Upfront surgery versus definitive chemoradiotherapy in patients with human Papillomavirus-associated oropharyngeal squamous cell cancer

Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Jacqueline R. Kelly, Henry S. Park, Yi An, Wendell G. Yarbrough, Joseph N. Contessa, Roy Decker, Saral Mehra, Benjamin L. Judson, Barbara Burtness, Zain Husain
ObjectivesCurrently, human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV-A OPC) is managed with either primary surgery or definitive chemoradiotherapy (CRT), despite the lack of supporting randomized prospective data. We therefore assessed the outcomes of each treatment strategy using the National Cancer Database (NCDB).MethodsThe NCDB was used to identify patients diagnosed with cT1 N2a-2b or cT2 N1-2b HPV-A OPC from 2010 to 2013 who underwent treatment with primary surgery or CRT. Demographic and clinicopathologic predictors of treatment were analyzed by the chi-square test and logistic regression. Overall survival (OS) was evaluated using multivariable Cox proportional hazard regression, Kaplan-Meier, log-rank test, and propensity score-matched analysis.ResultsWe identified 3063 patients; 1576 (51.5%) received CRT and 1487 (48.5%) underwent primary surgery. Median follow up was 32 months. 972 (65.4%) surgical patients received adjuvant CRT. On multivariable Cox regression, 3-year OS was comparable between surgery and CRT (hazard ratio [HR] 1.08, 95% confidence interval [CI] 0.83–1.41, P = 0.58). Inferior OS was significantly associated with increasing clinical T and N stage, older age, and non-private insurance. Propensity score-matching yielded a 2526 patient cohort and redemonstrated similar OS (HR, 1.09; 95% CI 0.81–1.47; P = 0.55). Comparable outcomes persisted in a subset analysis of patients with margin-negative resection, with 3-year OS 90.8% in CRT patients vs. 93.6% in surgery patients (log-rank P = 0.27).ConclusionsUpfront surgery and CRT yielded comparable 3-year OS outcomes in this cohort. In this national sample, 65.4% of surgical patients received trimodal therapy with adjuvant CRT, highlighting the need for improved patient selection for primary surgery.



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Chemoradiotherapy using retrograde superselective intra-arterial infusion for tongue cancer: Analysis of therapeutic results in 118 cases

Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Kenji Mitsudo, Yuichiro Hayashi, Shuhei Minamiyama, Nobuhide Ohashi, Masaki Iida, Toshinori Iwai, Senri Oguri, Toshiyuki Koizumi, Mitomu Kioi, Makoto Hirota, Izumi Koike, Masaharu Hata, Iwai Tohnai
ObjectivesTo evaluate the therapeutic results and rate of organ preservation in patients with squamous cell carcinoma of the tongue treated with retrograde superselective intra-arterial chemoradiotherapy.Materials and methodsBetween June 2006 and June 2015, 118 patients with tongue cancer were treated with intra-arterial chemoradiotherapy. Treatment consisted of radiotherapy (total 50–70 Gy) and daily concurrent intra-arterial chemotherapy (docetaxel, total 50–70 mg/m²; cisplatin, total 125–175 mg/m²) for 5–7 weeks. Locoregional control and overall survival rates were calculated by the Kaplan-Meier method. Cox's proportional hazards model was used for both univariate and multivariate analyses.ResultsThe median follow-up for all patients was 38.5 months (range, 3–129 months). After intra-arterial chemoradiotherapy, primary site complete response was achieved in 113 (95.8%) of 118 cases. Three-year locoregional control and overall survival rates were 80.3% and 81.5%, respectively. Grade 3 or 4 toxicities included neutropenia in 16.1% and mucositis in 87.3%. Grade 3 toxicities included anemia in 12.7%, thrombocytopenia in 3.4%, nausea/vomiting in 3.4%, dermatitis in 45.7%, dysphagia in 74.6%, and fever in 2.5% of patients. Late toxicity consisting of grade 3 osteoradionecrosis of the jaw occurred in 4.2% of patients. On univariate analysis, T stage and overall stage were significantly associated with locoregional control, and N stage and overall stage were significantly associated with overall survival. On multivariate analysis, the only significant predictor of overall survival was overall stage classification.ConclusionRetrograde superselective intra-arterial chemoradiotherapy for tongue cancer provided good overall survival and locoregional control.



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An internally validated prognostic model for success in revision stapes surgery for otosclerosis

Objectives/Hypothesis

To develop a prediction model that can accurately predict the chance of success following revision stapes surgery in patients with recurrent or persistent otosclerosis at 2- to 6-months follow-up and to validate this model internally.

Study Design

A retrospective cohort study of prospectively gathered data in a tertiary referral center.

Methods

The associations of 11 prognostic factors with treatment success were tested in 705 cases using multivariable logistic regression analysis with backward selection. Success was defined as a mean air-bone gap closure to 10 dB or less. The most relevant predictors were used to derive a clinical prediction rule to determine the probability of success. Internal validation by means of bootstrapping was performed. Model performance indices, including the Hosmer-Lemeshow test, the area under the receiver operating characteristics curve (AUC), and the explained variance were calculated.

Results

Success was achieved in 57.7% of cases at 2- to 6-months follow-up. Certain previous surgical techniques, primary causes of failure leading up to revision stapes surgery, and positions of the prosthesis placed during revision surgery were associated with higher success percentages. The clinical prediction rule performed moderately well in the original dataset (Hosmer-Lemeshow P = .78; AUC = 0.73; explained variance = 22%), which slightly decreased following internal validation by means of bootstrapping (AUC = 0.69; explained variance = 13%).

Conclusions

Our study established the importance of previous surgical technique, primary cause of failure, and type of the prosthesis placed during the revision surgery in predicting the probability of success following stapes surgery at 2- to 6-months follow-up.

Level of Evidence

2b. Laryngoscope, 2018

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Relationship among perceived stress, xerostomia, and salivary flow rate in patients visiting a saliva clinic

Abstract

Objective

This aimed to assess the potential role of chronic stress in saliva secretion, xerostomia, and oral health in a population attending a saliva clinic.

Materials and methods

Data of 114 patients who met the inclusion criteria and completed all questionnaires were analyzed in this study. Participants completed several validated questionnaires, including the Perceived Stress Scale, the Oral Health Impact Profile (OHIP-14), Xerostomia Inventory (XI), and Bother xerostomia Index (BI). Subsequently, the unstimulated, chewing-stimulated, and citric acid-stimulated saliva secretion rates were determined gravimetrically. Data were evaluated using Spearman's correlation analysis and the Mann–Whitney U test.

Results

A significant correlation was observed between perceived stress and XI score (r = 0.312, p = 0.001), as well as between perceived stress and BI score (r = 0.334, p = 0.001). Stress levels also were significantly associated with OHIP-14 scores (r = 0.420, p < 0.001), but an association between experienced stress and salivary flow rate could not be established.

Conclusion

In this population, perceived chronic stress seems to be related to several aspects of dry mouth, including the perception of dry mouth, suffering from dry mouth, and the impact on quality of life. These effects were independent of the use of psychotropic medication. No actual reduction in salivary flow was found. Further studies to explore the causal linkage of stress with xerostomia seem warranted.

Clinical relevance

Perceived chronic stress seems to be related with several aspects of dry mouth. This finding might be relevant in future prevention and treatment of xerostomia.

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Complex Association Patterns for Inflammatory Mediators in Induced Sputum from Subjects with Asthma

Abstract

Background

The release of various inflammatory mediators into the bronchial lumen is thought to reflect both the type and degree of airway inflammation, eosinophilic Th2, and Th9, or neutrophilic Th1, and Th17, in patients with asthma.

Aims

We investigated whether cytokines and chemokines differed in sputum from subjects with more severe compared with milder asthma, and if unbiased factor analysis of cytokine and chemokine groupings indicates specific inflammatory pathways.

Methods

Cell-free supernatants from induced sputum were obtained from subjects with a broad range of asthma severity (n=158) and assessed using Milliplex^® Cytokines/Chemokine kits I, II, and III, measuring 75 individual proteins. Each cytokine, chemokine, or growth factor concentration was examined for differences between asthma severity groups, for association with leukocyte counts, and by factor analysis.

Results

Severe asthma subjects had 9 increased and 4 decreased proteins compared to mild asthma subjects and fewer differences compared to moderate asthma. Twenty-six mediators were significantly associated with an increasing single leukocyte type: 16 with neutrophils (3 interleukins [IL], 3 CC-chemokines, 4 CXC-chemokines, 4 growth factors, TNF-α, and CX3CL1/Fractalkine); 5 with lymphocytes (IL-7, IL-16, IL-23, IFN-α2 and CCL4/MIP1β); IL-15 and CCL15/MIP1δ with macrophages; IL-5 with eosinophils; and IL-4 and TNFSF10/TRAIL with airway epithelial cells. Factor analysis grouped 43 cytokines, chemokines and growth factors which had no missing data onto the first 10 factors, containing mixes of Th1, Th2, Th9 and Th17 inflammatory and anti-inflammatory proteins.

Conclusions

Sputum cytokines, chemokines and growth factors were increased in severe asthma, primarily with increased neutrophils. Factor analysis identified complex inflammatory protein interactions, suggesting airway inflammation in asthma is characterized by overlapping immune pathways. Thus, focus on a single specific inflammatory mediator or pathway may limit understanding the complexity of inflammation underlying airway changes in asthma and selection of appropriate therapy.

This article is protected by copyright. All rights reserved.

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Systemic nocardiosis in a lepromatous leprosy patient with type 2 reaction

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Foreign body giant cell reaction to a Proplast/Teflon interpositional implant: a case report and literature review

Publication date: Available online 8 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Kevin C. Lee, Sidney B. Eisig, Michael A. Perrino




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Isolated light chain amyloidosis involving the parotid gland: A case report

Publication date: Available online 8 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Barzi Gareb, Michael Perry, Paul Joseph Tadrous
Amyloidosis in the parotid gland is rare and is usually associated with systemic amyloidosis. Localized amyloidosis in the parotid gland is extremely rare. The authors present a case of localized light chain amyloidosis of the parotid gland without systemic involvement. A 70-year-old woman with an asymptomatic presented with a swelling of the right parotid region. Physical examination, hematological and biochemical investigations, imaging, and cytology were non-conclusive. The patient underwent an extracapsular dissection of the right parotid gland. Histology showed that the tissue of the right parotid gland mostly consisted of amyloid depositions. The amyloid stained with antibodies to lambda light chains. Additional investigations showed no systemic involvement. The patient is asymptomatic 5 months after surgery. Clinicians should be aware of the possibility of localized AL amyloidosis in the parotid gland, especially if MRI, CT-imaging, and ultrasound are non-conclusive, and should recognize, evaluate, and treat it accordingly.



