Head and Neck Medicine by Alexandros G.Sfakianakis: 04/10/18

Τρίτη 10 Απριλίου 2018

Quantification of Histidine-Rich Protein 3 of Plasmodium falciparum

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.

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Down-Regulated miR-125a-5p Promotes the Reprogramming of Glucose Metabolism and Cell Malignancy by Increasing Levels of CD147 in Thyroid Cancer

Thyroid, Ahead of Print.

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The epidemiology of Helicobacter pylori infection in Europe and the impact of lifestyle on its natural evolution toward stomach cancer after infection: A systematic review

Helicobacter, EarlyView.

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Long‐term outcomes in oral cavity squamous cell carcinoma with adjuvant and salvage radiotherapy after surgery

The Laryngoscope, EarlyView.

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Retronasal olfaction in chronic rhinosinusitis

The Laryngoscope, EarlyView.

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Multiple perioral homogenous blue macules

Clinical and Experimental Dermatology, EarlyView.

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Current trends in the medical management of osteoradionecrosis using triple therapy

Publication date: Available online 9 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. Dhanda, L. Rennie, R. Shaw
Recent guidelines from the National Institute for Health and Care Excellence (NICE) have suggested that the medical management of osteoradionecrosis (ORN) of the jaws should be used in clinical trials only, and some drugs and therapeutics committees have withdrawn funds for such prescriptions. With increased scrutiny on the use of these agents, the aims of this study were to ascertain current trends in the presentation and management of ORN, with particular focus on which agents are being used.

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Re: re: Retroseptal transconjunctival approach for fractures of the zygomaticomaxillary complex: a retrospective study

Publication date: Available online 9 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Sharma

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Tetanus after a penetrating injury to the right globe: a case report

Publication date: Available online 9 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): B. Rushworth, L. Carter
A 24-year-old man attended the emergency department with a penetrating injury to the right globe after a road traffic accident. He later contracted tetanus for which he was given human tetanus immunoglobulin. Although it is rare, tetanus is life-threatening and a thorough immunisation history should be obtained before treatment of tetanus-prone injuries.

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Use of patient-reported outcome measures in oral and maxillofacial trauma surgery: a review

Publication date: Available online 9 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Ologunde, N.M.H. McLeod
In the UK, about one person/100/year sustains a facial injury, so trauma surgery accounts for a considerable part of the caseload in oral and maxillofacial surgery (OMFS). Patient-reported outcome measures (PROM) allow for patient-centred assessment of postoperative outcomes, but to our knowledge, most research in OMFS trauma does not currently include them. To investigate their use, we searched Medline to find relevant studies that reported outcomes from inception in January 1879 to August 2016. Those not in the English language and those that did not report operations were excluded. We retrieved 416 articles, of which 21 met the inclusion criteria (five randomised controlled trials and 16 cohort studies) yielding 16 outcome measures. Most of these had been devised by authors (eight studies), four studies reported use of the Geriatric Oral Health Assessment Index, and three the Nasal Obstruction Symptom Evaluation. Most were used in studies on mandibular surgery (n=13), followed by those on nasal and facial surgery (n=3 each). There is a great heterogeneity in the use of these assessments in OMF trauma. In view of their increasing importance compared with simpler objective measures that may not be relevant to the patients' own perception, more research is needed to establish which of them can be used to measure the QoL of patients treated for OMF trauma.

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Dentin dysplasia type I—A dental disease with genetic heterogeneity

Oral Diseases, EarlyView.

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Was bestimmt die Prognose von Patienten mit Störungen des Schluckvorganges?

Laryngo-Rhino-Otol 2018; 97: 232-234
DOI: 10.1055/s-0044-100285

Bock JM et al. Evaluation of the natural history of patients who aspirate. Laryngoscope 2017; 127: S1–S10 Die klinische Progression der Aspiration bis zu eventuellen pulmonalen Störungen ist nicht vollständig verstanden. Empfehlungen zur Ernährungsumstellung, Schwere von Penetration und Aspiration gemäß PAS sowie die Ätiologie der Dysphagie beeinflussen möglicherweise die Zeitspanne bis zum Auftreten des ersten pulmonalen Ereignisses sowie das Gesamtüberleben von Patienten mit VFS-dokumentierter, asymptomatischer Penetration und Aspiration.
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Laryngopharyngealer Reflux

Laryngo-Rhino-Otol 2018; 97: 238-245
DOI: 10.1055/s-0044-100794

Die Prävalenz von laryngopharyngealem Reflux (LPR) wird in der Allgemeinbevölkerung mit bis zu 31 % angegeben. Bei Patienten mit Stimmproblemen bzw. Kehlkopferkrankungen tritt ein LPR bei ca. 50 % der Patienten als Begleiterscheinung auf. Typische refluxbedingte Erkrankungen am Larynx sind eine chronische Laryngitis und das Kontaktgranulom. Nicht abschließend geklärt ist die Rolle des LPR bei der Genese des Stimmlippenkarzinoms. Für die Diagnose des LPR gibt es noch keine evidenzbasierten Daten, er kann jedoch üblicherweise klinisch aus der Kombination typischer Symptome (Heiserkeit, chronischer Hustenreiz/Räuspern, Globusgefühl/Dysphagie) und dem charakteristischen laryngoskopischen Bild (ein Schleimhauterythem bzw. eine Schleimhauthyperplasie mit Fältelung der Interarytenoidregion und ein Stimmlippenödem) gestellt werden. Gelegentlich wird eine LPR zusätzlich durch eine pharyngeale 24h-pH-Metrie-Untersuchung gesichert. Die Therapie des LPR umfasst mehrere Bereiche, wie z.B. diätetische Maßnahmen, die medikamentöse Therapie mit Protonenpumpeninhibitoren (PPIs) und ggf. eine chirurgische Intervention. Bei symptomatischen Patienten erfolgt oft eine Therapie mit PPIs, bei der der HNO-Arzt im engen Dialog mit dem Gastroenterologen steht.
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Zusammenhang zwischen Tinnituston und Frequenzbereich des Gehörverlusts

Laryngo-Rhino-Otol 2018; 97: 230-231
DOI: 10.1055/s-0044-100277

Keppler H et al. The relationship between tinnitus pitch and parameters of audiometry and distortion product otoacoustic emissions. J Laryngol Otol 2017; 131: 1017–1025 Ein chronischer Tinnitus ist mit einem reduzierten akustischen Reiz assoziiert. Auf die Schädigung reagiert das zentrale Hörsystem mit Veränderungen. Den Zusammenhang zwischen Tinnituston und Parametern der Audiometrie sowie der distorsiv produzierten otoakustischen Emissionen (DPOAE) untersuchten Ärzte des Hör-Sprachzentrums der Universität der belgischen Stadt Gent.
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Rhinoplastik

Laryngo-Rhino-Otol 2018; 97: 289-292
DOI: 10.1055/a-0549-3244

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Radiologisch basierte Therapie des Kehlkopfkrebses überprüft

