopus, and Web of Science.

Review Methods

Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilized to identify English-language studies reporting intranasal mucosal injury associated with prescription opioid abuse. Primary outcomes included clinical presentation, treatment strategies, and outcomes.

Results

Systematic review identified 61 patients for qualitative analysis. Common clinical features include facial pain without a history of chronic sinusitis or known immunodeficiency. Diagnostic nasal endoscopy revealed superficial debris with underlying tissue necrosis, consistent with a preliminary diagnosis of IFRS. Characteristic pathologic findings include mucosal ulceration with an overlying acellular substrate, often with polarizable material. Fungal colonization is often reported, with several accounts of angiocentric invasion in immunocompetent patients. Complete symptom resolution is expected following surgical debridement with cessation of intranasal opioid inhalation, with 89% of identified patients experiencing a complete resolution of disease.

Conclusion

TSR2 Induces laryngeal cancer cell apoptosis through inhibiting NF-κB signaling pathway

Objectives/Hypothesis

Human laryngeal squamous cell carcinoma (LSCC) is a malignancy that was discovered originally in the epithelial tissue of laryngeal mucosa. However, the underlying molecular mechanism is still not clear. In this study, we aimed to investigate the potential molecular mechanisms of TSR2 in the LSCC cell apoptosis.

Study Design

The expression of TSR2 was first analyzed in LSCC tissues. Then functional effects of TSR2 on Hep-2 and AMC-HN-8 cell lines were performed by overexpression pcDNA3.1-TSR2.

Methods

We investigated the expression level of TSR2 in LSCC tissues and cells by performing quantitative real-time polymerase chain reaction (qRT-PCR). The pcDNA3.1-TSR2 was constructed to explore the effect of overexpressing TSR2 in Hep-2 cells and AMC-HN-8 cells. We further investigated the effect of overexpressing TSR2 on cell apoptosis-related protein and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) p65 nuclear translocation through Western blot and terminal dUTP nick end-labeling assays.

Results

We found that TSR2 was downregulated in LSSC tissues and cells compared with the controls, and the overexpression of TSR2 in Hep-2 and AMC-HN-8 cells could promote cell apoptosis and related apoptosis proteins. The Western blot/qRT-PCR data further indicated that overexpression of TSR2 in Hep-2 and AMC-HN-8 cells could lead to a block of NF-κB signaling pathway via decreasing nuclear NF-κB p65 and increasing cytoplasm NF-κB p65. Moreover, overexpression of TSR2 significantly inhibited the phosphorylation of IκBα and IKKα/β.

Conclusions

The results indicated that TSR2-induced apoptosis was mediated by inhibiting the NF-κB signaling pathway, which may provide an effective target in gene therapy for LSCC.

Level of Evidence

NA Laryngoscope, 2017

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Down syndrome and pediatric obstructive sleep apnea surgery: A national cohort

Objectives/Hypothesis

To analyze the trend of sleep surgeries in pediatric patients with Down syndrome (DS) and obstructive sleep apnea (OSA), and to compare this to nonsyndromic (NS) children with OSA.

Study Design

Retrospective cohort database analysis.

Methods

Analysis of the 1997 to 2012 editions of the Kid's Inpatient Database was conducted. Using International Classification of Diseases, Ninth Revision codes, all patients with OSA were identified, and subsequently, subgroups of NS children and children with DS were identified. Trends of the number and types of sleep surgeries were analyzed.

Results

A total of 48,301 and 2,991 sleep surgeries were identified in the NS and DS groups, respectively, during the study period. Tonsillectomy with adenoidectomy was the most common procedure in both groups, but the proportion of tonsillectomy with adenoidectomy decreased over time (P < .01). The proportion of palatal surgery and tracheostomy also decreased significantly, whereas there was an increase in the proportion of lingual tonsillectomies, tongue-base reduction procedures, and supraglottoplasties performed in both groups over time. The relative rates of change in these procedures were higher in the DS population.

