Head and Neck Medicine by Alexandros G.Sfakianakis: 03/18/18

Κυριακή 18 Μαρτίου 2018

Outcome Analysis of Microlaryngeal Surgery for Benign Lesions of Vocal Cord Using Videostroboscopy and Voice Handicap Index

Abstract

Benign vocal cord mass lesions are common causes of dysphonia which are often surgically correctable. They include lesions like vocal polyps, vocal cysts, vocal nodules and Reinke's edema. A prospective study of 30 patients was carried out at SMS medical college and hospital between April 2014 to November 2015 after institutional ethical committee clearance. The purpose of our study was to evaluate outcome of microlaryngeal surgery for benign lesions of vocal cord using videostroboscopy and voice handicap index. All cases between the age group 15–60 years with clinical evidence of benign lesions of vocal cord were included in study. Preoperative amplitude, mucosal wave, glottic closure was seen by videostroboscopy and subjective assessment of severity of handicap in voice was assessed by set of questionnaire using voice handicap index (Jacobson et al. in Am J Speech Lang Pathol 6: 66–70, 1997). Postoperative follow up was done at 3rd week and 10th week, and outcome of microlaryngeal surgery was assessed using videostroboscope and voice handicap index. At the end of study data was compiled systemically and analysed using paired 't' test and Chi square test. Our study observed statistically significant improvement in amplitude and mucosal wave and glottic closure. Subjective improvement in perception of severity of handicap in voice was analysed by voice handicap index which shows statistically significant data. Overall our study conclude microlaryngeal surgery as an effective way for improvement in speech parameters, that can be assessed by use of videostroboscopy and voice handicap index.

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Outcome Analysis of Microlaryngeal Surgery for Benign Lesions of Vocal Cord Using Videostroboscopy and Voice Handicap Index

Abstract

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Aortic stent graft injury over active blood flow: over the fence

Description

A 72-year-old woman was admitted to our hospital complaining of chest pain at rest. She underwent thoracic endovascular repair (TER) using three stent grafts (GORE TAG 34x150, 34x200 and 26x200 mm; W. L. Gore & Associates, Flagstaff, Arizona, USA) with type B aortic dissection 5 years earlier (figure 1A). Coronary CT angiography (CTA) findings were inconclusive because of remarkable massive calcification in all coronary arteries. As a low-density area suspected of mural thrombus inside the second stent graft was detected (figure 1B), non-obstructive angioscopy was performed to evaluate graft failure besides invasive coronary angiography.1 No significant stenosis was found using invasive coronary angiography; however, suspicious blood flow through the graft was observed at the aneurysmal descending aorta in the middle of the second graft (figure 2 and video 1). Being uninfluenced by aortic blood flow, it was thought to exist...

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Book Review—Diagnostic Pathology: Lymph Nodes and Extranodal Lymphomas, 2nd Edition

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Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: In 1–2% of PET scans performed for the diagnosis or staging of non-thyroid cancers, incidental uptake of a thyroid lesion is detected. Read More….

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Cochlear implants in developing countries: practical and ethical considerations

No abstract available

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Overcoming developing-world challenges in cochlear implantation: a South American perspective

Purpose of review Effective hearing rehabilitation with cochlear implantation is challenging in developing countries, and this review focuses on strategies for childhood profound sensorineural hearing loss care in South America. Recent findings Most global hearing loss exists in developing countries; optimal cost-effective management strategies are essential in these environments. This review aims to assess and discuss the challenges of cochlear implantation effectiveness in South America. The authors searched electronic databases, bibliographies, and references for published and unpublished studies. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and failure rate. Costs were obtained from experts in South America using known costs and estimations whenever necessary. Recent studies reported several challenges in unilateral or bilateral cochlear implants: cochlear implant costs, deaf education costs, increasing need for cochlear implant capacity, and training and increasing longevity. Summary Cochlear implantation was very cost-effective in all South American countries. Despite inconsistencies in the quality of available evidence, the robustness of systematic review methods substantiates the positive findings of the included studies, demonstrating that unilateral cochlear implantation is clinically effective and likely to be cost-effective in developing countries. Correspondence to Sady S. Da Costa, MD, PhD, Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350 - Bairro Santa Cecília Porto Alegre, Rio Grande do Sul 90035-903, Brazil. E-mail: selaimen@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A comparison of neuromuscular electrical stimulation and traditional therapy, versus traditional therapy in patients with longstanding dysphagia