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The histologic detection of Helicobacter pylori in seropositive subjects is affected by pathology and secretory ability of the stomach

Abstract

Background

Helicobacter pylori is unevenly distributed in hypochlorhydric environments. The study aim was to elucidate the risk factors for a negative Giemsa staining finding in seropositive subjects by measuring the secretory ability of the stomach.

Methods

Subjects aged over 18 years were included consecutively after endoscopic biopsy at gastric lesions with color or structural changes. Blood was sampled for the serum pepsinogen (PG) assay and H. pylori serology test. After excluding the subjects with past H. pylori eradication, the risk factors for a negative Giemsa staining finding in seropositive subjects were analyzed.

Results

Among 872 included subjects, a discrepancy between the serum anti-H. pylori IgG and Giemsa staining findings was found in 158 (18.1%) subjects, including 145 Giemsa-negative, seropositive subjects. Gastric adenocarcinoma/adenoma (OR = 11.090, 95% CI = 3.490-35.236) and low serum PG II level (OR = 0.931, 95% CI = 0.899-0.963) were the independent risk factors for a negative Giemsa staining finding in seropositive subjects. The cutoff value of serum PG II level was 7.45 ng/mL (area under curve [AUC] = 0.904, 95% CI = 0.881-0.927). Follow-up studies of Giemsa staining at different sites of the stomach revealed that 75% of the Giemsa-negative seropositive subjects with adenocarcinoma are positive, whereas none of those with low serum PG II level of <7.45 ng/mL revealed positive findings.

Conclusions

The risk of a negative Giemsa staining finding in seropositive subjects is increased in gastric adenocarcinoma/adenoma specimens and in subjects with a diminished gastric secretory ability with low serum PG II level of <7.45 ng/mL. A false-negative Giemsa staining finding is common in subjects with adenocarcinoma, and therefore, additional biopsies at different sites should be performed in these subjects.

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Beneficial effect of Burdock complex on asymptomatic Helicobacter pylori-infected subjects: A randomized, double-blind placebo-controlled clinical trial

Abstract

Background

Burdock complex (BC) constitutes of burdock (Arctium lappa), angelica (Angelica sinensis), gromwell (Lithospermum erythrorhizon), and sesame (Sesamum indicum) oil, which are commonly used in traditional Chinese medicine (TCM) for treating various disorders. This study intended to examine the anti-H. pylori activity of BC on AGS cell model as well as in asymptomatic H. pylori-infected subjects.

Materials and Methods

AGS cell incubated with H. pylori and treated with BC to evaluate the minimum inhibition concentration (MIC), cell viability (MTT) anti-adhesion activity, and inflammatory markers. In case of clinical trial, H. pylori-positive subjects (urea breath test [UBT] >10%, n = 36) were enrolled and requested to intake BC (n = 19) or placebo (n = 17) for 8 weeks. Antioxidant capacity, total phenol, UBT, inflammatory markers were analyzed at the initial, 4th, 8th, and 10th weeks. Moreover, the endoscopic examination was carried out on baseline and 10th week.

Results

In vitro studies showed that BC treatment significantly inhibited (P < .05) the inflammatory markers and adhesion of H. pylori to AGS cell. However, H. pylori-infected subject ingested with BC for 8 weeks significantly decreased (P < .05) the UBT value, inflammatory markers with improved antioxidant activity, and phenolic levels as compared to placebo. Also, consumption of BC considerably healed the ulcer wound.

Conclusion

Overall, the BC could attenuate H. pylori infection by inhibiting H. pylori adhesion and subsequent inflammatory response on the gastric epithelial cell (AGS) as well as clinically ameliorated UBT, antioxidant capacity, and alleviated inflammation to display its anti-H. pylori activity.

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Counterfeit esthetic devices and patient safety in dermatology

Summary

This study addresses the dilemma concerned with meeting patients who may have encountered counterfeit esthetic devices in the marketplace. Over the past several years, we have witnessed a rise in counterfeit injectables and medical devices in our field. Often times, the procedures are marketed to patients at significantly reduced prices compared to competitors. Patients may be unaware that counterfeit devices exist and may unknowingly have procedures completed using untested and uncertified devices. It is important for clinicians to recognize when their patients may be encountering counterfeit devices, know what to do in this situation, and offer the best recommendations.

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Association between bilateral segmental vitiligo and lichen striatus: an expression of mosaicism?

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45th Annual Meeting of the Arbeitsgemeinschaft Dermatologische Forschung (ADF) Zurich, Switzerland, March 7-10, 2018

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Clinical Snippets

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Beyond the physico-chemical barrier: Glycerol and xylitol markedly yet differentially alter gene expression profiles and modify signalling pathways in human epidermal keratinocytes

Abstract

Polyols (e.g. glycerol, xylitol) are implicated as moisturizers of the skin and other epithelial tissues. However, we lack information about their exact cellular mechanisms and their effects on the gene expression profiles. Therefore, in this study, we aimed at investigating the effects of glycerol and xylitol on human epidermal keratinocytes. The polyols (identical osmolarities; xylitol: 0.0045%-0.45%; glycerol: 0.0027%-0.27%) did not alter cellular viability or intracellular calcium concentration. However, they exerted differential effects on the expression of certain genes and signalling pathways. Indeed, both polyols up-regulated the expression of filaggrin, loricrin, involucrin and occludin; yet, xylitol exerted somewhat more profound effects. Moreover, while both polyols stimulated the MAPK pathway, only xylitol induced the activation-dependent translocation of protein kinase Cδ, a key promoter of epidermal differentiation. Finally, in various keratinocyte inflammation models, both polyols (albeit with different efficacies) exerted anti-inflammatory effects. Taken together, these data strongly suggest that glycerol and xylitol differentially modulate expressions of multiple genes and activities of signalling pathways in epidermal keratinocytes. Thus, our findings invite clinical trials to explore the applicability and the impact of a combined glycerol-xylitol therapy in the management of various skin conditions.

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Issue Information

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A case of CD8+ and CD56+ cytotoxic variant of poikilodermatous mycosis fungoides: Dermoscopic features of reticular pigmentation and vascular structures

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A novel IKBKG mutation in a patient with incontinentia pigmenti and features of hepatic ciliopathy

Abstract

We describe a new mutation in exon 4 of IKBKG, encoding nuclear factor-kappa B in a patient with incontinentia pigmenti. The patient had a severe cholestatic liver disease with features of a ciliopathy and underwent liver transplantation. We cannot establish a link between incontinentia pigmenti, a very rare disease, and hepatic ciliopathy, but we suggest that hepatic evaluation should be considered in patients with incontinentia pigmenti.

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Valoración de la reacción emocional provocada por la prueba vestibular calórica mediante monitorización de variables fisiológicas

Publication date: Available online 8 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): Rafael Barona-de-Guzmán, Claudio Krstulovic-Roa, Elena Donderis-Malea, Luz Barona-Lleó
Introducción y objetivosLa valoración emocional que provoca el vértigo se realiza mediante la historia clínica y diversos cuestionarios subjetivos. El objetivo del presente trabajo es valorar la respuesta emocional de forma objetiva, en sujetos normales, durante la crisis de vértigo inducida.Material y métodoSe realizó la prueba vestibular calórica con agua fría en 30 sujetos sanos. Durante los 60s previos a la estimulación y los 60s posteriores a la misma se monitorizaron las siguientes variables fisiológicas: Conductabilidad cutánea, Volumen de pulso periférico, Temperatura corporal, Contracción muscular, Frecuencia cardiaca y Frecuencia respiratoria. Se valoró la velocidad angular máxima de la fase lenta del nistagmo provocado en cada estimulación.ResultadosDurante las crisis de vértigo, la conductabilidad cutánea presentó un aumento estadísticamente significativo con relación al periodo previo a las mismas, mientras que el volumen de pulso periférico presentó una disminución estadísticamente significativa. No hubo relación entre la velocidad angular de la fase lenta del nistagmo provocado y los cambios de la conductabilidad y el volumen de pulso periférico. La disminución provocada en el volumen de pulso periférico fue significativamente mayor en la segunda crisis de vértigo.ConclusionesLa conductabilidad cutánea y el volumen de pulso periférico cambiaron de forma significativa durante las crisis de vértigo. No Hubo relación entre la intensidad de la crisis vertiginosa provocada y los cambios producidos en estas variables. El estrés generado por la estimulación calórica es mayor en la segunda crisis, cuando el sujeto tiene experiencia del vértigo que provoca la estimulación.Introduction and objectivesThe emotional evaluation of the causes of vertigo is made using the clinical records and several subjective questionnaires. The aim of the present study is to evaluate the emotional response objectively, in normal subjects, during an induced vertigo crisis.Material and methodA caloric vestibular test with cold water was performed on 30 healthy subjects. The following physiological parameters were monitored during the 60seconds prior to and the 60seconds after the stimulation: Skin Conductivity, Peripheral Pulse Volume, Body Temperature, Muscle Contraction, Heart Rate, and Respiratory Rate. The maximum angular speed of the nystagmus slow phase at each stimulation was assessed.ResultsSkin conductance presented a statistically significant increase during the vertigo crisis in relation to the prior period while the peripheral pulse volume presented a statistically significant decrease. There was no relationship between the slow phase of the provoked nystagmus angular speed and skin conductance and peripheral pulse volume changes. The decrease in peripheral pulse volume was significantly higher in the second vertigo crisis.ConclusionsSkin conductance and peripheral pulse volume changed significantly during a vertigo crisis. There was no relation between the provoked vertiginous crisis intensity and the changes produced in those variables. The stress generated by the caloric stimulation is higher in the second crisis, when the subject has experience of the vertigo caused by the stimulation.



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Podoplanin expression as a predictive marker of dysplasia in oral leukoplakia

Recent studies have emphasized the role of podoplanin in oral lesions at risk of malignant transformation. We investigated a group of oral leukoplakias (OLs) to determine a possible relation between altered podoplanin expression and dysplasia, and to compare the results with those obtained by other, widely used biomarkers.