Conclusions

Tonsillectomy with adenoidectomy remains the most commonly performed procedure, although there was a significant increase in other sleep surgeries performed (lingual tonsillectomy, tongue-base reduction, and supraglottoplasty) between the two study periods, especially in children with DS.

Level of Evidence

2c. Laryngoscope, 00:000–000, 2017

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Unexpected prominent tension pneumosella five years after endoscopic endonasal transsphenoidal surgery

Tension pneumosella (TP) is a rare entity reported as the invagination of the sphenoid sinus mucosa into the skull base after endonasal transsphenoidal surgery. Few studies have reported on TP, and in these studies, invagination is confined to either the intrasellar or suprasellar area. We encountered a case of unexpected prominent TP toward the intracranial space 5 years after endoscopic endonasal transsphenoidal surgery (EETS) for a nonfunctioning pituitary adenoma. In addition, we present a hypothesis of the underlying mechanism by a pressure gradient change between the extracranial and intracranial space in TP formation. For repair, a pedicled nasal septal flap was fabricated from the remaining part of the septal mucosa, and a pedicled inferior turbinate flap was created. Moreover, the nasal septal cartilage was used as a rigid support for reconstruction, which was useful for preventing TP recurrence. This is the first report of an unexpected prominent TP after EETS. It is important for otorhinolaryngologists and neurosurgeons to be aware of the possibility of TP following EETS. Laryngoscope, 2017

http://ift.tt/2pInEHt

Localized Nasopharyngeal Amyloidosis: A Clinicopathologic Series of 7 Cases with a Literature Review

Abstract

Localized nasopharyngeal amyloidosis is an extremely rare entity with only 25 cases described in the English and German literature. We present a case series of seven patients with localized nasopharyngeal amyloidosis and combine the findings with a thorough review the literature.

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Localized Nasopharyngeal Amyloidosis: A Clinicopathologic Series of 7 Cases with a Literature Review

Abstract

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Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico

Publication date: Available online 26 December 2017
Source:Allergologia et Immunopathologia
Author(s): D.E.S. Larenas Linnemann, B.E. del Río Navarro, J.A. Luna Pech, J. Romero Lombard, J. Villaverde Rosas, M.C. Cano Salas, M. Fernández Vega, J.A. Ortega Martell, E.C. López Estrada, J.L. Mayorga Butrón, J. Salas Hernández, J.C. Vázquez García, I. Ortiz Aldana, M.H. Vargas Becerra, M. Bedolla Barajas, N. Rodríguez Pérez, A. Aguilar Aranda, C.A. Jiménez González, C. García Bolaños, C. Garrido Galindo, D.A. Mendoza Hernández, E. Mendoza López, G. López Pérez, G.H. Wakida Kuzonoki, H.H. Ruiz Gutiérrez, H. León Molina, H. Martínez de la Lanza, H. Stone Aguilar, J. Gómez Vera, J. Olvera Salinas, J.J. Oyoqui Flores, J.L. Gálvez Romero, J.S. Lozano Saenz, J.I. Salgado Gama, M.A. Jiménez Chobillon, M.A. García Avilés, M.P. Guinto Balanzar, M.A. Medina Ávalos, R. Camargo Angeles, R. García Torrentera, S. Toral Freyre, G. Montes Narvaez, H. Solorio Gómez, J. Rosas Peña, S.J. Romero Tapia, A. Reyes Herrera, F. Cuevas Schacht, J. Esquer Flores, J.A. Sacre Hazouri, L. Compean Martínez, P.J. Medina Sánchez, S. Garza Salinas, C. Baez Loyola, I. Romero Alvarado, J.L. Miguel Reyes, L.E. Huerta Espinosa, M.Á. Correa Flores, R. Castro Martínez
BackgroundWith the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma.MethodsThe guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management.ResultsThe selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference – all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6–11 years and ≥12 years.ConclusionsFor the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

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Localized Nasopharyngeal Amyloidosis: A Clinicopathologic Series of 7 Cases with a Literature Review

Abstract

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Amiodarone-associated bilateral vestibulopathy

Abstract

Background

Bilateral vestibulopathy (BVP) is a debilitating disorder characterized by the hypofunction of both vestibular end organs or nerves. The most frequent identifiable causes of BVP are ototoxic drug effects, infectious and autoimmune disorders. The majority of cases, however, remain idiopathic.

