Symptom control in chronic rhinosinusitis is an independent predictor of productivity loss

Publication date: Available online 1 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A.P. Campbell, L.P. Hoehle, K.M. Phillips, D.S. Caradonna, S.T. Gray, A.R. Sedaghat
AimsSinonasal symptoms cause significant productivity losses in patients with chronic rhinosinusitis (CRS). Patient-perceived CRS symptom control is a longitudinal measure of CRS symptomatology and is directly associated with general health-related quality of life (QOL) in patients with CRS. The aim of this study was to better understand the relationship between symptom control and productivity loss in CRS.Materials and methodsProspective cross-sectional cohort study of 200 patients with CRS. Patients categorized their CRS symptom control as "Not at all", "A little", "Somewhat", "Very", and "Completely". Lost productivity was assessed by determining the number of work and/or school days missed in the last 3 months due to CRS symptoms. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22). Associations were sought between lost productivity and patient-perceived CRS symptom control.ObjectiveTo determine the association between patient-perceived longitudinal symptom control and productivity in patients with CRS.ResultsA total of 200 participants (48% male, 52% female), with a mean age of 52 years (Standard Deviation [SD]: 16) were enrolled. The mean SNOT-22 score of participants was 33.5 (SD: 22.4). Participants missed a mean of 3 days (SD: 10) of work or school due to CRS. CRS symptom control classified as "not at all" was associated with 11 days of lost productivity due to CRS on univariate analysis (β=11.16, 95% CI: 5.39–16.94, P<0.001) and 8 days of lost productivity on multivariate analysis (β=8.02, 95% CI: 1.92–14.13, P=0.011). None of the other categories of patient-reported CRS symptom control were associated with lost productivity due to CRS.ConclusionsPatient-perceived control of CRS symptoms, an important metric previously shown to be significantly associated with QOL in CRS patients, is independently associated with lost productivity. These results motivate longitudinal studies to determine if improvement of CRS symptom control may reduce losses in productivity.



https://ift.tt/2HGBVNs

Oral Epignathus with Maxilla Duplication: Report of a Rare Case

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1649497

Epignathus is a rare congenital oropharyngeal teratoma that arises from the oropharynx, especially the sphenoid, palatine, and ethmoid bones. Teratomas are benign tumors containing cells from ectodermal, mesodermal, and endodermal layers. The incidence of epignathus is between 1:35,000 and 1:200,000 live births with a female predominance. We reported an uncommon case of epignathus in a female newborn baby with an ill-defined oral mass protruding through a cleft in the hard palate. Computed tomography scan showed a contrast-enhanced solid mass with areas of calcification simulating a unique case of maxilla duplication. Surgery was performed, the mass was excised successfully, and microscopic analysis confirmed the diagnosis of mature teratoma. The patient evolved with good general health and showed no clinical signs of recurrence. Although epignathus is a rare condition, it should be diagnosed in the fetus as early as possible, especially to avoid fatal airway obstruction. In such cases, the treatment option is exclusively surgical, and complete resection is curative in most cases during the early neonatal period.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2IcHVwG

New Algorithm for the Management of Orbital Blowout Fracture Based on Prospective Study

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1641714

Despite extensive debate and publications in the management of blowout fracture (BOF), there are still considerable differences in the surgeons' management of BOF due to a lack of reliable evidence-based studies. This article aimed to evaluate which BOF patients require surgical treatment due to functional and/or cosmetic deformities; evaluate which computed tomography (CT) scan findings predict these problems; and provide an algorithm in the management of BOF. Seventy-nine patients with BOF were treated conservatively and followed up prospectively regarding functional and cosmetic deformities for at least 1 year. The patients' CT scans were analyzed and several measurements were performed. Patients' symptoms and the clinical findings were correlated to the CT scan measurements. We found visible deformity in 37% of the patients, but only 10% chose to proceed to surgery due to cosmetic deformities. In patients with inferior BOF and a herniation < 1.0 mL, a visible deformity was found when the ratio between fracture and the fractured orbital wall areas was ≥42%, or the total area of the fracture was ≥ 2.3 cm2. In patients with inferior BOF and a herniation ≥ 1.0 mL, a visible deformity was found when the distance from the inferior orbital rim to the posterior edge of the fracture was ≥ 3.0 cm. In patients with inferomedial fracture, a visible deformity was found when the herniation was ≥ 0.9 mL. Diplopia improved significantly and remained in only 3% of the patients in nonoperated group. Hypoesthesia of the infraorbital nerve improved significantly, but 23% of the nonoperated and 50% of the operated patients still experienced loss of sensation at final control. In this prospective study, we found that not only herniated orbital volume but also other CT scan findings in BOF were crucial to predict late visible deformities. Based on these findings, we propose an algorithm for the prediction of late visible deformity with 83% accuracy. There are indications that diplopia without ocular motility disorder is due to edema and we recommend observation as long as the diplopia improves gradually.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2w9HrTA