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Randomised feasibility study to compare the use of Therabite® with wooden spatulas to relieve and prevent trismus in patients with cancer of the head and neck

Our aim was to compare the efficacy of the Therabite® jaw motion rehabilitation system (Atos Medical) with that of wooden spatulas to relieve and prevent trismus in patients who have had radiotherapy for stage three and four oral and oropharyngeal cancer. Secondary aims were to assess the feasibility and the impact of exercise on health-related quality of life (QoL), and the use of health services after treatment. We designed a randomised, open-label, controlled, three-centre feasibility study to compare the effectiveness and cost of the Therabite® and wooden spatulas.

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Current thinking about the management of recurrent pleomorphic adenoma of the parotid: a structured review

Pleomorphic adenoma is the most common tumour of the parotid gland, and can recur after excision. Recurrent pleomorphic adenoma can be a challenge to treat, and has variable outcomes. The aim of this review was to summarise current thinking in its management, which may be helpful to clinical teams and could improve patients' health-related quality of life. We searched several online databases using the key terms pleomorphic adenoma, recurrent pleomorphic adenoma, parotid gland tumours, parotid surgery, radiotherapy and parotid pleomorphic adenoma, and parotid surgery outcomes.

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Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV

To check the value of home particle repositioning maneuver in the prevention of the recurrence of posterior canal benign paroxysmal positional vertigo (pc-BPPV).

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Endoscopic pericranial flap design for the restoration of nasal mid-vault lining defects

Despite progress made in nasal reconstruction, the restoration of a large defect, including the whole septum and mid-nasal vault structures, remains a challenge. The pericranial flap (PCF) is used widely for the reconstruction of anterior cranial fossa defects. This article presents a surgical technique for nasal lining restoration with an endoscopic PCF design. This technique was used in patients with huge intranasal tumours. Two patients with nasal eosinophilic angiocentric fibrosis were treated.

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Biomechanical simulation of temporomandibular joint replacement (TMJR) devices: a scoping review of the finite element method

The aim of this study was to perform a literature review on the use of finite element modeling (FEM) for the evaluation of the biomechanical behavior of temporomandibular joint replacement (TMJR) devices. An electronic search of online medical and scientific literature database was conducted using selected search terms. The search identified 307 studies, of which 19 were considered relevant to this study. Of the 19 selected studies, 10 (52.6%) investigated the influence of geometry and fixation methods, while two (10.5%) evaluated the behavior of artificial condyle–fossa structures.

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The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review

Trigeminal neuralgia (TN) is characterized by sharp, electric shock-like pain, which can be triggered by trivial stimuli. Although medical and surgical treatments are available for TN, some patients experience refractory pain, which has a significant impact on their quality of life. The aim of this systematic review was to determine the psychosocial impact of orofacial pain in patients with diagnosed TN. A search was initiated in three electronic databases (Embase, MEDLINE, PubMed) to identify potential studies for inclusion in the review.

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Reduced salivary amylase activity in metabolic syndrome patients with obesity could be improved by treatment with a dipeptidyl peptidase IV inhibitor

Abstract

Objectives

The present study is to investigate the salivary gland function of metabolic syndrome (MetS) patients, as indicated by salivary flow rate, amylase activity, and salivary oxidative stress, by measuring MDA level.

Materials and methods

One hundred and eighty-one MetS patients from Maharaj Nakorn Chiang Mai Hospital were enrolled onto this study. The metabolic parameters of each patient were collected and evaluated. Unstimulated saliva was also collected for 5 min. Salivary gland functions, including salivary flow rate, amylase activity, and salivary MDA levels, were investigated.

Results

High levels of triglycerides, high-density lipoprotein, blood pressure, and waist circumference in MetS patients did not show a correlation with altered salivary gland function. However, a decrease in salivary flow rate was observed in MetS patients with hyperglycemia. In addition, decreased amylase activity was found in MetS patients with obesity (BMI ≥ 23 kg/m²). Salivary amylase activity of MetS patients treated with dipeptidyl peptidase IV (DPP-IV) inhibitor was significantly greater than that observed in MetS patients without a DPP-IV inhibitor. Moreover, the salivary amylase activity in MetS patients was found to be independently positively correlated with DPP-IV inhibitor therapy (r = 0.708, p < 0.01).

Conclusion

These findings suggest that obesity and hyperglycemia in MetS patients were associated with the impairment of salivary glands. Treatment with a DPP-IV inhibitor was found to exert beneficial effects on the salivary gland.

Clinical relevance

This study demonstrated the impairment of salivary glands of MetS patients and the beneficial effect of DPP-IV inhibitor treatment in the salivary glands.

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Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV

Publication date: Available online 8 March 2018
Source:Auris Nasus Larynx
Author(s): Elshahat Ibrahem Ismail, Ashraf Elsayed Morgan, Mohamed Moustafa Abdeltawwab
ObjectiveTo check the value of home particle repositioning maneuver in the prevention of the recurrence of posterior canal benign paroxysmal positional vertigo (pc-BPPV).MethodsIn this study, patients diagnosed as unilateral posterior canal BPPV were selected following an accurate evaluation using video goggle VNG system. All patients were managed by particle repositioning maneuver (PRM). Patients were instructed to do home PRM once weekly for five years. Then, they were divided into two groups (according to choice of patient to do PRM). The first group (control group) consisted of 144 patients who did not do home PRM; whereas the second group (study group) included 165 patients who performed home PRM. All patients (control & study groups) were followed up every four months for five years.ResultsThe study found out that the recurrence rate of pc-BPPV in control group was 33 patients in the first year (27.2%), 11 patients in second year (9%), 5 patients in third year (4%), 3 patients in fourth year (2.5%) and 3 patients in fifth year (2.5%). The recurrence of pc-BPPV in the treated side (study group) of patients was reported as 5 patients in the first year (3.5%), 3 patients in the second year (2%), 2 patients in the third year (1.4%), 2 patients in the fourth year (1.4%), and 1 patient in the fifth year (0.7%). There was statistically significant difference between the control and the study groups regarding the recurrence rates in the first year follow up which was the highest in first four months.ConclusionHome particle repositioning maneuver has the capacity to prevent the recurrence of pc-BPPV. It proved to be more successful and functional in minimizing the recurrence of the disease in the study than in the control group. Hence, home particle repositioning maneuver is highly recommended for one year at least in pc-BPPV.



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Adjusted calculation model of heparin management during cardiopulmonary bypass in obese patients: A randomised controlled trial

BACKGROUND Anticoagulation during cardiopulmonary bypass (CPB) is usually adapted to total body weight (TBW). This may be inaccurate in obese patients and lead to heparin overdose with a risk of bleeding. OBJECTIVES To validate the efficacy and safety of an adjusted calculation model of heparin dosing based on ideal body weight (IBW) rather than TBW in obese CPB patients, with an expected target mean plasma heparin concentration of 4.5 IU ml−1 after onset of CPB in the experimental group. DESIGN Prospective, randomised controlled study. SETTING University hospital. PATIENTS Sixty obese patients (BMI ≥ 30 kg m−2) scheduled for CPB were included from January to June 2016. INTERVENTIONS Patients received a bolus dose of unfractionated heparin of either 300 IU kg−1 of TBW or 340 IU kg−1 of IBW before onset of CPB. Additional adjusted boluses were injected to maintain an activated clotting time (ACT) of at least 400 s. MAIN OUTCOME MEASURES Plasma heparin concentration and ACT were measured at different time points. Total heparin doses and transfusion requirements were recorded. RESULTS The target heparin concentration of 4.5 IU ml−1 was reached in the IBW group at the onset of CPB and maintained at all time points during CPB. Heparin concentrations were significantly higher in the TBW group after the bolus (6.52 ± 0.97 vs. 4.54 ± 1.13 IU ml−1, P 

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Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial

BACKGROUND Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication. OBJECTIVE The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs. DESIGN A randomised controlled single-centre trial. SETTING University Medical Centre Mannheim, Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. April 2014 to August 2015. PATIENTS A total of 50 patients (women/men, 18 to 80 years old, ASA I to III) undergoing outpatient knee arthroscopy were included. A contra-indication to an allocated anaesthetic technique or an allergy to medication required in the protocol led to exclusion. INTERVENTIONS Either general anaesthesia with sufentanil, propofol and a laryngeal mask for airway-management or spinal with 40-mg CP 1% were used. We noted procedure times, patient satisfaction/recovery and conducted a 7-day follow-up. MAIN OUTOMES Primary outcome was duration of stay in the day-surgery centre. Secondary outcomes were first occurrence of pain, patient satisfaction, quality of recovery and adverse effects. In addition, we analysed treatment costs. RESULTS Spinal had faster recovery than general anaesthesia with patients reaching discharge criteria significantly earlier [117 min (66 to 167) versus 142 min (82 to 228), P = 0.0047]. Pain occurred significantly earlier in the general anaesthesia group (P = 0.0072). Costs were less with spinal anaesthesia (cost ratio spinal: general 0.57). Patients felt significantly more uncomfortable after general anaesthesia (P = 0.0096). CONCLUSION Spinal anaesthesia with 40-mg CP 1% leads to a significantly earlier discharge and is cheaper compared with general. TRIAL REGISTRATION German Clinical Trials Register, www.drks.de, identifier: DRKS00005989. Correspondence to Prof. Dr. med. Marc D. Schmittner, Head, Department of Anaesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683 Berlin, Germany Tel: +49 (0) 30 56 81 3100; fax: +49 (0) 30 56 81 3103; e-mail: marc.schmittner@ukb.de © 2018 European Society of Anaesthesiology

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Surgery first/early orthognathic approach may yield poorer postsurgical stability than conventional orthodontics first approach: a systematic review and meta-analysis

Publication date: Available online 7 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hongpu Wei, Zhixu Liu, Jiajie Zang, Xudong Wang
ObjectiveThere are conflicting views on the postsurgical stability of surgery first and surgery early approach in orthognathic surgery. We systematically reviewed the literature to compare the difference of postsurgical stability between surgery first/early approach(SFEA) and conventional ortho-first approach(COA).Study DesignPubMed, Embase, and Cochrane Library were searched for studies related to the postsurgical stability of SFEA. The primary outcome was the horizontal relapse at the pogonion. Weighted Mean Difference(WMD) with 95% CIs were pooled using a random-effects model.ResultsWe analyzed 12 studies (total of 498 participants). The pooled estimate suggested that the SFEA group manifest less postsurgical stability than COA group (WMD,1.50; P<0.00001), with moderate heterogeneity (I² = 53%). The result of subgroup analysis yielded no subgroup difference. Sensitivity analysis by omitting one study at a time further validated the robustness of the result.ConclusionsBased on the meta-analysis, the mandible tends to rotate counterclockwise more in the SFEA group, which indicate a poorer postsurgical stability than COA group. Patient screening and treatment plan should be reviewed carefully to compensate for possible postoperative relapse when adopting SFEA.



