Head and Neck Medicine by Alexandros G.Sfakianakis: 05/15/18

Τρίτη 15 Μαΐου 2018

Primary cutaneous aspergillosis at the site of cyanoacrylate skin adhesive in a neonate

Pediatric Dermatology, EarlyView.

https://ift.tt/2L5M2te

A Common Variation in the Caveolin 1 Gene Is Associated with High Serum Triglycerides and Metabolic Syndrome in an Admixed Latin American Population

Metabolic Syndrome and Related Disorders, Ahead of Print.

https://ift.tt/2InuB5v

Intraparotid facial nerve schwannoma: two case reports and a review of the literature.

Intraparotid facial nerve schwannoma: two case reports and a review of the literature.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):73-77

Authors: Simone M, Vesperini E, Viti C, Camaioni A, Lepanto L, Raso F

Abstract
SUMMARY: Schwannomas are rare benign tumours that arise from Schwann cells. The most known and studied is the intracranial vestibular schwannoma, even if it is not the most frequent. More often schwannomas arise from peripheral sensitive nerves, and the vagous is most involved among the cranial nerves. Intraparotid schwannomas account for just 10% of all facial involvement, so they are an extremely rare localisation. At present, there are less than 100 cases described in the literature. We performed a retrospective analysis of parotidectomy in two Italian hospitals and present two cases of intraparotid schwannoma and a review of the literature. In the first case, we performed a parotidectomy with a stripping of tumour from the nerve. In the other case, a hypoglossal-facial neurorrhaphy was performed. Follow-up was 24 months in the first (House-Brackmann II degree in temporal-ocular and III in facial-cervical branches) and 30 months in the second case (House-Brackmann III degree in both temporal-ocular and facial-cervical branches). Preoperative diagnosis of facial nerve schwannoma is a challenge; however, it is extremely important since post-operative palsy is common and often higher grade. Unfortunately, schwannoma has similar radiologic finding as more common pleomorphic adenoma and often FNAC is not helpful. Due to its rarity and benign nature, there is debate in the literature on the need for surgical removal. Wait-and-see is a valid option, but may could give problems in secondary surgery. Stripping or near-total removal can be useful in cases of limited involvement of the nerve. Neurorrhaphy can provide good functional results when facial sacrifice is needed.

PMID: 29756618 [PubMed - in process]

https://ift.tt/2Ihr9xn

Is it possible to define the ideal lips?

Is it possible to define the ideal lips?

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):67-72

Authors: Kar M, Muluk NB, Bafaqeeh SA, Cingi C

Abstract
SUMMARY: The lips are an essential component of the symmetry and aesthetics of the face. Cosmetic surgery to modify the lips has recently gained in popularity, but the results are in some cases disasterous. In this review, we describe the features of the ideal lips for an individual's face. The features of the ideal lips with respect to facial anatomy, important anatomical landmarks of the face, the facial proportions of the lips and ethnic and sexual differences are described. The projection and relative sizes of the upper and lower lips are as significant to lip aesthetics as the proportion of the lips to the rest of the facial structure. Robust, pouty lips are considered to be sexually attractive by both males and females. Horizontal thirds and the golden ratio describe the proportions that contribute to the beauty and attractiveness of the lips. In young Caucasians, the ideal ratio of the vertical height of the upper lip to that of the lower lip is 1:1.6. Blacks, genetically, have a greater lip volume. The shape and volume of a person's lips are of great importance in the perception of beauty by humans. The appearance of the lips in part determines the attractiveness of a person's face. In females, fuller lips in relation to facial width as well as greater vermilion height are considered to be attractive.

PMID: 29756617 [PubMed - in process]

https://ift.tt/2IM0h8b

Treatment of cholesteatoma with intact ossicular chain: anatomic and functional results.

Treatment of cholesteatoma with intact ossicular chain: anatomic and functional results.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):61-66

Authors: Pontillo V, Barbara F, DE Robertis V, Quaranta N

Abstract
SUMMARY: In case of cholesteatoma with intact ossicular chain, the primary aims of surgery are complete removal of the cholesteatoma matrix and reconstruction of a dry and safe middle ear; if possible, ossicular chain continuity and therefore the preoperative hearing must be preserved. The aim of this retrospective study is to present the experience of the U.O.C. Otorinolaringoiatria Universitaria of University of Bari "Aldo Moro" in treatment of intact ossicular chain cholesteatoma with Bondy modified radical mastoidectomy (BMRM) and canal wall up tympanoplasty (CWUT). The study group was composed of 65 subjects affected by cholesteatoma with intact ossicular chain. Mean age was 40.7 years (range 6-79), with 42 males and 23 females. 30 patients were treated by a BMRM and 35 by CWUT, in 22 cases without mastoidectomy and in 13 cases with mastoidectomy. Mean follow-up was 24.25 months. In the BMRM group, no cases of residual cholesteatoma located in the middle ear space were detected; at follow-up, 1 patient developed a retraction pocket (3.33%), 1 patient showed a small epidermal cysts of the tympanic membrane (3.33%) and 3 patients (10%) experienced otorrhoea. In CWUT, residual cholesteatoma was detected in 2 cases (5.7%); at follow-up, 3 patients presented recurrent cholesteatoma (8.57%; 2, 6 and 8 years after surgery), 3 cases a retraction pocket (8.57%) and one case otorrhoea (2.86%). Statistical analysis showed a significant higher number of residual cholesteatoma in CWUT (p 0.005) and differences in terms of long-term complications. No significant changes in hearing occurred post-operatively or at 1 year follow-up in either group. The current trend in our centre is to perform BMRM when indicated and CWUT preferably without mastoidectomy in case of mesotympanic cholesteatoma with normal OC.

PMID: 29756616 [PubMed - in process]

https://ift.tt/2jVUSgE

Correlation between musical aptitude and learning foreign languages: an epidemiological study in secondary school Italian students.

Correlation between musical aptitude and learning foreign languages: an epidemiological study in secondary school Italian students.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):51-55

Authors: Picciotti PM, Bussu F, Calò L, Gallus R, Scarano E, DI Cintio G, Cassarà F, D'Alatri L

Abstract
SUMMARY: The aim of this study was to assess if a correlation exists between language learning skills and musical aptitude through the analysis of scholarly outcomes concerning the study of foreign languages and music. We enrolled 502 students from a secondary Italian school (10-14 years old), attending both traditional courses (2 hours/week of music classes scheduled) and special courses (six hours). For statistical analysis, we considered grades in English, French and Music. Our results showed a significant correlation between grades in the two foreign languages and in music, both in the traditional courses and in special courses, and better results in French than for special courses. These results are discussed and interpreted through the literature about neuroanatomical and physiological mechanisms of foreign language learning and music perception.

PMID: 29756615 [PubMed - in process]

https://ift.tt/2Il4aO4

Transoral glossoepiglottopexy in the treatment of adult obstructive sleep apnoea: a surgical approach.

Transoral glossoepiglottopexy in the treatment of adult obstructive sleep apnoea: a surgical approach.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):38-44

Authors: Roustan V, Barbieri M, Incandela F, Missale F, Camera H, Braido F, Mora R, Peretti G

Abstract
SUMMARY: The treatment of obstructive sleep apnoea syndrome (OSAS) is still a matter of debate; among the different therapeutic alternatives, both surgical and conservative, treatment with continuous positive airway pressure (CPAP) is considered the "gold standard". The recent scientific literature reports that even if CPAP represents an effective solution for sleep apnoeas, 12% of patients do not benefit from its use. In most cases, primary collapse of the epiglottis is responsible for failure. We developed a surgical technique that provides a stable support to the epiglottis without influencing its function during swallowing while preserving laryngeal anatomy and physiology. The procedure we propose is based on that conceived by Monnier for children affected by laryngomalacia. We analysed a group of 20 patients who underwent glossoepiglottopexy between January 2015 and September 2016 and compared data (AHI, ODI, t90, ESS, EAT10, etc.) collected before and 6 months after surgery to demonstrate the safety and effectiveness of our glossoepiglottopexy (GEP). The results allow us to consider GEP as a valid choice to treat adults who suffer from sleep apnoeas.

PMID: 29756614 [PubMed - in process]

https://ift.tt/2IHFbrI

Neutrophil-to-lymphocyte ratio as a prognostic factor for pharyngocutaneous fistula after total laryngectomy.

Neutrophil-to-lymphocyte ratio as a prognostic factor for pharyngocutaneous fistula after total laryngectomy.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):31-37

Authors: Aires FT, Dedivitis RA, Kulcsar MAV, Ramos DM, Cernea CR

Abstract
SUMMARY: The role of systemic inflammatory response as a prognostic factor has been proposed in a variety of cancers. The purpose of this study was to investigate the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in the incidence of pharyngocutaneous fistula (PCF) in patients who underwent total laryngectomy. We conducted a retrospective cohort analysis of 141 patients with squamous cell carcinoma of larynx who underwent total laryngectomy from 2009 to 2015. The incidence of PCF was 49.6%. A higher risk of 23% was observed among patients with NLR > 2.5 for the occurrence of PCF (p = 0.007). Patients with laryngeal squamous cell carcinoma who present elevated values in the ration > LR> (> 2.5) presented a higher risk of developing pharyngocutaneous fistula in the postoperative setting of total laryngectomy.

PMID: 29756613 [PubMed - in process]

https://ift.tt/2Gi0NFx

Cancer of the head and neck: a set of indicators based on register and administrative data.