Laryngo-Rhino-Otol 2018; 97: 231-232
DOI: 10.1055/s-0044-100272

Ko HC et al. Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx. JAMA Otolaryngol Head Neck Surg 2017; 143: 1126–1133 Wie ist das Überleben von Patienten mit Kehlkopfkrebs im Stadium T3N0M0, die operativ oder mittels Radiotherapie behandelt wurden? Zur Klärung dieser Frage verglichen chinesische Wissenschaftler die retrospektiven Daten dieser Patienten über einen langfristigen Nachbeobachtungszeitraum.
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Endoskopische Frühdiagnostik von Karzinomen im oberen Aerodigestivtrakt

Laryngo-Rhino-Otol 2018; 97: 276-286
DOI: 10.1055/a-0575-3564

Der obere Aerodigestivtrakt ist mit endoskopischen Methoden gut zugänglich. Die Entwicklung moderner endoskopisch bildgebender Verfahren (EBV) hat dazu beigetragen, Tumorerkrankungen im oberen Aerodigestivtrakt frühzeitig zu entdecken und minimalinvasiv, onkologisch wirksam sowie funktionserhaltend zu behandeln. Damit wird ein gutes onkologisches Ergebnis bei Erhalt der Lebensqualität und Reduzierung der Mortalität und Komplikationsrate erreicht.
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Techniken der Stapedotomie

Laryngo-Rhino-Otol 2018; 97: 236-237
DOI: 10.1055/s-0044-102148

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Versorgung mit Hörgeräten und Hörimplantaten

Laryngo-Rhino-Otol 2018; 97: 235-235
DOI: 10.1055/s-0043-125366

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Zum richtigen Umgang mit Bonusmeilen

Laryngo-Rhino-Otol 2018; 97: 274-275
DOI: 10.1055/s-0043-125169

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Basic Otorhinolaryngology. A Step-by-Step Learning Guide, Second Edition

Laryngo-Rhino-Otol 2018; 97: 235-235
DOI: 10.1055/s-0043-125367

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Vorhersage von modalitätsspezifischen Arbeitsgedächtnisleistungen im Kindergartenalter

Laryngo-Rhino-Otol
DOI: 10.1055/a-0594-0244

Hintergrund Das Arbeitsgedächtnis (AG) als ein zentrales kognitives Konstrukt ist eine fundamentale Voraussetzung für Lernen und gilt als Marker für Entwicklungsstörungen. In den letzten Jahren hat es beachtliche Aufmerksamkeit in der Forschung gewonnen. Um Prädiktoren für phonologische und visuelle AG-Leistungen zu bestimmen, wurden hier multivariate Regressionsanalysen mittels generalisierter linearer Modelle gerechnet. Material und Methoden Das phonologische AG wurde durch das Nachsprechen von Nichtwörtern (SETK 3–5-Subtest PGN) und von Zahlenfolgen (K-ABC-Subtest), das visuell-räumliche durch die Imitation von Handbewegungen (K-ABC-Subtest) untersucht. Eine Intelligenzschätzung wurde durch das Ergebnis in der K-ABC-Skala „Ganzheitliches Denken" vorgenommen. Stichprobe: 169 Kindergartenkinder (49 % Jungen; 51 % Mädchen), überwiegend mit Migrationshintergrund und Deutsch als Zweitsprache, im mittleren Alter von 45,9 (SD 6,2; Min 36; Max 61) Monaten; zum Zeitpunkt der Untersuchung im Durchschnitt seit 9,9 (SD 6,9) Monaten im Kindergarten und durchschnittlich intelligent. Als Faktoren wurden Geschlecht und Migrationshintergrund festgelegt, als Kovariaten Lebensalter, Dauer des Kindergartenbesuchs bis zur Testung sowie ganzheitliches Denken in die Modelle aufgenommen. Ergebnisse Alle mittleren AG-Leistungen waren durchschnittlich. Nur das Alter zum Untersuchungszeitpunkt sowie das ganzheitliche Denken hatte einen signifikanten Einfluss auf die AG-Leistungen. Schlussfolgerung Im Alter von 36–61 Monaten lassen sich die beiden o. g. Arbeitsgedächtnissysteme als ein anlagebedingter, reifungsabhängiger und eher geschlechtsunspezifischer Mechanismus beschreiben.
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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2018; 97: 287-288
DOI: 10.1055/a-0549-3200

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Aerobe Belastung verschlechtert die Wahrnehmungsschwelle kurzer H2S-Impulse

Laryngo-Rhino-Otol
DOI: 10.1055/a-0589-1158

Hintergrund Ob sich bei akuter aerober körperlicher Belastung das Riechvermögen verschlechtert, wird in der Literatur widersprüchlich beschrieben. Material und Methoden Zur Klärung dieser Fragestellung wurden die passiven Wahrnehmungsschwellen für kurze H2S-Stimuli mittels eines Fluss-Olfaktometers inspirationssynchron bei nasaler Atmung im staircase Verfahren während einer Ruhephase, einer anschließenden submaximalen Belastung auf einem Fahrradergometer und einer nachfolgenden Erholungsphase bei Gesunden bestimmt und mit einander verglichen. Parallel fanden Messungen von Herzfrequenz, Blutdruck, Blutlaktat und Körpertemperatur statt, um eine aerobe Belastung abzusichern. Ergebnisse Die Versuchsteilnehmer hatten ihre höchsten Werte für die Wahrnehmungsschwelle in der Belastungsphase. Mittels rm-ANOVA und post-hoc-Tests war ein signifikanter Unterschied der Mittelwerte der Wahrnehmungsschwellen zwischen den Messungen in Ruhe und während körperlicher Belastung sowie zwischen der Erholungs- und Belastungsphase zu verzeichnen. Die Mittelwerte der Wahrnehmungsschwellen zwischen der Ruhe- und Erholungsphase differierten hingegen nicht. Schlussfolgerung Die Verschlechterung der olfaktorischen Wahrnehmungsschwellen während einer akuten aeroben körperlichen Belastung und deren unverzügliche Verbesserung während der Erholungsphase auf Ruhewerte lassen auf eine Beeinflussung der Riechschwelle durch die körperliche Anstrengung schließen. Als wahrscheinlichste Ursache hierfür kommt ein bei forcierter Nasenatmung ausgelöster Verdünnungseffekt durch zusätzlich einströmende geruchsneutrale Umgebungsluft in Betracht.
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Unklare submuköse Raumforderung im supraglottischen Bereich: Erste Fallbeschreibung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-100256

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Ossär destruierender, schmerzloser Tumor des Gesichtsschädels mit sekundärer Stirnhöhlenmukozele

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-123653

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2018; 97: 227-228
DOI: 10.1055/a-0549-3134

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Interne Validität des Acoustic Voice Quality Index Version 03.01 und des Acoustic Breathiness Index

