Editorial Board

Publication date: July 2018
Source:Clinical Immunology, Volume 192





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Are intraoral radiographs reliable in determining peri-implant marginal bone level changes? The correlation between open surgical measurements and peri-apical radiographs

Publication date: Available online 1 June 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Cassetta, R. Di Giorgio, E. Barbato
This study was performed to evaluate the reliability of peri-apical radiographs in determining peri-implant marginal bone level changes. The STROBE guidelines were followed. Marginal bone levels were measured at the time of implant insertion using a straight periodontal probe and using peri-apical radiographs. These intraoperative and radiographic measurements were repeated at the time of second surgery. All radiographs were analysed by two examiners blinded to the intraoperative measurements. To standardize the radiographic images, the long-cone parallel technique and a film-holding system were used. Intra-observer agreement and inter-observer variability were assessed using the intra-class correlation coefficient (ICC). Descriptive statistics, the t-test, and the Pearson correlation coefficient were also used. A total of 268 implants were inserted in 142 patients. Inter-observer agreement was 0.950; intra-observer variability was 0.980 and 0.973. The mean difference between the radiographic and intraoperative measurements was 0.50±1.55mm (range 0–8mm); the difference was statistically significant (P=0.000). A significant linear correlation was found between the marginal bone level changes evaluated intraoperatively and radiographically (P<0.005). Radiographic analysis significantly overestimated the level of peri-implant marginal bone compared to intraoperative measurements, but peri-apical radiographs are reliable in determining the bone level changes at different follow-ups.



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Radiological Study of the Ethmoidal Arteries in the Nasal Cavity and Its Pertinence to the Endoscopic Surgeon

Abstract

We studied the ethmoidal arteries using preexisting computer tomography of the paranasal sinuses (CT PNS) and statistically scrutinized data obtained between genders. A descriptive study from 77 CT PNS dated January 2016–December 2016 were collected and reviewed by two radiologists. A total of 54 (108 sides) CT PNS were studied of patients aged 18–77 years. 37 are male, 17 are female; with Bumiputera Sarawak predominance of 25 patients, 12 Malays, 16 Chinese and one Indian. Rate of identification are as follows: anterior ethmoidal artery (AEA)-100%, middle ethmoidal artery (MEA)-30%, posterior ethmoidal artery (PEA)-86%. The average distance from AEA–MEA is 8.1 ± 1.52 mm, MEA–PEA is 5.5 ± 1.29 mm and AEA–PEA is 12.9 ± 1.27 mm. The mean distance from PEA-the anterior wall of sphenoid is 7.7 ± 3.96 mm, and PEA-optic canal is 8.5 ± 3.1 mm with no statistical difference when compared between gender. AEA frequently presented with a long mesentery 57.4%, while 87.1% of PEA was hidden in a bony canal. The vertical distance of the AEA-skull base ranges from 0 to 12.5 mm whilst PEA-skull base is 0–4.7 mm. There is no statistical difference in distances of AEA, MEA nor PEA to skull base when analyzed between genders; t(82) = 1.663, p > 0.05, t(32) = 0.403, p > 0.05 and t(75) = 1.333, p > 0.05 respectively. We newly discovered, that 50% of MEA is hidden in a bony canal, and its distance to skull base ranged 0–5.3 mm. MEA and PEA less commonly have a short or long mesentery. Knowledge on the ethmoidal arteries especially in our unstudied population of diverse ethnicity, gains to assist surgeons worldwide, when embarking in endoscopic transnasal surgeries.

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Contact dermatitis with concomitant contact urticaria syndrome due to multiple ingredients of oxidative hair dye

Publication date: Available online 1 June 2018
Source:Allergology International
Author(s): Jun-ichi Iwata, Naoko Inomata, Megumi Sato, Mami Miyakawa, Toshiko Kawaguchi, Michiko Aihara




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The molecular allergology of subtropical grass pollen

Publication date: Available online 31 May 2018
Source:Molecular Immunology
Author(s): Thina Kailaivasan, Janet M. Davies
Grass pollens are amongst the most important aeroallergen sources world-wide triggering allergic rhinoconjunctivitis and asthma in sensitised patients. Much of what we know about the allergen components of grasses is informed by research on pollen of temperate (Pooideae) species that are abundant in the temperate climate zones. However, climate changes are altering the biogeographical distribution as well as timing and allergenicity of grass pollens. This provides an impetus for better understanding of the contribution of subtropical subfamilies of grasses to pollen allergy globally. Pollen of Chloridoideae (e.g. Cynodon dactylon; Bermuda grass) and Panicoideae (e.g. Paspalum notatum; Bahia grass or Sorghum halepense; Johnson grass) subfamilies are clinically important in subtropical zones of Australia, Asia, India, Africa, and America. These grasses differ ecologically and phylogenetically from temperate grasses and, importantly their allergen composition is qualitatively different. For example, subtropical grass pollens appear to lack the major group 5 grass pollen allergen family. In this review we summarize current knowledge of the epidemiology and immunology of subtropical Chloridoideae and Pancoideae pollen allergens, describe the biochemical characteristics of known isoforms and variants as well as properties and structures of subtropical pollen allergen components. Whilst only one subtropical allergen component; Cyn d 1 of Bermuda grass pollen, is available commercially for diagnostic use, in a natural purified form, a number of allergens of Panicoideae grass pollen; Zea m 1, Zea m 3 and Zea m 13 of maize, Pas n 1 and Pas n 13 of Bahia, as well as Sor h 1, Sor h 2, Sor h 13 and Sor h 23 of Johnson grass, have been discovered. Research effort is directed towards making available subtropical grass pollen allergen components as innovative treatment and diagnostic options that more specifically address the needs of patients from warmer regions of the globe.



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Monitoring system for investigating the effect of temperature change on optical properties

Abstract

Knowledge about the changes in optical properties is needed for planning safer and more accurate laser treatments. A monitoring system was developed to study how the optical properties of a lipid emulsion are affected by temperature changes. A double-integrating-sphere system is modified with a controlled heating apparatus to measure the temperature-dependent diffuse reflectance and total transmittance values. The absorption and reduced scattering coefficients were estimated from the reflectance and transmittance values using an inverse adding-doubling method. The total transmittance showed positive correlation with temperature while the diffuse reflectance was found to be negatively correlated. Although the absorption coefficient did not demonstrate a statistically significant change with temperature, the reduced scattering coefficient was negatively correlated. By using the obtained optical properties, Monte Carlo simulations were performed to observe the difference in light propagation within a tissue. The results indicate that temperature-dependent changes in optical properties should be taken into consideration for a safer laser treatment.

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The Revision Rhinoplasty Consult: The Art of Managing Expectations.