Cancer of the head and neck: a set of indicators based on register and administrative data.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):13-23

Authors: Andreano A, Ansarin M, Alterio D, Bruschini R, Valsecchi MG, Russo AG

Abstract
SUMMARY: Head and neck (H&N) tumours are a heterogeneous group of neoplasms with 5-year relative survival ranging from about 25% for the hypopharynx to 60% for the larynx in Europe. To improve survival rates, along with therapeutic improvements, it is important to standardise and optimise care received by patients with H&N tumours across different healthcare providers. To reach this goal, it is necessary to evaluate adherence to standards of received care at a population level. Published guidelines can serve as the basis to develop indicators, which can be computed from administrative health databases, measuring the adherence to specific recommendations at the individual level in unselected H&N cancer patients, identified from a population cancer register. We developed a set of indicators and calculated them in a cohort of 2007-2012 incident cases of H&N tumours in the cancer register of the Milan province (n = 1441 cases). The study cohort was mainly composed of men (77%) and patients older than 50 years (89%). Surgery was the most frequently employed treatment (66%). Ten percent of patients had no recorded treatment. Timing between cyto-histological assessment and first therapy for those having a recorded microscopic verification procedure was ≤ 60 days for 90.4% of patients undergoing surgery, 86.3% of those undergoing radiotherapy, and 90.7% of patients receiving chemotherapy. Eighty-three percent of patients underwent cyto-histological assessment in the 180 days before the first treatment. Evaluation by a pain therapist, opioid therapy or hospitalisation for palliative therapy in the 90 days before death was performed in 51% of patients who eventually died of cancer. This is the first Italian study defining and calculating quality indicators to monitor adherence to standards of care received by H&N cancer patients at a population level.

PMID: 29756612 [PubMed - in process]

https://ift.tt/2rHKvl3

Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation.

Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):56-60

Authors: Delgado-Vargas B, Medina M, Polo R, Lloris A, Vaca M, Pérez C, Cordero A, Cobeta I

Abstract
SUMMARY: The most frequent sequelae following a translabyrinthine approach for vestibular schwannoma resection is complete hearing loss on the affected side. Such patients could beneﬁt from a cochlear implant, provided that two essential requisites are met before surgery: a preserved cochlear nerve and a patent cochlea to accommodate the electrode array. The goal of our study is to determine the prevalence and extent of cochlear ossiﬁcation following a translabyrinthine approach. Postoperative MRI of 41 patients were retrospectively reviewed. Patients were classiﬁed according to the degree of cochlear obliteration into three groups (patent cochlea, partially obliterated cochlea and totally obliterated cochlea). The interval between surgery and the ﬁrst MRI was studied as well as its relationship with the rate of cochlear ossiﬁcation. At ﬁrst postoperative MRI (mean interval of 20 months), 78% of patients showed some degree of cochlear ossiﬁcation. Differences were found in the time interval between surgery and ﬁrst MRI for each group, showing a smaller interval of time the patent cochlea group (p > 0.05). When MRI was performed before the ﬁrst year after surgery, a larger rate of patent cochlea was found (p > 0.05). The present study suggests that cochlear ossiﬁcation is a time-depending process, whose grounds are still to be deﬁned.

PMID: 29756611 [PubMed - in process]

https://ift.tt/2IoQH7G

The hump columellar strut: a reliable technique for correction of nasal tip underprojection.

The hump columellar strut: a reliable technique for correction of nasal tip underprojection.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):45-50

Authors: Giacomini PG, Mocella S, DI Girolamo S, DE Berardinis R, Boccieri A

Abstract
SUMMARY: Nasal tip under projection is often found in rhinoplasty cases both for congenital or post-traumatic deformity. Nasal trauma may result in alteration of the external and internal nasal structures with following aesthetic impairment and difficulties in breathing. Post-traumatic surgery is frequent, but restoration of pre-traumatic form and function remains a challenge. The present paper describes a new method to increase tip projection by a columellar strut harvested from the autologous nasal bone and cartilage of the resected hump. A total of 15 cases (11 women/4 men, mean age 32.6 ± 12.3 years) of major tip projection/misalignment abnormalities to be corrected by increased nasal tip projection were drawn, and all underwent closed or open rhinoplasty with the placement of a bony columellar strut harvested from the resected hump of the patient. Short and long-term advantages of this procedure are to be underlined. Harvesting is routinely performed during dorsal resection and preparation of the graft is easy. Differently from bone of the vomer or the inferior turbinate, this is cortical bone straight in shape and rigid in framework, and therefore ideal to gain reliable tip support overtime. No additional harvesting areas are needed. Placement of this bony strut is carried out in the standard fashion without additional dissection or further procedures. Long-term follow-up shows maintained projection over time. This graft can be combined with various grafting or suturing techniques usually applied according to each surgeon's experience and the needs of each patient.

PMID: 29756610 [PubMed - in process]

https://ift.tt/2jX3vrg

Impact of resection margin status on oncological outcomes after CO2 laser cordectomy.

Impact of resection margin status on oncological outcomes after CO2 laser cordectomy.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):24-30

Authors: Aluffi Valletti P, Taranto F, Chiesa A, Pia F, Valente G

Abstract
SUMMARY: The management of positive resection margins in micro-endoscopic glottic laser surgery remains a controversial and critical point. This study aims to assess the impact of margin status after transoral laser surgery on local control, survival and organ preservation rates; the decision-making process and treatment options in cases with positive margins are also discussed. We retrospectively reviewed the clinical and histological records of 308 consecutive patients with primary early glottic carcinoma (T1a, T1b, selected T2) and treated with endoscopic laser cordectomy. Recurrence rates and survival related to margin status were analysed using the Kaplan-Meier method. Local relapses and disease-free-survival rates were significantly related to excision margin status (p < 0.001). In the T1a category (n = 228) no significant differences were observed in disease-free-survival (p = 0.889) and overall survival (p = 0.426) between patients submitted to further treatment (revision endoscopic surgery or radiotherapy) for positive excision margins and patients who were left untreated. In 20 of 24 (83%) patients with positive margins that were surgically re-excised, no residual carcinoma was detected. Margin status (mainly multifocal and deep positive margins) at first surgery was significantly related to the final organ preservation rate (p < 0.001). Margin status during laser cordectomy in early glottic cancer has a prognostic impact on local control of disease without compromising survival. Patients with multifocal and deep positive borders should be surgically retreated and strictly monitored to increase the organ preservation rates. Careful preparation and mapping of the surgical specimen enhances the accuracy of pathological examination by reducing the risk of overestimate positive margins.

PMID: 29756609 [PubMed - in process]

https://ift.tt/2IlDVqt

Nerve and vein preserving neck dissections for oral cancers: a prospective evaluation of spinal accessory nerve function and internal jugular vein patency following treatment.

Nerve and vein preserving neck dissections for oral cancers: a prospective evaluation of spinal accessory nerve function and internal jugular vein patency following treatment.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):7-12

Authors: Kumar Reddy GR, Hulikal N, Lakshmi AY, Vengamma B

Abstract
SUMMARY: Nerve and vein preserving modification of the radical neck dissection is commonly used in the management of oral squamous cell cancers. There is limited literature addressing nerve function and vein patency following treatment. We prospectively analysed 65 patients with nerve conduction study using surface electromyography at baseline, 1 month and 6 months post-surgery and colour Doppler of the internal jugular vein at baseline and 1 month post-surgery. We also studied functional outcomes of nerve sparing with arm abduction test and Neck Dissection Quality of Life questionnaire. There was a statistically significant increase in mean latency of motor action potential and decrease in the mean amplitude of the motor action potential following surgery, suggesting nerve dysfunction. Following surgery, there was a significant decrease in the diameter of the vein as well as an increase in the velocity of blood flow; there was partial thrombus in 5% of individuals. In conclusion, even though nerve dysfunction compromised shoulder abduction, vein dysfunction rarely resulted in any significant clinical impact.

PMID: 29756608 [PubMed - in process]

https://ift.tt/2jXH2dG

Anterior palatoplasty in the treatment of obstructive sleep apnoea - a systemic review.

Anterior palatoplasty in the treatment of obstructive sleep apnoea - a systemic review.

Acta Otorhinolaryngol Ital. 2018 Feb;38(1):1-6

Authors: Pang KP, Pang EB, Pang KA, Rotenberg B

Abstract
SUMMARY: This study seeks to determine the objective and subjective success rates of anterior palatoplasty and its variants for the treatment of obstructive sleep apnoea (OSA). A systematic review with two independent searches of Medline, PubMed, Cochrane Library and Evidence Based Medicine Reviews was performed to identify publications relevant to OSA and anterior palatoplasty. All relevant studies published before 30 June 2015 were included. Six studies were included in the systematic review. The numbers of patients in each paper ranged from 13 to 77 (total = 240), and mean age ranged from 21 to 51 years. Substantial and consistent improvement in polysomnography (PSG) outcomes were observed in patients after the anterior palatoplasty, with or without multilevel surgery. The results showed that the anterior palatoplasty technique provides significantly improvement in the post-operative Apnoea-Hypopnea Index. The mean pre-operative AHI (in the 6 papers) improved from 16.3 to 7.1, the snore visual analogue scale improved from 7.5 to 3.1 and the Epworth score reduced from 11.3 to 7.3 post-operatively. The overall pro-rated pooled success rate for all the patients was 72.5%, with a mean follow-up of 17.3 months. Anterior palatoplasty is an effective option in the management of patients with mild to moderate OSA.

PMID: 29756607 [PubMed - in process]

https://ift.tt/2IlBrsf

The oxen of Oxon Hill Manor: Pathological analyses and cattle husbandry in eighteenth‐century Maryland

International Journal of Osteoarchaeology, EarlyView.

https://ift.tt/2IjdlCt

Periodontitis in the historical population of Radom (Poland) from the 11th to 19th centuries

International Journal of Osteoarchaeology, EarlyView.

https://ift.tt/2jZWeqX

Multidisciplinary management of periocular tumour excision repair

Australasian Journal of Dermatology, EarlyView.

https://ift.tt/2IGmZOX

High burden of atopy in immigrant families in substandard apartments in Sweden – on the contribution of bad housing to poor health in vulnerable populations

Atopic disorders are a global concern. Studies in migrant populations can illuminate the interplay of genetic and environmental factors. Exposures related to bad housing (indoor dampness, mould growth, crowdin...

https://ift.tt/2IMS045

Commentary on: The Opioid Epidemic: Who Is Responsible and What Is the Solution?