Methods

Medical records of patients diagnosed with idiopathic BVP were examined in five dizziness clinics.

Results

We identified 126 patients with "idiopathic" BVP. Out of these, 15 patients had a history of Amiodarone treatment before the diagnosis of BVP, resulting in a 12% prevalence.

Conclusion

The present report supports the hypothesis that Amiodarone can cause BVP. Vestibular examination in patients taking Amiodarone and suffering from balance-related symptoms are recommended, to recognize this adverse effect as early as possible and allow for an informed judgement on a potential dose reduction or withdrawal for recovery of the vestibular function.

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The incidence of malignancy in clinically benign cystic lesions of the lateral neck: our experience and proposed diagnostic algorithm

Abstract

Aim

Solitary cystic masses of the lateral neck in an adult patient can pose a diagnostic dilemma. Malignancy must be ruled out since metastases arising from H&N cancers may mimic the presentation of benign cystic masses. Only a small number of studies have investigated the diagnostic management and malignancy rate of clinically benign solitary cervical cystic lesions. There are no established guidelines for the diagnostic evaluation.

Methods

Retrospective review of the clinical, cytological, radiological, and pathological records of all adult patients (> 18 years) operated on for second branchial cleft cysts (BrCC) between 1/2008–2010/2016. Patients with apparent primary H&N malignancy, history of H&N cancer or irradiation, preoperative fine needle aspiration (FNA) of highly suggestive or confirmed malignancy, missing pertinent data, or age less than 18 years were excluded from analysis.

Results

28 patients were diagnosed as having BrCC. The diagnosis was based on clinical findings, FNA cytology, and typical sonographic features. The histologic analysis determined an overall rate of malignancy of 10.7% (3/28): two patients had metastatic papillary thyroid carcinoma, and one patient had metastatic tonsillar squamous cell carcinoma. Purely cystic features on pre-operative ultrasound was the only significant predictor for true BrCC on final histology (p = .02).

Conclusions

Occult malignancy is not rare among adult patients presenting with a solitary cystic mass of the lateral neck. A diagnostic algorithm is proposed. Further studies are needed to establish the appropriate workup and management of an adult patient presenting with a solitary cystic mass of the lateral neck.

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Subcutaneous immunoglobulin for the treatment of deep morphoea in a child

Summary

Morphoea, also known as localized scleroderma, is a disorder characterized by excessive collagen deposition leading to thickening of the dermis and/or subcutaneous tissues. Intravenous IgG therapy has induced improvement in some fibrotic conditions. The primary indication for subcutaneous IgG (SCIG) is in primary immunodeficiency disorders as replacement therapy; however, recently there has been considerable interest in SCIG as an immunomodulatory agent. We report an 11-year-old girl with deep morphoea who was successfully treated with SCIG.

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Surgical removal of a giant iris stromal cyst: an intraoperative optical coherence tomography-guided approach

An 11-year-old girl was brought with the chief complaint of progressive diminution of vision in her right eye for the past 3 months. There was no history of ocular trauma or any ocular surgery. Systemic and family history was insignificant. Visual acuity was 20/20 in her left eye and counting finger close to face with projection of rays being accurate in her right eye. Slit lamp examination of her right eye showed large cystic lesion filling almost entire anterior chamber. With the help of various imaging modalities like anterior segment optical coherence tomography (OCT) and ultrasound biomicroscopy diagnosis of iris stromal cyst was confirmed. Right eye surgical removal of the iris stromal cyst was done under real-time imaging of intraoperative OCT (iOCT). Best-corrected visual acuity at 6 months follow-up was 20/20 without any recurrence. iOCT-guided approach for complete removal of the iris cyst seems more promising.