Facial plast Surg 2018; 34: 287-289
DOI: 10.1055/s-0038-1655734

Rhinoplasty is widely acknowledged to be a challenging operation. The success of the operation has long been measured in anecdotal ways. As the surgeon—do I think the outcome is good? Does the patient tell me they are happy? At hand is an obvious issue with patients sometimes not returning to their original doctor. Other times they may have minor concerns that take minimal effort to correct. Does that constitute a revision? In most circles, the ultimate definition of revision rhinoplasty is a return to surgery with the intent to correct a functional or aesthetic concern that arose after the original procedure.
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Functional Compromise in the Middle Vault in the Management of Revision Rhinoplasty

Facial plast Surg 2018; 34: 239-244
DOI: 10.1055/s-0038-1654677

As rhinoplasty procedures become more common, the need for revision surgeries increases as well. Unlike primary rhinoplasties, revision rhinoplasties can be more challenging because of anatomic differences from initial surgery, a lack of available cartilage, tissue remodeling responses, and other complications. As such, surgeons should be prepared to address revision rhinoplasty patients differently from primary rhinoplasty patients. Here, the authors describe a generalizable approach to revision functional rhinoplasty patients and detail some of the surgical techniques that can be employed to achieve optimal outcomes, with particular attention paid to procedures that can be used in the middle vault.
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Use of Translucent Template in the Reconstruction of Nasal Defects: A Novel Technique

Facial plast Surg 2018; 34: 339-340
DOI: 10.1055/s-0038-1653991

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Failure of Synthetic Implants: Strategies and Management

Facial plast Surg 2018; 34: 245-254
DOI: 10.1055/s-0038-1654676

Dorsal augmentation with synthetic implants is the most commonly performed rhinoplasty procedure, especially in the East-Asian region. However, as in all other surgical procedures, complications are inevitable. Complications that need to be managed surgically include displacement, deviation, suboptimal aesthetic outcome, extrusion, inflammation, infection, and changes in skin quality. Most complications can be easily managed with revision surgery. After the removal of the synthetic implant from the nasal dorsum, different dorsal implant materials such as dermofat, alloderm, or fascia-wrapped diced cartilage, conchal cartilage with perichondrial attachment, and costal cartilage are preferred. An irreversible change in the skin/soft tissue envelope poses a challenge that usually requires reconstructive surgery with a local flap. Therefore, early detection and prompt management of the complication are essential for minimizing the severity of the deformity and the complexity of the surgical procedures.
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Bilateral Tessier Type 3 Cleft—Repairment in a Single Session

Facial plast Surg 2018; 34: 335-336
DOI: 10.1055/s-0038-1653985

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

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The Twisted Nose: What to Do When It's Not Straight

Facial plast Surg 2018; 34: 255-260
DOI: 10.1055/s-0038-1653987

Septorhinoplasty is among the most common facial plastic and reconstructive surgeries and its complexities are reflected in a relatively high revision rate. The patient with a postoperative twisted nose presents an additional challenge and requires that the surgeon display empathy and possess a deep knowledge of the aesthetic and functional intricacies of the nose. Correction of the twisted nose should be approached in a systematic fashion with unique considerations for each "third" of the nose. While there are many options in the overall surgical armamentarium, each surgeon will find specific techniques that are most efficacious and reproducible for their individual practice. This article discusses select surgical "pearls" and techniques that can aid the surgeon in their own surgical decision-making.
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Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers

Facial plast Surg 2018; 34: 278-286
DOI: 10.1055/s-0038-1653988

Dissatisfaction with the appearance of the nasal tip is a common compliant in patients seeking revision surgery after rhinoplasty. Revision rhinoplasty is more technically difficult and unpredictable given the frequent presence of scar contracture, impaired skin envelope quality, and missing alar cartilage. This article describes some of the more common causes for tip revision surgery and techniques to address these abnormalities.
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Dorsal Failures: From Saddle Deformity to Pollybeak

Facial plast Surg 2018; 34: 261-269
DOI: 10.1055/s-0038-1653990

The nasal dorsum is an important component of a rhinoplasty and may be the primary motivation for seeking surgery. The nasal dorsum is a complex three-dimensional shape that is shrouded by local anesthetic and edema during surgery. This makes an accurate assessment of the surgical changes challenging. Complications related to dorsal modification include imbalances from over- or underresection of the structures of the nasal dorsum, inadequate or overaugmentation, an open-roof deformity, pollybeak, saddle nose, inverted-V, warped cartilage, visible grafts, contour problems, graft malposition, and extrusion. This review will discuss the common problems that can occur with dorsal modification during rhinoplasty.
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Cleft Rhinoplasty: Strategies for the Multiply Operated Nose

Facial plast Surg 2018; 34: 290-297
DOI: 10.1055/s-0038-1653986

Rhinoplasty, as a surgical procedure to improve the appearance of the nose while preserving or improving function, is complicated and difficult to master. Revision cleft rhinoplasty offers another tier of challenge. The symmetry, proportions, and definition of the nose are affected by the native cleft deformity but also previous surgical scars, cartilage grafts, and skin excisions. Our preferred approach is to use structural cartilage grafting to establish septal and lower lateral cartilage resiliency. Internal lining deficiency is addressed with skin or lining transfer, while excess nasal tip thickness is contoured to improve definition. Of the utmost importance, the cleft nasal deformity cannot be considered in isolation, but rather a combined amalgamation of the lip muscle and scar, dentofacial occlusion, and skeletal maxillary deficiency.
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The Art of Camouflage: When Can a Revision Rhinoplasty Be Nonsurgical?

Facial plast Surg 2018; 34: 270-277
DOI: 10.1055/s-0038-1653989

Rhinoplasty surgery is known to have revision rates up to 20%. Surgical revisions include the risk of anesthesia and scarring. The skilled injector may offer nonsurgical alternatives to patients when considering revision surgery. Injections can be done to improve symmetry or improve/camouflage deformities that are possibly too minor for surgery but bothersome to the patient. Injections can be performed using different filler materials, but these treatments also carry inherent risks.
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Surgical Tips for the Management of the Wide Nasal Base

Facial plast Surg 2018; 34: 337-338
DOI: 10.1055/s-0038-1653984

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Rhinoplasty: Why Do Revisions Still Occur?