Laryngo-Rhino-Otol
DOI: 10.1055/a-0596-7819

Hintergrund Akustische Messverfahren haben das Potential Heiserkeit und Behauchtheit objektiv zu messen und der Acoustic Voice Quality Index (AVQI) und der Acoustic Breathiness Index (ABI) zeigen gute Ergebnisse hinsichtlich Validität und Reliabilität. Das Ziel dieser Studie war die Überprüfung der internen Validität der aktuellen Version des AVQI 03.01 und des ABI im Deutschen. Hierzu wurde die Sensitivität gegenüber Stimmveränderungen im Heiserkeits- und Behauchtheitsgrad durch logopädische Stimmtherapie untersucht. Material und Methoden Insgesamt wurden 84 Stimmaufzeichnungen von fortlaufender Sprache und dem Vokal [a:] vor und nach einer Stimmtherapie verwendet. Alle Aufnahmen der 42 Probanden stammten von Stimmpatienten mit unterschiedlichen Schweregraden einer Dysphonie vor und nach einer konservativen Therapie. Alle Stimmen wurden von drei Stimmexperten nach dem RBH-System beurteilt. Ergebnisse Die Intra- Beurteiler Reliabilität ergab insgesamt eine hohe Reliabilität für Heiserkeit (Kappa Mittelwert = 0,76) und Behauchtheit (Kappa Mittelwert = 0,69). Die Inter- Beurteiler Reliabilität erreichte hingegen eine niedrigere Reliabilität für beide Stimmqualitätsaspekte, die zwischen Kappa = 0,27 und 0,29 lag. Für beide Messverfahren, AVQI und ABI, zeigte sich ein deutlicher Zusammenhang zwischen der Perzeption von Veränderungen der Stimmqualität vor und nach der Therapie und dem Messergebnis (Heiserkeit vs. AVQI: r = 0,715, p < 0,01 und Behauchtheit vs. ABI: r = 0,712, p < 0,01). Die Unterschiede waren auch nicht signifikant. Schlussfolgerung Die Resultate zeigten, dass AVQI Version 03.01 und ABI eine hohe interne Validität haben, um Stimmveränderungen nach Intervention zu erfassen. AVQI und ABI sind zwei valide und robuste Messinstrumente, die Heiserkeit und Behauchtheit objektiv messen können.
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Validierung der deutschen Version des Eating Assessment Tool bei Kopf-Hals-Tumor-Patienten

Laryngo-Rhino-Otol
DOI: 10.1055/a-0596-7780

Hintergrund Die Erfassung von subjektiv empfundenen Schluckbeschwerden bildet ein wichtiges Element in einem multidimensionalen und damit modernen Management von schluckgestörten Patienten infolge eines Kopf-Hals-Tumors. Zur Verfügung steht hier der international anerkannte und validierte 10-Item-Fragebogen EAT-10, der 2008 von Belafsky et al. entwickelt und validiert wurde. Ziel der vorliegenden Studie ist die Übersetzung des EAT-10 in die deutsche Sprache und dessen Validierung für Patienten mit einem Kopf-Hals-Tumor. Material und Methoden Nach Übersetzung des EAT-10 ins Deutsche gemäß den Richtlinien zur Übersetzung fremdsprachlicher Messinstrumente erfolgte die Validierung des gEAT-10 anhand von 210 Kopf-Hals-Tumor-Patienten. Ermittelt wurden die Reliabilität anhand der internen Konsistenz (Cronbachs Alpha) und Eigentrennschärfe (Spearman-Korrelation). Die Konstruktvalidität wurde geprüft anhand der uni- und multivariaten Berechnung der Verteilung von gEAT-10-Gesamtscores abhängig von Geschlecht, Alter, BMI, Tumorstadium und -lokalisation sowie der Art der onkologischen Therapie. Ergebnisse Die interne Konsistenz betrug α = 0,94. Die Eigentrennschärfe variierte zwischen ρ = 0,59 und ρ = 0,85. Es ließ sich kein signifikanter Zusammenhang zwischen gEAT-10-Gesamtscore und Geschlecht bzw. Alter univariat erkennen, jedoch einer für BMI, Tumorstadium und -lokalisation sowie Art der onkologischen Therapie. In der Regression lieferte dagegen nur das Tumorstadium ein signifikantes Ergebnis. Schlussfolgerung Der gEAT-10 erwies sich als ein reliabler und konstruktvalider Fragebogen zur Erfassung subjektiver Schluckbeschwerden bei Patienten mit Kopf-Hals-Tumor.
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Veränderte Indikation zur Parotidektomie im nordwestlichen Brandenburg:Eine Longitudinaluntersuchung

Laryngo-Rhino-Otol
DOI: 10.1055/a-0596-7714

Hintergrund Kenntnisse über die Indikationen zu einer Parotidektomie basieren auf den Mitteilungen einzelner Kliniken, Tumor- und Krankenhausdatenbanken. Die Studie prüft die Hypothese, dass sich die Operationsindikation während der vergangenen Jahre verändert hat. Material und Methoden Wir führten eine retrospektive Beobachtungsstudie der Patienten durch, die zwischen 1975 und 2016 (Einteilung in 4 Quartilen) in einem Ausbildungskranken haus einer Medizinischen Hochschule mit Schwerpunktversorgung eine Parotidektomie erhielten. Ergebnisse 405 Männer und 366 Frauen wurden wegen eines benignen (600/78 %) oder malignen (116/15 %) Tumors oder einer Parotitis (55/7 %) operiert. Der Anteil der benignen Tumore blieb weitgehend konstant (78 %), der der malignen Tumore stieg (7 %–23 %) bei gleichzeitigem Abfall der Parotitiden (17 % – < 1 %). Bei den benignen Tumoren fiel der Anteil der pleomorphen Adenome (60 % –24 %), während Warthin Tumore häufiger auftraten (23 % –58 %). Unter den malignen Tumoren stieg der Anteil der Metastasen von 2/13 auf 31/49 (insbes. Plattenepithelkarzinomen der Haut). Diskussion Die vorliegende Studie zeigt die sinkende Bedeutung der Parotitis als Indikation für eine Parotidektomie bedingt durch verbesserte nicht-chirurgische Verfahren. Die ansteigende Prävalenz von Warthin-Tumoren in der aktuellen Arbeit war mit einem steigenden Anteil der Raucher assoziiert. Der Anstieg der Malignome war auf die steigende Prävalenz von intraparotidealen Matastasen der Plattenepithelkarzinome der Haut zurückzuführen. Die Ergebnisse der histologischen Diagnosen basieren auf der Auswertung von Krankenakten und können bisher nicht durch die Auswertungen überregionaler Tumordatenbanken oder Krankenhausstatistiken (ICD- oder DRG-Bezug) generiert werden. Hierzu befürworten die Autoren die Einrichtung eines speziellen Speicheldrüsenregisters.
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Direct estimation of human trabecular bone stiffness using cone-beam computed tomography

Publication date: Available online 10 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Eva Klintström, Benjamin Klintström, Dieter Pahr, Torkel Brismar, Örjan Smedby, Rodrigo Moreno
ObjectivesThe aim of this study was to evaluate the possibility of estimating biomechanical properties of trabecular bone through finite element (FE) simulations using dental cone beam computed tomography (CBCT) data.Study designFourteen human radius specimens were scanned in three CBCT devices: 3D Accuitomo 80, NewTom 5G, and Verity. The imaging data was segmented using two different methods. Stiffness (Young's modulus), shear moduli, and the size and shape of the stiffness tensor were studied. Corresponding evaluations using micro-CT were regarded as the reference standard.ResultsThe 3D Accuitomo 80 showed good performance in estimating stiffness and shear moduli, but was sensitive to the choice of segmentation method. NewTom 5G and Verity yielded good correlations, but they were not as strong as the Accuitomo. The CBCT devices overestimated both stiffness and shear compared to the micro-CT estimations.ConclusionsFE-based calculations of biomechanics from CBCT data are feasible, with strong correlations for the Accuitomo 80 scanner combined with an appropriate segmentation method. Such measurements might be useful for predicting implant survival by in vivo estimations of bone properties.