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The recurrent pleomorphic adenoma conundrum

Purpose of review Recurrent pleomorphic adenoma (RPA) is uncommon. Treatment selection is based on the likely possibility of minimizing the risk of tumour recurrence, avoiding local functional and cosmetic sequelae, and eradicates the possibility of metastatic or malignant transformation. Much has changed since the topic was reviewed in 2001, and this manuscript comments on clinical progress and discusses patient treatment options. Recent findings Surgery is the preferred treatment for head and neck pleomorphic adenoma. Over the recent decade the surgical radicality is favoured for parotid and submandibular gland pleomorphic adenoma, from total gland and tumour removal to endoscopic or minimal open extracapsular tumour excision. Currently molecular pathology and biomarker research has not identified any evidence that separates pleomorphic adenoma from RPA, thus supporting that tumour recurrence is likely associated with surgery. Revision surgery has been reported to be frequently noncurative depending on the extent of the primary surgery, with the added risk of local cosmetic and functional sequelae. Radiotherapy as a nonsurgical modality has advanced and has been shown to be effective in controlling, if not curing, high-risk patients who have identifiable prognostic factors of developing a recurrence and patients with RPA. Summary Current surgical management of pleomorphic adenoma is associated with improved quality of life and minimal disturbance to cosmetic and functional. The reported incidence of RPA has been reduced by 'expert surgeons' but with limited short-term follow-up following more recent surgical modifications. Patients with RPA should be offered treatment that includes surgery and/or radiotherapy and should be encouraged to partake of this decision making process. Correspondence to Professor Patrick J. Bradley, MBA, FRCS, 10 Chartwell Grove, Mapperley Plains, Nottingham NG3 5R, UK. Tel: +44 115 9201611; e-mail: pjbradley@zoo.co.uk Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Oncologic and functional outcomes of patients treated with transoral CO2 laser microsurgery or radiotherapy for T2 glottic carcinoma: a systematic review of the literature

Purpose of review To give an overview of the laryngeal preservation and functional outcomes of patients treated with transoral CO2 laser microsurgery (TLM) or radiotherapy for T2 glottic carcinoma. This information supports physicians and patients in treatment counselling and choices. Recent findings A recent systematic review showed that local control rates at 5-year did not differ between radiotherapy and TLM for T2 glottic tumours. However, there is a lack of comparative data on laryngeal preservation as well as functional outcomes in T2 glottic carcinoma. Summary Laryngeal preservation for T2 tumours in this review is higher for patients treated primarily with TLM (88.8 vs. 79.0%). It is important to differentiate between tumours with normal and impaired mobility (T2a and T2b) because the latter showed poorer prognosis for both TLM and radiotherapy. Involvement of the anterior commissure does not result in significantly lower oncological results, if adequately staged and treated. More studies are needed to support these data and to compare the functional outcomes between TLM and radiotherapy for T2 glottic carcinoma. Correspondence to Martine Hendriksma, MD, Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. E-mail: m.hendriksma@lumc.nl Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Transcranial magnetic stimulation and subjective tinnitus. A review of the literature, 2014–2016

Publication date: Available online 26 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Londero, P. Bonfils, J.P. Lefaucheur
Subjective tinnitus is a symptom in many ENT pathologies, for which there is no curative treatment. It may be poorly tolerated by some patients, who develop attention or sleep disorder or even major anxiety and depression, severely impairing quality of life. Pathophysiological models of the genesis and maintenance of tinnitus symptomatology highlight maladaptive cerebral plasticity induced by peripheral hearing loss. Although not fully elucidated, these changes in neuronal activity are the target of various attempts at neuromodulation, particularly using repetitive transcranial magnetic stimulation (rTMS), which has been the focus of various clinical studies and meta-analyses. A recent consensus statement (Lefaucheur, 2014) reported level-C evidence (possible efficacy) for rTMS using low frequency (1Hz) tonic stimulation targeting the left cerebral cortex. However, many questions remain concerning the use of this technique in everyday practice. The present article reports a recent literature review using the search-terms "tinnitus" and "rTMS" in the PubMed and Cochrane databases for April 2014 to December 2016.