Purpose of review Dysphagia in adults arises from a range of causes including acquired neurological disorders and some cancers. Previous research has suggested that treatment using neuromuscular electrical stimulation (NMES) when used in conjunction with conventional therapy is effective. This review describes the recent literature and a small prospective case series carried out in the United Kingdom. This study contributed to support National Institute of Clinical Excellence (NICE) guidance for clinicians who wish to include NMES in a rehabilitation programme for dysphagic patients, specifically with reference to safety and the impact on swallowing function of this intervention. Recent findings In 2014, the UK NICE issued guidelines enabling UK therapists to trial the use of NMES, but the guidelines also sought additional evidence on the impact on swallowing function of NMES and the incidence of side effects. This small prospective case series investigated both of these aspects with a group of patients with dysphagia of neurological origin who had not achieved adequate swallowing function with traditional therapy alone. This study recruited 10 adult patients with dysphagia of neurological origin. All had previously received traditional swallowing therapy for at least 6 months but only achieved a Functional Oral Intake Scale of 4 or less (a scale for amounts and types of oral intake). The total study period was 10 weeks for each subject comprising 5 weeks of traditional therapy delivered three times a week followed by 5 weeks of NMES concurrent with traditional therapy (NMES + traditional therapy) delivered three times a week using the VitalStim stimulator (VitalStim Therapy, UK). In addition, the Quality of Life in Swallowing and Eating Assessment Tool 10 (quality of life scales) were determined to allow comparison between studies. Nine subjects achieved an improvement in swallowing function after NMES + traditional therapy was measured using the Functional Oral Intake Scale, giving a statistically significant improvement (P

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Cochlear implants in developing countries: practical and ethical considerations

No abstract available

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Overcoming developing-world challenges in cochlear implantation: a South American perspective

A comparison of neuromuscular electrical stimulation and traditional therapy, versus traditional therapy in patients with longstanding dysphagia

Fate of mandibular canals displaced by enlarged cystic lesions: does the inferior alveolar neurovascular bundle relocate to its original position?

Publication date: Available online 17 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Y.-S. Han, H. Lee, B.-M. Seo
Our aim was to identify the positional changes of the inferior alveolar neurovascular bundle and evaluate the relocation of the displaced mandibular canal after enucleation of a cyst. Seventy patients (72 sites) who had had cysts enucleated were divided into three groups based on the degree of encroachment of the cystic lesion into the mandibular canal and whether a bone graft had been inserted after the cyst had been enucleated. The mean (range) of patients' ages was 45 (18–75) years, and there were 29 male and 41 female patients. Group A comprised cysts with encroachment on the mandibular canal that were enucleated without a bone graft; Group B consisted of cysts with no encroachment of the mandibular canal, but were enucleated without a bone graft; and Group C comprised cysts with encroachment of the mandibular canal that were enucleated with a bone graft. The displacement of the mandibular canal was identified from analysis of computed tomographic (CT) images. Changes in the position of the mandibular canal were measured on panoramic radiographs. The mandibular canal was repositioned superiorly by a mean (SD) of 2.4 (1.65)mm after enucleation of the cyst, which was significant in Group A (p<0.001), but not in Groups B and C. These results indicate that the displaced inferior alveolar neurovascular bundles that were not surrounded by bony canal tended to relocate towards a supposedly normal position, and after enucleation of the cyst the mandibular canal was remodelled in this new location. This tendency to relocate was blocked by bone grafting. Bone grafts are therefore recommended in cases where enough bony height is required for future insertion of implants.

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Rare Report of Unilateral Postauricular Dermoid Cyst

Dermoid cysts are benign developmental anomalies that occurred as a result of the sequestration of the skin along the lines of embryonic closure. Those occurring in the cervicofacial region are uncommon, accounting for about 7% of all dermoids and its presence in postauricular region is further exceptionally rare. A healthy 19-year-old Asian boy presented with a unilateral postauricular cyst that had been present since childhood without any symptom. The computed tomography scan revealed an encapsulated tumor with no intracranial extension. Histological examination of a biopsy taken from the lesion revealed a unilocular cyst found in the deep dermis and subcutaneous tissue. Multinuclear giant cells and fragments of hair shaft are infiltrated in the cystic wall. Some keratin materials are seen in the intracystic area. However, the lining cells are not found. These histologic findings were suggested of the dermoid cyst. Patients with postauricular dermoid cysts usually seek medical advice for the cosmetic reasons because of the embarrassing look of the prominent unilateral or bilateral ears. The treatment of postauricular dermoid cyst is complete surgical excision of the cyst wall. Incomplete removal may result in recurrence or infection; thus, complete surgical excision is necessary. The prognosis is excellent without further complication. Address correspondence and reprint requests to Hwan Jun Choi, MD, PhD, Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Bongmyeong-dong, Dongnam-gu, Cheonan-si, Chungcheongnam-do 330-721, Republic of Korea; E-mail: medi619@hanmail.net Received 28 August, 2017 Accepted 17 December, 2017 This work was supported by the Soonchunhyang University Research Fund. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Swallowing and Temporomandibular Disorders in Adults