Facial plast Surg 2018; 34: 237-238
DOI: 10.1055/s-0038-1654678

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Satisfaction with Facial Appearance and Quality of Life after Treatment of Face Scars with a Transparent Facial Pressure Mask

Facial plast Surg
DOI: 10.1055/s-0038-1648249

Treatment of facial hypertrophic scars and deformities has developed from the use of elastic fabric hoods to transparent facemasks. The clinical effects of these masks have been described. However, the psychological impact of wearing such a mask is not well documented. The aim of this study was to assess patients' satisfaction with their current facial appearance, to assess the end result of facemask therapy, and to assess the decision to have undergone facemask therapy by means of four different FACE-Q questionnaires. Out of the eligible 87 patients who completed the facemask therapy between January 2012 and November 2017, 42 filled out the questionnaires. These patients wore a custom-fabricated facemask because of facial hypertrophic scars and severe postsurgical facial irregularities. Patients who wore the mask 12 to 16 hours per day were significantly more satisfied with the end result compared with those who wore it 4 to 8 hours daily. Also, patients who wore the mask 8 to 12 and 12 to 16 hours each day were more satisfied to have undergone therapy compared with those who wore it 4 to 8 hours daily. Furthermore, patients who finished therapy 3 to 4 years and 4 to 5 years ago reported a significant higher satisfaction with facial appearance compared with those who completed therapy in a time period shorter than 1 year ago. Patients who finished therapy 3 to 4 years ago reported higher satisfaction with their facial appearance compared with those who finished therapy 2 to 3 years ago. Additionally, the Patient and Observer Scar Assessments Score (POSAS) showed a significant reduction between start and end of therapy. This study shows facemask therapy to result in long-lasting stable results. It also shows a longer daily wearing of the facemask to result in the highest satisfaction according to patients.
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Food-induced Anaphylaxis in Infants and Children

Publication date: Available online 1 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Waheeda Samady, Jennifer Trainor, Bridget Smith, Ruchi Gupta
BackgroundRecent recommendations to introduce peanut products to infants for peanut allergy prevention requires a focused assessment of infant anaphylaxis.ObjectiveThis study describes the symptomatology of food-induced anaphylaxis (FIA) in infants (<12 months) compared to older pediatric cohorts.MethodsRetrospective review between June 2015 and June 2017 of children presenting with FIA at a large urban children's hospital emergency department (ED).ResultsA total of 357 cases of FIA were evaluated: 47 in infants (<12 months), 43 in toddlers (12 to 24 months), 96 in young children (2 to 6 years), and 171 in school-aged children (>6 years). Infants presented with gastrointestinal (GI) involvement more frequently than any other age group (89% vs 63% [P = .003], 60% [P <.001], and 58% [P <.001]). Additionally, infants and young children presented with skin involvement more frequently than school-aged children (94% and 91% vs 62% [P <.001]). Respiratory symptoms were more common in older cohorts (17% in infants vs 44% in young children [P <.001] and 54% in school-aged children [P <.001]). Egg and cow's milk were more common causes of FIA in infants compared to school-aged children (egg, 38% vs 1% [P <.001]; milk, 17% vs 7% [P =.03]). Only 21% of infants with FIA had eczema and 36% had a history of food allergy.ConclusionInfants with FIA primarily presented with GI and skin manifestations. Egg was the most common food trigger in infants. Most infants with FIA did not have eczema or a history of food allergy.



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Changes in chronic rhinosinusitis symptoms differentially associate with improvement in general health-related quality of life

Publication date: Available online 1 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Marlene M. Speth, Lloyd P. Hoehle BA, Katie M. Phillips, David S. Caradonna, Stacey T. Gray, Ahmad R. Sedaghat




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Are there different subtypes of eosinophilic esophagitis?

Publication date: Available online 1 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jay Adam Lieberman




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Bedroom Exposure to Airborne Allergens in the Chicago Area Using a Patient-Operated Sampling Device

Publication date: Available online 1 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Julian Gordon, Paul Detjen, Sai Nimmagadda, Laura Rogers, Sanjay Patel, James Thompson, Rachel Reboulet, Prasanthi Gandhi
Background: In current practice, allergens in vacuum collected dust are used as surrogates for inhalable allergens. We developed an airsampling device that can be used by patients themselves for direct measurement of airborne allergen concentrations in their own homes.Objective: To demonstrate the use of this device to establish allergen concentration reference ranges in a target population. To evaluate relationships of patient-reported information to measured allergen concentrations.Methods: Patients from 5 allergist's practices in the Chicagoland region were provided with instructions, questionnaire, informed consent forms and samplers to run for 5 days in their bedrooms. Samples were collected from cartridges and assayed by multiplex immunoassays for 12 common household allergens and ELISA for ragweed.Results: Unique allergen profiles were obtained for 102 patient homes. Samples with allergen concentrations above the limit of detection were: total dust mite: 28%; cat, 61%; dog, 64%; mouse, 12%; rat, 0%; cockroach, 4%; Alternaria, 6%; Aspergillus, 21%; birch pollen 1%; grass, 8%; ragweed, 5%. Of those, 75 completed questionnaires, providing meta-data for further analysis. Pet allergens correlated significantly with number of pets owned. Humidity correlated with dust mite allergens, open windows with Alternaria and mouse allergens, HEPA filter use with reduced levels of several allergens. Many other variables showed no significant correlations.Conclusion: The combination of ease of use, high air sampling rate and sensitive immunoassays permitted the measurement of airborne allergens concentrations in homes and establishment of reference ranges. Patientreported information permitted identification of factors that could relate to allergen concentrations and suggest remedial measures.



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The extent of vestibular impairment is important in recovery of canal paresis of patients with vestibular neuritis

We questioned whether the extent of vestibular impairment affected the recovery of vestibular function in acute vestibular neuritis (VN). The objective of this study was to identify how the extent of vestibular impairment influenced the recovery from canal paresis (CP) in patients with VN.

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Reply to: comment on “Liquid nitrogen cryotherapy for chronic recalcitrant interdigital candidiasis of toe-spaces – an uncontrolled pilot study”

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About melanocyte activation in idiopathic guttate hypomelanosis by 5-fluorouracil tattooing

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Folliculitis Decalvans: Effectiveness of Therapies and Prognostic Factors In A Multicenter Series of 60 Patients With Long-Term Follow-Up

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Safety and efficacy of hydrogen peroxide topical solution, 40% (w/w) in patients with seborrheic keratoses: results from two identical, randomized, double-blind, placebo-controlled, phase 3 studies (A-101-SEBK-301/302)

Capsule Summary

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Influence of age and marital status on stage at diagnosis and survival of patients with Merkel cell carcinoma: a SEER based cohort study

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A cross-sectional study of clinical distinctions between neuropathic and inflammatory pruritus

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REPLY to MS#JAAD-D-18-00380

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“Soft corn versus Candidiasis!”

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A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis

Previous studies found conflicting results about whether atopic dermatitis (AD) begins in adulthood.

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Are intraoral radiographs reliable in determining peri-implant marginal bone level changes? The correlation between open surgical measurements and peri-apical radiographs

This study was performed to evaluate the reliability of peri-apical radiographs in determining peri-implant marginal bone level changes. The STROBE guidelines were followed. Marginal bone levels were measured at the time of implant insertion using a straight periodontal probe and using peri-apical radiographs. These intraoperative and radiographic measurements were repeated at the time of second surgery. All radiographs were analysed by two examiners blinded to the intraoperative measurements. To standardize the radiographic images, the long-cone parallel technique and a film-holding system were used.