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Computer-assisted resection and reconstruction of bilateral osteoradionecrosis of the mandible using two separate flaps prepared from a single fibula

Publication date: Available online 7 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Rui Chen, Han-qing Zhang, Zi-xian Huang, Shi-hao Li, Da-ming Zhang, Zhi-quan Huang
Objectives: Osteoradionecrosis of the mandible is a late radiation-induced complication that becomes a major concern of head and neck cancer survivors. Study Design: In this study, we present a case of a nasopharyngeal carcinoma (NPC) patient who developed extensive bilateral osteoradionecrosis of the ascending ramus of the mandible. Preoperative virtual surgical planning was performed, the obtained data was then utilized to fabricate patient-specific cutting templates. The bilateral mandibular defects were reconstructed using two separate flaps prepared from a single fibula. Results: Both of the defects were successfully reconstructed, and aesthetic and functional results were achieved. Conclusion: Bilateral mandibular osteoradionecrosis can be managed with virtual surgical planning and reconstructed using two separate flaps prepared from a single fibula.



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Effect of 660 nm visible red light on cell proliferation and viability in diabetic models in vitro under stressed conditions

Abstract

The current study evaluated the photobiomodulatory effect of visible red light on cell proliferation and viability in various fibroblast diabetic models in vitro, namely, unstressed normal (N) and stressed normal wounded (NW), diabetic wounded (DW), hypoxic wounded (HW) and diabetic hypoxic wounded (DHW). Cells were irradiated at a wavelength of 660 nm with a fluence of 5 J/cm² (11.23 mW/cm²), which related to an irradiation time of 7 min and 25 s. Control cells were not irradiated (0 J/cm²). Cells were incubated for 48 h and cellular proliferation was determined by measuring 5-bromo-2′-deoxyuridine (BrdU) in the S-phase (flow cytometry), while viability was assessed by the Trypan blue exclusion test and Apoptox-glo triplex assay. In comparison with the respective controls, PBM increased viability in N- (P ≤ 0.001), HW- (P ≤ 0.01) and DHW-cells (P ≤ 0.05). HW-cells showed a significant progression in the S-phase (P ≤ 0.05). Also, there was a decrease in the G2M phase in HW- and DHW-cells (P ≤ 0.05 and P ≤ 0.05, respectively). This study concludes that hypoxic wounded and diabetic hypoxic wounded models responded positively to PBM, and PBM does not damage stressed cells but has a stimulatory effect on cell viability and proliferation to promote repair and wound healing. This suggests that the more stressed the cells are the better they responded to photobiomodulation (PBM).

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Cancer immunotherapy in patients with brain metastases

Abstract

The exclusion of "real-world" patients from registration clinical trials of cancer immunotherapy represents a significant emerging issue. For instance, a large fraction of cancer patients develops brain metastases during the course of the disease, but results from large prospective clinical trials investigating this considerable proportion of the cancer patient population are currently lacking. To provide a useful tool for the clinician in a "real-world" setting, we have reviewed the available literature regarding the safety and efficacy of immune check-point inhibitors in patients with cancer metastatic to the brain. Overall, these data provide encouraging evidence that these therapeutic agents can induce intracranial objective responses, particularly in patients with asymptomatic and previously untreated brain metastases. Larger prospective studies are needed to confirm these initial results.

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Advances in the Approach to the Patient with Food Allergy

Publication date: Available online 8 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Amy M. Scurlock, Stacie M. Jones
Advances in food allergy diagnosis, management, prevention and therapeutic interventions have been significant over the past two decades. Evidence based national and international guidelines have streamlined food allergy diagnosis and management, while paradigm shifting work in primary prevention of peanut allergy has resulted in significant modifications in the approach to early food introduction in infants and toddlers. Innovative investigation of food allergy epidemiology, systems biology, impact, and management has provided important insights. While active therapeutic approaches to food allergy presently remain experimental, progress toward licensed therapies has been substantial. Mechanistic understanding of the immunologic processes underlying food allergy and immunotherapy will inform the future design of therapeutic approaches targeting the food allergic response. Global strategies to mitigate the substantial medical, economic, and psychosocial burden of food allergy in affected individuals and families will require engagement of stakeholders across multiple sectors in research, healthcare, public health, government, educational institutions and industry. However, the relationship between the well-informed allergy care provider and the patient and family remains fundamental for optimizing the care of the patient with food allergy.



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Refractory Airway Type-2 Inflammation in a Large Subgroup of Asthmatics treated with Inhaled Corticosteroids

Publication date: Available online 7 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Michael C. Peters, Sheena Kerr, Eleanor M. Dunican, Prescott G. Woodruff, Merritt L. Fajt, Bruce D. Levy, Elliot Israel, Brenda R. Phillips, David T. Mauger, Suzy A. Comhair, Serpil C. Erzurum, Mats W. Johansson, Nizar N. Jarjour, Andrea M. Coverstone, Mario Castro, Annette T. Hastie, Eugene R. Bleecker, Sally E. Wenzel, John V. Fahy
BackgroundAirway type 2 inflammation is usually corticosteroid sensitive, but the role of type 2 inflammation as a mechanism of asthma in patients on high dose inhaled corticosteroids (ICS) is uncertain.ObjectiveTo determine if airway type 2 inflammation persists in patients treated with ICS and to evaluate the clinical features of patients with steroid resistant airway type-2 inflammation.MethodsWe used qPCR to generate a composite metric of type-2 cytokine gene expression (type 2 Gene Mean, "T2GM") in induced sputum cells from healthy controls, severe asthma patients on ICS (n=174), and non-severe asthma patients on ICS (n=85). We explored relationships between asthma outcomes and the T2GM, and the utility of non-invasive biomarkers of the airway T2GM.ResultsThe sputum cell T2GM in asthma subjects was significantly increased in asthma subjects and remained high following treatment with intramuscular triamcinolone. We used the median value for the T2GM as a cutoff to classify "steroid-treated type 2-low" (stT2-low) and "steroid-resistant type 2-high" (srT2-high) subgroups. Compared to patients with stT2-low asthma, those with srT2-high asthma were older age and had more severe asthma. Blood eosinophil cell counts predicted srT2-high asthma when BMI was < 40, but not when it was ≥40, whereas, blood IgE strongly predicted srT2-high asthma when age was < 34 years but not when it was ≥34.ConclusionDespite ICS therapy many asthmatics have persistent airway type 2 inflammation, (srT2-high asthma) and these patients are older and have more severe disease. Body weight and age modify the performance of blood-based biomarkers of airway type-2 inflammation.



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Non-PTLD Malignancy post HSCT in patients with Primary Immunodeficiency: UK experience

Publication date: Available online 7 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Mohamed Najib Mohamed Unni, Reem Elfeky, Kanchan Rao, Zohreh Nademi, Robert Chiesa, Persis Amrolia, Roderick Skinner, Olga Slater, Austen Worth, Terence Flood, Mario Abinun, Sophie Hambleton, Waseem Qasim, Hubert B. Gaspar, Andrew J. Cant, Andrew R. Gennery, Paul Veys, Mary A. Slatter
Secondary malignancy post haematopoietic stem cell transplantation (HSCT) for malignant disorders is well recognized. There are very few published reports on malignancy post HSCT for Primary Immunodeficiency (PID). We report 12 cases of 944 patients, who developed non-PTLD malignancy post-HSCT for PID.



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A RAB27A 5’UTR structural variant associated with late-onset hemophagocytic lymphohistiocytosis and normal pigmentation

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Bianca Tesi, Jelena Rascon, Samuel C.C. Chiang, Birute Burnyte, Alexandra Löfstedt, Anders Fasth, Miriam Heizmann, Sandra Juozapaite, Rosita Kiudeliene, Egle Kvedaraite, Valdone Miseviciene, Audrone Muleviciene, Martha-Lena Müller, Magnus Nordenskjöld, Reda Matuzeviciene, Ruta Samaitiene, Carsten Speckmann, Sigita Stankeviciene, Vytautas Zekas, Matthias Voss, Stephan Ehl, Nerija Vaiciene-Magistris, Jan-Inge Henter, Marie Meeths, Yenan T. Bryceson




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Managing Asthma in Pregnancy (MAP) trial: FeNO levels and childhood asthma

Publication date: Available online 8 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Matthew Morten, Adam Collison, Vanessa E. Murphy, Daniel Barker, Christopher Oldmeadow, John Attia, Joseph Meredith, Heather Powell, Paul D. Robinson, Peter D. Sly, Peter G. Gibson, Joerg Mattes
BackgroundThe single-centre double-blind, randomised controlled Managing Asthma in Pregnancy (MAP) trial in Newcastle, Australia, compared a treatment algorithm using the fraction of exhaled nitric oxide (FeNO) in combination with asthma symptoms (FeNO group) against a treatment algorithm using clinical symptoms only (clinical group) in pregnant asthmatic women (ANZ Clinical Trials Registry, number 12607000561482). The primary outcome was a 50% reduction in asthma exacerbations during pregnancy in the FeNO group. However, the effect of FeNO-guided management on the development of asthma in the offspring is unknown.ObjectiveWe sought to investigate the effect of FeNO-guided asthma management during pregnancy on asthma incidence in childhood.Methods179 mothers consented to participate in the Growing Into Asthma (GIA) double-blind follow-up study with the primary aim to determine the effect of FeNO-guided asthma management on childhood asthma incidence.Results140 children (78%) were followed up at 4 to 6 years of age. FeNO-guided as compared to symptoms only based approach significantly reduced doctor diagnosed asthma (25·9% versus 43·2%; odds ratio [OR] 0.46, 95% confidence interval [CI] 0.22 to 0.96, p=0.04). Furthermore frequent wheeze (OR 0.27; CI 0.09 to 0.87, p=0.03), use of short-acting beta agonists (OR 0.49; CI 0.25 to 0.97; p=0.04), and emergency department visits for asthma (OR 0.17, CI 0.04 to 0.76; p=0.02) in the past 12 months were less common in children born to mothers from the FeNO group. Doctor diagnosed asthma was associated with common risk alleles for early-onset asthma at gene locus 17q21 (p=0·01 for rs8069176; p=0·03 for rs8076131), and higher airways resistance (p=0·02) and FeNO levels (p=0·03). A causal mediation analysis suggested natural indirect effects of FeNO-guided asthma management on childhood asthma through "any use" and "time to first change in dose" of inhaled corticosteroids during the MAP trial (OR 0.83; CI 0.59 to 0.99 and OR 0.90, CI 0.70 to 1.03, respectively).ConclusionFeNO-guided asthma management during pregnancy prevented doctor diagnosed asthma in the offspring at preschool age, in part mediated through changes in use and dosing of inhaled corticosteroids during the MAP trial.