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Arch bars in the mouth for 17 years – A case report

Publication date: Available online 20 December 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Vikas Sandilya, Neelam Noel Andrade, Paul C. Mathai, Natarajan Chelappa Balaji
Arch bars are commonly used in maxillofacial surgery but their intraoral presence for an extremely long period is quite uncommon or rare. So when such a patient reports and denies having any complaints all these years, the question that presents is, how is this possible? What kept the patient so long? A review of the existing literature shows, despite being common in trauma care, failure to follow-up has not received the due attention. This study retrospectively reviews the various factors implicated for failure to follow-up and the proposed corrective measures. The objective is to identify such potential patients beforehand thereby facilitating efficient trauma care.

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Orthopaedic Bone Tap: A ‘Jugaad’ for Zygomatic Bone Reduction

Abstract

Introduction

The use of the Carroll-Girard screw in the management of zygomatic complex fractures has been well documented. The instrument provides an excellent degree of control over the movements of the disrupted zygomatic bone. Often mentioned in textbooks and literature, they are not routinely available for the Indian maxillofacial surgeon. This often prevents the regular use of this approach.

Material and methods

We have used the 2.5-mm orthopaedic bone tap that is very commonly available and routinely used in orthopaedic surgeries for reduction of the malar bone.

Conclusion

The orthopaedic bone tap is easy to use and functions as an excellent alternative to the traditional Carroll-Girard screw.

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Comparative Analysis of Radiosurgery and Scalpel Blade Surgery in Impacted Mandibular Third Molar Incisions: a Clinical Trial

Abstract

Aims

This study aims to compare the outcome of radiosurgically assisted incision technique with the conventional scalpel blade technique in impacted mandibular third molar incisions.

Methods

On 100 patients (50 patients each in GROUP R and GROUP S) with impacted mandibular third molar, incisions were given using radio surgical and scalpel technique, respectively. Impacted third molars were classified according to Winter's classification. Two types of incisions (Ward's and modified Ward's) were performed. Results were evaluated considering various parameters like surgical ease, field of surgery, odour, bleeding, discomfort/pain, post-operative analgesic intake and healing in both groups.

Results

In our study, mean age of patient was 25.30 years, 54% were females and 46% males; mesioangular was the most common type of impaction, and the average length of incision was 3.105 ± 0.546 cm. There was a significant statistical difference (p < 0.01) in the five measure moments (field of surgery, surgical ease, intra-operative bleeding, odour and post-operative analgesic intake at 3–5th day) between the impacted molars operated with scalpel and the ones done with radiosurgery. There was statistically insignificant difference in pain/discomfort, healing and post-operative analgesic intake at 1st and 7–10th day.

Conclusions

Radiosurgery was very effective in providing clear field of surgery, surgical ease and created less intra-operative bleeding than scalpel blade surgery making day to day minor oral surgery less stress full and productive.

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Effect of Milliamperage Reduction on Pre-surgical Implant Planning Using Cone Beam Computed Tomography by Surgeons of Varying Experience

Abstract

Background

Differences in CBCT units and the lack of standardization result in exposure to radiation doses beyond what is required for diagnostic purposes, especially when planning the surgical placement of dental implants.

Aim

To assess the influence of low- and high-dose milliamperage settings on CBCT images for objective and subjective implant planning among senior specialists (5 years of experience) and juniors (fresh graduates).

Materials and Methods

Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using the Carestream CS 9300 machine. Cross-sectional slices of both image qualities were evaluated by the 5 seniors and the 5 juniors for subjective image utility for implant planning and for objective linear bone measurements.

Results

There were no significant differences in bone measurements taken on high- or low-dose images by all seniors and by the majority of juniors (p > 0.05). In qualitative image assessments, there was independence between assessment and image quality for almost all observers. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low- and high-dose images for senior observers (from K = 0.287 at low dose to K = 0.718 at high does) but not for juniors (K = 0.661 and K = 0.509 for low and high dose, respectively).