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Does volumetric measurement of cervical lymph nodes serve as an imaging biomarker for locoregional recurrence of oral squamous cell carcinoma?

Publication date: Available online 10 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ali-Farid Safi, Martin Kauke, Hendrik Jung, Marco Timmer, Jan Borggrefe, Thorsten Persigehl, Hans-Joachim Nickenig, Max Zinser, David Maintz, Matthias Kreppel, Joachim Zöller

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Adenoid cystic carcinoma of head and neck: A retrospective clinical analysis of a single institution

Adenoid cystic carcinoma (ACC), first described by Billroth in 1856, was originally called cylindroma because of its histologic appearance [1]. ACC is a rare tumor, accounting for about 1% of head and neck tumors, but it is the most common malignancy of the minor salivary glands [2]. Characteristically, ACC progresses slowly, with wide perineural invasion; lymphatic spread to the neck is rare. Histologically, adenoid cystic carcinomas also arise in other sites in the head and neck field, such as the major salivary glands, the tracheobronchial tree, the esophagus, the lacrimal gland, and even sites outside the head and neck.

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Risk factors for postoperative delirium in patients undergoing free flap reconstruction for oral cancer

The aim of this study was to investigate risk factors for postoperative delirium in patients undergoing free flap reconstruction for defects after oral cancer resection. This was a non-randomized, retrospective cohort study involving 102 patients who underwent oral cancer resection and free flap reconstruction. Data were collected from the medical records. Postoperative delirium occurred in 34 patients (33.3%), of whom 27 were male and seven were female. High preoperative total protein and albumin, diabetes mellitus, history of smoking, use of hypnotics or antipsychotics, time until getting out of bed after surgery, and postoperative insomnia were significantly related to delirium in the univariate analysis (P<0.05).

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Identification of ‘Point A’ as the prevalent source of error in cephalometric analysis of lateral radiographs

Deviations in measuring dentofacial components in a lateral X-ray represent a major hurdle in the subsequent treatment of dysgnathic patients. In a retrospective study, we investigated the most prevalent source of error in the following commonly used cephalometric measurements: the angles Sella-Nasion-Point A (SNA), Sella-Nasion-Point B (SNB) and Point A-Nasion-Point B (ANB); the Wits appraisal; the anteroposterior dysplasia indicator (APDI); and the overbite depth indicator (ODI). Preoperative lateral radiographic images of patients with dentofacial deformities were collected and the landmarks digitally traced by three independent raters.

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Clinicopathological investigation of odontogenic fibroma in tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is an autosomal dominant inherited disease characterized by systemic hamartoma and diverse systemic features. TSC1 and TSC2 are the causative genes, and mental retardation, epileptic seizures, and facial angiofibroma develop in many patients with the disease. The case of a patient with TSC who developed a central odontogenic fibroma of the mandible is reported here. The patient was a 21-year-old woman who was referred with a swelling of the labial gingiva in the region of the right lower lateral incisor and canine.

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Palatal orthodontic miniscrew insertion using a CAD-CAM surgical guide: description of a technique

The aim of this report was to describe a new computer-guided technique for a controlled site preparation and palatal orthodontic miniscrew insertion using a dedicated software. A surgical guide was designed after planning the appropriate insertion sites on three-dimensional images created by the fusion of cone-beam computed tomography (CBCT) and digital dental model images. Pre- and postoperative CBCT images were compared and the angular, coronal, and apical deviations between the planned and the placed miniscrews were calculated.

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Assessing an oral surgery specific protocol for patients on direct oral anticoagulants: a retrospective controlled cohort study

Chronic therapy with the new direct oral anticoagulants (DOACs) poses new challenges for dental practitioners assessing the risk versus benefit of cessation versus non-cessation of anticoagulant therapy for dentoalveolar procedures. A retrospective controlled cohort study was designed to evaluate a non-cessation protocol for patients taking DOACs in the setting of dental extractions. A records review covering the period 1 January 2016 to 31 December 2016 identified 43 patients on DOAC therapy; 53 dentoalveolar procedures were performed under local anaesthesia, of which 15 included varying degrees of peri-procedural cessation.

https://ift.tt/2GRsPgj

A prospective study examining the effects of treatment timing in the management of mandible fractures

The ideal timing for treatment of mandible fractures has not been well established. The objective of this study was to analyse the effects of treatment timing in the surgical management of mandible fractures. A prospective evaluation of 215 continuous patients with a total of 359 mandible fractures was undertaken. Nine outcome variables were analysed in relation to treatment delay by logistic regression modelling: wound dehiscence, hardware exposure, local postoperative infection, malocclusion, trismus, nerve damage, fracture non-union, return to theatre, and radiographic outcome.

https://ift.tt/2qmZxev

A prospective study examining the effects of treatment timing in the management of mandible fractures

Publication date: Available online 10 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.J.L. Hurrell, M.C. David, M.D. Batstone
The ideal timing for treatment of mandible fractures has not been well established. The objective of this study was to analyse the effects of treatment timing in the surgical management of mandible fractures. A prospective evaluation of 215 continuous patients with a total of 359 mandible fractures was undertaken. Nine outcome variables were analysed in relation to treatment delay by logistic regression modelling: wound dehiscence, hardware exposure, local postoperative infection, malocclusion, trismus, nerve damage, fracture non-union, return to theatre, and radiographic outcome. Nineteen additional variables were included in the analysis to adjust for potential confounding. Delay was measured in days and ranged from 0 to 41days, with a mean delay of 4.6days. The incidence of wound dehiscence, hardware exposure, local postoperative infection, trismus, nerve damage, fracture non-union and return to theatre was 6%, 4%, 11%, 8.5%, 47%, 2% and 8%, respectively. Objective malocclusion and poor radiographic outcomes were evident in 13% and 4.5% of cases, respectively.No statistically significant association was found between treatment delay and treatment outcomes.The findings of this study suggest it may be safe to delay the definitive treatment of mandible fractures. Treatment delay may allow for improved resource distribution and prioritization of more time-dependent interventions.

https://ift.tt/2JBz8Td

Identification of ‘Point A’ as the prevalent source of error in cephalometric analysis of lateral radiographs