Pulling and Pushing Stem Cells to Control Their Differentiation

Much has already been done to achieve precisely controlled and customised regenerative therapies. Thanks to recent advances made in several areas relevant to regenerative medicine including the use of stimuli-responsive materials, 4-dimensional biofabrication, inducible pluripotent stem cells, control of stem cell fate using chemical and physical factors, minimal access delivery, and information-communication technology. In this short perspective, recent advances are discussed with a focus on a recent report on the use of mechanical stretching of nanoparticle-laden stem cells by using external magnetic field to induce defined cardiac line differentiation. Although more and more tools are becoming available for engineering tissue models tissues and the range of potential applications is expanding, there is still much work to be done before it is proved to work with human cells, form tissues and ultimately achieve application in the clinic.

https://ift.tt/2HFA0Zz

Purpose of Zygoma Reduction: Not Just for a Smaller Cheek Bone

No abstract available

https://ift.tt/2rcUhuo

Application of Micromirror in Microsurgical Clipping to the Intracranial Aneurysms

Objective: The aim of the study was to explore the values and disadvantages of micromirror in the intracranial aneurysm clipping surgery. Methods: Micromirror was used to assist microsurgical clipping to 36 intracranial aneurysms in 31 patients, of which 3 were carotid-ophthalmic artery aneurysms, 3 were anterior choroidal artery aneurysms, 11 were posterior communicating artery aneurysms, 7 were middle cerebral artery aneurysms, 10 were anterior communicating artery or anterior cerebral artery aneurysms, and the rest were a posterior cerebral artery aneurysm and a posterior inferior cerebellar artery aneurysm. The micromirror was used before and after clipping to observe the anatomic features of necks hidden behind and medial to aneurysms, to visualize surrounding neurovascular structures, and to verify the optimal clipping position. Intraoperative indocyanine green fluorescein angiography, postoperative computerized tomography angiography, and digital subtraction angiography confirmed the success of sufficient clipping. Results: Intraoperative indocyanine green angiography, postoperative computerized tomography angiography , or digital subtraction angiography were performed and showed no case of wrong or insufficient clipping of aneurysm. Conclusions: Micromirror-assisted microsurgical clipping to the intracranial aneurysm is safe, sufficient, convenient, and practical.

https://ift.tt/2KvpFNA

The Progress on Noma Disease and Its Surgical Treatment

No abstract available

https://ift.tt/2rgytxV

Rhinogenic Contact Point Headache: Surgical Treatment Versus Medical Treatment

Rhinogenic contact point headache (RCPH) is a headache syndrome secondary to mucosal contact points in the sinonasal cavities, in the absence of inflammatory signs, hyperplastic mucosa, purulent discharge, sinonasal polyps, or masses. It may result from pressure on the nasal mucosa due to anatomic variations among which the septal deviation, septal spur, and concha bullosa, are the most commonly observed. In recent years, RCPH has remained a subject of controversy regarding both its pathogenesis and treatment. This study aimed to investigate the effect of surgical and medical treatment of pain relief in patients with RCPH, evaluating the intensity, duration, and frequency of headaches, and the impact of different treatments on quality of life. Ninety-four patients with headache, no symptoms or signs of acute and chronic sinonasal inflammation and who present with intranasal mucosal contact points positive to the lidocaine test were randomized into 2 equal groups and given medical or surgical treatment. The authors used visual analog scale, number of hours, and days with pain to characterize the headache and Migraine Disability Assessment score (MIDAS) to assess the migraine disability score before and 3 to 6 months after treatment. After treatment the severity, duration, and frequency of the headache decreased significantly (P 

https://ift.tt/2HFzESJ

Effects of Platelet-Rich Fibrin Membrane on Sciatic Nerve Regeneration

Alternative treatment approaches to improve the regeneration capacity of damaged peripheral nerves are currently under investigation. The objective of the present study was to evaluate the effects of platelet-rich fibrin (PRF) membrane after sciatic nerve crush injury in rabbits by histomorphometric and electromyographic analysis. The left sciatic nerves of 20 male Vienna rabbits were clamped for 30 seconds to induce crush injuries. Animals were randomly divided into 2 groups: PRF and control. For each animal in the PRF group, a PRF membrane was wrapped around the injured part of the sciatic nerve to form a tube. No additional treatment was performed in the control group. After a 12-week healing period, tissue samples from the injured nerve region were harvested and the g-ratio of axons, axon density, and impulse transmission changes were evaluated. Analysis revealed that axon density differences were not statistically significant between groups (P = 0.139). The rate of nerve fibers with optimum g-ratio was significantly lower in the PRF group than in the control group (P = 0.02). Conduction velocity differences between groups were not statistically significant. Although PRF application has previously shown positive regeneration effects on maxillofacial tissues, local PRF membrane application in tube form did not show any histomorphometric or functional improvement in peripheral nerve crush injury recovery.

https://ift.tt/2KuoqhM

Can Tumor Size Be a Predictive Factor of Olfactory Dysfunction After Endoscopic Endonasal Trans-Sphenoidal Approach?