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An experimental study on antitumoral effects of KI-21-3, a synthetic fragment of antimicrobial peptide LL-37, on oral squamous cell carcinoma

The aim of this study was to investigate the oncolytic properties of KI-21-3, a shortened fragment of LL-37, against oral squamous cell carcinoma (OSCC) in an animal model.

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Post-Partum Thrombotic Thrombocytopenic Purpura (TTP) in a Patient with known Idiopathic (Immune) Thrombocytopenic Purpura: a case report and review of the literature

Incidences of immune thrombocytopenic purpura occur in 1 in every 1000–10,000 pregnancies accounting for 3% of all thrombocytopenic pregnancies. A pre-existing immune thrombocytopenic purpura is known to be a ...

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Postpartum acute fatty liver of pregnancy: a case report

Acute fatty liver of pregnancy can be a very dramatic clinical event with significant risk of mortality to healthy women. The pathogenesis is still unknown. It usually occurs in the third trimester or in the i...

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Clinical antibacterial effectiveness and biocompatibility of gaseous ozone after incomplete caries removal

Abstract

Objectives

To evaluate local effect of gaseous ozone on bacteria in deep carious lesions after incomplete caries removal, using chlorhexidine as control, and to investigate its effect on pulp vascular endothelial growth factor (VEGF), neuronal nitric oxide synthase (nNOS), and superoxide dismutase (SOD).

Materials and methods

Antibacterial effect was evaluated in 48 teeth with diagnosed deep carious lesion. After incomplete caries removal, teeth were randomly allocated into two groups regarding the cavity disinfectant used: ozone (open system) or 2% chlorhexidine. Dentin samples were analyzed for the presence of total bacteria and Lactobacillus spp. by real-time quantitative polymerase chain reaction. For evaluation of ozone effect on dental pulp, 38 intact permanent teeth indicated for pulp removal/tooth extraction were included. After cavity preparation, teeth were randomly allocated into two groups: ozone group and control group. VEGF/nNOS level and SOD activity in dental pulp were determined by enzyme-linked immunosorbent assay and spectrophotometric method, respectively.

Results

Ozone application decreased number of total bacteria (p = 0.001) and Lactobacillus spp. (p < 0.001), similarly to chlorhexidine. The VEGF (p < 0.001) and nNOS (p = 0.012) levels in dental pulp after ozone application were higher, while SOD activity was lower (p = 0.001) comparing to those in control pulp.

Conclusions

Antibacterial effect of ozone on residual bacteria after incomplete caries removal was similar to that of 2% chlorhexidine. Effect of ozone on pulp VEGF, nNOS, and SOD indicated its biocompatibility.

Clinical relevance

Ozone appears as effective and biocompatible cavity disinfectant in treatment of deep carious lesions by incomplete caries removal technique.

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The use of mineralized bone allograft as a single grafting material in maxillary sinus lifting with severely atrophied alveolar ridge (1–3 mm) and immediately inserted dental implants. A 3- up to 8-year retrospective study

Abstract

Objective

The primary aim of our study was to evaluate the efficacy of mineralized bone allograft alone in sinus floor augmentation with simultaneous implant placement in cases with severe atrophy of the residual maxillary bone (bone height < 4 mm).

Methods

Thirty-five dental implants were placed in 29 patients who underwent sinus augmentation via traditional lateral window technique from 2008 to 2013. Patients with residual alveolar height between 1 and 3 mm at the site of implantation were included in the study. The height of residual bone was initially estimated by plain panoramic X-ray and reevaluated intraoperatively by precise micrometric measurement at the site of implantation. Implants of 13 mm height and 3.5 or 4.3 mm in diameter were inserted simultaneously. Mineralized bone allograft was used alone to augment the sinus floor.

Results

No wound dehiscence was recorded. In one case there was a postoperative site infection which subsided with antibiotics without implant failure. One implant migrated during the postoperative period to the maxillary sinus and was removed. One implant failed. The remaining 33 implants were successfully loaded. Follow-up ranged from 3 to 8 years.

Conclusions

Maxillary sinus lift in severely absorbed alveolar ridges with simultaneous implant placement could be safely performed using mineralized allograft alone, rendering the procedure less invasive and less time-consuming.

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TNFAIP3 (A20) – The Immunological Rheostat

Publication date: Available online 1 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Asher Maroof, Dhavalkumar D. Patel




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Auto-antibodies to IgE and FceRI and the Natural Variability of SYK Expression in Basophils

Publication date: Available online 1 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Donald MacGlashan
BackgroundSecretion from human basophils and mast cells requires the activity of SYK but expression of SYK is highly variable in the general population and this variability predicts the magnitude of IgE-mediated secretion. One known mechanism of modulating SYK expression in human basophils is aggregation of FceRI.ObjectiveThis study examines the possibility that functional auto-antibodies are present in a wide variety of subjects and in particular, subjects whose basophils poorly express SYK. It also tests whether any found antibodies could modulate SYK expression in maturing basophils and whether interaction with FcgRIIb/CD32b modulates the effect.MethodsAn experimental algorithm for classifying the nature of histamine release induced by serum from 3 classes of subjects was developed.ResultsThe frequency of functional auto-antibodies that produce characteristics concordant with FceRI-mediated secretion was zero in 34 subjects without chronic spontaneous urticaria (CSU). In subjects with CSU, the frequency was lower than expected, approximately 7%. For the 5/68 unique CSU sera tested that contained anti-FceRI or anti-IgE Abs, these antibodies were found to induce down-regulation of SYK in both peripheral blood basophils and basophils developed from CD34+ progenitors. Blocking interaction of these antibodies with CD32b did not alter their ability to down-regulate SYK expression.ConclusionsThis study establishes that functional auto-antibodies to IgE/FceRI do not provide a good explanation for the variability in SYK expression in basophils in the general population. They do show that if antibodies with these characteristics are present, they are capable of modulating SYK expression in developing basophils.

Teaser

The wide variability in the critical signaling tyrosine kinase SYK observed in the general population is not explained by the presence of auto-antibodies to IgE or FceRIalpha.