Publication date: Available online 10 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): P. Grogger, C. Sacher, S. Weber, G. Millesi, R. Seemann
Deviations in measuring dentofacial components in a lateral X-ray represent a major hurdle in the subsequent treatment of dysgnathic patients. In a retrospective study, we investigated the most prevalent source of error in the following commonly used cephalometric measurements: the angles Sella-Nasion-Point A (SNA), Sella-Nasion-Point B (SNB) and Point A-Nasion-Point B (ANB); the Wits appraisal; the anteroposterior dysplasia indicator (APDI); and the overbite depth indicator (ODI). Preoperative lateral radiographic images of patients with dentofacial deformities were collected and the landmarks digitally traced by three independent raters. Cephalometric analysis was automatically performed based on 1116 tracings. Error analysis identified the x-coordinate of Point A as the prevalent source of error in all investigated measurements, except SNB, in which it is not incorporated. In SNB, the y-coordinate of Nasion predominated error variance. SNB showed lowest inter-rater variation. In addition, our observations confirmed previous studies showing that landmark identification variance follows characteristic error envelopes in the highest number of tracings analysed up to now. Variance orthogonal to defining planes was of relevance, while variance parallel to planes was not. Taking these findings into account, orthognathic surgeons as well as orthodontists would be able to perform cephalometry more accurately and accomplish better therapeutic results.

https://ift.tt/2EBo9Fl

Risk factors for postoperative delirium in patients undergoing free flap reconstruction for oral cancer

Publication date: Available online 10 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T. Makiguchi, S. Yokoo, J. Kurihara
The aim of this study was to investigate risk factors for postoperative delirium in patients undergoing free flap reconstruction for defects after oral cancer resection. This was a non-randomized, retrospective cohort study involving 102 patients who underwent oral cancer resection and free flap reconstruction. Data were collected from the medical records. Postoperative delirium occurred in 34 patients (33.3%), of whom 27 were male and seven were female. High preoperative total protein and albumin, diabetes mellitus, history of smoking, use of hypnotics or antipsychotics, time until getting out of bed after surgery, and postoperative insomnia were significantly related to delirium in the univariate analysis (P<0.05). In a multiple logistic regression model, high preoperative albumin (odds ratio 4.45), postoperative insomnia (odds ratio 10.72), and history of smoking (odds ratio 2.91) were significant risk factors for delirium (P<0.05). The analysis of laboratory data before and after surgery showed greater decreases in albumin, total protein, and haemoglobin after surgery in patients with postoperative delirium than in those without this condition. These results show that the perioperative maintenance of nutritional status and early postoperative management of the sleep cycle are important to prevent delirium after oral cancer resection and free flap reconstruction.

https://ift.tt/2JBz3yT

Assessing an oral surgery specific protocol for patients on direct oral anticoagulants: a retrospective controlled cohort study

Publication date: Available online 10 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): E. Lababidi, O. Breik, J. Savage, H. Engelbrecht, R. Kumar, C.W. Crossley
Chronic therapy with the new direct oral anticoagulants (DOACs) poses new challenges for dental practitioners assessing the risk versus benefit of cessation versus non-cessation of anticoagulant therapy for dentoalveolar procedures. A retrospective controlled cohort study was designed to evaluate a non-cessation protocol for patients taking DOACs in the setting of dental extractions. A records review covering the period 1 January 2016 to 31 December 2016 identified 43 patients on DOAC therapy; 53 dentoalveolar procedures were performed under local anaesthesia, of which 15 included varying degrees of peri-procedural cessation. A control group of 50 patients on uninterrupted warfarin therapy undergoing 59 dentoalveolar procedures was identified. The incidence, severity, and timing of bleeding events were recorded for each group. Four (10.5%) minor bleeding events were recorded in the non-cessation DOAC group and nine (15.3%) minor bleeding events in the warfarin group. No bleeding events were recorded in the DOAC cessation group. Comparison of the incidence of bleeding events between the non-cessation DOAC group and the warfarin group showed no statistically significant difference (odds ratio 0.65, P=0.56). Within the limitations of this study, dental extractions in the context of continuing DOAC therapy can be performed safely provided extra local haemostatic measures are applied.

https://ift.tt/2IKH6rx

Efficacy and Safety of Ixekizumab Over 4 Years of Open-Label Treatment in a Phase 2 Study in Chronic Plaque Psoriasis

Interleukin-17A is a critical cytokine involved in psoriasis pathogenesis., The efficacy of ixekizumab, an interleukin-17A monoclonal antibody, was maintained for up to 4 years without apparent increases in health risks or safety issues in moderate-to-severe psoriasis patients., Long-term ixekizumab treatment is an option for moderate-to-severe psoriasis patients.

https://ift.tt/2GNPx98

Dermoscopy is a useful bedside tool for the evaluation of cutaneous Loxoscelism

https://ift.tt/2GOk8zl

Improving classification of melanocytic nevi: BRAF V600E expression associated with distinct histomorphologic features

BRAF V600E mutation is a common genetic driver of melanocytic nevi and melanoma. BRAF V600E is associated with distinct histomorphologic features in melanocytic nevi, including dermal and congenital growth patterns. Understanding the genetic-morphologic correlates in melanocytic nevi may facilitate a more accurate classification and improved diagnosis of melanocytic neoplasms.

https://ift.tt/2HePrqC

Diversity in Dermatology: Roadmap for Improvement

The American Academy of Dermatology (AAD) has taken an active stance in addressing the lack of racial and ethnic diversity in the specialty. At the AAD President's Conference on Diversity in Dermatology held August 5, 2017, key action items were identified in three main areas in order to increase the number of practicing, board-certified dermatologists who are underrepresented in medicine (UIM). These include: increasing the pipeline of UIM students applying to medical school; increasing the exposure and level of interest of UIM medical students in dermatology; and increasing the number of UIM students recruited into dermatology residency programs.

https://ift.tt/2IF9sUj

Neutrophilic dermatoses. Part I. Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet’s disease

Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features, but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes.

https://ift.tt/2HePnHo

Neutrophilic dermatoses. Part II. Pyoderma gangrenosum and other bowel and arthritis associated neutrophilic dermatoses

Chromosome 1q23.3q31.1 deletion associated with decreased newborn screening of T cell receptor rearrangement circles (TRECs)

We report a female newborn with abnormal newborn screening (NBS) for severe combined immunodeficiency (SCID)/T cell lymphopenia and chromosome 1q23.3q31.1 deletion. The infant was born at 36-weeks gestation with a birthweight of 1160 grams. At 20-weeks gestation, intrauterine growth retardation, bilateral cleft-lip and cleft-palate, absent kidney, absent stomach bubble, and lateral ventriculomegaly were identified. At birth, she had microcephaly, hypertelorism, bilateral low-set ears with over-folded helices, bilateral complete cleft-lip and cleft-palate, holosystolic murmur and a split second heart sound with a loud P2, sacral dimple, small hands with brachydactyly, left hand with single transverse palmar crease, clinodactyly of 5th fingers bilaterally, small feet bilaterally, and overlapping 2nd and 3rd toe on the right foot.

https://ift.tt/2HazFNf

Mepolizumab use: post-approval academic practice experience

Severe asthma of the eosinophilic subtype is associated with significant morbidity and mortality and health-care costs due to recurrent asthma exacerbations and need for treatment with oral corticosteroids 1,2. Thus, steroid-sparing medications for eosinophilic asthma have been sought to improve outcomes in these patients.

https://ift.tt/2GNGS2l

Oral corticosteroids should be available on-hand at home for the next asthma exacerbation!