Background and Objective: The aim of this study is to investigate the relationships between tumor size, nasal symptoms including olfactory function, and posoperative atrophic mucosal changes after the endoscopic endonasal transsphenoidal approach (EETSA). Methods: This was a retrospective review of the medical records of 112 patients who underwent the 2 nostrils/4 hands EETSA with bilateral modified nasoseptal rescue flaps between February 2009 and January 2016. Pre- and postoperative paranasal sinus computed tomography, nasal cavity endoscopic images, the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), the Nasal Obstruction Symptoms Evaluation, and the Sino-Nasal Outcome Test-20 were conducted. Nasal mucosal changes as determined by endoscopy were divided into 4 groups: normal to normal, Group A; atrophy to atrophy, Group B; normal to atrophy, Group C; and atrophy to more atrophy, Group D. The Mimics program was used to calculate nasal cavity volume changes after surgery. Results: There were significant differences between pre- and postoperative olfactory function as reflected by the CCCRC (P 

https://ift.tt/2reWhST

Comparison of the Effects of Cigarette Smoking on Male and Female Vocal Folds

Objective: To investigate effects of smoking cigarette on male and female larynges and compare them. Method: Eighteen adult Wistar Albino rats were included to study; 9 were male and 9 female. The exposure groups each contained 6 rats, and the control groups 3 rats. Six male constituted group 1 and 6 female constituted group 2. Group 1 and 3 were exposed to smoke. Group 2 and 4 were composed of 3 males and 3 females, respectively. Smoke from 10 cigarettes was delivered in each of the morning and afternoon daily for 1 month. At the end of 4 weeks, all rats were sacrificed and their larynges were evaluated histopathologically. Results: Microscobic evaluation of epithelium of vocal folds revealed no significant difference between study groups. There was also no difference between study and control groups. Subepitelial tissue showed no difference between study groups but angiogenesis and inflammation were higher in study groups. Epithelial analysis of false vocal folds showed significant difference between study groups. Female epithelium showed more hyperplastic and metaplastic changes. Conclusion: Cigarette smoke damaged both the vocal folds and false vocal folds. The female false vocal folds were more susceptible to damage than the males.

https://ift.tt/2HFzL0B

Power-Assisted Particulate Bone Grafting Effectively Prevents Osseous Defects After Cranial Vault Reconstruction

Background: Cranial vault reconstruction (CVR) is the gold standard in the operative treatment of craniosynostosis. Full thickness osseous defects (FTOD) of the calvaria have been observed in 5% to 15% patients after CVR, with higher rates cited in the fronto-orbital advancement (FOA) subset. Particulate bone graft (PBG) harvested manually has been shown to decrease FTOD after FOA from 24% to 5.5%. The authors used a modified technique using a powered craniotome, with the hypothesis that the technique would also improve outcomes. Methods: A retrospective review was performed of patients who underwent CVR for craniosynostosis between 2004 and 2014. Patient demographics, diagnosis, age, operative details, and postoperative care were reviewed in detail. Categorical, nonparametric variables were compared by Fisher exact tests. Results: A total of 135 patients met inclusion criteria. The most common diagnoses were metopic (n = 41), sagittal (n = 33), and unilateral coronal craniosynostosis (n = 31); 65% (n = 88) underwent FOA, 29% (n = 39) underwent single-stage total vault reconstruction, and 6% (n = 8) had a posterior vault reconstruction. CVR was performed without PBG in 95 patients and with PBG in 40 patients. Without PBG, FTOD were discovered on clinical examination in 18% of patients (n=17): 11 presented with subcentimeter defects, while 6 had larger defects requiring revision cranioplasty (6% operative revision rate). Among those receiving PBG, 1 patient presented a subcentimeter FTOD (2.5% FTOD incidence and 0% operative revision rate). Conclusion: Particulate bone graft harvested with a powered device decreases the rate of FTOD and reoperation rate after CVR for craniosynostosis.