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Hemodynamic Management of Patients During Endovascular Treatment of Acute Ischemic Stroke Under Conscious Sedation: A Retrospective Cohort Study

Background: Anesthetic modality and hemodynamic management during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) are potential contributors to the success of revascularization. The aims of our study were to review the hemodynamic management by anesthesiologists and clinical outcomes in patients undergoing MT under conscious sedation. Methods: Retrospective cohort study of patients with anterior circulation AIS from January 2012 to March 2016. Primary outcome was hemodynamic intervention, defined as administration of vasoactive drugs to maintain systolic blood pressure (BP) between 140 and 180 mm Hg. The secondary outcome was poor hemodynamic control, defined as BP outside target for >15 minutes despite hemodynamic intervention. We performed regression analysis to determine the predictors of hemodynamic intervention and poor hemodynamic control. Results: A total of 126 patients were included in this study; 92% (116) receiving conscious sedation and 8% (10) no sedation. Upon arrival to the neuroradiology suite, systolic BP was 180 mm Hg in 14.3%. Hemodynamic intervention was required in 38.9% of patients; 15.1% for hypotension and 19.8% for hypertension. In the multivariate analysis, systolic BP on hospital admission (odds ratio, 1.02; 95% confidence interval, 1.00-1.04; P=0.019) constituted a predictor for hemodynamic intervention. Poor hemodynamic control occurred in 12.7% of patients, with lower baseline systolic BP being associated with higher risk of intraprocedural hypotension (odds ratio, 0.92; 95% confidence interval, 0.89-0.96; P

https://ift.tt/2Ldi7yx

A low cost and stepwise training model for skull base repair using a suturing and knotting technique during endoscopic endonasal surgery

Abstract

Purpose

Cerebrospinal fluid leakage is always the primary complication during the endoscopic endonasal skull base surgery. Dural suturing technique may supply a rescue method. However, suturing and knotting in such a deep and narrow space are difficult. Training in the model can improve skills and setting a stepwise curriculum can increase trainers' interest and confidence.

Methods

We constructed an easy model using silicone and acrylic as sphenoid sinus and using the egg-shell membrane as skull base dura. The training is divided into three steps: Step 1: extracorporeal knot-tying suture on the silicone of sphenoid sinus, Step 2: intra-nasal knot-tying suture on the same silicone, and Step 3: intra-nasal egg-shell membrane knot-tying suture. Fifteen experienced microneurosurgical neurosurgeons (Group A) and ten inexperienced PGY residents (Group B) were recruited to perform the tasks. Performance measures were time, suturing and knotting errors, and needle and thread manipulations. The third step was assessed through the injection of full water into the other side of the egg to verify the watertight suture. The results were compared between two groups.

Results

Group A finishes the first and second tasks in significantly less time (total time, 125.1 ± 10.8 vs 195.8 ± 15.9 min) and fewer error points (2.4 ± 1.3 vs 5.3 ± 1.0) than group B. There are five trainers in group A who passed the third step, this number in group B was only one.

Conclusions

This low cost and stepwise training model improved the suture and knot skills for skull base repair during endoscopic endonasal surgery. Experienced microneurosurgical neurosurgeons perform this technique more competent.

https://ift.tt/2J4syUm

A low cost and stepwise training model for skull base repair using a suturing and knotting technique during endoscopic endonasal surgery

Abstract

Purpose

Cerebrospinal fluid leakage is always the primary complication during the endoscopic endonasal skull base surgery. Dural suturing technique may supply a rescue method. However, suturing and knotting in such a deep and narrow space are difficult. Training in the model can improve skills and setting a stepwise curriculum can increase trainers' interest and confidence.

Methods

We constructed an easy model using silicone and acrylic as sphenoid sinus and using the egg-shell membrane as skull base dura. The training is divided into three steps: Step 1: extracorporeal knot-tying suture on the silicone of sphenoid sinus, Step 2: intra-nasal knot-tying suture on the same silicone, and Step 3: intra-nasal egg-shell membrane knot-tying suture. Fifteen experienced microneurosurgical neurosurgeons (Group A) and ten inexperienced PGY residents (Group B) were recruited to perform the tasks. Performance measures were time, suturing and knotting errors, and needle and thread manipulations. The third step was assessed through the injection of full water into the other side of the egg to verify the watertight suture. The results were compared between two groups.

Results

Group A finishes the first and second tasks in significantly less time (total time, 125.1 ± 10.8 vs 195.8 ± 15.9 min) and fewer error points (2.4 ± 1.3 vs 5.3 ± 1.0) than group B. There are five trainers in group A who passed the third step, this number in group B was only one.

Conclusions

This low cost and stepwise training model improved the suture and knot skills for skull base repair during endoscopic endonasal surgery. Experienced microneurosurgical neurosurgeons perform this technique more competent.

https://ift.tt/2J4syUm

Evaluating the impact of translated written discharge instructions for patients with limited English language proficiency

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Minyoung Jang, Michal J. Plocienniczak, Kian Mehrazarin, Wasif Bala, Kevin Wong, Jessica R. Levi
IntroductionPatients with limited English language proficiency have indicated that they believe post-operative instructions written in their native language will improve comprehension over verbal translation alone, but the effect of this has not been previously studied. We hypothesize that providing written discharge instructions in Spanish for native Spanish speakers will improve comprehension regarding post-operative care after routine otolaryngologic procedures when compared to instructions written in English.MethodsThis prospective randomized controlled trial enrolled subjects who met criteria from June 2016 to November 2016. Subjects were Spanish-speaking parents and legal guardians of children undergoing tympanostomy tube insertion, adenoidectomy, and/or tonsillectomy. Subjects were given written discharge instructions in either English or Spanish. Both cohorts received standard verbal counseling in Spanish as well. Primary outcome was score on a standardized quiz assessing comprehension of discharge instructions. Patient satisfaction and preferences were secondary outcomes assessed through a survey. Participants underwent follow up one month after initial enrollment.ResultsTwenty subjects were enrolled, with ten receiving written discharge instructions in Spanish and ten receiving instructions written in English. There was no significant difference in comprehension scores between the two groups. Eleven participants completed the survey on patient satisfaction and preferences. Most subjects (91%, 10/11, p<0.01) preferred written instructions in their native language and subjectively felt this would improve their comprehension. However, there was no significant effect on patient satisfaction.ConclusionsSpanish-speaking patients indicate a strong preference for written discharge instructions in their native language, although there was no significant difference in short-term comprehension of instructions written in English vs. Spanish on objective evaluation. Accommodating these preferences may improve long-term comprehension and patient satisfaction, and ultimately build invaluable rapport between providers and patients.



https://ift.tt/2xBCdk8

Editorial Board

Publication date: June 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 5





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Open reduction and internal fixation of palatal fractures using three-dimensional plates

Publication date: June 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 5
Author(s): Karthik R, Cynthia S, Vivek N, Prashanthi G, Saravana Kumar S, Rajyalakshmi V
The maxilla is arguably the most anatomically intricate structure of the craniofacial skeleton, and the hard palate is an important bone that regulates the width and architecture of the face. The management of palatal fractures has long been a matter of debate, and varies with anatomical pattern and other injuries to the craniofacial skeleton. We have studied 18 palatal fractures during a five-year period that were treated using 3-dimensional rectangular plates placed across the palatal vault together with fixation of other fractures of the facial bones. Healing was satisfactory in all patients by 12weeks, with no complications. We think that open reduction and internal fixation of palatal fractures with 3-dimensional plates offers adequate stability with minimal complications.