Conclusion

Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient concordance for qualitative assessment. Judicious optimization of milliamperage settings based on individual diagnostic requirements can result in significant dose reduction without compromising diagnostic decision-making.

http://ift.tt/2oSfdZF

Surgical Treatment of Unicoronal Synostosis: A Simplified Technique without Orbital Osteotomy

Background: Although referrals for nonsyndromic frontal plagiocephaly have been increased during the past several years, successful surgical repair of unicoronal synostosis (UCS) remains a challenge for craniofacial surgeons. Most surgical techniques followed to correct supraorbital rim elevation and temporal constrictions are being noticed less and often require a secondary revision. But this new technique consists of correcting the affected ipsilateral frontal, temporal, and superior orbital rim areas in the first operation. Methods: From 1995 to 2016, a total of 154 cases of UCS were operated by first author. A total of 91 patients were operated with standard technique, whereas the new technique was applied on 63. Whitaker scoring system was used for evaluation of patients after surgery. Results: Data analysis shows a significant difference between 2 operation techniques results (P = 0.007). None of the patients from the new technique group required revision surgery. Conlusions: We believe that our new technique have less invasive osteotomy on the frontal bone and no manipulation of the orbital bone, so provide sufficient bone graft and is applicable even for younger patients (

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Treatment Approach to Severe Microgenia Cases: Combined Use of Osseous and Implant Genioplasty

Introduction: As well as the chin is an important esthetic unit of the facial structure, it is also the region having a key role in the appearance of the face. Correction of cosmetic and functional deformities that may occur in this region because of serious hypoplasia (microgenia) is performed by chin augmentation. Chin augmentation is most frequently performed via implant or osseous genioplasty in the literature. Both 2 techniques have their own advantages and disadvantages. In the literature, various studies comparing these 2 techniques and their long-term results are present, but in some severe microgenia cases, these techniques can be insufficient only for augmentation. In such cases, combined use of implant and osseous genioplasty techniques can come up and data and experiences regarding such combined uses are limited in the literature. In our study, we aim to report our experiences and long-term results regarding 3 cases to whom chin augmentation combined with implant and osseous method is applied because of serious chin hypoplasia (microgenia). Method: Three patients to whom chin augmentation combined with osseous and implant genioplasty was applied because of severe microgenia between 2011 and 2016 are included in our study. Before the chin restoration, orthognathic surgery or maxillomandibular distraction applications owing to existing obstructive sleep apnea, malocclusion, or facial asymmetry, are performed in the patients. In preoperative period, chin augmentation amount required is planned for all the patients via cephalometric analysis and the operations of all the patients are performed under general anesthesia via intraoral access. Results: Among 3 patients, 2 were male and 1 was female and their mean age was 27.3 years (22–33). In all the patients, primarily horizontal subapical sliding osteotomy was performed and advancement was performed. After osteotomy, mean 8-mm osseous advancement was obtained and Medpor implant was placed in the chin at the same session for additional augmentation. Mean advancement amount obtained by the Medpor implants was 9 mm. A total average of 17-mm augmentation was obtained in the patients via osseous and implant genioplasty. The reflection of this advancement amount on the soft tissue was measured as 13 mm. Mean follow-up period is 24 months and the patients did not encounter with a major complication in the postoperative period. In the postoperative period, early-period band application was performed at the chin of the patients to reduce edema and to support immobilization. Conclusions: Chin contour is an important part of facial aesthetics and osseous genioplasty is the ideal treatment option for the correction of most chin deformities. However, in some serious microgenia cases, osseous genioplasty may be insufficient to correct the existing deformity. In such cases, it is seen that the combined correction procedures to be applied together with the implant use can be applicable in terms of the safety and its long-term results. Address correspondence and reprint requests to Kemal Findikcioglu, MD, Gazi University Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, 14th floor Besevler, Ankara, Turkey; E-mail: kemaldoctor@yahoo.com Received 30 April, 2017 Accepted 4 October, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Clinical and laboratory evaluation of the effects of different treatment modalities on titanium healing caps: a randomized, controlled clinical trial

Abstract

Objectives

The objective of this study is to evaluate the effects of treatment modalities on titanium surface characteristics and surrounding tissues.