https://ift.tt/2rilegq

Piezosurgery for Treatment of Large Recurrent Mandibular Osteoma

Background: Osteomas are infrequent benign bone tumors of uncertain etiology. They are usually situated at extremities and their occurrence in the jaws is relatively rare. There are 3 types of osteoma: central, peripheral, and extraskeletal. Preoperative presumptive diagnosis is performed by means of radiography using orthopantomographs, computerized tomographs, or cone beam scans. Treatment is surgical and consists of careful exeresis and curettage of the adjacent tissue. In recent years, piezoelectric surgery has been used to treat bone pathologies in the maxillofacial area, orthopedic surgery, and neurosurgery. When used for the exeresis of a bone lesion, the device minimizes risks and eliminates possible complications arising from affectation of the vascular and nerve structures close to the lesion. Objective: This clinical report describes a peripheral mandibular osteoma situated in the left mandibular basilar which recurred 45 years after surgical treatment at another center. Methods: For resection, the surgical approach followed the scar remaining from the earlier surgery and was performed using piezoelectric surgery. Surgery did not cause hemorrhagic complications, affect the sensitivity of the left labial menton, or cause paralysis of the lower lip. Conclusions: Based on the present patient, it may be concluded that mandibular osteoma treatment by means of piezoelectric surgery makes precise exeresis possible with less affectation of the important surrounding structures such as the inferior alveolar nerve and the marginal mandibular branch of the facial nerve.

https://ift.tt/2HDUMbQ

Bone-Conditioned Medium Obtained From Calvaria, Mandible, and Tibia Cause an Equivalent TGF-β1 Response In Vitro

Bones with different embryological origin and mode of ossification are supposed to vary in their capacity for supporting graft consolidation. The aim of the current pilot study was to assess the TGF-β1 activity of bone chips obtained from distinct anatomic locations. Conditioned medium was prepared from bone chips harvested from pig calvaria, mandible, and tibia. Human oral fibroblasts were exposed to bone-conditioned medium (BCM) followed by reverse transcriptase polymerase chain reaction of the TGF-β1 target genes. Also an immunoassay for interleukin 11 (IL-11) and TGF-β1 was performed. The impact of BCM on alkaline phosphatase activity was determined with murine MC3T3-E1 osteogenic cells. The authors report here that BCM contains TGF-β1 in the ng/mL range. Bone chips prepared from pig calvaria, mandible, and tibia femur had a similar capacity for increasing the expression of the TGF-β1 target genes IL-11, NOX4, and PRG4. Correspondingly, immunoassays revealed similar production of IL-11 by human oral fibroblasts. Furthermore, conditioned medium obtained from the 3 bones decreased alkaline phosphatase activity in MC3T3-E1 osteogenic cells. These preliminary data demonstrate that particulated bone grafts, regardless of embryological origin, mode of ossification and morphology, release a similar TGF-β1 activity.

https://ift.tt/2ree5xw

The Sellar Tumor: Metastasis or Chordoma?

Chordomas are uncommon, locally invasive chordate tumors, which are mostly observed in the axial skeleton. Numerous papers have described similar patients around different anatomic locations; however, rare document previously reported that intracranial chordoma was associated with clear cell renal cell carcinoma (ccRCC). The authors report a 51-year-old male patient with a history of right radical nephrectomy for ccRCC presented to us with progressive blurred vision. Ophthalmic examination showed vision loss and visual field defects. Magnetic resonance imaging demonstrated pituitary tumor with hemorrhage, which was compressing the optic chiasm. He underwent a transnasal endoscope resection of the sellar mass. The immediate postoperative pathologic result was simply considered to be pituitary metastasis from ccRCC. After further immunohistochemical study, pathology diagnosis was made the necessary corrections to be the sellar chordoma. The authors summarize this exceptional patient and review the pertinent literature briefly.

https://ift.tt/2KvptxQ

Comparison of Tongue-in-Groove and Columellar Strut on Rotation and Projection in Droopy Nasal Tip: Contribution of a Cap Graft

Underrotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to correct droopy tip and to achieve a desirable nasal tip rotation such as lateral crural steal, lateral crural overlay, tongue-ingroove, columellar strut graft, tip rotation sutures, cephalic trimming, and others. In this study, the effects of tongue-in-groove (TIG) and columellar strut graft (CS) and the contribution of cap graft on nasal tip rotation and projection were evaluated. Twenty-eight consecutive patients who underwent open approach rhinoplasty by the same senior author (ULD) between January 2015 and December 2016 with the diagnosis of septonasal deformity and droopy nasal tip were included. In 9 of these patients nasal tip was constructed with strut graft, in 6 patients with both strut and cap grafts, in 6 patients with TIG technique and in 7 patients with both TIG and cap graft. Standardized right lateral images were taken preoperatively and 6 months postoperatively to use for further assessments. The nasal tip rotation was evaluated by measuring nasolabial angle (NLA) and the nasal projection (NP) was evaluated by using the Goode method. Finally, the postoperative values of NLA and NP at the 6th month were compared with preoperative recorded values in between groups. Each group showed increase at nasal projection; however, significance was present only in CS graft and TIG groups (P=0.011 and P=0.027 relatively). Each 4 groups showed significant increase in nasal tip rotation. In addition, the comparison of percent changes between preoperative and postoperative NP and NLA revealed no difference (P=0.56 and P=0.431 relatively). In conclusion, the authors argued that TIG and CS graft techniques are both reliable methods to correct droopy nasal tip and using additional cap graft over dome area when required is safe and useful.