Introduction: Temporomandibular disease (TMD) etiology is multifactorial and is related to many perpetuating, predisposing, and initiating factors. The daytime parafunctions may have an important role in TMD pathogenesis. The most frequent parafunctions analyzed were the static parafunction (ie, clenching) and the dynamic parafunction (ie, grinding). In the present paper, the authors evaluated the swallowing (an oral function/parafunction) with the surface electromyography in patients with TMD. Materials and Methods: Twenty patients with TMD problems (nonhealthy patients, NHP) (mean age: 33 ± 1.994; 8 men and 12 women) and 20 healthy matched subjects (HP) (34.4 ± 2.782; 6 men and 14 women) were selected and examined. On each patient, an 8-channel surface electromyography was done during saliva swallowing. Results: Nonhealthy patients presented higher masseter and temporalis activation (P

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Traumatic Bony Ankylosis of Temporomandibular Joint as a Complication After Reduction Malarplasty

Reduction malarplasty is one of the most commonly performed cosmetic and plastic surgery in Asian countries. Bony ankylosis of the temporomandibular joint (TMJ) occurs usually as a result of trauma, infection, failed surgeries, and autoimmune diseases. Reduction malarplasty has low incidence of TMJ-related complications. A 33-year-old female patient came with complaint of restricted mouth opening around 18 mm, which was developed immediately after the reduction malarplasty 2 years before. On computed tomography image, bony adhesion and the defect from the surgical drilling were found around right TMJ. The TMJ interpositional gap arthroplasty with temporalis myofascial pedicled flap was done with simultaneous right coronoidectomy. Interincisal opening increased up to 47 mm intraoperatively. Address correspondence and reprint requests to Jun-Young Paeng, DDS, PhD, Department of Oral and Maxillofacial Surgery, Kyungpook National University School of Dentistry, Daegu, Republic of Korea; (e-mail: jypaeng@gmail.com). Received 4 November, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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High-Flow Extracranial–Intracranial Bypass for Giant Cavernous Carotid Aneurysm

Giant intracranial aneurysms have always been remain the most difficult cerebrovascular lesions to treat, especially for giant cavernous carotid aneurysm (CCA). The treatment of giant CCA is a greatest challenge for neurosurgeons. Surgical clipping morbidity and mortality rates are relatively high, and endovascular embolization also have a high complication. The authors reported a special 74-year-old female patient who presented with blurred vision and double vision for 3 years, a giant CCA was found by digital subtraction angiography and computed tomography angiography. In the end, the CCA was treated using high-flow external carotid artery to middle cerebral artery bypass and clipping distal of the aneurysm. This technique and treatment was successful and without ischemia and neurologic sequelae. Also, their long-term follow-up demonstrated that brain tissue perfusion was better than before. Based on the literature reviewing, this technique might be an alternative strategy for intracranial giant unruptured aneurysms, especially for not suitable for direct clipping or with a high risk for endovascular embolization. Address correspondence and reprint requests to Yuhai Wang, Xingyuan North Road 101, Wuxi, China; E-mail: wangyuhai1516@163.com Received 28 November, 2017 Accepted 7 January, 2018 Junhui Chen, Chunlei Zhang, and Peipei Li contributed equally to the manuscript. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Aging Surgeon and the Secret of Longevity

No abstract available

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Characteristics of the Development of the Maxillae and Vomer in Patients With Bilateral Cleft Lip and Palate