Materials and methods

Eighteen participants each had four titanium healing caps (HC) attached to four newly inserted implants. After healing, each HC was randomly assigned to either (1) titanium curettes (TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) only rubber cup polishing (CON). Probing depths (PD), bleeding on probing (BOP), matrix metalloproteinase 8 (MMP-8), and periopathogens were recorded before and 3 months following instrumentation. After final assessments, HCs were removed, cleaned, and subjected to (a) bacterial colonization (Streptococcus gordonii, 24 h; mixed culture, 24 h) and (b) gingival fibroblasts (5 days). HC surfaces were analyzed with a scanning electron microscope (SEM).

Results

No significant differences between the groups were evident before or after instrumentation for PD and BOP (except TC showed a significant decrease in PD; p = 0.049). MMP-8 levels and bacterial loads were always very low. MMP-8 decreased further after instrumentation, while bacteria levels showed no change. No significant differences (p > 0.05) were evident in bacterial colonization or fibroblast attachment. A comparison of the overall mean SEM surface roughness scores showed a significant difference between all groups (p < 0.0001) with the lowest roughness after EP.

Conclusions

All treatments performed yielded comparable outcomes and may be implemented safely.

Clinical relevance

Clinicians may fear implant surface damage, but all instrumentation types are safe and non-damaging. They can be implemented as needed upon considering the presence of staining and soft and hard deposits.

http://ift.tt/2pzmWfw

Effect of flapless ridge preservation with two different alloplastic materials in sockets with buccal dehiscence defects—volumetric and linear changes

Abstract

Objective

To test whether or not one out of two alloplastic materials used for ridge preservation (RP) is superior to the other in terms of volumetric and linear ridge changes over time.

Materials and methods

In 16 adult beagle dogs, the distal roots of P3 and P4 were extracted and 50% of the buccal bone plate removed. Ridge preservation was performed randomly using two different alloplastic bone grafting substitutes (poly lactic-co-glycolic acid (PLGA) coated biphasic calcium phosphate particles consisting of 60% hydroxyapatite (HA) and 40% beta-tricalcium phosphate (ß-TCP=test 1), (a biphasic calcium phosphate consisting 60% HA and 40% ß-TCP=test 2) and a resorbable collagen membrane or a control group (sham). Sacrifice was performed at three time-points (4, 8, 16 weeks later). Impressions were taken before extraction, after RP, and at sacrifice, allowing for assessment of volumetric changes. A multi-way ANOVA was computed, and partial Type-II F tests were performed.

Results

Both ridge preservation procedures minimized the volume loss compared to spontaneous healing. The median buccal volume changes between pre-extraction and sacrifice were − 1.76 mm (Q1 = − 2.56; Q3 = − 1.42) for test 1, − 1.62 mm (Q1 = − 2.06; Q3 = − 1.38) for test 2, and − 2.42 mm (Q1 = − 2.63; Q3 = − 2.03) for control. The mean ridge width measurements did not show statistically significant differences between test 1 (− 2.51 mm; Q1 = − 3.25; Q3 = − 1.70) and test 2 (− 2.04 mm; Q1 = − 3.82; Q3 = − 1.81) (p = 0.813), but between test and control (− 3.85 mm; Q1 = − 5.02; Q3 = − 3.27) (p = 0.003).

Conclusions

Both RP techniques were successful in maintaining the buccal contour from pre-extraction to sacrifice to a similar extent and more favorable compared to spontaneous healing.

Clinical relevance

Alloplastic materials can successfully be used for RP procedures.

http://ift.tt/2l1usv7

Αρχειοθήκη ιστολογίου

Τετάρτη 27 Δεκεμβρίου 2017

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