https://ift.tt/2rgyrWP

An Unusual Presentation of Conjunctival Dermolipoma With a Skin Tag

Dermolipoma is considered the second most common benign conjunctival tumor in children after nevus. Usually, dermolipoma located just deep in the superotemporal bulbar and forniceal conjunctiva. The authors describe an uncommon presentation of dermolipoma that arise in the conjunctiva as well as in the skin of the lateral canthus. A 5-month-old baby with lateral limbal lesion involving the conjunctiva and the skin underwent excision biopsy. The pathological examination found a dermolipoma in the conjunctiva as well as in the dermis. The outcomes of the excision were satisfactorily functional and cosmetic. This is only the second case of dermolipoma in the dermis in normal baby that described those far in the literature. This case should raise the awareness that dermolipoma should be considered in differential diagnosis of lesions of the lateral cantus and the periocular skins near it.

https://ift.tt/2Kwsyxo

Large-Scale Skin Resurfacing of the Upper Extremity in Pediatric Patients Using a Pre-Expanded Intercostal Artery Perforator Flap

Background: The repair of extensive upper limb skin lesions in pediatric patients is extremely challenging due to substantial limitations of flap size and donor-site morbidity. We aimed to create an oversize preexpanded flap based on intercostal artery perforators for large-scale resurfacing of the upper extremity in children. Method: Between March 2013 and August 2016, 11 patients underwent reconstructive treatment for extensive skin lesions in the upper extremity using a preexpanded intercostal artery perforator flap. Preoperatively, 2 to 4 candidate perforators were selected as potential pedicle vessels based on duplex ultrasound examination. After tissue expander implantation in the thoracodorsal area, regular saline injections were performed until the expanded flap was sufficient in size. Then, a pedicled flap was formed to resurface the skin lesion of the upper limb. The pedicles were transected 3 weeks after flap transfer. Flap survival, complications, and long-term outcome were evaluated. Result: The average time of tissue expansion was 133 days with a mean final volume of 1713 mL. The thoracoabdominal flaps were based on 2 to 6 pedicles and used to resurface a mean skin defect area of 238 cm2 ranging from 180 to 357 cm2. In all cases, primary donor-site closure was achieved. Marginal necrosis was seen in 5 cases. The reconstructed limbs showed satisfactory outcome in both aesthetic and functional aspects. Conclusion: The preexpanded intercostal artery perforator flap enables 1-block repair of extensive upper limb skin lesions. Due to limited donor-site morbidity and a pedicled technique, this resurfacing approach represents a useful tool especially in pediatric patients.

https://ift.tt/2ril7S2

Quantification of Surgical Route Parameters for Exposure of the Jugular Foramen Via a Trans-Mastoidal Approach Exposing Jugular Foramen in Three-Dimensional Visualization Model

Objective: Surgical operation within the region of the jugular foramen presents a great challenge. The authors characterized the quantitative impact of surgical window parameters on the exposure of the jugular foramen via a trans-mastoidal approach. Methods: Computed tomography and magnetic resonance imaging data were used to establish a 3-dimensional model of the jugular foramen region. The mastoidale, posterior edge of the mastoid, and the superior edge of the bony external acoustic meatus were selected as points a, b, and c. The anterior edge of the tuberculum jugulare was selected as point d. The midpoints of line segments ab, ac, and bc were selected as points e, f, and g. Triangle abc was divided into triangles aef, beg, cfg, and efg. Surgical corridors of the triangular pyramid were outlined by connecting the above triangles to point d. Anatomic exposure was evaluated by measuring the area and volume of various structures within each route. Statistical comparisons were performed via analysis of variance. Results: The model allowed for adequate visualization of all structures. The areas of triangles beg and efg were greater than those of triangles aef and cfg (P 

https://ift.tt/2KvphP8

Posterior Vault Distraction Osteogenesis in Nonsyndromic Patients: An Evaluation of Indications and Safety