The aim of this study was to investigate the anatomical features of the maxillae and vomer in patients with bilateral cleft lip and palate (BCLP). Craniofacial measurements of 24 adult BCLP patients (GB) and 32 normal adult controls (GN) were carried out. We measured the width and length of the maxillae, their relative positions with respect to the coronal plane passing through the basion, and the volume, length, cross-sectional area, and mean width of the vomer. Between-group differences were assessed using independent-sample t tests. Finite element models (FEMs) were used to explore the bite forces acting on the bone by evaluating the distribution of stress and bone displacement. The mean vomer volume and width were significantly larger in the GB group than in the GN group (P = 0.000), whereas the length was significantly shorter (P = 0.000). The anterior maxillary length (A1-P3M⊥CP) was significantly larger in the GB group (P = 0.013), whereas the posterior maxillary length (P3M-P6M⊥CP) and overall maxillary length (A1-P6M⊥CP) at the dental level were significantly reduced (P

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An Algorithm for Airway Management in Patients With Pierre Robin Sequence

Purpose: Airway management in neonates with Pierre Robin sequence (PRS) can be challenging. The goal was to describe the algorithm developed by the authors over the past 8 years. Methods: A retrospective case series analyzing airway management in neonates with PRS admitted to the neonatal intensive care unit at a tertiary care pediatric hospital was performed. The utility of the proposed algorithm for airway management incorporating more consistent use of polysomnography (PSG), and airway assessment was assessed. Results: A total of 31 neonates with PRS (12 men, 19 women) with a mean gestational age of 38.2 weeks were analyzed. Thirteen (41.9%) patients had a named syndrome, chromosomal abnormality, or global delay. Twenty (64.5%) patients had pre-intervention PSG, and severe obstructive sleep apnea with an apnea-hypopnea index (AHI) ≥ 10 events/hour was identified in 19 (95.0%). Mandibular distraction osteogenesis was performed in 18 (58.1%) patients, and improved the AHI on post-operative PSGs. Direct assessment of the upper and lower airways was performed in 19 patients, and 13 (68.4%) were found to have secondary airway pathology. Presence of a concomitant syndrome was significantly associated with need for tracheostomy. Conclusion: The algorithm differs from previous ones in that it relies on rigorous pre- and post-intervention PSG (including with a nasopharyngeal airway), as well as that it allows flexibility between treatment options given the whole-patient clinical scenario and endoscopic findings. Results from these studies may be integrated to stratify patients into those who are most likely to benefit from conservative interventions or surgical procedures. Address correspondence and reprint requests to Jeffrey C. Rastatter, MD, Division of Otolaryngology – Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 25, Chicago, IL 60611; E-mail: jrastatter@luriechildrens.org Received 18 August, 2017 Accepted 29 January, 2018 Presented at the American Academy of Otolaryngology – Head and Neck Surgery Annual Meeting, September 20, 2016, San Diego, CA. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Osteosarcoma of the Ethmoid Sinus

Osteosarcoma (OS) is a malignant bone tumor and it is very rare in head and neck region. If it arises in this area, most common localizations of this tumor are mandible and maxilla and ethmoid sinus is very rare site for this malignancy. A 43-year-old female admitted to our clinic with the complaint of pain in the right half of the face and headache persisting for 2 months. According to the clinical symptoms and imaging studies, sinonasal ossifying fibroma was suspected. For this reason, patient was operated endoscopically and histopathological examination revealed that osteoid matrix producing atypical osteoblastic cells so these findings identified osteoblastic variant OS. This article is about a very rare case of OS of ethmoid sinus. The differential diagnosis, general characteristics, and classification of this tumor, radiological features, and surgical techniques are also presented. Address correspondence and reprint requests to Zülküf Burak Erdur, MD, Department of Otolaryngology Head and Neck Surgery, Istanbul University Cerrahpasa Medicine Faculty, Istanbul Üniversitesi Cerrahpaşa Tip Fakültesi Yerleşkesi Kocamustafapaşa Cd. No: 53, Cerrahpaşa, 34098 Fatih/Istanbul, Turkey; E-mail: burakerdur@hotmail.com Received 6 December, 2017 Accepted 2 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reconstruction of Complex Facial Asymmetry: Problems and Refinements

This article describes 2 patients with complex facial asymmetry characterized by hemiarhinia, microorbitism, palpebral fissure shortening, ipsilateral canthal dystopia, maxillomandibular hypoplasia, and occlusal plane inclination. These unusual phenotypes are part of the oculoauriculo-vertebral spectrum. Their devastating functional, esthetic, and psychologic effects demand the use of different craniofacial surgery techniques, in order to alleviate the profound impact of these pathologies. Initial skeletal balance through bimaxillary distraction osteogenesis and orbital expansion sets the basis for further reconstruction of the nose and periorbital area with local tissue. Address correspondence and reprint requests to Oswaldo Javir Gómez Díaz, MD, Division of Plastic Surgery, School of Medicine, National University of Colombia, Caracas Avenue 1–13, Office of Surgical Specialties, Third Floor, Bogotá D.C., Colombia; E-mail: oswaldogomez@me.com Received 28 May, 2017 Accepted 2 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Combined Application of Database and Three-Dimensional Image Registration Technology in the Restoration of Total Nose Defect