Asthma is characterized in many patients by recurrent exacerbations. For those patients, it is not generally a question of whether an exacerbation will recur. Rather the question is when will the next exacerbation occur? Unfortunately, that is not readily predictable. Patients with sthma exacerbation fill emergency rooms and are a major cause of hospitalization. Children with asthma, particularly, are prone to recurrent exacerbations, and asthma is the most frequent medical indication for children to be hospitalized.

https://ift.tt/2Hc3eOI

Factors correlated with repeated aspirin dosing during aspirin desensitization

Aspirin desensitization is an appropriate procedure for many patients with aspirin-exacerbated respiratory disease (AERD). Patients can require aspirin re-dosing, which prolongs the desensitization process. The frequency of this is not widely reported, nor is it known which patients will require multiple re-dosing.

https://ift.tt/2GNGYXL

The pediatric asthma yardstick: practical recommendations for a sustained step-up in asthma therapy for children with inadequately controlled asthma

Current asthma guidelines recommend a control-based approach to management involving assessment of impairment and risk followed by implementation of treatment strategies individualized according to the patient's needs and preferences. However, for children with asthma, achieving control can be elusive. While tools are available to help children (and families) track and manage day-to-day symptoms, when and how to implement a longer-term step-up in care is less clear. Furthermore, treatment is challenged by the three age groups of childhood – adolescence (12-18 years old), school age (6-11 years old), and young children (≤ 5 years old), and what works for one age group may not be the best approach for another.

https://ift.tt/2HcAZzf

Mepolizumab use: post-approval academic practice experience

Publication date: Available online 10 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Mariel R. Benjamin, Bruce S. Bochner, Anju T. Peters

https://ift.tt/2qn2bRD

Oral corticosteroids should be available on-hand at home for the next asthma exacerbation!

Publication date: Available online 10 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Miles Weinberger, Leslie Hendeles, Mutasim Abu-Hasan

https://ift.tt/2GNDZmb

Factors correlated with repeated aspirin dosing during aspirin desensitization

Publication date: Available online 10 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Charles F. Schuler, James L. Baldwin, Alan P. Baptist
BackgroundAspirin desensitization is an appropriate procedure for many patients with aspirin-exacerbated respiratory disease (AERD). Patients can require aspirin re-dosing, which prolongs the desensitization process. The frequency of this is not widely reported, nor is it known which patients will require multiple re-dosing.ObjectiveTo determine the frequency of and factors associated with repeat aspirin re-dosing during desensitization.MethodsCharts of aspirin desensitization procedures from 2011-2016 at the University of Michigan Allergy/Immunology Clinic were reviewed. Reactions with provoking doses and number of dose repetitions were characterized. Prior AERD history, medical history, medications, and baseline spirometry were also recorded. Bivariate correlation and multivariate logistic regression were used to analyze associations between patient characteristics and need for repeated dosing of aspirin.ResultsA total of 84 positive reacting patients during desensitization were found. 33% of these patients required two or more aspirin dose repetitions during desensitization. Requiring two or more repeat doses during desensitization was associated with male gender (odds ratio = 6.194, p = 0.008), FEV1 decrease during desensitization (odds ratio = 1.075 per percent point drop, p = 0.021), and initial aspirin provoking dose during desensitization of 81 mg or lower (odds ratio = 11.111, p = 0.003). No association was found with pre-desensitization medications, asthma severity, AERD duration, or number/character of reported prior aspirin reactions.ConclusionDuring aspirin desensitization for AERD, approximately 1/3 of our patients require multiple repeat doses. Risk factors for multiple repeated doses include male gender, drop in FEV1, and lower aspirin provoking doses during desensitization. This information can help inform which patients might require multiple re-dosing for desensitization.

https://ift.tt/2qk3Abi

The pediatric asthma yardstick: practical recommendations for a sustained step-up in asthma therapy for children with inadequately controlled asthma

Publication date: Available online 10 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Bradley E. Chipps, Leonard B. Bacharier, Judith R. Farrar, Daniel J. Jackson, Kevin R. Murphy, Wanda Phipatanakul, Stanley J. Szefler, W. Gerald Teague, Robert S. Zeiger
Current asthma guidelines recommend a control-based approach to management involving assessment of impairment and risk followed by implementation of treatment strategies individualized according to the patient's needs and preferences. However, for children with asthma, achieving control can be elusive. While tools are available to help children (and families) track and manage day-to-day symptoms, when and how to implement a longer-term step-up in care is less clear. Furthermore, treatment is challenged by the three age groups of childhood – adolescence (12-18 years old), school age (6-11 years old), and young children (≤ 5 years old), and what works for one age group may not be the best approach for another. The Pediatric Asthma Yardstick provides an in-depth assessment of when and how to step-up therapy for the child with not well or poorly controlled asthma. Development of this tool follows the others in the Yardstick series, presenting patient profiles and step-up strategies based on current guidance documents, but modified according to newer data and the authors' combined clinical experience. The objective is to provide clinicians who treat children with asthma practical and clinically relevant recommendations for each step-up and each intervention, with the intent of helping practitioners better treat their pediatric patients with asthma, particularly those who do not always respond to recommended therapies.

https://ift.tt/2GRdUms

Chromosome 1q23.3q31.1 deletion associated with decreased newborn screening of T cell receptor rearrangement circles (TRECs)

Publication date: Available online 10 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Julia S. Lee, Bradley A. Becker, Amelia Kirby, Alan P. Knutsen

https://ift.tt/2qk3zEg

Sentinel lymph node biopsy in cutaneous head and neck melanoma

Abstract

Purpose

Sentinel lymph node biopsy (SLNB) is now a standard of care for cutaneous melanoma, but it is still controversial for cutaneous head and neck melanoma (CHNM). This study aims to confirm the feasibility, accuracy and low morbidity of SLNB in CHNM and evaluate its prognostic value.

Methods

A monocentric and retrospective study on patients with CHNM treated in our tertiary care center (Gustave Roussy) between January 2008 and December 2012 was performed. The feasibility, morbidity and prognostic value of this technique were analysed.

Results

One hundred and twenty-four consecutive patients were included. SLNB was realized in 97.6% of the cases. No significant post-operative morbidity was observed. Nineteen percents of patients had a positive SN while only 14.3% of complete lymph node dissections (CLND) had additional nodal metastasis. The risk of recurrence after positive SN was significantly higher (69.2 vs 30.8%, p = 0.043). The false omission rate was low with 7.1%. Overall survival and disease-free survival were better in the negative SN group (82 vs 49%, p < 0.001 and 69.3 vs 41.8%, p = 0.0131). The risk of recurrence was significantly higher in the positive SN group (p = 0.043) and when primary tumour was ulcerated (p = 0.031). Only the mitotic rate of the primary tumour was associated with SN positivity (p = 0.049).