Purpose: The purpose of this study was to evaluate the indications, safety, and short-term outcomes of posterior vault distraction osteogenesis (PVDO) in patients with no identified acrocephalosyndactyly syndrome (study) and to compare those to a syndromic cohort (controls). Methods: Demographic and perioperative data were recorded and compared across the study and control groups for those who underwent PVDO between January 2009 and December 2016. Univariate analysis was conducted using χ2 and Fisher exact tests for categorical variables, and Mann–Whitney U test for continuous variables. Results: Sixty-three subjects were included: 19 in the nonsyndromic cohort, 44 in the syndromic cohort. The cohorts had similar proportion of subjects exhibiting pansynostosis (42.1% of nonsyndromic versus 36.4% of syndromic, P = 0.667). The nonsyndromic cohort was significantly older (4.04 ± 3.66 years versus 2.55 ± 3.34 years, P = 0.046) and had higher rate of signs of raised intracranial pressure (68.4% versus 25.0%, P = 0.001) than the syndromic cohort. There was no significant difference in perioperative variables or rate of complications (P > 0.05). The mean total advancement distance achieved was similar, 27 ± 6 mm in the nonsyndromic versus 28 ± 8 mm in the syndromic cohort (P = 0.964). All nonsyndromic subjects with signs of raised intracranial pressure demonstrated improvement at an average follow-up of 22 months. Conclusion: As in the syndromic patient, PVDO is a safe and, in the short-term, effective modality for cranial vault expansion in the nonsyndromic patient. The benefits and favorable perioperative profile of PVDO may therefore be extended to patient populations other than those with syndromic craniosynostosis.

https://ift.tt/2rdDwzb

Review of “Why Do General Surgeons Decide to Retire? A Population-Level Survey” by Poushay HM, Kagedan DJ, Hallet J, Conn LG, Beyfuss K, Nadler A, Ahmed N, Wright FC in Ann Surg 267: e4–e5, 2018

No abstract available

https://ift.tt/2HGSl8n

Modified Lengthening Temporalis Myoplasty Involving an Extended Lazy-S Incision to Avoid Facial Scar Formation

Background: Lengthening temporalis myoplasty is a faster and less invasive alternative to free muscle transfer for smile reconstruction. However, it requires a nasolabial fold incision, which leaves a midfacial scar. Based on esthetic considerations, a modified approach, involving an extended lazy-S (parotidectomy) incision instead of a nasolabial fold incision, was developed. Methods: A cadaveric study involving 10 hemifaces was conducted. From February 2013 to March 2016, the modified lengthening temporalis myoplasty procedure was employed in 10 patients. The results were graded from 1 (poor) to 5 (excellent) according to the Terzis grading system. The excursion of the oral commissure was also measured. Results: The extended lazy-S incision provides easy and safe access to the coronoid process and good visibility. The patients' mean age was 56.5 years, and the mean duration of the postoperative follow-up period was 22.2 months. The patients' underlying conditions included acoustic neuroma (n = 2), Bell palsy (n = 3), congenital conditions (n = 2), brain infarction (n = 1), Ramsay Hunt syndrome (n = 1), and malignant parotid lymphoma (n = 1). One patient suffered a surgical site infection, which was successfully treated with irrigation. All the patients achieved improvements in smile symmetry: 2, 5, and 3 patients obtained excellent, good, and moderate results, respectively. The excursion of the oral commissure ranged from 5 to 10 mm. Conclusion: The modified lengthening temporalis myoplasty procedure provides satisfactory functional outcomes without causing significant complications. It does not leave a facial scar and is a preferable option, especially for young and female patients, and patients who have undergone ablative surgery involving the parotid region.

https://ift.tt/2rgeoaS

Hemodynamic Assessment with SPY-Indocyanine Green Angiography in Expansion Period: A Study for Expansion Capsule Pressure Optimization

Tissue expansion-related severe complication exists, and the poor blood supply is one of the causes. After decades of negative correlation between capsule pressure and blood flow was verified, the widely recognized expansion capsule pressure is still absent. A prospective randomized controlled trial was performed to explore the optimal expanding capsule pressure. Thirty subjects were randomly divided into 5 groups, received a weekly expanding on 60-, 70-, 80-, 90-, and 100-mm Hg capsule pressure, respectively. All patients achieved 8-week follow-up; hemodynamic assessment by SPY-indocyanine green (ICG) angiography was taken every 2 weeks. Standardized indexes from SPY-ICG angiography were used to assess the blood supply, in which the ratio of ingress rate and the ingress rate of normal skin (IR/NIR) reflects the arterial perfusion level, and the ratio of Engress Rate and IR (ER/IR) indicates the venous reflux level. The expansion-related adverse events during the trial were recorded. The IR/NIR and the ER/IR are both obviously negatively correlated to the capsule pressure of tissue expander (P ≤ 0.05, the ER/IR's correlation coefficient = −0.453; the IR/NIR's correlation coefficient = −0.482). The post-expansion IR/NIR increased significantly after 8 weeks of expansion (P ≤ 0.05) in 90-mm Hg group. And the post-expansion ER/IR was significantly elevated (P ≤ 0.05) in 80 and 90-mmHg groups. There were 2 expansion-related complications reported in 100-mm Hg group, whereas no complication occurred in 4 other lower groups. SPY-ICG angiography is an objective measurement for tissue expansion hemodynamic monitoring. The expanding capsule pressure of 80 to 90 mm Hg is a reasonable upper limit.