Objective: The purpose of this study is to present a virtual planning protocol based on the database and three-dimensional (3D) image registration technology for the restoration of the total nasal defect, and evaluate its feasibility and clinical efficacy. Methods: Patients were scanned with a FaceScan to obtain the 3D facial model which was stored in an Extensible Neuroimaging Archive Toolkit (XNAT) database. Personalized search and similarity evaluation were performed in the database to find a normal 3D facial model with the highest similarity to the patient's. Then, the 2 models were imported into the dedicated software for 3D image registration to get the 3D model of the nasal defect part and the preoperative planning 3D facial model of virtual restoration. Subsequently, the dimensionality reduction algorithm was conducted to transform the 3D model of the nasal defect to a 2D flatten one for determining the scope of the forehead flap during surgery. Four weeks after the insetting surgery of forehead flap pedicle, the postoperative 3D facial model was gained. At last, the clinical efficacy was evaluated by comparing the difference between the preoperative planning and postoperative 3D facial model. Results: The nasal shapes of the patients were good after the operation, and the results revealed that the maximum error was ranging from 3.12 to 4.07 mm with the mean error from 0.92 to 1.04 mm. Conclusion: The database and 3D image registration technology provide a new approach for precisely determining the scope of total nasal defect and the forehead flap, which may be used for reference in the accurate restoration of other facial soft tissue defects. Address correspondence and reprint requests to Wei Tang, MD, PhD, Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, NO. 14 3rd Section, Renmin South Road, Chengdu 610041, China; E-mail: mydrtw@vip.sina.com Received 2 December, 2017 Accepted 2 February, 2018 The first 2 authors contributed equally to this work. This study was supported by Program of Science and Technology Department of Sichuan Province (2014SZ0157-2). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Upper Eyelid Blepharoplasty With Voltaic Arc Dermabrasion

The aging to the upper eyelid complex includes skin laxity, resulting in rhytids, orbicularis oculi hypertrophy, and pseudohermitian of orbital fat and nowadays a high number of patients seeking cosmetic surgery. Excess and laxity of upper eyelid skin affect more than 90% of women, the impact of these problems on the patient's self-esteem can become important enough to affect quality of life in psychological and sociocultural terms. The aim of the study was to evaluate the clinical efficacy of blepharoplasty with an electrosurgical technology for treatment of skin laxity of upper eyelid, which produced a lid retraction and an elevation of the upper lid without complications. This retrospective evaluation was conducted from October 2008 to July 2015, where 80 patients (56 female and 24 male) were treated for excess and laxity of upper eyelid skin with voltaic arc dermabrasion. The outcome was that all patients displayed some aspects of tissue contraction that stretched the lax skin of the upper eyelids, resulting in cosmetic improvement. In conclusion this technique was predictable and useful to remove the laxity of upper eyelid skin minimal recurrence rates, and acceptable aesthetics. Address correspondence and reprint requests to Professor Antonio Scarano, DDS, MD, Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy; E-mail: ascarano@unich.it Received 8 November, 2017 Accepted 2 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Relationship Between Third Mandibular Molar Angulation and Distal Cervical Caries in the Second Molar

Third lower molar partially erupted is commonly encountered in dental practice. This situation challenges clinicians with the dilemma whether to remove or to monitor it, because this molar can cause pathology of the adjacent second molar. The aim of this retrospective study is to evaluate the relationship between third mandibular molar and distal cervical caries in second molar. This retrospective study analyzed 55 digital orthopantograms of adult patients and a total number of 95 mandibular third molars were assessed for eruption status, angulation, radiographic evidence of caries or restoration in the mandibular third molar, and radiographic evidence of caries or restoration in the distal surface of the mandibular second molar. The distal cervical caries in second molar is associated with fully erupted and partially erupted wisdom molar in horizontal, mesioangular and vertical position and less with presence of caries in third molar. There are caries lesions in distal second molars in mesioangular position when adjacent third molar is caries free. Address correspondence and reprint requests to Eitan Mijiritsky, DMD, Scientific Coordinator of Maxillofacial Surgery, Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Ehud Str 12, Tel-Aviv 69350, Israel; E-mail: Mijiritsky@bezeqint.net Received 29 November, 2017 Accepted 2 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Congenital Vomer Defect Incidentally Detected on Preoperative Evaluation for Nasal Septoplasty and Turbinoplasty