https://ift.tt/2J7eUzY

Training Groups

Publication date: June 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 5





https://ift.tt/2HbKryH

Pembrolizumab for Nasopharyngeal Carcinoma Patients With Detectable Plasma Epstein-Barr Virus DNA

Condition:   Immunotherapy With Pembrolizumab for Nasopharyngeal Carcinoma Patients
Intervention:   Drug: Pembrolizumab
Sponsors:   National Health Research Institutes, Taiwan;   National Taiwan University Hospital;   Koo Foundation Sun Yat-Sen Cancer Center;   Chang Gung Memorial Hospital;   Taichung Veterans General Hospital;   China Medical University Hospital;   Changhua Christian Hospital;   National Cheng-Kung University Hospital
Not yet recruiting

https://ift.tt/2IZ4YMK

PROCLAIM-CX-2029: A Trial to Find Safe and Active Doses of an Investigational Drug CX-2029 for Patients With Solid Tumors or DLBCL

Conditions:   Solid Tumor, Adult;   Head and Neck Cancer;   Non Small Cell Lung Cancer;   Pancreatic Cancer;   Diffuse Large B Cell Lymphoma
Intervention:   Drug: CX-2029
Sponsor:   CytomX Therapeutics
Not yet recruiting

https://ift.tt/2swd3gU

Histiocytic Necrotizing Lymphadenitis Involving the Neck: Radiology-Pathology Correlation

Abstract

Histiocytic necrotizing lymphadenitis is an uncommon autoimmune condition characterized by fever, leukopenia, and neck swelling. Diagnostic imaging, including ultrasound and CT, typically demonstrates conglomerates of enlarged cervical lymph nodes with hypervascular cortices and areas of necrosis. Ultimately, the diagnosis is confirmed with the histopathologic findings of paracortical coagulative necrosis with karyorrhectic debris, abundant histiocytes, and absence of neutrophils. Other potential etiologies, such as other causes of infectious lymphadenitis, tuberculosis, lymphoma, and systemic lupus erythematosus, must be excluded. These features are exemplified in this sine qua non radiology–pathology correlation article.

https://ift.tt/2sxrEsv

The Relationships Between Cold Ischemia Time, Kidney Transplant Length of Stay, and Transplant-Related Costs

BACKGROUND Recent changes in policies guiding allocation of transplant kidneys are predicted to increase sharing between distant geographic regions. The potential exists for an increase in cold ischemia time (CIT) with resulting increases in delayed graft function (DGF) and transplant-related costs (TRC). We sought to explore the impact of CIT on metrics that may influence TRC. METHODS Between 2006 and 2014, 81,945 adult solitary deceased donor kidney transplants (KT) were performed in the United States; 477 (0.6%) at our institution. Regression models were constructed to describe the relationship between CIT on DGF and length of stay (LOS). Using hospital accounting data, we created regression models to evaluate the effect of DGF on LOS and TRC. RESULTS In multivariable models, longer CIT was associated with an increased rate of DGF (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.38-1.44) and increased LOS (1.04; 1.02-1.05). Recipients at our institution who developed DGF had longer LOS (1.71; 1.50-1.95), suggesting that the effect is partially mediated by DGF. After adjusting for LOS, neither CIT nor DGF were independently associated with increased TRC. However, an increased LOS resulted in an increase in TRC by $3422 (95% CI: $3180 - $3664) per additional day, indicating that the effect of CIT on TRC is partially mediated through LOS. CONCLUSION The prolongation of CIT is associated with an increase in DGF rates and LOS, resulting in increased TRC. This study raises the need to balance increased access of traditionally-underserved populations to KT with the inadvertent increase in TRC. Presented at the American Transplant Congress 2016 (Boston, MA). Correspondence: Oscar K. Serrano, MD, Department of Surgery, Division of Transplantation, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN 55455. Email: serra01@umn.edu Authorship: •Participated in research design: Serrano, Vock, Matas, Finger. •Participated in the writing of the paper: Serrano, Vock, Finger. •Participated in the editing of the paper: Serrano, Vock, Chinnakotla, Dunn, Kandaswamy, Pruett, Feldman, Matas, Finger. •Participated in the performance of the research: Serrano, Chinnakotla, Dunn, Kandaswamy, Pruett, Matas, Finger. •Contributed new reagents or analytic tools: Vock, Feldman •Participated in data analysis: Serrano, Vock, Matas, Finger. Disclosure: The authors declare no conflicts of interest. Funding: The authors declare no funding received for this work. DISCLAIMER The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2soX05o

Donor Specific Antibody Surveillance and Graft Outcomes in Pediatric Kidney Transplant Recipients

Introduction The development of de novo donor-specific antibodies (dnDSA) has been associated with rejection and graft loss in kidney transplantation, and DSA screening is now recommended in all kidney transplant recipients. However, the clinical significance of dnDSA detected by screening patients with a stable creatinine remains unclear. Methods 103 patients

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Evaluation of surgery and surgical results of Baha® Attract system implantations – single centre experience of hundred twenty five cases

Publication date: Available online 31 May 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Wojciech Gawęcki, Andrzej Balcerowiak, Ewelina Kalinowicz, Maciej Wróbel
IntroductionBone-anchored hearing aids are currently well-established solutions for treatment of hearing-impaired patients.ObjectiveTo evaluate the surgery of the Baha^® Attract system, healing process and soft tissue condition after the processor activation.Methods125 patients implanted with the Baha^® Attract system during a 4 year period in a single ENT department were analysed. Evaluated parameters comprised: details of surgery, healing process and soft tissue condition at the time of the processor activation and on subsequent follow-up visits.ResultsThe implantation was conducted under local anaesthesia in 96% of patients. The mean surgery time was 42min. Soft tissue reduction was performed in 43.2% of cases; bone polishing in 23.2% and bipolar coagulation in all the cases. Healing was uneventful in 92.8%. 10 days after the surgery, pain was reported in 48% of cases. On subsequent follow-up visits, 1 month and 3 months after the surgery, pain was present in 18.4% and 2.4% of cases respectively. Similarly, numbness and paresthesia, initially reported in 84% and 15.2%, were present in 60% and 11.2% after a month, and in 17.6% and 1.6% after three months. After the processor attachment, no serious problems were observed in the analysed group during follow-up visits. However, mild redness and/or mild pain over the magnet were observed in 9.6% of patients.ConclusionImplantation of the Baha^® Attract system is an easy and safe procedure. It can be performed under local anaesthesia in adults. There are no major surgical problems or complications, and the healing process proceeds efficiently in most patients. Postoperative pain is usually mild and gradually decreases in the following months. Numbness in the operated area is frequent, but as reinnervation occurs in time, the numb patch decreases in size and finally completely disappears in most cases.



https://ift.tt/2LOQIUS

Postoperative Care Handbook of the Massachusetts General Hospital

No abstract available

https://ift.tt/2kGWF9G

Starving Patients Before Cataract Surgery Under Regional Anesthesia: Needed or Not?