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Ten-year survival and chipping rates and clinical quality grading of zirconia-based fixed dental prostheses

Abstract

Objectives

To prospectively evaluate the clinical long-term outcome of 3- to 6-unit fixed dental prostheses (FDPs) made of hot isostatic pressed (HIP) zirconia frameworks, veneered with a synthetic sintering glass-ceramic.

Materials and methods

A total of 27 different restorations were cemented in 21 patients. FDPs were examined with regard to biological and technical complications/failures. Additionally, clinical quality was assessed based on (i) the California Dental Association (CDA) criteria, (ii) the patient's viewpoint according to Hickel, and (iii) periodontal parameters. Descriptive statistics were computed. The Kaplan-Meier estimator was used for the survival and chipping-free rates. Wilcoxon signed ranks test (ordinal/continuous data) or the McNemar test (binary data) was used to describe the periodontal outcome of abutment teeth versus that of the respective control teeth.

Results

After a mean observation period of 10.0 ± 2.1 years, the dataset comprised 15 patients with 20 (mainly posterior) FDPs. The 10-year survival rate and 10-year chipping-free rate were 95.0% (CI 86.0–100%) and 78.8% (CI 62.2–99.7%), respectively. Evaluation based on the CDA criteria yielded satisfactory (excellent or acceptable) results for all categories. This was also confirmed by the high level of patient satisfaction. The periodontal health of tissues adjacent to the study teeth was clinically acceptable, but inferior to the ones of control teeth.

Conclusions

FDPs made from CAD/CAM-fabricated HIP zirconia ceramic frameworks have a favorable survival rate. However, because damage to the surface texture showed a disproportionate increase after long-term usage, additional long-term studies are required.

Clinical relevance

The outstanding mechanical properties of zirconia-based systems have contributed to the belief that all-ceramics are a reliable material for prosthetic restorations. However, only long-term reports (such as this one) provide more detailed information on actual clinical efficacy.

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Transcriptomic analysis of FUCA1 knockdown in keratinocytes reveals new insights in the pathogenesis of fucosidosis skin lesions

Abstract

Fucosidosis is a rare lysosomal storage disease which has been classified into two subtypes, depending on the severity of clinical signs and symptoms. Fucosidosis patients' skin abnormalities include angiokeratoma corporis diffusum, widespread telangiectasia, thick skin, hyperhidrosis and hypohidrosis, acrocyanosis and distal transverse nail bands. It has been described that >50% of fucosidosis patients have angiokeratoma. At molecular level, fucosidosis is caused by lysosomal alpha-L-fucosidase (FUCA1) gene mutations. Obtaining samples for functional studies has been challenging due to the inherent difficulty in finding affected individuals. The effect of FUCA1 dysfunction on gene expression is unknown.

The aim of the present study was to analyse, in keratinocytes, the transcriptomic effect of FUCA1 knock-down for a better understanding of skin lesions' pathogenesis affecting fucosidosis patients. FUCA1 knock-down (siRNA) was performed in human HaCaT immortalised keratinocytes. Affymetrix arrays and qPCR were used for analysing gene expression. Bioinformatics was used for functional clustering of modified genes.

387 genes showed differential expression between FUCA1 silenced and non-silenced cells (222 up-regulated and 165 down-regulated). Upregulated genes belonged to two major groups: keratinocyte differentiation/epidermal development (n=17) and immune response (n= 61). Several transcription factors were upregulated in FUCA1-siRNA transfected cells. This effect might partly have been produced by abnormal transcription factor expression, i.e. FOXN1. We thus propose that fucosidosis-related skin lesions (e.g. angiokeratoma) and those of other diseases (e.g. psoriasis) might be caused by dysfunctions in common aetiological overlapping molecular cascades.

This article is protected by copyright. All rights reserved.

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3D skin models for 3R research: the potential of 3D reconstructed skin models to study skin barrier function

Abstract

The skin barrier is an important shield regulating the outside-in as well as inside-out penetration of water, nutrients, ions and environmental stimuli. We can distinguish four different barrier compartments, the physical, chemical, immunological and microbial skin barrier. Well-functioning of those is needed to protect our body from the environment. To better understand the function and the contribution of barrier dysfunction in skin diseases, 3D skin or epidermal models are a valuable tool for in vitro studies. In this review we summarize the development and application of different skin models in skin barrier research. During the last years enormous effort was made on optimizing these models to better mimic the in vivo composition of the skin, by fine-tuning cell culture media, culture conditions and including additional cells and tissue components. Thereby in vitro barrier formation and function has been improved significantly. Moreover, in this review we point towards changes and chances for in vitro 3D skin models to be used for skin barrier research in the nearby future.

This article is protected by copyright. All rights reserved.

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An Uncommon Cutaneous Lesion

A male smoker in his 60s presented with a right supraclavicular cutaneous mass that had persisted for 2 years; a biopsy of a pulmonary nodule showed a well-differentiated adenocarcinoma with lepidic pattern, and further workup revealed an intestinal tumor as the primary source. What is your diagnosis?

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Errors in Questionnaire Scoring Algorithm

In the Original Investigation titled "Development and Initial Validation of a Consumer Questionnaire to Predict the Presence of Ear Disease," published online on August 3, 2017, and in the October 2017 issue of JAMA Otolaryngology–Head & Neck Surgery, there were errors in the analysis code for 3 of the questionnaire items (questions 16, 18, and 19). For these 3 questions, the 4-item rating scales were dichotomized incorrectly. Using the corrected algorithm resulted in changed sensitivity and specificity, odds ratios, and 95% CIs, as detailed herein. The corrections are also explained in a Letter to the Editor. In the abstract Results, descriptions of the sensitivity and specificity have been corrected to 90% (95% CI, 84%-94%) and 72% (95% CI, 59%-82%), respectively, for the training sample and 76% (95% CI, 61%-87%) and 80% (95% CI, 51%-95%) for the test sample, respectively. In the Statistical Analysis paragraph of the Methods section, rating scale items should have been dichotomized as 0 for "never" and "occasionally" and as 1 for "sometimes" and "always" rather than scored on a scale of 0 to 4. In the Results section, the odds ratio and 95% CI for the association between CEDRA score and presence of disease changed. In addition, the probability, sensitivity, and specificity values changed. In the third paragraph of the Discussion, all percentages have changed. Figure 2 has been replaced with a graph incorporating a corrected receiver operating characteristic curve, and the figure caption has been updated. This article was corrected online.

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Opsoclonus-Myoclonus Syndrome—Reply

In Reply We thank Drs Kim and Budhram for their valuable suggestion. Owing to the 600-word limit in the Observation section, much of the information associated with this patient had to be omitted in the article. Herein we fill in some of the gaps. We agree that magnetic resonance imaging is the first priority for excluding a paraneoplastic or parainfectious origin when treating a patient with opsoclonus. Small cell carcinoma of the lung, breast cancer, and ovarian cancer are most prevelent in adults with opsoclonus, whereas neuroblastoma accounts for more than 50% prevalence in children. Of course, such work-up had been done in this patient, yet the results were negative. Occasionally, other neoplasms (ie, non-Hodgkin's lymphoma, malignant lymphoma) have also been related to opsoclonus. In addition, many parainfectious origins were proposed, namely, streptococcus, varicella-zoster virus, Epstein-Barr virus, human immunodeficiency virus (HIV), and lyme disease, for example.

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Opioid Prescription Patterns Among Patients With Head and Neck Cancer

This cross-sectional analysis quantifies the use of opioid analgesics among patients with head and neck cancer and compares this with use among patients with lung or colon cancer.

http://ift.tt/2FDbiqT

Brain-Derived Neurotrophic Factor Therapy and Cochlear Implantation

This Viewpoint cites several examples of how brain-derived neurotrophic factor therapy affects outcomes of cochlear implantation.

http://ift.tt/2Hh5ekW

Opsoclonus-Myoclonus Syndrome—Additional Clinical Considerations

To the Editor We read with interest the report by Hsu et al describing a 39-year-old woman with opsoclonus-myoclonus syndrome (OMS). Although an intriguing case, several aspects of the treatment should be addressed for others who may encounter this condition.

http://ift.tt/2FEvGrI

Patient-Reported Dysphagia After Thyroidectomy

This patient open-interview study attempts to characterize the effect of swallowing-related symptoms after thyroidectomy on patient quality of life and related outcomes.

http://ift.tt/2Hh5aSe

Errors in Items and Algorithm in Questionnaire for Validation Study

To the Editor We write to report a scoring algorithm error that was included in our article, "Development and Initial Validation of a Consumer Questionnaire to Predict the Presence of Ear Disease," published online on August 3, 2017, and in the October 2017 issue of JAMA Otolaryngology–Head & Neck Surgery. In this study, we examined the validity of the Consumer Ear Disease Risk Assessment (CEDRA), a questionnaire for the self-assessment of risk of ear diseases associated with hearing loss. The error was discovered by a member of our research team who was preparing a digital version of the questionnaire used in our study. The error occurred in the analysis code for 3 of the 28 questionnaire items included in the scoring (questions 16, 18, and 19). For these 3 questions, the 4-item rating scales were dichotomized incorrectly. After correcting the algorithm for these questions, we found slightly different results, without any differences in statistical significance of these results. The overall results and conclusions remain unchanged.

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Otolaryngology Resident Education and the Core Competencies

This systematic review summarizes the quantity and nature of otolaryngology residency training literature and evaluates whether this literature aligns with the 6 core competencies identified by the Accreditation Council for Graduate Medical Education.

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Survival and Time to Radiation After Surgery in Head and Neck Cancer

Using data from the National Cancer Database, this cohort study examines the association of delayed time to radiotherapy with survival outcomes in patients with head and neck squamous cell carcinoma.

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Postoperative cesarean pain: real but is it preventable?