A perforation in posterioinferior portion of nasal septum is rare and caused by vomeral defect. We report a case of 56-year-old man who had a vomer defect, which was detected incidentally during preoperative evaluation of nasal septoplasty and turbinoplasty. The patient had a surgery of septoplasty and bilateral turbinoplasty under general anesthesia. There was no septal mucosal tear or defect during septoplasty and turbinoplasty. When the patient who has vomeral defect with nasal obstruction is planned for septoplasty and turbinoplasty, the surgery should be performed carefully to protect the mucosa. Address correspondence and reprint requests to Jung Hyun Chang, MD, PhD, Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10444, Republic of Korea; E-mail: jhrhino.chang@gmail.com Received 24 July, 2017 Accepted 4 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Nano-Biphasic Calcium Phosphate Ceramic for the Repair of Bone Defects

Calcium phosphate bioceramics has recently experienced increased interest in bone reconstruction. Mimicking of natural structure of bone, like the use of nanomaterials, is an attractive approach for generating scaffolds for bone regeneration. The aim of present study was to evaluate the effect of nanonization on the biphasic calcium phosphate (BCP) ceramic in the repair of bone cavities in the canine mandible. A commercial BCP was dry-milled in a high energy planetary ball mill with zirconia balls and container. Three holes (8 mm in diameter) were outlined to the depth of cortical bone of mandibular angle of 5 dogs bilaterally. The first hole (positive control group A, n = 10) was filled in with commercial BCP material. The second hole was loaded with the nanonized BCP (experimental group C, n = 10) and the third one was left untreated (negative control group B, n = 10). The defects were allowed to regenerate for 8 weeks. New bone formation was greater in groups A and C than in B. No difference was seen between group A and group C (P = 0.676). The residual bone material in group C (19.34 ± 8.03) was as much as one-half of that in group A (38.69 ± 7.90%) (P = 0.000). The negative control group B presented the highest amount of soft tissue within the bone defects. The least percentage of marrow space was found in the positive control group (13.23 ± 13.52). Our results depicted that the rate of resorption increased significantly after nanonization even though the nano-sized BCP failed to make a superior regeneration than the ordinary BCP. Address correspondence and reprint requests to Majid Rezaei, DDS, MSc, No 501, Sobhan Building, Javanshir St, Kermanshah 67137-433227, Iran; E-mail: m.rezaei@kums.ac.ir Received 15 November, 2017 Accepted 7 February, 2018 This study was financially supported by vice chancellery for research and technology, Kermanshah University of Medical Sciences (No 94123). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Cranioplasty: An Institutional Experience

Cranioplasty is a common procedure in neurosurgical practice, but associated with high complication rates. In the current study, the authors describe surgical characteristics and results of cranioplasty performed in a tertiary teaching hospital in Brazil. Data were obtained from electronic medical records of cranioplasties performed between January 2013 and November 2016. The sample comprised of 33 patients, and the mean follow-up time was 16 months. Patients presented most of the times a good preoperative status, with 84.8% of patients classified between 0 and 3 at modified Rankin scale and 78.7% with 4 or 5 points at Glasgow Outcome Scale. The most common initial diagnosis was vascular disease (48% of patients) followed by traumatic brain injury (36% of patients). The majority of cranioplasties used an autograft: the autologous bone flap removed during a previous surgery (craniectomy) and stored in the abdominal subcutaneous fat (67% of patients). In 3 patients, the polymethylmethacrylate prosthesis was custom-made prior to the operation using 3-dimensional printing, based on computed tomography images. Five patients (15% of patients) developed symptoms related to surgical site infection, manifesting at an average of 5 weeks following the procedure. Three of them presented scalp dehiscence before the infection symptoms. Cranioplasty should be performed early, as long as clinical conditions are good and the patient has overcome the acute phase of neurological injury. Address correspondence and reprint requests to Aderaldo Costa Alves Junior, MD, Departamento de Neurologia, Psicologia e Psiquiatria, Distrito de Rubião Jr, S/N, Botucatu, SP, Brazil. CEP: 18618-970; E-mail: aderaldoneuro@gmail.com Received 24 September, 2017 Accepted 7 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Ophthalmologic Complications Associated With Oculofacial Plastic and Esthetic Surgeries