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1653952

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

Article in Thieme eJournals:
Table of contents | Full text

https://ift.tt/2InUFNX

Commentary on: The Role of Postoperative Imaging after Orbital Floor Repair

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1645864

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

Article in Thieme eJournals:
Table of contents | Full text

https://ift.tt/2IHWvNe

Addressing the Opioid Epidemic: Impact of Opioid Prescribing Protocol at the University of Minnesota School of Dentistry

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1649498

Prescription opioid medications continue to be abused on an epidemic level and have been shown to be a "gateway" drug to heroin abuse. Individuals experimenting with opioids commonly fall in the 10- to 19-year age range in which dentists are the highest prescribers. To reduce the number of excess opioids, the Department of Oral and Maxillofacial Surgery, University of Minnesota, developed and implemented an evidence-based opioid prescribing policy. Data were collected via electronic health record for the previous year and compared with the year following the protocol implementation. The results showed a drastic decrease (>46%) in the number of prescriptions given over a 1-year period. All departments reported a decrease in opioid prescriptions and the average number of tablets per prescription. The concern of undertreating pain was not found to be significant, as there was no increase in after-hours calls, recall appointments, or documentable emergency room visits. The results support the efficacy of an opioid prescribing policy's ability to lower the frequency and number of opioids given to patients, while still adequately treating patients' pain. Continued evaluation and modifications of the protocol and close monitoring of prescriber habits will enhance patients' pain control while also limiting the number of opioids available for abuse.
[...]

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

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

https://ift.tt/2Inw2Ru

Simultaneous Septal Perforation Repair with Septorhinoplasty: A 31-Year Experience

Facial plast Surg
DOI: 10.1055/s-0038-1654675

Septal perforation repair and septorhinoplasty (SRP) each present unique surgical challenges. However, in many instances, these procedures may be performed together successfully. In this study, the authors aim to determine the safety and effectiveness of combining primary or revision SRP and septal perforation repair via an open approach. A retrospective review was carried out of all consecutive patients who had SRP and septal perforation repair via an open approach between 1986 and 2017 in the senior author's practice. Perforation closure in surgery and at the patient's last follow-up, resolution of presenting symptoms, cosmetic results, and complications were analyzed. Records for 141 patients who had simultaneous septal perforation repair and SRP via an open approach, with a mean follow-up of 3.24 years, were reviewed. The mean anterior–posterior perforation dimension was 1.41 ± 0.89 cm, and the mean vertical perforation dimension was 1.16 ± 0.59 cm. The most common etiologies for septal perforation were previous SRP (35.4%) and septoplasty (24.1%). An overall 93.6%, perforation closure, 91.1% symptom relief, and 91.2% patient satisfaction with cosmetic results were achieved. Septal perforations under 1.5 cm in height were closed in 96.7% of patients as opposed to 71.4% of patients with perforations 1.5 cm or taller. Minor revision rhinoplasties were performed in 7.0% of patients. Postoperative infections were rare and noted in only two (1.4%) patients. In the largest study of its kind to date, the authors have shown that in experienced hands septal perforation repair may be performed simultaneously with primary or revision SRP via an open approach without compromising the perforation repair outcome. The vertical dimension of a septal perforation and presence of mucosa above and below a perforation are important considerations for the difficulty of a perforation closure, as septal mucosa is recruited from these locations in our technique of four-quadrant intranasal bipedicled mucosal advancement flap closure.
[...]

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

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

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Comprehensive Surgical Strategies for the Management of Pachydermoperiostosis

Facial plast Surg
DOI: 10.1055/s-0038-1653992

The cosmetic and functional deformities induced by thickened folds and furrows are the main complaints of patients in pachydermoperiostosis (PDP). However, traditional drug therapy only has a limited effect for its unclear genetic pathogenesis. Surgical treatment has now become one of the optimal strategies mainly aiming for its cosmetic improvement. Here we describe a comprehensive management of PDP approached with surgical procedure thereby showing markedly improved cosmetic outcome. Experientially, the surgical treatment of PDP is effective and may be preferentially recommended for PDP patients especially of severe degree.
[...]

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

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

https://ift.tt/2k0JxMA

Erratum: Intra-Arterial Thrombolytic Therapy Is Not a Therapeutic Option for Filler-Related Central Retinal Artery Occlusion

Facial plast Surg
DOI: 10.1055/s-0038-1656550

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

Article in Thieme eJournals:
Table of contents | Full text

https://ift.tt/2Kq4RpM

A stepped approach for the management of symptomatic internal derangement of the temporomandibular joint

Improved symptomatic, functional, and fluoroscopic outcomes following serial “series of three” double-balloon dilation for cricopharyngeus muscle dysfunction

Reporting quality of randomized controlled trials in otolaryngology: review of adherence to the CONSORT statement

Randomized controlled trials are the gold standard in medical and surgical research to assess the efficacy of therapeutic interventions. The reporting of these trials should be of high quality to allow readers...

https://ift.tt/2Ktz7QS

Three-dimensional changes of proximal segments in facial asymmetry patients after bilateral vertical ramus osteotomy

The intraoral vertical ramus osteotomy (IVRO) is a useful technique for mandibular setback surgery. However, there is a tendency for lateral flaring of the proximal segments on the non-deviation side after the correction of mandibular asymmetry with this technique. The purpose of this retrospective study was to evaluate the positional changes of the proximal segments after IVRO setback in skeletal class III patients with asymmetry, using preoperative and postoperative computed tomography scan data, and to apply the results in clinical practice.

https://ift.tt/2InFpoj

Persistent buccopharyngeal membrane: a rare entity

A buccopharyngeal membrane is bilaminar with ectoderm on one side and endoderm on the other. It separates the primordial mouth from primitive pharynx and foregut, and around day 26 of embryonic development, breaks down as a result of stress caused by the growth of the primitive face in all three dimensions.1 Failure to rupture, results in the presence of a congenital intraoral buccopharyngeal membrane.

https://ift.tt/2rOYR2q

Dermatology education in internal medicine residency programs: A nationwide survey of program directors

https://ift.tt/2KpTuOz

Transoral videolaryngoscopic surgery for papillary carcinoma arising in lingual thyroid

Carcinoma arising in lingual thyroid is an extremely rare entity accounting for only 1% of all reported ectopic thyroids. Here, we report a case of carcinoma arising in lingual thyroid, which has been successfully managed by transoral resection and bilateral neck dissections.A lingual mass 4-cm in diameter with calcification was incidentally detected by computed tomography at medical check-up. No thyroid tissue was observed in normal position. Ultrasound examination showed bilateral multiple lymphadenopathies.

https://ift.tt/2wJ7rW3

Miriam’s Journey to Sound

"It was one of the best days of my life," says Miriam Green in an emotionally charged voice. "I wish... Read the full article...

https://ift.tt/2IGWBoh

Save the Date: Dr. Steven Zeitels to Speak at ORL Frontiers Next Month

Steven Marc Zeitels, MD, is the invited speaker for ORL Frontiers 2018, which will be held Saturday, June 23, at... Read the full article...

https://ift.tt/2Iq7JT7

Amber Luong, MD, PhD Recognized as Trailblazer

Amber Luong, MD, PhD, associate professor of otorhinolaryngology, has been recognized with the 2017 Helen F. Krause, MD Memorial Trailblazer... Read the full article...

https://ift.tt/2k2NUXb

Laparoscopic splenectomy for solitary splenic metastasis in a patient with ovarian cancer with a long disease-free interval: a case report

In general, splenic metastasis of epithelial ovarian cancer is considered a terminal stage resulting in widespread metastasis. Solitary splenic metastasis of epithelial ovarian cancer is rare in patients with ...

https://ift.tt/2Gkxke5

Dengue fever complicated with Guillain-Barré syndrome: a case report and review of the literature

Dengue is an arboviral infection classically presenting with fever, arthralgia, headache, and rashes. It is hyperendemic in Sri Lanka and has a major impact on health. Neurological complications of dengue feve...

https://ift.tt/2rIvC1F

Laser reduction of specific microorganisms in the periodontal pocket using Er:YAG and Nd:YAG lasers: a randomized controlled clinical study

Abstract

The objective of this study was to evaluate the microbiological and clinical outcomes following nonsurgical treatment by either scaling and root planing, combination of Nd:YAG and Er:YAG lasers, or by Er:YAG laser treatment alone. The study involved 60 patients with generalized chronic periodontitis, randomly assigned into one of three treatment groups of 20 patients. The first group received scaling and root planing by hand instruments (SRP group), the second group received Er:YAG laser treatment alone (Er group), and the third group received combined treatment with Nd:YAG and Er:YAG lasers (NdErNd group). Microbiological samples, taken from the periodontal pockets at baseline and 6 months after treatments, were assessed with PET Plus tests. The combined NdErNd laser (93.0%), followed closely by Er:YAG laser (84.9%), treatment resulted in the highest reduction of all bacteria count after 6 months, whereas SRP (46.2%) failed to reduce Treponema denticola, Peptostreptococcus micros, and Capnocytophaga gingivalis. Full-mouth plaque and bleeding on probing scores dropped after 6 months and were the lowest in both laser groups. The combination of NdErNd resulted in higher probing pocket depth reduction and gain of clinical attachment level (1.99 ± 0.23 mm) compared to SRP (0.86 ± 0.13 mm) or Er:YAG laser alone (0.93 ± 0.20 mm) in 4–6 mm-deep pockets. Within their limits, the present results provide support for the combination of Nd:YAG and Er:YAG lasers to additionally improve the microbiological and clinical outcomes of nonsurgical periodontal therapy in patients with moderate to severe chronic periodontitis.

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Dexmedetomidine as an adjuvant during general anesthesia

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Outcomes and prognostic factors for parotid acinic cell Carcinoma: A National Cancer Database study of 2362 cases

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Claudia Scherl, Masanari G. Kato, Evren Erkul, Evan M. Graboyes, Shaun A. Nguyen, Angela C. Chi, Patrick F. Morgan, Terry A. Day
ObjectivesTo evaluate the demographics, clinical features, survival outcomes, and prognostic indicators of patients with acinic cell carcinoma (ACC) of the parotid gland with emphasis on the roles of grade, tumor size, and nodal status in survival.Materials and methodsA retrospective analysis of cases diagnosed between 2004 and 2012 from the National Cancer Database was performed. Multivariable logistic regression was used to determine factors associated with survival.Results2362 cases were identified. Most patients were females (61.3%) and Caucasian (85.4%) with a median age of 54 years (range, 18–90 years). Most tumors were <3 cm in size (75.8%). Regional metastases and high-grade histology were rare (8.2%, 5.1%). All patients received surgery as primary treatment with 42.7% of patients receiving adjuvant radiation therapy or chemoradiotherapy. 5 year overall survival was 88.6%. On multivariable analysis, age >70 years (hazard ratio [HR]: 10.05, 95% confidence interval [CI]: 5.64–17.91), high-grade (HR: 5.30, 95% CI: 3.39–8.29), tumor size of 3 to 6 cm (HR: 1.53, 95% CI: 1.10–2.12), tumor size >6 cm (HR: 2.98, 95% CI: 1.681–5.289), pN2+ (HR: 3.14, 95% CI: 2.10–4.69), T4 (HR: 2.89, 95% CI: 1.74–4.80) were significant prognosticators.ConclusionAlthough patients with ACC generally are considered to have a favorable prognosis, an aggressive subgroup with poor outcomes was identified. This group is characterized by high-grade, advanced T classification, tumors larger than 3 cm, with regional metastases and age greater than 70 years. Histologic grade is a substantially stronger predictor of survival than T and N classifications.