Purpose of review Cesarean section is the most common surgical procedure performed in the world. Postoperative pain management remains a challenge, particularly in a context of enhanced recovery after surgery. Several barriers related to the specific condition of 'postpartum recovery' may prevent application of effective analgesia in this population. The present review focuses on novel approaches of cesarean section postoperative pain assessment, beyond pain-rating intensity, including objective patient-centered recovery parameters. Predictive tools currently available to target patients at high risk of acute and chronic pain are also examined. Recent findings Postoperative pain after cesarean section is more severe than reported in the majority of randomized control trials. Pain seriously interferes with early and also late functional recovery, although Enhanced Recovery after Surgery (ERAS) programmes are being promoted. Pain-rating scores can differ from scores of physical comfort and physical independence, which are priorities for postpartum patients. Further, the value of subjective pain intensity rating to adapt analgesic prescription is misleading and may promote opioid over-prescription. Available tools to predict at-risk patients for severe pain after cesarean section are not easy to use in daily clinical practice and have, at best, moderate predictive value. Summary Patient and healthcare provider education on reported pain and well tolerated analgesic use is the key to improve postpartum pain management after cesarean section. Correspondence to Patricia Lavand'homme, MD, PhD, Department of Anesthesiology, Cliniques Universitaires St Luc - University Catholic of Louvain, Av Hippocrate 10, B-1200 Brussels, Belgium. Tel: +32 2 764 18 21; fax: +32 2 764 36 99; e-mail: patricia.lavandhomme@uclouvain.be Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Can This Topical Cream Prevent Nonmelanoma Skin Cancer?

A study tested whether prophylactic application of topical fluorouracil can prevent nonmelanoma skin cancer.
Medscape Dermatology

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Parotid adenoid cystic carcinoma: Retrospective single institute analysis

Publication date: Available online 7 March 2018
Source:American Journal of Otolaryngology
Author(s): Mohamed Nazmy ElBeltagi




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Nasal polyposis pathophysiology: Endotype and phenotype open issues

Publication date: Available online 7 March 2018
Source:American Journal of Otolaryngology
Author(s): Giuseppe Brescia, Claudia Zanotti, Daniela Parrino, Umberto Barion, Gino Marioni
PurposeEndotyping chronic rhinosinusitis with nasal polyps (CRSwNP) poses a challenge for rhinologists nowadays. Phenotyping CRSwNP proved inappropriate as an approach to their classification because of their common clinical features. Endotyping, being based on the pathogenic mechanism, provides a precise picture more appropriate for use in clinical practice. Patients' treatment and follow-up can thus be tailored to cope with the degree of aggressiveness of a specific CRSwNP endotype.The aim of this study was to analyze the available information about the main currently accepted endotypes of CRSwNP; furthermore, we reported and commented evidence regarding some clinical conditions associated with nasal polyposis which could be related with new endotypes.Materials and methodsPubmed and Scopus electronic database were searched. The main available studies about CRSwNP endotyping published predominantly in the last 5 years were critically analyzed.ResultsThe pathophysiological features of some asthma-related CRSwNP (allergic fungal rhinosinusitis, aspirin-exacerbated respiratory disease) are quite well understood, including them among known endotypes of CRSwNP. On the other hand, because of their known pathophysiological mechanisms, some well-known diseases associated with aggressive forms of CRSwNP, such as eosinophilic granulomatosis with polyangiitis, primary ciliary dyskinesia and cystic fibrosis, should be investigated as potentially related with CRSwNP endotypes.ConclusionsCRSwNP comprises several inflammatory endotypes defined by different pathogenic mechanisms. These endotypes correlate with the disease's clinical manifestations and behavior. A thorough understanding of CRSwNP endotypes will enable targeted medical therapies and tailored follow-up protocols.



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The association between otogenic lateral sinus thrombosis and thrombophilia – A long-term follow-up

Publication date: Available online 7 March 2018
Source:American Journal of Otolaryngology
Author(s): Schneider Shay, Kapelushnik Joseph, Kraus Mordechai, El-Saied Sabri, Levi Itai, Kaplan Daniel Michael
PurposeOtogenic lateral sinus thrombosis (OLST) is an intracranial, potentially life-threatening complication of acute and chronic otitis media. Since congenital thrombophilic disorders are risk factors for cerebral venous thrombosis, OLST may be related to thrombophilia. The aim of our study was twofold: to evaluate whether patients who suffered from OLST in childhood also have thrombophilia, and whether these patients experienced thromboembolic episodes in future years.Study designRetrospective case series.MethodsThe medical charts of all children hospitalized for OLST at Soroka University Medical Center of Israel, a tertiary referral hospital, from January 1983 to September 2014 were reviewed. The patients were invited for a follow-up visit and comprehensive medical history was taken along with a physical examination and laboratory work-up for thrombophilia.Main findingsSeven patients were included in the study. Of these, 3 (43%) had results suggesting thrombophilic disorders manifested by elevated levels of factor IX and decreased levels of protein S activity (n = 1), decreased levels of proteins C and S activity (n = 1), and elevated levels of antibodies to cardiolipin (n = 1). No patients experienced clear thrombophilic events; however, 2 patients (29%) with later proven thrombophilia suffered neurologic sequelae, possibly suggesting thrombophilic events.ConclusionsPediatric OLST secondary to acute otitis media and mastoiditis may reflect an underlying thrombophilia. Laboratory work-up for thrombophilia should be performed, and anticoagulant treatment may be warranted in managing these patients.



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Analysis of non-posterior canal benign paroxysmal positional vertigo in patients treated using the particle repositioning chair: A large, single-institution series

Publication date: Available online 7 March 2018
Source:American Journal of Otolaryngology
Author(s): Alexander L. Luryi, David Wright, Juliana Lawrence, Seilesh Babu, Michael LaRouere, Dennis I. Bojrab, Eric W. Sargent, John Zappia, Christopher A. Schutt
PurposeBenign paroxysmal positional vertigo (BPPV) involving the horizontal and superior semicircular canals is difficult to study due to variability in diagnosis. We aim to compare disease, treatment, and outcome characteristics between patients with BPPV of non-posterior semicircular canals (NP-BPPV) and BPPV involving the posterior canal only (P-BPPV) using the particle repositioning chair as a diagnostic and therapeutic tool.MethodsRetrospective review of patients diagnosed with and treated for BPPV at a high volume otology institution using the particle repositioning chair.ResultsA total of 610 patients with BPPV were identified, 19.0% of whom had NP-BPPV. Patients with NP-BPPV were more likely to have bilateral BPPV (52.6% vs. 27.6%, p < 0.0005) and Meniere's disease (12.1% vs. 5.9%, p = 0.02) and were more likely to have caloric weakness (40.3% vs. 24.3%, p = 0.01). Patients with NP-BPPV required more treatments for BPPV (average 3.4 vs. 2.4, p = 0.01) but did not have a significantly different rate of resolution, rate of recurrence, or time to resolution or recurrence than patients with posterior canal BPPV.ConclusionsComparison of NP-BPPV and P-BPPV is presented with reliable diagnosis by the particle repositioning chair. NP-BPPV affects 19% of patients with BPPV, and these patients are more likely to have bilateral BPPV and to require more treatment visits but have similar outcomes to those with P-BPPV. NP-BPPV is common and should be part of the differential diagnosis for patients presenting with positional vertigo.



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Progressive functional improvement in hemiglossectomy defects reconstructed with radial forearm free flap at 6-months

Publication date: Available online 7 March 2018
Source:American Journal of Otolaryngology
Author(s): Khoi Anh Nguyen, Truong Xuan Bui, Hue Van Nguyen, Richard O. Wein
ObjectiveThe purposes of the study was to evaluate for the functional improvement of outcomes of patients undergoing surgical management for tongue cancer at varying periods after surgery.DesignCase series with intervention.ParticipantsThirty consecutive patients, from 2011 to 2015, with carcinoma of the tongue undergoing surgical resection and reconstruction with a radial forearm free flap.Main measuresThe Speech Intelligibility Test (SIT) is used for objective evaluation of speech function. The 7-point ordinal scale Functional Oral Intake Score (FOIS) was used to estimate the swallowing function.ResultsThe patients included were 25 men and 5 women with a mean age of 50.4 years (range – 27–65). All tumors were squamous cell carcinomas and all patients underwent a hemiglossectomy. There were two complete flap failures, with a resultant flap success rate of 93.3%. The initial mean speech intelligibility scores at 1-month increased from 72.3 ± 0.2 to 77.7 ± 8.9 at 6-months after surgery (p = 0.05). Similarly, the mean score of swallowing function improved from 6.1 at 1-month to 6.8 at 6-months after surgery (p = 0.05).ConclusionReconstruction of hemiglossectomy defects with a radial forearm free flap offers functional benefits in speech and deglutition that demonstrate progressive improvement when 1- and 6-month post-surgical assessments are compared.



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Identification of specifically reduced Th2 cell subsets in allergic rhinitis patients after sublingual immunotherapy

Abstract

Background

Although Th2 cells are well known to play important roles in allergic diseases including allergic rhinitis (AR), the factors that induce and sustain the pathogenesis of AR remain unclear. The recent development of sublingual immunotherapy (SLIT) is expected to allow changes to the underlying pathogenesis of AR. However, which Th2 cell subsets are important in house dust mite-induced AR (HDM-AR), the influence of SLIT on the pathogenic Th2 cells, and the association of Th2 cell subsets with SLIT efficacy have not been clarified.

Methods

The cytokine production and frequency of HDM-reactive T cell subsets in peripheral blood mononuclear cells (PBMCs) were evaluated using flow cytometry in 89 HDM-AR patients (placebo (n=43) and HDM 300 IR (n=46)) who participated in a placebo-controlled study of SLIT with HDM tablets. All patients provided samples both before treatment as a baseline and at the end of the 52-week study. The PBMCs were stained with CellTrace^™ Violet (CTV) before culture with HDM extract, and HDM-reactive T cells were detected as the proliferated cells with diminished CTV.

Results

HDM-reactive IL-5⁺IL-13⁺CD27⁻CD161⁺CD4⁺ cells and ST2⁺CD45RO⁺CD4⁺ cells were observed in the peripheral blood from each patient with HDM-AR; these cells significantly decreased after SLIT in the group treated with active tablets. HDM-reactive ST2⁺CD45RO⁺CD4⁺ cells were significantly lower in active-responders.

Conclusion

Allergen-reactive ST2⁺CD45RO⁺CD4⁺ cells or those combined with IL-5⁺IL-13⁺CD27⁻CD161⁺CD4⁺ cells may be useful as markers indicating the successful treatment of SLIT. These cells may play a crucial role in the pathogenesis of AR as pathogenic memory Th2 cells.

This article is protected by copyright. All rights reserved.