Purpose: To assess the ophthalmologic complications after oculofacial plastic and esthetic surgeries, including their incidence and management. Methods: A retrospective study was performed on 110 patients who presented with ocular complications followed by oculofacial plastic and esthetic surgeries from January 2014 to December 2015. The incidence and management of complications after each surgery or procedure were analyzed. Results: For lower eyelid blepharoplasty, the common complications were chemosis and lower eyelid ectropion. There was also a case of canalicular laceration. Exposure keratitis and corneal abrasion were the most common complications after upper eyelid blepharoplasty. Chemosis frequently occurred after lateral cathoplasty, but other complications, such as ectropion, trichiasis, and lacrimal fistula, were also seen. Nasolacrimal duct obstruction occurred in some cases of orthognathic surgery, and was managed with endonasal dacryocystorhinostomy. Inflammatory lipogranuloma was a common complication after autologous fat transplantation. Conclusion: Complications after oculofacial plastic and esthetic surgeries are not rare. Ophthalmologists must be aware of not only common complications but also rare and possibly serious conditions that may occur after such surgeries. Address correspondence and reprint requests to Hye Sun Choi, MD, Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Youngshinro 136, Youngdeungpo-gu, 07301, Seoul, South Korea; E-mail: hs0903@kimeye.com. Received 15 November, 2017 Accepted 7 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Clinical Notes on Chiari Malformation

Chiari malformations (CMs) are variant structural setup of cerebellum and brain stem at the craniovertebral junction. Normally the cerebellum and parts of the brain stem lie above the foramen magnum. When the part of the cerebellum and/or brainstem protrudes into the upper spinal canal through foramen magnum, it is defined as CM. Chiari malformations may develop when part of the skull is smaller than normal or misshapen, due to which the cerebellum herniates into spinal canal through foramen magnum. This compresses the cerebellum and brainstem affecting functions controlled by these parts and blocks the flow of cerebrospinal fluid that surrounds and cushions the brain and spinal cord. Chiari malformation may cause sensory loss, ataxia, weakness, nystagmus, spastic limbs to name a few. Thus, various morbid and mortal neurologic disorders result from CM. Therefore, sound and thorough knowledge of CM and its variant anatomy are essential for diagnosis and management of neurologic disorders. Therefore, review study has been carried out for updating and consolidating the knowledge of all the variations of CMs. Literature search was carried out using databases, SciELO, ScopeMed, MEDLINE, PubMed, and Wiley Online Library. Papers containing original data were selected and secondary references retrieved from bibliographies. Various terms related to CMs were used for net surfing. The knowledge will be of immense importance to neurologists and neurosurgeons to diagnose and treat the CMs and decrease the mortality associated with CM and to radiologists for correctly interpreting the magnetic resonance imaging. Address correspondence and reprint requests to Dr Rajani Singh, Additional Professor, Department of Anatomy, AIIMS Rishikesh, Veerbhadramarg, 249203 Uttrakhand, India; E-mail: nani_sahayal@rediffmail.com Received 12 December, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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A Quantitative Analysis of Weight Gain Following Mandibular Distraction Osteogenesis in Robin Sequence

Mandibular distraction osteogenesis (MDO) is an effective treatment modality for children suffering from upper airway obstruction from Robin Sequence (RS). Mandibular distraction osteogenesis has been shown to have positive effects on oral feeding and for relieving respiratory obstruction, but its effects on postoperative weight gain are poorly understood. This study quantitatively analyzes weight gain following MDO. A retrospective chart review identified 22 RS children who underwent MDO. Patient weight data, feeding methods pre- and postoperatively, and polysomnography data pre- and postoperatively were collected. Each patient's weight plotted over time was then compared with his or her closest standardized growth curve, and linear regression analysis was utilized to quantify patient growth by calculating actual and expected average daily weight gain (g/d). Percentile changes were analyzed as well. Children gained significantly less weight than expected from birth to time of MDO and significantly more weight than expected from MDO to device removal, MDO to 6 months postoperatively, and MDO to 12 months postoperatively. The average growth percentile for the cohort was 37.3 at birth, declined to 22.7 by MDO, and increased to 28.5 and 33.5 at device removal and 6 months postoperatively, respectively. More than 70% of children were exclusively orally fed within 6 months of MDO. Children with isolated Robin Sequence had superior weight gain than children with syndromic Robin Sequence following surgery. In conclusion, MDO helps improve weight gain following surgery, particularly for infants with isolated Robin Sequence, and has positive effects on oral feeding and respiration. Address correspondence and reprint requests to Derek M. Steinbacher, MD, DMD, Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, P.O. Box 8041, New Haven, CT 06520-8062; E-mail: Derek.Steinbacher@yale.edu Received 8 August, 2017 Accepted 3 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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An atypical autistic phenotype associated with a 2q13 microdeletion: a case report