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Faktenblatt: Epidemiologie des malignen Melanoms in Deutschland

Zusammenfassung

Dieses Faktenblatt bietet eine Übersicht über die Epidemiologie zum malignen Melanom in Deutschland, dabei wird für beide Geschlechter die Inzidenz und Mortalität sowie das 10-Jahres-Überleben für das maligne Melanom insgesamt und für einzelne histologische Subtypen dargestellt.

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Management of tinnitus in children: Review of literature and effect of counseling

Publication date: August 2018
Source:Auris Nasus Larynx, Volume 45, Issue 4
Author(s): Doh Young Lee, Ji Young Lee, Young Ho Kim
ObjectiveTinnitus in children has not been studied sufficiently to date. And, there is no consensus regarding the management of tinnitus in children. Tinnitus counseling can be considered as the most basic tool among therapeutic options of tinnitus in children. In this article, the importance of management in children with tinnitus is highlighted through the review of the literature. Also, we present survey results regarding usefulness and necessity of tinnitus counseling provided from parents of children with tinnitus.MethodsStudies reporting the management of pediatric tinnitus were reviewed by searching the Pubmed (MEDLINE) databases for studies published from 1980 through 2017. Three articles were eligible for review in terms of quantitative measurement of tinnitus improvement. Survey for eighteen participants were performed who visited our clinic, improvement by counseling and subjective benefit were evaluated by questionnaire. Various demographic and audiologic parameters were subjected into correlation analysis of benefit of counseling.ResultsThree studies which included management of pediatric tinnitus were reviewed. One article reported that children with hearing loss failed to show improvement of tinnitus by hearing aids. However, recent two articles showed that children with or without hearing loss showed fair improvement of tinnitus by tinnitus retraining therapy and noise generator. The survey demonstrated that overall 83.3% showed subjective improvement by tinnitus counseling. Among demographic and audiological parameters, benefit from counseling was significantly associated with age and presence of hearing loss (p=0.037 and p=0.005, respectively).ConclusionsPediatric tinnitus is likely to have a higher chance of improvement by counseling alone or combination therapy without medication. Conservative management of tinnitus based on education and counseling instead of medical or surgical treatment should be developed more.

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Editorial Board

Publication date: August 2018
Source:Auris Nasus Larynx, Volume 45, Issue 4

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3D-constructive interference into steady state (3D-CISS) labyrinth signal alteration in patients with vestibular schwannoma

Publication date: August 2018
Source:Auris Nasus Larynx, Volume 45, Issue 4
Author(s): Franca Wagner, Evelyn Herrmann, Roland Wiest, Andreas Raabe, Corrado Bernasconi, Marco Caversaccio, Dominique Vibert
ObjectiveTo evaluate signal intensity of the inner ear using 3D-CISS imaging and correlated signal characteristics in patients with vestibular schwannoma to neuro-otological symptoms.MethodsSixty patients with unilateral vestibular schwannoma were retrospectively reviewed. All patients had had initial and follow-up magnetic resonance imaging (MRI). Individual treatment strategies consisted of "wait-and-watch", surgical tumour resection, stereotactic radiosurgery or both surgery and stereotactic radiosurgery. For all patients a complete baseline and treatment course neuro-otological examination was re-studied.ResultsOn initial MRI, 3D-CISS sequence signal loss of the membranous labyrinth was present in 20 patients (33.3%); signal loss of cochlea in 20 (33.3%) and coincident signal loss of sacculus/utriculus in 17 (85%) of them. Sequential analysis of follow-up MRI series demonstrated slightly increased labyrinthine signal degradation, independently of the chosen therapy. Correlation of initial MRI results with initial neuro-otological symptoms showed significance only for cochlear obstruction versus vertigo (p=0.0397) and sacculus/utriculus obstruction versus vertigo (p=0.0336). No other statistically significant relationships were noted.Conclusion3D-constructive interference into steady state (3D-CISS) is appropriate for observing inner ear signal loss in patients with vestibular schwannoma. However, except for vertigo, no significant correlation was noted between initial neuro-otological symptomatology and signal loss of the inner ear.

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Cochlear implant function in a patient with Jervell and Lange-Nielsen syndrome after defibrillation by countershock

Publication date: August 2018
Source:Auris Nasus Larynx, Volume 45, Issue 4
Author(s): Shinsuke Kaneshiro, Harukazu Hiraumi, Kirito Shimamoto, Kaori Sasamori, Yumiko Kobayashi, Hiroaki Sato
Jervell and Lange-Nielsen syndrome (JLNS), a rare autosomal recessive congenital QT prolongation syndrome, is characterized by cardiac arrhythmias, syncopal episodes, and profound deafness. A cochlear implant (CI) for patients with JLNS is expected to result in hearing improvement. Sometimes, defibrillation is required if a patient experiences lethal arrhythmia. In this paper, we report a pediatric patient with JLNS who received defibrillation after CI surgery in his right ear at the age of 2 years. With intensive care, the post-operative course was uneventful, and the patient acquired satisfactory speech and hearing abilities. Five years after the surgery, he underwent defibrillation because of the incidence of syncopal attack. Thereafter, arrhythmic syncope recurred three times, which necessitated defibrillation therapy. To prevent recurrence of cardiac arrhythmia, he underwent ICD (implantable cardioverter-defibrillator) implantation at the age of 11 years. At present, CI works well and provides good hearing, while syncopal attack is prevented by ICD. From the experience of this case, electronic circuit of CI is thought to tolerate emergency countershock if the speech processor is removed.

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

Publication date: August 2018
Source:Auris Nasus Larynx, Volume 45, Issue 4
Author(s): Chin-Fang Chang, Ming-Yu Hsieh, Mu-Kuan Chen, Ming-Chih Chou

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Parvovirus B19 induced red cell aplasia in a heart transplant patient diagnosed on pleural fluid

No abstract available

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On Reporting of the Outcomes from Clinical Trials; a Call to Order

No abstract available

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Association between duration of delayed graft function, acute rejection and allograft outcome after deceased donor kidney transplantation

Background Prolonged duration of delayed graft function (DGF) may be associated with adverse allograft outcomes, but the association between threshold duration of DGF, acute rejection and long-term allograft loss remains undefined. We aimed to determine the impact of DGF duration on allograft outcomes and to assess whether this association was mediated by acute rejection. Methods Using data from the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, Cox proportional modelling was used to determine the association between quartiles of DGF duration, acute rejection at 6 months and death-censored graft loss (DCGL). Mediation analysis was conducted to determine whether acute rejection was a causal intermediate between DGF and DCGL. Results Of 7668 deceased donor kidney transplants between 1997-2014, 1497 (19.5%) recipients experienced DGF requiring dialysis. The median (interquartile range) duration of DGF was 7(9) days, with 25% requiring dialysis for ≥14 days. Among recipients who had experienced DGF duration of 1-4 days, the adjusted HR for duration of 5-7, 8-13 and ≥14 days were 1.13 (95%CI 0.83-1.55;p=0.43), 1.44 (1.08-1.91;p=0.013), and 1.99 (1.50-2.65;p

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Pregnancy and Heart Transplantation: Giving Birth After a New Life

No abstract available

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A new life: motherhood after heart transplantation. A single center experience and review of literature

Background Pregnancy after heart transplantation (HTx) may expose the recipient to hemodynamic and immunologic risks, and the newborn to toxic effects of immunosuppressive therapy. Adequate preconception counseling is crucial to identify optimal timing and to modify immunosuppressive therapy in order to minimize risks for both the mother and the fetus. Method We describe our experience with 12 pregnancies occurred in 11 women who had undergone HTx at our center. Results Pregnancies ran without severe complications or rejections, and none of the babies shown major defects at birth. However, as reported in the literature, weight at birth rated in lower range in most of the newborns, probably due to in utero cyclosporine exposure. Up to now, none of the babies showed clinical signs of heart disease, although more than half of the mothers had an inherited or familial cardiomyopathy. Conclusions Despite potential mother and fetal complications, successful pregnancy and delivery are possible after HTx, provided that optimum timing, close monitoring and therapy adjustments are guaranteed. Becoming a mother appears to be an important achievement for young women after HTx, even when there is the risk to transmit an inheritable heart disease. Address for correspondance: Francesca Macera: francesca.macera@ospedaleniguarda.it DISCLOSURES The authors have no conflicts of interest to disclose. AUTHORSHIP: MF, OL, MV acquired the data. MF, OL drafted the manuscript. MG, FM made critical revision for key intellectual contents. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The Anti-inflammatory Effect of Hydrogen on Lung Transplantation Model of Pulmonary Microvascular Endothelial Cells During Cold Storage Period