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Chronic urticaria can be caused by cancer and resolves with its cure

Abstract

We present 26 cases (ours and 25 from an extended literature review) in which chronic spontaneous urticaria (CSU) seems to be caused by a malignancy (mostly carcinoma or hematologic malignancy): the CSU precedes the neoplasia diagnosis by some months (2-8mo in 80%) and resolved days after chemotherapy/ surgical resection of the malignancy. In three patients, the urticaria flare-up alerted the treating physician of neoplasia recurrence. There could be publication bias, but the narrow time-span between cancer remission and urticaria resolution and especially the recurrence of urticaria that led to detection of cancer relapse in some of our cases are arguments in favor of a causal relationship. Physicians treating CSU should be aware of this. As in all CSU, complete blood count, C reactive protein and erythrocyte sedimentation rate should form part of the initial work-up. As age-indicated screening, over 45 years, a mastography/prostate antigen test should be taken and in recalcitrant, treatment-resistant CSU i.a. a thyroid gland ultrasound could be considered to rule out the most frequently associated malignancies.

This article is protected by copyright. All rights reserved.

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Incidence of cephalosporin-induced anaphylaxis and clinical efficacy of screening intradermal tests with cephalosporins: a large multicenter retrospective cohort study

Abstract

Background

Few studies have investigated the incidence of anaphylaxis induced by individual or structurally similar cephalosporins. The aims of the study were to assess the incidence of cephalosporin-induced anaphylaxis and evaluate the clinical efficacy of screening skin tests.

Methods

In this retrospective cohort study, we obtained information on total cephalosporin use and cephalosporin-induced anaphylaxis in intravenous cephalosporin recipients in 12 general hospitals between 2013 and 2015. Cephalosporins were divided into four groups according to similar side-chain structures. The incidence of cephalosporin-induced anaphylaxis was assessed for each cephalosporin, cephalosporin generation and side-chain group. To verify the efficacy of screening intradermal tests (IDT) with cephalosporin, the 12 hospitals were assigned to the intervention or control group depending on whether they performed screening IDT before the administration of cephalosporins.

Results

We identified 76 cases of cephalosporin-induced anaphylaxis with 1,123,345 exposures to intravenous cephalosporins (6.8 per 100,000 exposures) and the incidence of fatal anaphylaxis by cephalosporin was 0.1 cases per 100,000 exposures. The highest incidences of anaphylaxis occurred in the ceftizoxime (13.0 cases per 100,000 exposures) and side-chain group 1 (cefepime, cefotaxime, ceftizoxime, ceftriaxone and cefuroxime; 9.3 per 100,000). There was no case of anaphylaxis induced by cefoxitin, cefmetazole, cefminox and cefotiam. The clinical effectiveness of routine screening IDT was not significant (p = 0.06).

Conclusions

The incidence of cephalosporin-induced anaphylaxis differed according to individual drugs and side-chain structure. Although screening IDT showed no clinical efficacy in general, it may be useful for certain cephalosporins.

This article is protected by copyright. All rights reserved.

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Research in oral and maxillofacial surgery: infrastructure and innovation

Publication date: Available online 7 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Anastasios Kanatas




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Minimally-invasive operations on the temporomandibular joint with a new retractor: technical note

Publication date: Available online 7 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D. Debevc, A. Kansky




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Bifurcation of the inferior dental nerve canal: an anatomical study

Publication date: Available online 7 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): N.P. Shah, L. Murtadha, J. Brown
The aims of this study were to find the incidence of bifurcation of the inferior dental nerve (IDN) canal, to describe the characteristics of this variant, and to examine the sensitivity and specificity of dental panoramic tomography to identify it. We classified bifurcations by size and position relative to the main canal and the lower third molar using cone-beam computed tomography (CT) and dental panoramic tomography. In our study of 281 patients, 106 (38%) had bifurcations, and in one quarter, these were classified as large accessory canals. Bifurcations were most commonly found posterior to the lower third molar (n=64, 57%) or within 2mm of the roots of the third molar (n=40, 38%). The sensitivity and specificity of dental panoramic tomography to identify all bifurcations was 11% (95% CI: 5.67 to 17.97) and 91% (95% CI: 85.58 to 94.68), respectively; this was 33% (95% CI: 15.63 to 55.32) and 94% (95% CI: 90.34 to 96.50), respectively, for large bifurcations. Our use of cone-beam CT suggested an incidence of bifid canals of 38%, with a variation in size and distribution in relation to the lower third molar. It also showed that the sensitivity of panoramic radiography to identify them was poor.



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Current thinking about the management of recurrent pleomorphic adenoma of the parotid: a structured review

Publication date: Available online 8 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Kanatas, M.W.S. Ho, T. Mücke
Pleomorphic adenoma is the most common tumour of the parotid gland, and can recur after excision. Recurrent pleomorphic adenoma can be a challenge to treat, and has variable outcomes. The aim of this review was to summarise current thinking in its management, which may be helpful to clinical teams and could improve patients' health-related quality of life. We searched several online databases using the key terms pleomorphic adenoma, recurrent pleomorphic adenoma, parotid gland tumours, parotid surgery, radiotherapy and parotid pleomorphic adenoma, and parotid surgery outcomes. Information collected included sample size, recurrence rate, condition of the facial nerve, type of operation, adjuvant treatments associated with recurrence, and clinical outcome. We screened 2301 papers, of which 49 were eligible. There was no consensus among authors about management. There are few if any randomised studies, and so conclusions in most papers were based on coherent arguments. Pleomorphic adenomas of the parotid tend to recur after long intervals, with a propensity towards multifocal disease, and the risk of recurrence (which depends on the initial surgical technique) is higher when the initial operation was done at a young age, after enucleation, and if the initial margins were invaded. Published conclusions suggest that the accepted management varies from observation in selected cases to total parotidectomy with or without postoperative radiotherapy.



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Treatment of lower lip pits in Van der Woude syndrome: a systematic review

Publication date: April 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 4
Author(s): M. Peralta-Mamani, Á. Terrero-Pérez, G. Dalben, C.M.F. Rubira, H.M. Honório, I.F. Rubira-Bullen
The presence of lower lip pits in individuals with Van der Woude syndrome (VWS) may cause discomfort due to saliva secretion. Furthermore, one of the main complaints in relation to lip pits is poor aesthetics, which often affects quality of life. The aim of this systematic review was to identify the best technique for the surgical removal of lower lip pits in terms of aesthetic and functional characteristics. A search of the PubMed, Embase, Web of Science, Science Direct, and Scopus databases was performed on December 27, 2016, which retrieved 88 records without duplicates. Among these papers, three ultimately met all eligibility criteria. The three studies included a total of 61 individuals, with follow-up ranging from 6 months to 10 years and sample collection from 10 to 24 years. The findings demonstrated that the outcome of surgical removal of lower lip pits was better with the use of vertical wedge excision, inverted-T lip reduction, Mutaf–Goldstein technique and modified simple excision than with simple excision. Simple excision may result in postoperative complications, such as mucocele and pit recurrence.



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Editorial Board/Reviewing Committee

Publication date: April 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 4





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Reaching the vertical versus horizontal target position in multi-segmental Le Fort I osteotomy is more difficult, but yields comparably stable results to one-segment osteotomy

Publication date: April 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 4
Author(s): J. Meewis, D. Govaerts, B. Falter, K. Grisar, E. Shaheen, G. Van de Vyvere, C. Politis
This retrospective cohort study evaluated the postoperative outcomes of preoperatively planned positional changes for Le Fort I osteotomy in 77 patients (average age 26.6 years). Movement relapse and planning accuracy were evaluated by lateral cephalometric analysis, with an average follow-up of 257 days. In one-segment osteotomy cases, 73% of the horizontal movements were positioned within 2mm of the surgical plan. With posterior–inferior repositioning of the maxilla, results fell within 2mm of the prescribed plan in 60% of cases. Maxillary advancement and superior repositioning proved more stable than inferior maxillary repositioning. Relapse did not differ between three-piece and one-piece osteotomies for any movements; however, in three-piece cases, only half of the positional changes on average stayed within 2mm of the prescribed surgical plan. Relapse did not vary with bone grafting among the groups. To summarize, in most Le Fort I osteotomy cases, the surgical plan is achieved within 2mm, with posterior extrusion of the maxilla showing the greatest deviation both in reaching the target and maintaining the result achieved. Although maxillary segmentation makes the surgical plan more difficult to achieve, the results are at least as stable as those of one-piece osteotomies.



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Quantitative analysis of facial soft tissue perfusion during hypotensive anesthesia using laser-assisted indocyanine green fluorescence angiography

Publication date: April 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 4
Author(s): J. McCabe, C. Guevara, J. Renfroe, T. Fattahi, S. Salman, B. Steinberg
The aim of this study was to quantitatively evaluate the efficacy of induced hypotensive anesthesia in decreasing facial soft tissue perfusion during orthognathic surgery using laser-assisted indocyanine green fluorescence angiography. This retrospective study involved the evaluation of 16 patients who underwent orthognathic surgery. Data collection included facial tissue perfusion of the bilateral cheeks and chin at normotension and with pharmacologically induced hypotensive anesthesia. There were statistically significant differences in the facial tissue perfusion at normal and depressed levels of blood pressure (P<0.001). This study used an objective measure to demonstrate the long-standing belief that hypotensive anesthesia is efficacious in reducing tissue perfusion in the surgical field. The data suggest that pharmacologically depressing the level of mean arterial pressure by 18% may result in a 41–52% decrease in facial soft tissue perfusion. This study reports a novel method of quantitative analysis.



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Evaluation of peri-implant bone levels and soft tissue dimensions around zirconia implants—a three-year follow-up study

Publication date: April 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 4
Author(s): K. Kniha, K.A. Schlegel, H. Kniha, A. Modabber, F. Hölzle, K. Kniha
The aim of this study was to measure bone levels around zirconia implants during follow-up of up to 3 years. Additionally, the effect of clinical contact point positions on the papilla deficit was evaluated. Eighty-one patients with 105 zirconia implants were examined at the 3-year follow-up. Bone levels were measured on the date of implant placement and at 3 months, 1year, and 3 years thereafter. Distances between the first bone–implant contact and the contact point of the crowns and between the bone level at the adjacent tooth and the contact point of the crowns were assessed. The effect of the clinical contact point position on the papilla deficit was also assessed. Significant reductions in the distances between the bone–implant contact and the implant shoulder, as well as the contact point of the crowns, and between the bone level at the adjacent tooth and the contact point of the crowns, were found. A significant association was found between the papilla deficit and the height of the contact point. Implant survival was 100% and implant success was 95.4%. While zirconia implants presented little bone loss up to 1year, significant bone apposition was observed up to 3years. Low contact points correlated with full papillae, whereas high contact points were associated with a papilla deficit.