https://ift.tt/2re1uKQ

Oromandibular dystonia screening questionnaire for differential diagnosis

Abstract

Objectives

Oromandibular dystonia, which is characterized by stereotypic, task-specific, or sustained contractions of masticatory and/or lingual muscles, is frequently misdiagnosed as temporomandibular disorders or psychogenic disease. Diagnostic delay in oromandibular dystonia is not acceptable; thus, a screening tool that can distinguish this condition from a temporomandibular disorder may be helpful for medical professionals unfamiliar with involuntary movements or temporomandibular disorders.

Materials and methods

A questionnaire that included questions on the clinical features of oromandibular dystonia, such as stereotypy, task-specificity, sensory tricks, and morning benefit, and included questions to rule out temporomandibular disorders (total point range 0–40) was administered to 553 patients suspected to have involuntary movements.

Results

Based on a careful examination and the differential diagnosis, the patients were divided into four groups: oromandibular dystonia (n = 385), oral dyskinesia (n = 84), psychogenic (functional) movement disorder (n = 50), and temporomandibular disorders (n = 34). The questionnaire had a high level of internal consistency as measured by the Cronbach's α (0.91), and item-total correlation was significant (p < 0.001). The test-retest reliability on two separate occasions showed a significant correlation (p < 0.001). Mean total scores of the questionnaire significantly differed among oromandibular dystonia (32.0), temporomandibular disorders (10.4; one-way analysis of variance, p < 0.001), oral dyskinesia (21.0; p < 0.001), and psychogenic (functional) movement disorder (13.7; p < 0.001).

Conclusions

Findings of this study suggest that the present questionnaire is a simple diagnostic tool that is useful for tentative differentiation of oromandibular dystonia from temporomandibular disorders.

Clinical relevance

This screening tool can be used to distinguish oromandibular dystonia from temporomandibular disorders.

https://ift.tt/2KvcBYn

Microbial accumulation on different suture materials following oral surgery: a randomized controlled study

Abstract

Background

The aim of the study was to compare bacterial accumulation on different suture materials following oral surgery.

Methods

Patients scheduled for implant or periodontal surgery were included in the study. Upon flap closure, four different sutures were placed in a randomized sequence—silk, coated polyglactin, nylon, and polyester. Ten days following surgery, the sutures were removed and incubated in aerobic as well as anaerobic conditions for 7 days and colony-forming units (CFUs) were calculated. Association between bacterial accumulation and periodontal diagnosis, type of surgery, and antibiotic treatment were also tested.

Results

All sutures in all patients were found to contain bacteria. Overall, nylon sutures showed significantly lower CFU levels compared to silk, coated polyglactin, and polyester sutures. The type of surgery (implant vs. periodontal surgery) did not significantly influence bacterial accumulation. Also, periodontal diagnosis had little impact on CFU counts. Interestingly, post-surgical antibiotic treatment also had only a minor effect on bacterial accumulation on the various sutures.

Discussion

The results indicate that the monofilamentous nylon sutures showed less microbial accumulation than the other tested materials that were all braided. This effect may be due to material qualities as well as suture macrostructure. Type of surgery, periodontal diagnosis, and antibiotic consumption have little effect on bacterial accumulation of sutures.

Clinical relevance

The study provides the microbial profile of commonly used sutures and may assist in suture selection during clinical procedures.

https://ift.tt/2FymDVf

Improving influenza vaccines: challenges to effective implementation

Fan Zhou | Mai-Chi Trieu | Richard Davies | Rebecca Jane Cox

https://ift.tt/2rdQb6b

Endocytosis regulation by autophagy proteins in MHC restricted antigen presentation

Christian W .Keller | Monica Loi | Laure-Anne Ligeon | Monique Gannagé | Jan D Lünemann | Christian Münz

https://ift.tt/2JIYgq1

Role of calcium permeable channels in dendritic cell migration

Pablo J Sáez | Juan C Sáez | Ana-María Lennon-Duménil | Pablo Vargas

https://ift.tt/2I1Y9ZA

International Comparison of Abdominal Fat Distribution Among Four Populations: The ERA-JUMP Study