Background Lung ischemia-reperfusion injury (LIRI) remains an important factor for the early mortality of lung transplantations. Hydrogen (H2) can attenuate lung injury and improve lung function in animal experiments. In previous studies, pulmonary microvascular endothelial cells (PMVECs) were used to simulate LIRI. We hypothesized that H2 can alleviate inflammatory injury in a PMVECs lung transplantation model in the cold ischemia phase. Methods PMVECs were divided into 4 groups: Blank, Control, Oxygen (O2), and Hydrogen (H2). The Blank group included PMVECs without treatment. During the cold storage period, the O2 group was aerated with 40% O2 and 60% N2, and the H2 group was aerated with 3% H2, 40% O2 and 57% N2. The Control group was aerated without gases. The mixed gases were replaced every 20 min for 4 h. During the transplantation period, the sealed containers were warmed for 1 h at room temperature. In the reperfusion period, the containers were aerated with 50% O2, 5% CO2 and 45% N2 at 37 °C. Results The concentrations of IL-6 and TNF-α in the extracellular solutions were significantly decreased, and the concentration of IL-10 was increased in the H2 group. ICAM-1 expression was inhibited by hydrogen. Furthermore, hydrogen decreased the activation of NF-κB and phosphorylation level of p38. Cell apoptosis was alleviated. The pathological changes in the cell and mitochondria were alleviated after hydrogen administration. Conclusion Hydrogen attenuated inflammatory response in a PMVECs lung transplantation model during cold storage. The effect may be achieved by inhibition of p38 MAPK and NF-κB pathways. Correspondence information: Huacheng Zhou, Department of Anesthesiology, the Fourth Affiliated Hospital, Harbin Medical University, Harbin 150001, China. Email: zhouhuacheng@163.com AUTHORSHIP Guangchao Zhang √_ Conceived and designed the research; √_ Analyzed the data; √_ Performed statistical analysis; √_ Handled funding and supervision; √_ Drafted the manuscript; √_Made critical revision of the manuscript for important intellectual content Zhe Li √_ Conceived and designed the research; √_ Acquired the data; √_ Performed statistical analysis; √_ Drafted the manuscript; √_Made critical revision of the manuscript for important intellectual content Chao Meng √_ Conceived and designed the research; √_ Acquired the data; √_Made critical revision of the manuscript for important intellectual content Jiyu Kang √_ Conceived and designed the research; √_ Acquired the data; √_Made critical revision of the manuscript for important intellectual content Mengdi Zhang √_ Acquired the data; √_ Analyzed the data; √_Made critical revision of the manuscript for important intellectual content Liangjuan Ma √_ Analyzed the data; √_Made critical revision of the manuscript for important intellectual content Huacheng Zhou √_ Conceived and designed the research; √_ Analyzed the data; √_ Performed statistical analysis; √_Made critical revision of the manuscript for important intellectual content Disclosure: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The National Nature Science Foundation of China (Grant 81570088). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Nicht metastasiertes Rektumkarzinom

Zusammenfassung

Die Chirurgie nimmt die Schlüsselrolle in der kurativen Therapie des Rektumkarzinoms ein. Bei Niedrigrisikokarzinomen genügt die Vollwandexzision. Fortgeschrittenere oder biologisch aggressivere Karzinome im Stadium I werden im Sinne einer total mesorektalen Exzision operiert. Karzinome im Stadium II/III des oberen Drittels werden meist wie Kolonkarzinome behandelt. Bei ausgedehntem lymphogenem Befall oder organüberschreitendem Wachstum ist eine neoadjuvante Radiochemotherapie (RCTX) vor der Operation sinnvoll. Karzinome im Stadium II/III des unteren/mittleren Drittels werden multimodal behandelt. Dabei ist die neoadjuvante RCTX effektiver als die adjuvante, bei gleichzeitig besserer Verträglichkeit. Die Operation erfolgt nach einem Intervall von 6 bis 8 Wochen. In frühen Tumorstadien mit klinisch unsicherem Lymphknotenbefall kann der Verzicht auf die neoadjuvante RCTX gerechtfertigt sein. Bei kleinen Tumoren ohne Lymphknotenmetastasen ist alternativ auch ein organerhaltendes Vorgehen möglich.

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PAI‐1, CAIX, and VEGFA expressions as prognosis markers in oral squamous cell carcinoma

Journal of Oral Pathology &Medicine, EarlyView.

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Comparison of Bone Grafts From Various Donor Sites in Human Bone Specimens

The objective of the current study was to compare the three-dimensional (3D) morphometric microstructure in human cadaveric bone specimens taken from various commonly utilized donor sites for autogenous bone grafting. Autogenous bone grafts can be harvested from various anatomic sites and express heterogeneous bone quality with a specific 3D microstructure for each site. The long-term structural integrity and susceptibility to resorption of the graft depend on the selected donor bone. Micro-computed tomography generates high-resolution datasets of bone structures and calcifications making this modality versatile for microarchitecture analysis and quantification of the bone. Six bone specimens, 10 mm in length, where anatomically possible, were obtained from various anatomical sites from 10 human dentate cadavers (4 men, 6 women, mean age 69.5 years). Specimens were scanned using a micro-computed tomography device and volumetrically reconstructed. A virtual cylindrical inclusion was reconstructed to analyze the bone mineral density and structural morphometric analysis using bone indices: relative bone volume, surface density, trabecular thicknesses, and trabecular separation. Calvarial bone specimens showed the highest mineral density, followed by the chin, then mandibular ramus then the tibia, whereas iliac crest and maxillary tuberosity had lower bone mineral densities. The pairwise comparison revealed statistically significant differences in the bone mineral density and relative bone volume index in the calvaria, mandibular ramus, mandibular symphysis groups when compared with those in the iliac crest and maxillary tuberosity, suggesting higher bone quality in the former groups than in the latter; tibial specimens expressed variable results. Address correspondence and reprint requests to Mohammad Kamal, MD, DMD, Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße, Aachen, Republic of Germany; E-mail: mkamal@ukaachen.de Received 4 October, 2017 Accepted 9 March, 2018 Mohammad Kamal and Felix Gremse contributed equally to this work and are considered as joint first authors. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Electromyographic Activity of the Masseter and Temporal Muscles in Patients With Nonsyndromic Complete Unilateral Cleft Lip and Palate: 2-Stage Versus 1-Stage Palate Repair

Objective: To assess the electromyographic activity of the masseter and temporal muscles in cleft patients who underwent 1-stage palate repair versus 2-stage palate repair. Methods: Thirty-two patients with nonsyndromic complete unilateral cleft lip and palate operated by 2 different protocols for palate repair, 1-stage (group 1, n = 16) versus 2-stage with delayed hard palate closure (group 2, n = 16) were available in the retrospective longitudinal study. Standardized electromyographic records of the masseter and anterior portion of temporal muscles were obtained with 2 repetitions during mastication and rest. Results: No statistically significant (all P > 0.05) differences were observed in the electromyographic data between the groups 1 and 2. Conclusion: There were similar electromyographic activity of masseter and temporal muscles during mastication and at rest after 1- and 2-stage palate closure. Address correspondence and reprint requests to Anelise Sabbag, SLP, Department of Speech and Language Pathology , SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo CEP: 13084–880, Brazil; E-mail: anesabbag01@gmail.com Received 10 October, 2017 Accepted 9 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Greater Occipital Nerve Decompression for Occipital Neuralgia

The aim of the study was to evaluate the effectiveness of greater occipital nerve decompression for the management of occipital neuralgia. Eleven patients of medical refractory occipital neuralgia were enrolled in the study. Local anaesthetic blocks were used for confirming diagnosis. All of them underwent surgical decompression of greater occipital nerve at the level of semispinalis capitis and trapezial tunnel. A pre and postoperative questionnaire was used to compare the severity of pain and number of pain episodes/month. Mean pain episodes reported by patients before surgery were 17.1 ± 5.63 episodes per month. This reduced to 4.1 ± 3.51 episodes per month (P

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Maternal Folic Acid Supplementation and the Risk of Oral Clefts in Offspring

Introduction: There is controversial evidence from the literature regarding the protective effect of folic acid supplementation during pregnancy against orofacial clefts. The authors undertook this meta-analysis to assess whether folate supplementation during pregnancy can reduce the risk of nonsyndromic cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO) in infants. Methods: Eligible articles were identified by searching databases, including PubMed, Medline, Scopus, ISI (Web of Knowledge) to September 2017. A meta-analysis was performed to evaluate the effects of maternal supplementation on oral clefts. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using Stata software. Publication bias was assessed by the Begg and Egger test. (Registration ID: CRD42018083922) Results: Out of the 1630 articles found in the authors' initial literature searches, 6 cohort studies, and 31 case-control studies were included in the authors' final meta-analysis. The results of the main analysis revealed that maternal folate supplementation was associated with a modest but statically significant decreased risk of all cleft subtypes (OR = 0.69, 95% CI: 0.60, 0.78). Folic acid intake alone was inversely associated with CL/P (OR = 0.73, 95% CI: 0.62–0.85,) but to a lesser extent than CPO (OR = 0.75, 95% CI = 053–1.04). Multivitamin intake had a significant protective effect for CL/P (OR = 0.65 95% CI = 0.55–0.80) as well as CPO (OR = 0.69, 95% CI = 0.53–0.90). Conclusions: Our results indicate that maternal supplementation in early pregnancy reduces the risk of nonsyndromic CL/P and CPO in infants. These data can serve to reassure women planning a pregnancy to consume multivitamins during the periconception period to protect against oral clefts. Address correspondence and reprint requests to Elaheh Shadkam, MD, Orthodontic Department, Mashhad Dental School, Vakilabad blvd, Azadi square, Mashhad 91735, Iran; E-mail: elaheshadkam@yahoo.com Received 28 October, 2017 Accepted 27 January, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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Reinforcement of Lower Lateral Cartilage Using Sliced Costal Periphery to Reconfigure Nasal Tip in Asian Rhinoplasty