No abstract available

https://ift.tt/2swuJZL

Race/Ethnicity and Sex Both Affect Opioid Administration in the Emergency Room

BACKGROUND: Although racial/ethnic and sex disparities have been examined in health care generally and pain management more specifically, the combined influence of these sociodemographic factors together has not been well documented. The aim of this study was to examine the association between administration of opioid analgesics in the emergency department (ED) and interaction of race/ethnicity and sex. METHODS: We conducted a retrospective cohort study using 2010–2014 Center for Disease Control-National Hospital Ambulatory Medical Care Survey data for patients 12–55 years of age presenting to EDs with a primary diagnosis of appendicitis or gallbladder disease as defined by International Classification of Diseases, Ninth Revision codes. The primary outcome was the receipt of opioid analgesic medications. Secondary outcomes included: receipt of nonopioids, receipt of antiemetic medications, wait time to see a provider, and length of visit in the ED. The association between sex and analgesic receipt within Caucasian non-Hispanic and non-Caucasian groups was evaluated adjusting for pain score on presentation, patient age, emergent status, city/noncity location, number of comorbidities, time of visit (month, day of the week, standard versus nonstandard working hours, year), and US region. RESULTS: After exclusions, a weighted sample of 553 ED visits was identified, representing 2,622,926 unique visits. The sample population was comprised of 1,858,035 (70.8%) females and 1,535,794 (58.6%) Caucasian non-Hispanics. In adjusted models, Caucasian non-Hispanic males 317,427/525,435 (60.4%) were slightly less likely to receive opioids than Caucasian non-Hispanic females 621,638/1,010,360 (61.5), odds ratio = 0.962, 95% CI, 0.955–0.970; P

https://ift.tt/2J0U09A

Fibrinogen Concentrate in Cardiovascular Surgery: A Meta-analysis of Randomized Controlled Trials

BACKGROUND: Postoperative bleeding remains a frequent complication after cardiovascular surgery and may contribute to serious morbidity and mortality. Observational studies have suggested a relationship between low endogenous plasma fibrinogen concentration and increased risk of postoperative blood loss in cardiac surgery. Although the transfusion of fibrinogen concentrate has been increasing, potential benefits and risks associated with perioperative fibrinogen supplementation in cardiovascular surgery are not fully understood. METHODS: PubMed, Cochrane Library, Ovid MEDLINE, Embase, Web of Science, and China National Knowledge Infrastructure were searched on January 15, 2017, with automated updates searched until February 15, 2018, to identify all randomized controlled trials (RCTs) of fibrinogen concentrate, whether for prophylaxis or treatment of bleeding, in adults undergoing cardiovascular surgery. All RCTs comparing fibrinogen infusion versus any other comparator (placebo/standard of care or another active comparator) in adult cardiovascular surgery and reporting at least 1 predefined clinical outcome were included. The random-effects model was used to calculate risk ratios and weighted mean differences (95% confidence interval [CI]) for dichotomous and continuous variables, respectively. Subgroup analyses by fibrinogen dose and by baseline risk for bleeding were preplanned. RESULTS: A total of 8 RCTs of fibrinogen concentrate in adults (n = 597) of mixed risk or high risk undergoing cardiovascular surgery were included. Compared to placebo or inactive control, perioperative fibrinogen concentrate did not significantly impact risk of all-cause mortality (risk ratio, 0.41; 95% CI, 0.12–1.38; I2 = 10%; P = .15). Fibrinogen significantly reduced incidence of allogeneic red blood cell transfusion (risk ratio, 0.64; 95% CI, 0.49–0.83; I2 = 0%; P = .001). No significant differences were found for other clinical outcomes. Subgroup analyses were unremarkable when analyzed according to fibrinogen dose, time of infusion initiation, mean cardiopulmonary bypass time, and rotational thromboelastometry/fibrinogen temogram use (all P values for subgroup interaction were nonsignificant). CONCLUSIONS: Current evidence remains insufficient to support or refute routine perioperative administration of fibrinogen concentrate in patients undergoing cardiovascular surgery. Fibrinogen concentrate may reduce the need for additional allogeneic blood product transfusion in cardiovascular surgery patients at high risk or with evidence of bleeding. However, no definitive advantage was found for reduction in risk of mortality or other clinically relevant outcomes. The small number of clinical events within existing randomized trials suggests that further well-designed studies of adequate power and duration to measure all-cause mortality, stroke, myocardial infarction, reoperation, and thromboembolic events should be conducted. Future studies should also address cost-effectiveness relative to standard of care. Accepted for publication April 30, 2018. Funding: This work was supported by the Department of Anesthesia and Perioperative Medicine, Western University. The authors declare no conflicts of interest. 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/KegmMq). Reprints will not be available from the authors. Address correspondence to Janet Martin, PharmD, MSc(HTA&M), Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, University Hospital, Room C3-412, 339 Windermere Rd, London, ON N6A 5A5, Canada. Address e-mail to jmarti83@uwo.ca. © 2018 International Anesthesia Research Society

https://ift.tt/2Hai2sQ

Inhibition of Fatty Acid Amide Hydrolase Improves Depressive-Like Behaviors Independent of Its Peripheral Antinociceptive Effects in a Rat Model of Neuropathic Pain

BACKGROUND: Neuropathic pain is often associated with depression. Enhancing endocannabinoids by fatty acid amide hydrolase (FAAH) inhibitors relieves neuropathic pain and stress-induced depressive-like behaviors in animal models. However, it is unclear whether FAAH inhibitor can relieve neuropathic pain–induced depression by or not by its antinociceptive effects. METHODS: Adult male Wistar rats with chronic constriction injury (CCI) to the sciatic nerve were treated with the systemic FAAH inhibitor URB597 (5.8 mg·kg−1·day−1, intraperitoneally) or peripherally acting FAAH inhibitor URB937 (1.6 mg·kg−1·d−1, intraperitoneally; n = 11–12). The treatment was applied from the 15th day after surgery and continued for 15 days. Mechanical withdrawal threshold was examined by Von Frey test before surgery and on the 28th day after CCI. Depressive-like behaviors were evaluated by forced swimming test (FST) and novelty-suppressed feeding (NSF) after 15-day treatment. The levels of anandamide and 2-arachidonoylglycerol in hippocampus were examined by liquid chromatography and mass spectrometry. Hippocampal neurogenesis including proliferation, differentiation, and survival of newborn cells was assessed by immunohistochemistry. RESULTS: After CCI injury, the rats developed significantly nociceptive and depressive-like behaviors, indicated by persistent mechanical hypersensitivity in Von Frey test, significantly prolonged immobility time in FST (sham: 84.2 ± 13.4 seconds versus CCI: 137.9 ± 18.8 seconds; P

https://ift.tt/2J0TTea

Resuscitation of Endotheliopathy and Bleeding in Thoracic Aortic Dissections: The VIPER-OCTA Randomized Clinical Pilot Trial