Conclusion

As in other sites, SLNB status is a strong prognostic factor with comparable false omission rate and no superior morbidity.

https://ift.tt/2HaHrqx

RETRACTED ARTICLE: Interleukin-33 promotes helper T cell type-2/17 inflammation in children with allergic rhinitis

https://ift.tt/2GLXsj9

Potential risk factors associated with the development of synechiae following functional endoscopic sinus surgery

Abstract

Purpose

Synechiae formation in the middle meatus is the most common complication of functional endoscopic sinus surgery (FESS). Our objectives were to determine the incidence of synechiae occurring in a cohort of patients that have undergone FESS and identify characteristics associated with the development of synechiae postoperatively.

Methods

A retrospective chart review was conducted of CRS patients, with or without nasal polyposis, that had undergone bilateral FESS in the past. All patients had received non-absorbable spacers intraoperatively that were left in situ for 6 days. Demographic and preoperative variables were analyzed to identify synechiae risk factors. A multivariable logistic regression model was constructed to estimate the probability of developing synechiae, given demographic and preoperative variables.

Results

Two hundred cases of bilateral FESS were retrospectively reviewed. Thirty-eight (19.0%, 95% CI 13.6–24.4%) patients developed synechiae. Individuals receiving primary FESS and nasal septal reconstruction (NSR) were strongly associated with the development of synechiae (OR 3.5, 95% CI 1.5–8.5; OR 3.0, 95% CI 1.3–6.9). A multivariable logistic regression model adjusting for NSR, recurrent FESS, concha bullosa, requirement of anterior and posterior ethmoidectomy, Lund-Mackay CT score and gender, identified the likelihood of developing synechiae with a sensitivity of 68%, specificity of 73%, positive predictive value of 38% and likelihood ratio of 2.5.

Conclusion

Patients undergoing primary FESS and NSR are at greatest odds of developing postoperative synechiae. Methods of assessing risk factors and preventing synechiae formation in this population should be evaluated in future prospective investigations.

https://ift.tt/2GQhJ7t

Tertiary referral centers.

Patients

Eight patients affected by an intralabyrinthine schwannoma, with or without extension to the internal auditory canal, that underwent surgery with a transcanal transpromontorial approach, were included in the study. The average age at presentation was 47 years. Patients' characteristics, symptoms, tumor features, and surgical results were analyzed.

Interventions

All patients were diagnosed and evaluated pre-operatively with high-resolution, gadolinium-enhanced MRI and CT scan of the temporal bone, and underwent surgery via either transcanal transpromontorial endoscopic approach (TTEA) or enlarged transcanal transpromontorial endoscopic approach (ETTA).

Main outcome measures

Hearing function was evaluated with the Hearing Classification System according to the Committee on Hearing and Equilibrium Guidelines. Facial nerve function was evaluated using the House–Brackmann grading system (HB).

Results

In six patients out of eight, a TTEA was performed, whereas, due to the extension of the pathology to the cerebellopontine angle, two patients underwent an ETTA. The mean follow-up period was 15.5 months (range 1–69). No intra-operative and post-operative major complications were observed. Post-operative facial nerve function was normal in seven out of eight patients (grade I HB). One patient presented a grade II HB.

Conclusion

The endoscopic approach to cochlear schwannoma represents a good treatment option for patients and should be preferred to other more invasive surgical techniques when indicated, to reduce complications, hospitalization, and offer to patients the chance to eradicate the disease, thus avoiding the stress of a long-life radiological follow-up.

Level of evidence

https://ift.tt/2HehWES

Improved overall survival in head and neck cancer patients after specific therapy of distant metastases

Abstract

Purpose

While metastases directed therapy for oligometastatic disease is recommended in different cancer entities, the treatment of solitary metastases in head and neck squamous cell carcinoma (HNSCC) patients is not clearly defined.

Methods

A retrospective analysis was performed on data from 143 HNSCC patients treated between 2001 and 2016 in a tertiary university hospital. Clinical factors and outcome were measured using the median survival of patients receiving metastases specific therapy in comparison with matched control patients.

Results

In 37 patients, distant metastases were treated specifically with either surgery and/or stereotactic ablative radiotherapy and had with 23.97 months a more than three times higher median survival than 10 untreated matched controls with potentially treatable distant metastases (7.07 months).

Conclusions

Our retrospective analysis demonstrates a significant survival benefit for HNSCC patients who received a specific therapy regarding distant metastasis irrespective of localization as compared to a matched control cohort.

https://ift.tt/2qkFUEO

Does microbial colonisation of a neck drain predispose to surgical site infection: clean vs clean-contaminated procedures

Abstract

Based on the principles of MMC we could successfully establish a laryngeal fibrogenesis model employing hVFF. Our finding of dose-dependent HGF effects is important before going into clinical trials in humans and has never been shown before. Our model provides a novel option to screen various potential antifibrotic compounds under standardized conditions in a short time.

https://ift.tt/2qqHsgD

Commentary on ‘‘European status on temporal bone training: a questionnaire study’’

https://ift.tt/2GQ78JB

Predictive factors of a beneficial quality of life outcome in patients undergoing primary sinonasal surgery: a population-based prospective cohort study

Abstract

Purpose

To assess predictive factors of a beneficial quality of life (QoL) outcome after primary sinonasal surgery.

Methods

A population-based prospective cohort study among 160 adult patients undergoing primary sinonasal surgery (76 septoplasties, SP; 84 endoscopic sinus surgeries, ESS) was conducted. We collected QoL data using the Sinonasal Outcome Test-22 (SNOT-22) before and after surgery. A beneficial QoL outcome was defined as a SNOT-22 score change ≥ 9 points 12 months after surgery. Various demographic, clinical and symptom-related factors predicting a beneficial QoL outcome were sought using binary logistic regression analysis.

Results

The mean age of the patients was 39 years (range 18–61) and 82 (51%) were males. The SNOT-22 score change varied markedly after SP (range − 17 to + 80) and ESS (range − 20 to + 58), but on average it improved (median + 15 after SP and + 16 after ESS). 41 patients (64%) achieved beneficial QoL outcome after SP and 46 (66%) after ESS. In a multivariate analysis, poor QoL before surgery (preoperative SNOT-22 ≥ 20 points) predicted a beneficial QoL outcome after SP and ESS (adjusted odds ratio 10; 95% confidence interval 1.6–64 and 12; 2.5–55, respectively) and a senior surgeon operating after SP (9.9; 1.5–67). On receiver operating characteristic curve analysis, the integer threshold value for the preoperative SNOT-22 score that gave the highest sensitivity (74%) and specificity (70%) was 30.

Conclusions

QoL change after primary SP and ESS varies. A preoperative SNOT-22 score of at least 30 best predicted a beneficial QoL outcome after both procedures.

https://ift.tt/2qqHd5d

Olfactory cleft evaluation: a predictor for olfactory function in smell-impaired patients?