Background: Reinforcement of lower lateral crura (LLC) is an imperative prophylaxis against the secondary deformity of alar and nasal tip in Asian rhinoplasty. The common limitation of the existing techniques is loss of nasal tip's mobility to a large degree in exchange for structural stability. In search for a natural and animated postoperative nasal tip, the elasticity and rigidity of coastal periphery was taken into account. Method: Two pieces of sliced costal periphery (SCP) were used to reinforce the LLC. One hundred twenty patients who accepted this technique and completed 18-month follow-up were included in this study. They were all females in which 67 patients underwent the primary rhinoplasty, and the remaining 53 patients underwent the revision rhinoplasty. Two pieces of septal extension grafts and 2 strips of SCP were used in all patients. Videos and pictures were taken and analyzed preoperatively and at 18 months postoperatively. Result: The videos and pictures showed the pleasing contour and mobility of nasal tip. No complications associated with the LLC occurred. All patients who underwent primary rhinoplasty were pleased about the postoperative contour and mobility of nasal tip. In revision rhinoplasty group, 30 patients (56.6%) who had complained about the stiffness or mobility loss of the nasal tip before became satisfied with the soft and animated nasal tip after the surgery. Conclusion: Reinforcement of LLC by SCP is a promising technique to achieve natural and animated nasal tip. Moreover, this technique is helpful to prevent or restore the problems associated with the inherent weak or iatrogenic cripple of LLC in Asians rhinoplasty. Studies with longer follow-up and larger sample should be done to trace the reliability and practicability in the long run. Address correspondence and reprint requests to Baokai Li, MD, Shanghai Mylike Medical Cosmetic Hospital, 789 West Yanan Road, Changning District, Shanghai, China; E-mail: 458649766@qq.com Received 2 November, 2017 Accepted 11 February, 2018 YN, HZ, and BL contributed equally to this paper. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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A Giant Congenital Soft Tissue Sinonasal Fibromyxoma of the Nose in a Newborn Baby

Myxomas of the nose are very rare benign neoplasms. They grow slowly, infiltrate the surrounding bone cortex, and develop multiple local recurrences with no distant metastasis. Almost, even knowing seen at any age, it is very rare in newborn. The authors present a patient with sinonasal soft tissue fibromyxoma in a newborn baby nose followed by the literature. Address correspondence and reprint requests to Nur Yucel Ekici, MD, Adana Numune Training and Research Hospital, Adana, Turkey; E-mail: nuryekici@hotmail.com Received 6 November, 2017 Accepted 7 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Endoscopy-Assisted Frontal Sinus Obliteration

Comminuted fractures of the anterior table of the frontal sinus involving frontonasal ducts are traditionally treated with sinus obliteration. This technique entails precise mucosa removal which requires unimpeded visualization of the bony recesses. To achieve adequate access to the mucosa, temporary removal of a large part of the frontal bone may often be necessary. This in turn increases fracture comminution requiring placement of additional hardware associated with the risk for bony malalignment, infection, plate palpability, and visibility, especially in thin-skin individuals. Endoscopy, offering magnified visualization and less invasive access, is reported to be beneficial in sinus injury management. Therefore, it may be also considered an adjunct in open-approach management of severely comminuted fractures. The authors' patient suffered from comminuted fractures of the anterior and posterior tables of the frontal sinus and nasal bone fractures with involvement of the frontonasal ducts. Due to the extent of the injury he underwent frontal sinus obliteration procedure using the pericranial flap. To avoid additional osteotomy, endoscopic approach was undertaken to achieve the complete removal of the sinus mucosa. The fracture by itself offered an "access port" for the endoscope and electrical cautery. The patient's recovery was uneventful. Endoscopy employed in frontal sinus obliteration appears to be instrumental in obtaining meticulous mucosa removal, obviating the need for additional osteotomy of the frontal bone. Address correspondence and reprint requests to Ewa Komorowska-Timek, MD, Advanced Plastic Surgery, 3855 Burton Street SE, Suite A, Grand Rapids, MI 49546; E-mail: etimek@apsgr.com Received 22 November, 2017 Accepted 16 February, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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Temporal Progression of Craniofacial Dysmorphology in Unilateral Coronal Synostosis: A Mechanistic Hypothesis

Aim: This study chronicles skull base and face development in nonsyndromic unilateral coronal synostosis (UCS) during infancy, to characterize the mechanistic progression of facial dysmorphology. Methods: Computed tomography scans from 51 subjects were reviewed (26 UCS, 25 controls) and data were reconstructed. Patients were stratified into 5 age groups. A series of measurements were taken from the reconstructions. Results: All patients had a unilaterally fused coronal suture at the time of analysis. Asymmetry of the sphenoid wings was present across all age groups. The sphenoid wing ipsilateral to the fused suture consistently had a more acute angle from the midline. At 19 days of age, ipsilateral nasal root and cribriform plate deviation are noted, as well as increased contralateral zygoma antero-posterior length. Patients younger than 2 months also had elongated posterior cranial bases. At 2 to 3 months of age, the cranial base widens in the anterior portion of the middle cranial fossa with an increased ipsilateral pterion to sella distance. The most delayed change observed was the increase in contralateral orbital rim angle at 7 to 12 months of age compared to normal. Conclusion: After suture fusion, sphenoid wing changes are among the earliest restructural malformations to take place. This suggests that the cascade of dysmorphology in UCS originates in the cranial vault, then progresses to the skull base, and lastly to the facial structures. Ipsilateral orbital changes are early facial changes in UCS that begin before 2 months of age. This is then followed by changes in the contralateral face later in development. Address correspondence and reprint requests to John A. Persing, MD, Section Chief, Irving and Silik Polayes Professor of Surgery (Plastic), Plastic and Reconstructive Surgery, Yale School of Medicine, 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520; E-mail: john.persing@yale.edu Received 28 November, 2017 Accepted 23 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Endoscopically Assisted Modified Caldwell-Luc Approach to Enucleation of Dentigerous Cyst With Ectopic Tooth From the Maxillary Sinus

Dentigerous cysts in the craniomaxillofacial complex are a benign pathology commonly associated with ectopically placed teeth. Owing to slow and asymptomatic growth, they often attain considerable size before diagnosis that may compromise adjacent anatomical structures. Various techniques for removal of dentigerous cysts from the maxillary sinus have been described. This case report demonstrates a hybrid endoscopically assisted modification of the Caldwell-Luc approach to provide the technical advantages of both techniques Address correspondence and reprint requests to Dr Andrew Cheng, BDS, MBBS, Oral and Maxillofacial Surgery Unit, Adelaide Dental Hospital. Frome Rd, Adelaide, South Australia 5000, Australia; E-mail: ahacheng@hotmail.com Received 27 September, 2017 Accepted 30 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2IgDPEF

Nodular Tenosynovitis of the Temporomandibular Joint: An Entity Not Yet Described

Nodular tenosynovitis usually affects the hands and it represents a benign pathology with locally aggressive behavior. Its etiology could be related to chronic inflammatory processes such as trauma, metabolic disturbance, and joint diseases. Histopathological analysis is required for a diagnosis of certainty and surgery represents the treatment of choice. There are no cases in the literature that describe a nodular tenosynovitis affecting the temporomandibular joint (TMJ) The main aim of the present report therefore, is to describe this unusual case and to show the utility of arthroscopic procedures in managing intra-articular tumors of the TMJ. Address correspondence and reprint requests to Paolo Cariati, Hospital Neurotraumatologico, Departamento de Cirugía Oral y Maxilofacial, Carretera de Jaen s/n, 18013, Granada, Spain; E-mail: paolocariati1@gmail.com Received 29 November, 2017 Accepted 7 February, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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Treatment of Craniosynostosis: The Impact of Hospital Surgical Volume on Cost, Resource Utilization, and Outcomes

The authors aim to quantify the impact of hospital volume of craniosynostosis surgery on inpatient complications and resource utilization using national data. Children

https://ift.tt/2rHM8OX

A Case of Juvenile Psammomatoid Ossifying Fibroma on Skull Base

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare tumor that occurs in maxillary sinus or orbit. Complete removal is required due to the aggressive and locally destructive nature. It is hard to distinguish from psammomatoid meningioma in cranial lesion and to remove completely. The authors are presenting a case of 26-year-old male with JPOF on skull base and report this case with review of literature. Address correspondence and reprint requests to Jin Hee Cho, MD, PhD, Department of Otorhinolaryngology – Head and Neck Surgery, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul 07345, South Korea; E-mail: entcho@catholic.ac.kr Received 17 May, 2017 Accepted 4 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Management of Severe Cicatricial Entropion With Labial Mucous Membrane Graft in Cicatricial Ocular Surface Disorders

The management of cicatricial entropion represents a therapeutic challenge especially when the underlying causes are progressive cicatricial diseases that affect the ocular surface. The authors aimed to report long-term efficacy of labial mucous membrane graft to manage severe cicatricial entropion of the upper eyelid. This study is a retrospective chart review of patients who underwent tarsotomy associated with labial mucous membrane graft to treat severe cicatricial entropion of the upper eyelid. Surgeries were performed over a 16-year period. Clinical data (age, gender, etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period) were extracted from these patients' charts. Etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period were evaluated. Sixty-three eyelids from 44 patients underwent surgery. Mean follow-up was 48.4 ± 46.1 months (range 6 months to 15 years). Main underlying diagnoses were Stevens–Johnson syndrome (63%), trachoma (19%), chemical injury (8%), and trauma (5%). Forty-three patients (98%) reported improvement of ocular symptoms after the procedure. Complete resolution (restoration of the upper eyelid margin to normal anatomic position with good esthetic appearance) was achieved in 52 eyelids (83%). Recurrence occurred in 7 (11%) eyelids. No postoperative infection, failure of graft survival, or other complications were observed. The use of labial mucous membrane as a posterior lamella graft showed good functional and cosmetic outcomes, long-term stability and low recurrence rates in the treatment of severe cicatricial entropion of the upper eyelid. Address correspondence and reprint requests to Midori H. Osaki, MD, MBA, Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Paulista School of Medicine, São Paulo, SP, Brazil; Osaki Ophthalmic Plastic Surgery, Vergueiro St, 2045 St 1009, São Paulo, SP, Brazil 04101-000; E-mail: midori_osaki@yahoo.com.br Received 10 February, 2018 Accepted 6 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Comparison of the peripheral antinociceptive effect of somatostatin with bupivacaine and morphine in the rodent postoperative pain model