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Changes in condylar volume and joint spaces after orthognathic surgery

Publication date: April 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 4
Author(s): R.J. da Silva, C.V. Valadares Souza, G.A. Souza, G.M.B. Ambrosano, D.Q. Freitas, E. Sant'Ana, C. de Oliveira-Santos
The aim of this study was to evaluate the changes in condylar volume and joint spaces occurring in patients undergoing bimaxillary orthognathic surgery for the treatment of class II deformities, by means of cone beam computed tomography (CBCT). Initial and follow-up (at least 6 months) CBCT examinations of 114 condyles (57 patients) were studied retrospectively. Linear measurements of the joint space and volumetric analysis of changes in condylar volume were performed using Dolphin 3D Imaging in association with ITK-SNAP 3.0.0 segmentation software. The paired t-test and Pearson correlation coefficient were applied, and a descriptive analysis was performed. Mean condyle volumes were significantly smaller at follow-up (P=0.0125). There were significant reductions in superior and medial joint spaces in the follow-up examinations (both P<0.05). Positive correlations were found when comparing the mean changes in anterior, superior, and posterior space values between the right and left sides. No significant correlation was observed between changes in volume and joint spaces. In conclusion, there was a reduction in mean condylar volume after orthognathic surgery in class II patients. However, changes in volume for each condyle may be variable. Such changes in condylar volume may occur independently on the left and right sides, and do not correlate with changes in joint spaces.



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Biomaterials in temporomandibular joint replacement: current status and future perspectives—a narrative review

Publication date: April 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 4
Author(s): N. De Meurechy, A. Braem, M.Y. Mommaerts
The alloplastic total temporomandibular joint (TMJ) prosthesis has a long history, with many different materials and designs used. While several of these materials have proven valuable over time, many others have not been suitable for implantation, resulting in failure and the need for explantation of the implant. Because of the failure of several of these systems, the use of alloplastic prostheses has reduced dramatically, despite their advantages over autogenous restoration. The aim of this narrative review is to discuss the criteria that must be met by a biomaterial in order for it to be considered suitable for implantation, as well as the common complications that can occur. Currently used materials are highlighted, as well as potential future materials that might prove better suitable for implantation. Several surface modification techniques are proposed as an alternative to the materials used in current TMJ prosthesis systems.



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Fluctuating asymmetry of the normal facial skeleton

Publication date: April 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 4
Author(s): J. Gateño, T.L. Jones, S.G.F. Shen, K.-C. Chen, A. Jajoo, T. Kuang, J.D. English, M. Nicol, J.F. Teichgraeber, J.J. Xia
The purpose of this study was to produce reliable estimations of fluctuating facial asymmetry in a normal population. Fifty-four computed tomography (CT) facial models of average-looking and symmetrical Chinese subjects with a class I occlusion were used in this study. Eleven midline landmarks and 12 pairs of bilateral landmarks were digitized. The repeatability of the landmark digitization was first evaluated. A Procrustes analysis was then used to measure the fluctuating asymmetry of each CT model, after all of the models had been scaled to the average face size of the study sample. A principal component analysis was finally used to establish the direction of the fluctuating asymmetries. The results showed that there was excellent absolute agreement among the three repeated measurements. The mean fluctuating asymmetry of the average-size face varied at each anthropometric landmark site, ranging from 1.0mm to 2.8mm. At the 95% upper limit, the asymmetries ranged from 2.2mm to 5.7mm. Most of the asymmetry of the midline structures was mediolateral, while the asymmetry of the bilateral landmarks was more equally distributed. These values are for the average face. People with larger faces will have higher values, while subjects with smaller faces will have lower values.



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The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review

Publication date: Available online 8 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L.N. Melek, M. Devine, T. Renton
Trigeminal neuralgia (TN) is characterized by sharp, electric shock-like pain, which can be triggered by trivial stimuli. Although medical and surgical treatments are available for TN, some patients experience refractory pain, which has a significant impact on their quality of life. The aim of this systematic review was to determine the psychosocial impact of orofacial pain in patients with diagnosed TN. A search was initiated in three electronic databases (Embase, MEDLINE, PubMed) to identify potential studies for inclusion in the review. All types of study published in English that reported psychosocial measures using validated psychometric questionnaires were included. A total of 585 articles were retrieved from the search. These were screened thoroughly, leading to the selection of 13 articles for data extraction and final analysis. The results show the chronic overwhelming nature of TN, with pain levels varying from mild to severe. Psychometric scores indicated mild to moderate depression, moderate to severe anxiety, and moderate to severe functional limitation of daily life activities in TN patients. Therefore, psychological support within a multidisciplinary team is recommended for TN patients to help them cope better with their chronic disorder and to improve the efficacy of treatment.



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Biomechanical simulation of temporomandibular joint replacement (TMJR) devices: a scoping review of the finite element method

Publication date: Available online 8 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y.L. Rodrigues, M.T. Mathew, L.G. Mercuri, J.S.P. da Silva, B. Henriques, J.C.M. Souza
The aim of this study was to perform a literature review on the use of finite element modeling (FEM) for the evaluation of the biomechanical behavior of temporomandibular joint replacement (TMJR) devices. An electronic search of online medical and scientific literature database was conducted using selected search terms. The search identified 307 studies, of which 19 were considered relevant to this study. Of the 19 selected studies, 10 (52.6%) investigated the influence of geometry and fixation methods, while two (10.5%) evaluated the behavior of artificial condyle–fossa structures. The TMJR devices assessed in these studies included TMJ Inc. (aka Christensen; 63.2%), Zimmer Biomet (15.7%), Stryker (10.5%), and a theoretical intramedullary condylar component (5.3%); 26.3% of the studies evaluated custom TMJR devices. Such studies provided important data on the distribution of strain and stress through TMJR structural components and surrounding bone by using different software systems and methods. The mean stress values were lower on a custom TMJR condyle–ramus component and the supporting bone than on the stock device. FEM proved to be an accurate and valuable biomechanical simulation tool for studying the current TMJR devices and should be considered a useful tool for the improvement and development of future joint replacement devices.



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Endoscopic pericranial flap design for the restoration of nasal mid-vault lining defects

Publication date: Available online 8 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Bastaninejad, E. Karimi, N. Saeedi, E. Amirizad
Despite progress made in nasal reconstruction, the restoration of a large defect, including the whole septum and mid-nasal vault structures, remains a challenge. The pericranial flap (PCF) is used widely for the reconstruction of anterior cranial fossa defects. This article presents a surgical technique for nasal lining restoration with an endoscopic PCF design. This technique was used in patients with huge intranasal tumours. Two patients with nasal eosinophilic angiocentric fibrosis were treated. The structural involvement was similar in each case. The tumour was resected completely by combined endoscopic and external methods through an open rhinoplasty approach. The resulting defect included the whole nasal septum, bilateral upper lateral cartilage, and the entire mid-nasal vault mucosal lining. Reconstruction was achieved by endoscopic PCF design for internal lining reconstruction and rib cartilage for framework repair. The first patient was followed up for 18months and the second for 8months. No infection occurred in the postoperative period. Framework stability and texture were good, and both nasal shapes were acceptable. In conclusion, this endoscopic PCF approach for restoring the internal nasal lining appears to be a good choice in selected cases.



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Triple innervation for re-animation of recent facial paralysis

Publication date: Available online 7 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Federico Biglioli, Fabiana Allevi, Dimitri Rabbiosi, Silvia Cupello, Valeria Marinella Augusta Battista, Alberto Maria Saibene, Giacomo Colletti
Recent facial palsies are those in which fibrillations of the mimetic musculature remain detectable by electromyography (EMG). Such fibrillations generally cease 18 to 24 months after palsy onset. During this period, facial re-animation surgery seeks to supply new neural inputs to the facial nerve.Neural usable sources were divided into qualitative (contralateral facial nerve) and quantitative (hypoglossus and masseteric nerve), depending on the type of stimulus provided.To further improve the extent and quality of facial re-animation, we here describe a new surgical technique featuring triple neural inputs: the use of the masseteric nerve and 30% of the hypoglossus nerve fibres as quantitative sources was associated with the contralateral facial nerve (incorporated via two cross-face nerve grafts) as a qualitative source in order to restore facial movements in 24 consecutive patients.The use of two quantitative motor nerve sources together with a qualitative neural source appears to improve re-animation after facial paralysis, despite earlier doubts as to whether patients could use different nerves to produce facial movements. In fact, movement was much improved. Smiling according to emotions and blinking seem to be better assured if cross-face nerve grafting is performed in two steps rather than one.



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3D Computer Simulation Analysis of the Flap Volume Change in Total Tongue Reconstruction Flaps

Publication date: Available online 8 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Hyung Hwa Jeong, Woo Shik Jeong, Jong Woo Choi, Seung Eun Jeong, Soon Yuhl Nam, Seung Ho Choi, Yoon Sei Lee, Hyeun A. Kim, Young Jun Kim
BackgroundA decreased flap volume can be an obstacle to proper phonation and swallowing. In this study we verified the proportion of volume decrease using 3D reconstructed images and identified the contributors to flap volume loss.MethodsWe retrospectively analyzed all patients who underwent radical excision of tongue cancer and reconstructive surgery in our institution from January 2003 to October 2016. Segmentation of the DICOM images, 3D rendering of the neotongue flap, and analysis of the reconstructed images were performed using SPlanner V1® software.ResultsThe first postoperative imaging work-up was performed within an average of 22 days (T1). The last follow-up images were taken at an average of 6.25 months (T2). The mean flap volume at T2 was reduced to 82.99 per cent compared with T1, and flap height was reduced to 91.85 per cent, giving mean volume and height decreases of 17.01 per cent and 8.15 per cent, respectively. Neither the volume/height difference between T1 and T2 nor the flap volume/height discrepancy compared with the preoperative tongue affected speech or feeding function. The difference between the flap and preoperative tongue volumes was significantly related to the presence of complications (p = 0.0153). Initial flap volume was significantly related to the flap volume reduction (p = 0.0159).ConclusionsThe mean flap volume reduction is the only factor significantly related to initial flap volume. Our realistic 3D reconstructed image and novel software enables us to more precisely predict the flap volume of the postoperative state and preoperatively evaluate the required flap size for covering defects.



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