Abstract

Determining chewing efficiency using a solid test food and considering all phases of mastication

Publication date: Available online 10 April 2018
Source:Archives of Oral Biology
Author(s): Ting Liu, Xinmiao Wang, Jianshe Chen, Hilbert W. van der Glas
ObjectivesFollowing chewing a solid food, the median particle size, X50, is determined after N chewing cycles, by curve-fitting of the particle size distribution. Reduction of X50 with N is traditionally followed from N ≥ 15-20 cycles when using the artificial test food Optosil^®, because of initially unreliable values of X50. The aims of the study were (i) to enable testing at small N-values by using initial particles of appropriate size, shape and amount, and (ii) to compare measures of chewing ability, i.e. chewing efficiency (N needed to halve the initial particle size, N(1/2-Xo)) and chewing performance (X50 at a particular N-value, X50,N).Design8 subjects with a natural dentition chewed 4 types of samples of Optosil particles: (1) 8 cubes of 8 mm, border size relative to bin size (traditional test), (2) 9 half-cubes of 9.6 mm, mid-size; similar sample volume, (3) 4 half-cubes of 9.6 mm, and 2 half-cubes of 9.6 mm; reduced particle number and sample volume. All samples were tested with 4 N-values. Curve-fitting with a 2nd order polynomial function yielded log(X50)-log(N) relationships, after which N(1/2-Xo) and X50,N were obtained.ConclusionsReliable X50-values are obtained for all N-values when using half-cubes with a mid-size relative to bin sizes. By using 2 or 4 half-cubes, determination of N(1/2-Xo) or X50,N needs less chewing cycles than traditionally. Chewing efficiency is preferable over chewing performance because of a comparison of inter-subject chewing ability at the same stage of food comminution and constant intra-subject and inter-subject ratios between and within samples respectively.

https://ift.tt/2JwR94K

Long-term evaluation of the stability of dentin matrix following treatments with aqueous solutions of titanium tetrafluoride at different concentrations

Publication date: Available online 10 April 2018
Source:Archives of Oral Biology
Author(s): E.C. Bridi, A.A. Leme-Kraus, B. Aydin, R.T. Basting, A.K. Bedran-Russo
ObjectiveThe purpose of this study was to investigate the effects of aqueous solutions of different concentrations of titanium tetrafluoride (TiF4) on dentin matrix stability up to six months.DesignDentin specimens prepared from fifteen nonerupted molars were demineralized and randomly distributed into groups: 2.5% TiF4, 4% TiF4, 1000 ppm NaF, and control (distilled water). The modulus of elasticity (ME) and dry masses of the dentin matrix were determined at baseline, and up to 6 months following treatment. Collagen solubilization was estimated by hydroxyproline (HYP) quantification in the simulated body fluid used to store the dentin specimens.ResultsThe 2.5% TiF4 group presented higher ME immediately after treatment, and at 3 and 6 months storage, whereas 4% TiF4 showed higher means at 3 and 6 months (p < 0.001). No significant differences were observed among the groups over time (p = 0.9325). However, the 2.5% TiF4 group showed significantly higher ME than the control group, immediately after treatment. All the groups presented significantly higher mass change immediately, compared with 3 and 6 months (p < 0.0001). Except for the 4% TiF4 group, HYP release was higher in the first quarter (p = 0.0152), when no significant differences were found among the groups. In the second quarter, the means were significantly higher in the 2.5% TiF4 and 4% TiF4 groups. The group treated with 2.5% TiF4 had a statistically higher HYP release than the control group.ConclusionAn aqueous solution of 2.5% TiF4 increases the immediate stiffness values, but does not stabilize the collagenous dentin matrix.

https://ift.tt/2IIH2Jb

Determining chewing efficiency using a solid test food and considering all phases of mastication

Long-term evaluation of the stability of dentin matrix following treatments with aqueous solutions of titanium tetrafluoride at different concentrations

A simple management option for chronically impacted sharp tracheobronchial foreign bodies in children

Distally impacted chronic tracheobronchial sharp foreign bodies in children are a management challenge that presents with clinical subtlety and extreme variability. The use of image guided techniques, imaginat...

https://ift.tt/2IEzuHm

Hemorrhagic stroke after Epley maneuver: a case report

This is the first case to our knowledge of a serious adverse event following the Epley maneuver, which is the treatment of choice for benign paroxysmal positional vertigo (BPPV), the most common vestibular dis...

https://ift.tt/2Hfmz1z

An update on molecular cat allergens: Fel d 1 and what else? Chapter 1: Fel d 1, the major cat allergen

Cats are the major source of indoor inhalant allergens after house dust mites. The global incidence of cat allergies is rising sharply, posing a major public health problem. Ten cat allergens have been identif...

https://ift.tt/2Ho9UXF

Antenatal Spontaneous Renal Forniceal Rupture Presenting as an Acute Abdomen

Background. Renal forniceal rupture is a lesser-known cause of acute abdomen in pregnancy. The ureteral compression by the gravid uterus places pregnant women at a higher risk. Sequelae in pregnancy could include intractable pain, acute kidney injury, and preterm birth. Case. A 22-year-old primigravida with no prior medical history presented with an acute abdomen in her second trimester. The diagnosis of renal forniceal rupture was made by a radiologist using MRI. A percutaneous nephrostomy catheter was placed, and the patient's pain was relieved. She subsequently delivered at term. Conclusion. Upon presentation of an acute abdomen in pregnancy, providers may not include renal forniceal rupture in their differential as readily as obstetric or gynecologic causes, resulting in delayed diagnosis, unnecessary invasive interventions, and potentially adverse maternal and neonatal outcomes. Increasing provider awareness could result in improved outcomes.

https://ift.tt/2GR44Ri

Impact of cognitive function on oral perception in independently living older people

Abstract

Objectives

Oral tactile perception is important for better mastication, appetite, and enjoyment of food. However, previous investigations have not utilized comprehensible variables thought to have negative effect on oral perception, including aging, denture wearing, and cognitive function. The aim of this study was to elucidate the impact of cognitive function on oral perception in independently living older individuals.

Materials and methods

The study sample was comprised of 987 participants (466 males, 521 females; age 69–71 years). Oral examinations, assessments of cognitive function in preclinical level by Montreal Cognitive Assessment (MoCA)-J, and determination of oral stereognostic ability as an indicator of oral perception were performed. Related variables were selected by univariate analyses; then, multivariate logistic regression model analysis was conducted.

Results

Univariate analyses revealed that number of teeth, removable dentures usage, and cognitive function respectively had a significant relationship with stereognostic score. Next, the subjects were classified into good and poor perception groups (lowest 17.4%) according to oral stereognostic ability. Logistic regression analysis revealed that lower cognitive function was significantly associated with poor oral perception (OR = 0.934, p = 0.017) after controlling for other variables.

Conclusions

Cognitive decline even in preclinical stage was associated with reduced oral perception after controlling for gender, tooth number and denture use in independent living older people.

Clinical relevance

This study suggested that preclinical level of change in cognitive function affected oral perception. Dental practitioners and caregivers may need to pay attention to reduced oral perception among older people even if they do not have trouble in daily life.

https://ift.tt/2Hosf6O

Αρχειοθήκη ιστολογίου

Τρίτη 10 Απριλίου 2018

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