BACKGROUND AND OBJECTIVES Infiltration of surgical wound with local anaesthetics attenuate postoperative pain. However, side effects can also occur. Somatostatin (SST) and its analogues like octreotide reportedly reduce peripheral sensitisation. The current study evaluates peripherally mediated antinociceptive effect of SST in a rat model of postoperative pain. This was compared with bupivacaine and morphine under identical experimental conditions. DESIGN Randomised vehicle-controlled blind study. SETTING Pain research laboratory, All India Institute of Medical Sciences, New Delhi from February 2014 to July 2017. EXPERIMENTAL SUBJECT Rodent hind paw incision model. INTERVENTIONS Sprague-Dawley rats were subjected to incision and one of the following drugs administered into the open wound once by a micropipette: SST (10, 30 or 100 μg), bupivacaine (3, 10, 30, 50 or 100 μg) or morphine (100 μg). Antinociceptive effect of SST was further evaluated for its reversibility, site of action, effect on spinal c-fos expression and blood glucose level. The site of action of morphine was also investigated. MAIN OUTCOME MEASURE Nociception was estimated by nonevoked (guarding behaviour) and evoked (mechanical allodynia and thermal hyperalgesia) pain behaviours between 2 h and days 4 to 7. RESULTS Nociception was maximum 2 h after incision. SST (10 to 100 μg) significantly attenuated guarding behaviour between 2 h and day 2. A delayed inhibitory effect was observed on allodynia. Bupivacaine (10 to 100 μg doses) similarly decreased guarding score up to day 2 though evoked pain behaviours were relatively unaffected. In contrast, morphine produced a potent but transient inhibitory effect on guarding score at 2 h, which was mediated by both peripheral and central opioid receptors. The antinociceptive effect of SST was peripherally mediated by type 2 receptors and was associated with decreased c-fos staining. Blood glucose level was unaltered. CONCLUSION Guarding behaviour, which likely represents pain-at-rest following surgery, was attenuated by both bupivacaine and SST to comparable extents. This novel peripherally mediated antinociceptive effect of SST needs further evaluation. Correspondence to Subrata Basu Ray, Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110029, India Tel: +91 11 26593453; fax: +91 11 26588641; e-mail: raysb48@gmail.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Rare Location for Pilonidal Sinus: the Nasal Dorsum

Pilonidal sinuses are recurrent chronic inflammatory lesions which may occur due to penetration of hair particles into skin. Herein, the authors report a pilonidal sinus case that is unusually seen on nasal dorsum and totally excised with the open technique rhinoplasty method. A 20-year-old male patient was admitted to the authors' outpatient clinic with complaints of dysmorphism and discharge from nasal dorsum. Physical examination revealed a swelling in nasal dorsum and hair-containing fistula. Excision was performed with an open rhinoplasty approach. Histo-pathology examination revealed pilonidal sinus. While pilonidal sinus is usually located in sacro-coccygeal region, it may also be seen in atypical localizations like nasal dorsum. Although the prediagnosis of a hair-containing lesion usually includes dermoid cyst, pilonidal sinus should also be considered and histo-pathological examination should certainly be performed. It is a problematic condition when it is symptomatic; however, management and treatment of the disease is easy when correct diagnosis is made. Address correspondence and reprint requests to Ayhan Kars, MD, Otorhinolaryngology Clinics, Regional Training and Research Hospital, Erzurum 25040, Turkey; E-mail: drakars25@hotmail.com Received 23 December, 2017 Accepted 11 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Extended Release Liposomal Bupivacaine Injection (Exparel) for Early Postoperative Pain Control Following Palatoplasty

Introduction: Liposomal bupivacaine (LB) is a long-acting local anesthetic reported to decrease postoperative pain in adults. The authors demonstrate the safe use of LB in pediatric patients with improved pain control following palatoplasty. Materials and Methods: Retrospective patient series of all single-surgeon palatoplasty patients treated at a tertiary craniofacial center from August 2014 to December 2015 were included. All patients received 1.3% LB intraoperatively as greater palatal nerve and surgical field blocks in 2-flap V–Y pushback palatoplasty. Postoperative oral intake, opioids administered, duration of hospitalization, and FLACC (face, legs, activity, cry, consolability) pain scores were measured. Results: Twenty-seven patients (16 males and 11 females, average age of 10.8 months, weight 8.8 kg) received 2.9 ± 0.9 mL (2.6 ± 1.9 mg/kg) 1.3% LB. Average FLACC scores were 2.4 ± 2.2/10 in the postanesthesia care unit and 3.8 ± 1.8/10 while inpatients. Oral intake was first tolerated 10.3 ± 11.5 hours postoperatively and tolerated 496.4 ± 354.2 mL orally in the first 24 hours postoperatively. Patients received 8.5 ± 8.4 mg hydrocodone equivalents (0.46 ± 0.45 mg/kg per d hydrocodone equivalents) and were discharged 2.1 ± 1.3 days postoperatively. Opioid-related adverse events included emesis in 7.4% and pruritis in 3.7% of patients. Conclusions: The LB may be used safely in pediatric patients. Intraoperative injection of LB during palatoplasty can yield low postoperative opioid use and an early and adequate volume of oral intake over an average hospital stay. Further cost-efficacy studies of LB are needed to assess its value in pediatric plastic surgery. Address correspondence and reprint requests to Kristopher M. Day, MD, Apt N104, 5840 Lake Resort Terrace, Chattanooga, TN 37415; E-mail: kristophermday@gmail.com Received 2 January, 2018 Accepted 9 March, 2018 Presented at 40th Annual Thuss Lecture of the Department of Plastic Surgery at the Vanderbilt University Medical Center; April 15, 2017 in Nashville, TN; and Plastic Surgery the Meeting, the annual scientific meeting of the American Society of Plastic Surgery; October 7, 2017 in Orlando, FL. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Outcomes of Sphincter Pharyngoplasty in the Cleft Population

Introduction: Sphincter pharyngoplasty (SP) is becoming increasingly popular for correction of velopharyngeal insufficiency (VPI) after cleft palate repair because of high success rate, low incidence of postoperative obstructive sleep apnea (OSA), and ease of revision in case of failure. This study is a meta-analysis of SP outcomes, reasons for failure, and revision strategies. Methods: A comprehensive review of the literature on SP outcomes was conducted. Sphincter pharyngoplasty failure was defined as persistent hypernasality, incomplete velopharyngeal port (VP) closure on instrumental evaluation with concomitant VPI, or nonresolving hyponasality and/or OSA persisting >3 months after surgery. Two-tailed paired Student t test was used to compare outcomes between syndromic versus nonsyndromic patients and preoperative versus postoperative OSA rates. Results: Forty-four publications evaluating 2402 patients were included. Overall SP success rate was 78.4% (77.3% in nonsyndromic vs 84.8% in syndromic patients, P = 0.11). Overall primary revision rate was 17.8% (20% in nonsyndromic vs 15.4% in syndromic patients P = 0.97). Most failures (89.5%) manifested as persistent VPI with continued hypernasality requiring revision, whereas 10.5% of failures manifested as obstructive symptoms and/or severe hyponasality requiring revision. Causal factors of SP failure were the following: large central port (62.8%), dehiscence (15.5%), tight port (12.1%), and low-inset (9.7%). Primary revision success rate was 75.6%. Obstructive sleep apnea rates increased from 5.1% to 18.4% (P = 0.02). Conclusions: This study suggests that SP can resolve VPI in 78.4% of patients, which can be increased to 94.7% after one revision. Most failures are technique-dependent; therefore, there could be significant ground for improvement of outcomes. Address correspondence and reprint requests to Bahar Bassiri Gharb, MD PhD, Department of Plastic Surgery, 9500 Euclid Avenue, Desk A6-522, Cleveland, OH 44195; E-mail: bassirb@ccf.org Received 18 July, 2017 Accepted 10 November, 2017 The authors report no conlicts of statements. © 2018 by Mutaz B. Habal, MD.

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Study to Evaluate the Safety and Activity (Including Distribution) of 177Lu-3BP-227 in Subjects With Solid Tumours Expressing Neurotensin Receptor Type 1.

Conditions: Pancreatic Ductal Adenocarcinoma; Colorectal Cancer; Gastric Cancer; Squamous Cell Carcinoma of the Head and Neck; Bone Cancer; Advanced Cancer; Recurrent Disease; Metastatic Tumours
Intervention: Drug: 177Lu-3BP-227 (also called 177Lu-IPN01087)
Sponsor: Ipsen
Not yet recruiting

https://ift.tt/2rIhAx9

The Swedish grommet register – Hearing results and adherence to guidelines

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Marie Gisselsson-Solen
ObjectivesThe insertion of grommets is one of the most commonly performed surgical procedures in children. The underlying reason might be otitis media with effusion (OME) with concomitant hearing loss, recurrent acute otitis media (rAOM) or a combination of the two. Sweden has a national quality register for children receiving grommets with the purpose of evaluating how treatment guidelines are followed, and if surgery confers good quality health care. The purpose of this study was to investigate the circumstances during which Swedish children receive grommets and to examine how doctors follow the guidelines for grommet surgery.MethodsQuality register data was extracted from 2010 to 2016, and information on reasons for surgery, audiometry, number of AOM episodes, type of grommet etc was analysed.ResultsThe dominating reason for surgery was OME (71%). A large proportion (27%) of children with OME had not undergone a preoperative audiometry, despite national guidelines stating that it is hearing impairment that calls for surgery. Furthermore, among those who had done audiometry, 47% did not have a hearing impairment as measured by pure tone average. Nevertheless, a significant hearing improvement (11 dB, p < 0.001) was seen on post-operative follow-ups in those children who underwent audiometry. Forty-four percent of children operated due to rAOM had had fewer episodes of AOM than recommended as an indication for surgery, though this figure should be interpreted with caution as GP diagnosed episodes are not entered in the register.ConclusionEven though grommet insertions are quick and confer a low per-operative risk, it seems many children undergo surgery without a clear indication. This puts them at an unnecessary risk of per-operative as well as long-term complications. Since the procedure is so common, it also means large sums of money are spent on operations that might not be necessary.

https://ift.tt/2Ihbez3

A stepped approach for the management of symptomatic internal derangement of the temporomandibular joint

Abstract

Background

Internal derangement is the clinical and pathological condition of disc displacement of the temporomandibular joint. Management of these cases involve conservative and surgical treatment options. Minimally invasive surgical procedures namely arthrocentesis and arthroscopy are promising techniques in the management of internal derangement. However patient selection algorithms, indications for minimally invasive procedures and details of the techniques should be further studied for safe and cost effective management of these cases.