Autism spectrum disorders are serious neurodevelopmental disorders that affect approximately 1% of the population. These disorders are substantially influenced by genetics. Several recent linkage analyses have...

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Severe abdominal pain and diarrhea – unusual multiple myeloma presentation with a severe prognosis: a case report

Multiple myeloma is a hematologic disease with high mortality rates all over the world. The diagnosis has always been challenging since the first case was reported in 1844. For that reason the diagnostic crite...

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Comparing Simultaneous Liver-Kidney Transplant Strategies: A Modified Cost-Effectiveness Analysis

Background The proportion of patients with kidney failure at time of liver transplantation is at an historic high in the United States. The optimal timing of kidney transplantation with respect to the liver transplant is unknown. Methods We used a modified cost-effectiveness analysis to compare four strategies: the old system ("pre-OPTN"), the new Organ Procurement Transplant Network (OPTN) system since August 10, 2017 ("OPTN"), and two strategies which restrict simultaneous liver-kidney transplants ("safety net" and "stringent"). We measured "cost" by deployment of deceased donor kidneys (DDKs) to liver transplant recipients and effectiveness by life years (LYs) and quality-adjusted life years (QALYs) in liver transplant recipients. We validated our model against Scientific Registry for Transplant Recipients data. Results The OPTN, safety net and stringent strategies were on the efficient frontier. By rank order, OPTN > safety net > stringent strategy in terms of LY, QALY and DDK deployment. The pre-OPTN system was dominated, or outperformed, by all alternative strategies. The incremental LY per DDK between the strategies ranged from 1.30 to 1.85. The incremental QALY per DDK ranged from 1.11 to 2.03. Conclusion These estimates quantify the "organ"-effectiveness of various kidney allocation strategies for liver transplant candidates. The OPTN system will likely deliver better liver transplant outcomes at the expense of more frequent deployment of DDKs to liver transplant recipients. Corresponding Authors: Jane C. Tan, 750 Welch Rd, Suite 200, MC 5785, Palo Alto CA 94304, 650-725-9891. janetan@stanford.edu; W. Ray Kim, 300 Pasteur Drive, Always M211, Stanford CA 94305, 650-725-6511. wrkim@stanford.edu Authorship: X.S.C.: Research design, data acquisition, data analysis, results interpretation, paper writing. W.R.K.: Research design, results interpretation, paper writing. J.C.T.: Research design, data acquisition, results interpretation, paper writing. G.M.C.: Research design, results interpretation, paper writing. J.G.: Research design, data analysis, results interpretation, paper writing. The authors declare no conflict of interest. Research reported here was supported by the John M. Sobrato Gift Fund (J.C.T.) and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K24DK092336 (W.R.K.) and K24 DK085446 (G.M.C.). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Real-Time Ultrasound-Assisted Thoracic Epidural Placement: A Feasibility Study of a Novel Technique

The placement of thoracic epidural catheters is complicated by the layering of the vertebral lamina. Therefore, traditional blind palpation techniques require insertion of an epidural needle with likely contact of lamina with redirections into the epidural space. We discuss a safe and consistent technique using true real-time ultrasound visualization of the needle with a paramedian sagittal oblique view to improve the consistency of placing an epidural in the thoracic spine for postoperative analgesia. Successful epidural placement was achieved in every patient. All catheters were found to be effective for use in the postoperative phase. Accepted for publication November 20, 2017. Address correspondence to: Amitabh Gulati, MD, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (e-mail: gulatia@mskcc.org). The authors have no sources of funding to declare for this article. This work was presented in part as an abstract at the American Society of Regional Anesthesia and Pain Medicine's 42nd Annual Regional Anesthesiology and Acute Pain Medicine Meeting; April 6 to 8, 2017; San Francisco, CA. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Αρχειοθήκη ιστολογίου

Κυριακή 18 Μαρτίου 2018

Abstract

Abstract