Metabolic Syndrome and Related Disorders, Volume 16, Issue 4, Page 166-173, May 2018.


https://ift.tt/2FxK8NO

Wernekink commissure syndrome with palatal myoclonus at onset: a case report and review of the literature

Wernekink commissure syndrome causes a peculiar combination of internuclear ophthalmoplegia, dysarthria, and delayed-onset palatal myoclonus. Palatal myoclonus is thought to be secondary to delayed hypertrophi...

https://ift.tt/2HGbTdg

FDA Approves Adjuvant Combo for BRAF+ Melanoma

The two targeted therapies, dabrafenib and trametinib, are already approved in combination in the metastatic setting.
FDA Approvals

https://ift.tt/2KqoyyN

Early Response Evaluation of Proton Therapy by PET-imaging in Squamous Cell Carcinoma Located in the Head and Neck

Condition:   Squamous Cell Carcinoma of the Head and Neck
Intervention:   Radiation: Intensity Modulated Proton Therapy (IMPT) +/- Chemotherapy
Sponsors:   Leiden University Medical Center;   Holland Particle Therapy Centre (HollandPTC)
Not yet recruiting

https://ift.tt/2KuY7HU

Utility of concurrent direct laryngoscopy and bronchoscopy with drug induced sleep endoscopy in pediatric patients with obstructive sleep apnea

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Morgan Bliss, Swati Yanamadala, Peter Koltai
ObjectivesThe goal of this report was to find the frequency of synchronous airway lesions (SAL) identified during microdirect laryngoscopy and bronchoscopy (MDLB) that influenced treatment decisions beyond the information provided by drug induced sleep endoscopy (DISE) alone in children with obstructive sleep apnea (OSA) at a tertiary care pediatric hospital.MethodsThis was a retrospective chart review of all pediatric patients who underwent drug induced sleep endoscopy in conjunction with direct laryngoscopy and bronchoscopy as part of a comprehensive airway evaluation for obstructive sleep apnea at a tertiary care pediatric hospital.ResultsThree hundred thirty-five patients with obstructive sleep apnea were evaluated with both sleep endoscopy and direct laryngoscopy with bronchoscopy. Five percent of patients had SAL identified on MDLB contributing to airway obstruction. Three patients (0.9%) who underwent MDLB for OSA required surgical correction of SAL that was identified.ConclusionIn a limited subset of patients, direct laryngoscopy with bronchoscopy provides additional positive findings to aid with treatment planning for obstructive sleep apnea.



https://ift.tt/2raqkMi

State of deaf children in West Bengal, India: What can be done to improve outcome

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Suniti Chakrabarti
ObjectivePrelingual deafness in children demands urgent action as best outcome is dependent on earliest possible diagnosis and intervention. Objective of this study was to determine age of suspicion, diagnosis, intervention, and outcome in a representative group of deaf children in West Bengal, India, and suggest ways of improving these parameters.MethodsIn this cross-sectional study, ages of suspicion, diagnosis, intervention and outcome of 303 randomly selected deaf children were elicited from a cohort of 1316 children with deafness identified in an earlier study.ResultsMedian ages of suspicion, diagnosis and amplification were 18, 72 and 84 months respectively. Age of suspicion was significantly related to parental education (p < 0.05); age of diagnosis to parental education and socio-economic status (p < 0.001) and children's geographic location (p < 0.01). Following diagnosis, 86% of children received hearing aids but only 6% used their aids consistently; 86% were non-verbal, 12% could communicate with a mixture of speech and gesture and only 2% with speech alone.ConclusionCurrent situation of deaf children in West Bengal, and evidence indicates, in much of India, is insupportable. However, widely diverse socio-economic conditions and scarcity of public health infrastructure preclude one solution of the problem for the whole country. In absence of the ideal universal newborn hearing screening, rigorously monitored and costed pilot programs of different models of early detection and intervention using newborn hearing screening, targeted screening and trial of calibrated noisemakers by primary care workers should be tried to see which works best where, so that successful programs can be scaled up over time.



https://ift.tt/2JGBY8l

Head and neck presentation of Gardner Syndrome: A pediatric case series

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Dawn Goral, Julie Highland, Mark A. Lovell, Kenny H. Chan




https://ift.tt/2jkEsOU

Pre-operative evaluation of the adult patient undergoing elective noncardiac surgery: updated guideline from the European Society of AnaesthesiologyDirection and not directives

No abstract available

https://ift.tt/2KtCVlJ

Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology

The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate – wherever possible – this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34 066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

https://ift.tt/2Fw1qLA

Anaesthesia in High-Risk Patients

No abstract available

https://ift.tt/2KqHlde