This manuscript aims to retrospectively analyze the significance of a stepped surgical treatment approach (arthrocentesis under local anaesthesia as the first line of treatment, followed by arthroscopic lysis and lavage under general anaesthesia in unresolving cases) of internal derangement with or without osteoarthritis.

Methods

This is a retrospective cohort study. Case notes of 1414 patients that were managed with a standard protocol were reviewed. Appropriate inclusion and exclusion criteria were set. Thirty-three patients were eligible for inclusion. Parameters recorded were pain-free inter-incisal opening, spontaneous pain, pain on function, difficulty on chewing, and perceived disability on jaw movements. Pre-operative and post-operative (at the end of the follow up period) pain free maximum interincisal opening values were compared with paired t test and the subjective parameters were evaluated with Chisquare analysis. Treatment outcome and success rate according to American Association of Oral and Maxillofacial Surgeons were descriptively shown.

Results

Interincisal opening values increased, and the number of patients with severe or medium rated subjective parameters were reduced at discharge. These improvements were found to be statistically significant. Clinical (Wilkes) staging of internal derangement pre-operatively and at discharge remained either unchanged or was lower. Treatment outcome and success according to American Association of Oral and Maxillofacial Surgeons criteria was 94%.

Conclusion

The stepped approach for the management of symptomatic internal derangement with or without osteoarthritis is a successful treatment strategy with favourable therapeutic outcomes.

https://ift.tt/2k0ujXQ

Reporting quality of randomized controlled trials in otolaryngology: review of adherence to the CONSORT statement

Abstract

Background

Methods

The objectives of our study were to assess the extent to which the recent Otolaryngology – Head and Neck Surgery (ORL-HNS) randomized control trials in the top nine journals and in the top Canadian journal comply with the Consolidated Standards of Reporting Trials (CONSORT) statement, and to identify the CONSORT items most in need of improvement. Based on the impact factor and circulation number of 2014, the top nine Otolaryngology journals and the top Canadian Otolaryngology journal were selected and were searched to identify RCTs published in English and between 2010 and 2014. Two authors independently reviewed and extracted data using a standardized data extraction form constructed with the help of a medical librarian. Our outcome was to assess the adherence of articles reporting to the CONSORT items. Descriptive statistics were used.

Results

One hundred and eighty-two Otolaryngologic RCTs were identified in the top nine international journals and in the top Canadian journal. The inter-rater reliability between two raters was 0.32. The extent of adherence to CONSORT Statement ranged from 25 to 93.5% with a mean of 59.0% and a median of 59.4%. Only 6.5% of RCTs described the individual responsible for enrolling and assigning subjects and method of randomization; 32.4% reported the estimated effect size and precision; 40.6% reported a sample size calculation and 32.4% mentioned external validity or implications of the findings.

Conclusion

Findings revealed that the reporting of RCTs in the top nine ORL-HNS journals and in the top Canadian ORL-HNS journal is suboptimal. The quality of reporting can be improved by addressing the three CONSORT items found most deficient in this study namely, sample size calculations, estimated effect size and precision, and external validity.

https://ift.tt/2IoX4rE

Improved symptomatic, functional, and fluoroscopic outcomes following serial “series of three” double-balloon dilation for cricopharyngeus muscle dysfunction

Abstract

Background

Cricopharyngeus muscle dysfunction (CPMD) is a common cause of dysphagia. We employ a progressive series of three double-balloon dilations separated by 4–6 weeks between procedures as a primary treatment option. The purpose of this study was to evaluate subjective, functional and objective improvement in swallowing after three serial dilations for CPMD.

Methods

We retrospectively evaluated patients between June 1, 2014, and June 30, 2016, who underwent a series of three double-balloon dilations for CPMD. Pre- and post-dilation Eating Assessment Tool-10 (EAT-10), Functional Oral Intake Scale (FOIS), pharyngeal constriction ratio, pharyngeal area, and pharyngoesophageal segment (PES) opening were compared.

Results

Seventeen patients with CPMD underwent serial double-balloon dilation procedures separated by one month. Mean age of the cohort was 73.5 (SD ± 13.3) years, and 53% were female. The mean EAT-10 improved from 24.7 (SD ± 7.8) to 15.9 (SD ± 10.2) [p = 0.0021]. Mean FOIS improved from 5.4 (SD ± 1.4) pre- to 6.3 (SD ± 0.9) post-treatment (p = 0.017). Mean UES opening increased from 1.05 (SD ± 0.34) cm to 1.48 (SD ± 0.41) cm (p = 0.0003) in the anteroposterior fluoroscopic view and from 0.58 (SD ± 0.18) to 0.76 (SD ± 0.30) cm (p = 0.018) in the lateral view. Pharyngeal constriction ratio (PCR), a surrogate measure of pharyngeal strength, improved from 0.49 (SD ± 0.37) to 0.24 (SD ± 0.15) (p = 0.015), however pharyngeal area (PA) was unchanged.

Conclusions

A progressive series of three double-balloon dilations for cricopharyngeus muscle dysfunction resulted in improved patient reported dysphagia symptom scores and objective fluoroscopic swallowing parameters.

https://ift.tt/2ImWpXR

Paediatric osteofibrous dysplasia-like adamantinoma with classical radiological findings

Description

A 16-year-old girl presented with a 1-month history of a painful lump on the right tibia. There was no history of trauma; she had no medical conditions and was physically active. On examination, she had a diffuse bony lump in the middle third of the right tibia with some localised tenderness. There was no neurovascular deficit and no bony masses were present elsewhere.

Plain radiograph of the right leg (figure 1) showed a well-circumscribed, slightly expansile, mixed sclerotic and lytic lesion of the anterior diaphysis of the right tibia. The sclerosis and lysis were seen as a multilocular 'soap bubble' appearance. No aggressive features including periosteal reaction or soft-tissue abnormality were present. A subsequent MRI scan confirmed the presence of an extensive lesion involving the anterior cortex of the midshaft of the right tibia, extending a vertical distance of 20 cm. The lesion appeared confined to...

https://ift.tt/2rHToej

Case of drug-induced interstitial lung disease secondary to adalimumab

We report a rare case of drug-induced intestinal lung disease (ILD) secondary to adalimumab, a tumour necrosis factor alpha-receptor blocker. A 52-year-old smoker with ankylosing spondylitis, treated with adalimumab, presented with progressive breathlessness. A high resolution CT chest demonstrated predominantly upper-zone patchy ground glass changes and small bilateral pleural effusions. Bronchoscopy and bronchoalveolar lavage showed no evidence of infection or malignant cells and an echocardiogram was normal. The working diagnosis was that of possible adalimumab-induced ILD. Adalimumab was subsequently stopped. The patient's breathlessness and cough improved on cessation of the drug. A further CT chest several months later showed resolution of the ground glass changes. Adalimumab-induced ILD is rare. We review the literature surrounding this and discuss the diagnostic challenges. This case highlights the importance of considering the possibility of drug-induced lung disease in patients taking adalimumab.

https://ift.tt/2wQXbv5

Endoscopic diagnosis of a goblet cell carcinoid tumour of the appendix

Primary malignancies of the appendix are rare. Of these, less than 5% are goblet cell carcinoid (GCC) tumours. The majority of GCC present with findings of acute appendicitis or advanced peritoneal spread. We describe a rare presentation of GCC as subtle mucosal abnormality of the appendiceal orifice seen on colonoscopy performed for iron-deficiency anaemia. Biopsies were interpreted as adenocarcinoma; however, final surgical pathology confirmed GCC of the appendix with caecal involvement. The patient recovered well from surgery, anaemia resolved and follow-up did not show metastatic disease.

https://ift.tt/2rFLKRS

A mysterious postoperative rash

This case report describes the development of a rash in a patient admitted with large bowel obstruction secondary to carcinoma of the sigmoid colon. The patient underwent a Hartmann's procedure and right hemicolectomy for a metastatic deposit at the terminal ileum. On postoperative day 3, the patient developed a bullous haemorrhagic rash on the thighs, flanks and abdomen, associated with a sharp drop in platelet count. Suspicion of heparin-induced skin necrosis was raised, and prophylactic enoxaparin was switched to fondaparinux. Skin biopsy results later confirmed the diagnosis. Clinical suspicion of heparin-induced skin necrosis is essential and should prompt a switch between prophylactic agents, in order to prevent potentiation of this life-threatening side effect.

https://ift.tt/2wL10So

Non-operative management of an isolated lateral collateral ligament injury in an adolescent patient and review of the literature

We present a rare case of isolated traumatic pure ligamentous rupture of the lateral collateral ligament of the knee in an adolescent high-level footballer managed non-operatively with a good functional outcome and return to sport in 4 months.

https://ift.tt/2rHTnHh

10-year-old with concha bullosa pyogenic mucocele

A 10-year-old girl presented with episodes of migraine. A nasal mass was found randomly during work-up. Interpreted as an osteoma, the mass was removed during endoscopic surgery. However, the histopathological examination turned out to be a pyomucocele in the right middle turbinate, which is an extremely rare yet benign condition in children.

https://ift.tt/2Kn9HEm

Inflammatory myofibroblastic tumour: an unusual presentation including small bowel obstruction and palpable abdominal mass

A 41-year-old man with no medical history presented with 2 weeks of nausea, vomiting, a new palpable abdominal mass, constipation and a 14kgweight loss. On admission, CT abdomen and pelvis demonstrated a 6.9x3.7 cm soft-tissue abdominal mass deep to and invading the lower anterior abdominal wall with tethering of the urinary bladder and potential involvement of the urachus. Subsequently, a biopsy demonstrated a low-grade spindle cell neoplasm compatible with inflammatory myofibroblastic tumour with immunostain positive for smooth muscle actin and desmin and negative for CD21, CD117, DOG-1, TKE-1, mdm2, CD34 and ALK. One week following admission, he underwent en bloc excision of the mass including abdominal wall (umbilicus, portions of rectus sheath and muscle), bladder dome, right colon and a segment of small bowel. Final pathology of the mass confirmed an inflammatory myofibroblastic tumour, and his postoperative course was uneventful.

https://ift.tt/2rGVZp0

Αρχειοθήκη ιστολογίου

Τρίτη 15 Μαΐου 2018

Abstract

Zusammenfassung

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Abstract

Background

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Abstract

Background

Methods

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Conclusions