BACKGROUND: Thoracic aorta dissection is an acute critical condition associated with shock-induced endotheliopathy, coagulopathy, massive bleeding, and significant morbidity and mortality. Our aim was to compare the effect of coagulation support with solvent/detergent-treated pooled plasma (OctaplasLG) versus standard fresh frozen plasma (FFP) on glycocalyx and endothelial injury, bleeding, and transfusion requirements. METHODS: Investigator-initiated, single-center, blinded, randomized clinical pilot trial of adult patients undergoing emergency surgery for thoracic aorta dissection. Patients were randomized to receive OctaplasLG or standard FFP as coagulation factor replacement related to bleeding. The primary outcome was glycocalyx and endothelial injury. Other outcomes included bleeding, transfusions and prohemostatics at 24 hours, organ failure, length of stay in the intensive care unit and in the hospital, safety, and mortality at 30 and 90 days. RESULTS: Fifty-seven patients were included to obtain 44 evaluable on the primary outcome. The OctaplasLG group displayed significantly reduced damage to the endothelial glycocalyx (syndecan-1) and reduced endothelial tight junction injury (sVE-cadherin) compared to standard FFP. In the OctaplasLG group compared to the standard FFP, days on ventilator (1 day [interquartile range, 0–1] vs 2 days [1–3]; P = .013), bleeding during surgery (2150 [1600–3087] vs 2750 [2130–6875]; P = .046), 24-hour total transfusion and platelet transfusion volume (3975 mL [2640–6828 mL] vs 6220 mL [4210–10,245 mL]; P = .040, and 1400 mL [1050–2625 mL] vs 2450 mL [1400–3500 mL]; P = .027), and goal-directed use of prohemostatics (7/23 [30.4%] vs 13/21 [61.9%]; P = .036) were all significantly lower. Among the 57 patients randomized, 30-day mortality was 20.7% (6/29) in the OctaplasLG group and 25% (7/28) in the standard FFP group (P = .760). No safety concern was raised. CONCLUSIONS: In this randomized, clinical pilot trial of patients undergoing emergency surgery for thoracic aorta dissections, we found that OctaplasLG reduced glycocalyx and endothelial injury, reduced bleeding, transfusions, use of prohemostatics, and time on ventilator after surgery compared to standard FFP. An adequately powered multicenter trial is warranted to confirm the clinical importance of the findings. Accepted for publication May 8, 2018. Funding: This investigator-initiated trial was funded by internal department funds and an unrestricted research grant from Octapharma AG, the manufacturer of OctaplasLG, paid to and administered by Copenhagen University Hospital, Rigshospitalet, to support the execution of the trial covering expenses to assisting staff, on-call research assistants, blood samples, laboratory analyses, etc. Octapharma AG also supplied the investigational product of the trial free of charge. None of the authors involved have received ­personal income from Octapharma AG, have shares or financial interests in Octapharma AG, and Octapharma AG had no role in the design of this study, its execution, analysis, interpretation of the data, writing of the article, or decision to submit results. Conflicts of Interest: See Disclosures at the end of the article. 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/KegmMq). The trial was registered before patient enrollment at clinicaltrials.gov (NCT02253082, principal investigator: J.S.; date of registration: October 1, 2014). Reprints will not be available from the authors. Address correspondence to Jakob Stensballe, PhD, Section for Transfusion Medicine, Capital Region Blood Bank and Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100, Denmark. Address e-mail to jakob.stensballe@regionh.dk. © 2018 International Anesthesia Research Society

https://ift.tt/2syuPQy

Primary Intraosseous Hemangioma of the Foreman Rotundum Area

The primary intraosseous hemangioma is extremely rare in foreman rotundum area. However, it is very important for radiologists and otolaryngologists to be aware of it, in order to be able to provide accurately diagnosis as well choose the best treatment plan. The purpose of this article is to describe imaging features of this kind of tumor. Address correspondence and reprint requests to Dapeng Hao, MD, Department of Radiology, The Affiliated Hospital of Qingdao University, No 59 of Haier Road, Laoshan District, Qingdao City, Shandong Province, China; E-mail: haodp_2009@163.com Received 2 November, 2017 Accepted 26 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2HaZg4z

Single-Center Surgical Experience of the Treatment of Craniopharyngiomas With Emphasis on the Operative Approach: Endoscopic Endonasal and Open Microscopic Transcranial Approaches

This study aimed to report the authors' single-center clinical experience about craniopharyngiomas and discuss surgical outcomes of these patients according to the type of surgical approach (endoscopic endonasal or open microscopic transcranial approach). Twenty-four patients diagnosed with craniopharyngiomas between May 2013 and April 2017 were considered for inclusion. The patients were divided into 2 groups according to the surgical approach (open transcranial microscopic approach [group A] and endoscopic endonasal approach [group B]). These groups were compared in terms of postoperative surgical outcome scores (extent of tumor removal, visual deficit, hydrocephalus, metabolic disorders, and Glasgow coma scale) and hospitalization interval. There was no patient of mortality in both groups. In this study, 4 of the 13 patients in group A and 9 of the 11 patients in group B underwent gross total resection. However, 1 patient in group B underwent repair because of cerebrospinal fluid leakage postoperatively. In addition, 1 patient in group A had a wound healing problem postoperatively. The postoperative outcome scores were 9.5 in group A and 11.5 in group B. The hospitalization interval in group A (range, 7–9 days) was longer than that in group B (range, 5–7 days). The endoscopic endonasal approach should be considered the first-line surgical treatment modality in patients with a preliminary diagnosis of craniopharyngioma in terms of low complication risk, minimal invasiveness, and better outcome scores. Open microscopic transcranial procedures may be combined with this approach in a single session for challenging cases. Address correspondence and reprint requests to Gokmen Kahilogullari, MD, PhD, Department of Neurosurgery, Faculty of Medicine, Ankara University, Ibni Sina Hospital, 06640 Sihhiye, Ankara, Turkey; E-mail: gokmenkahil@hotmail.com Received 26 October, 2017 Accepted 10 March, 2018 Preparation of this article was partly supported by the Turkish Neurosurgical Society. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2slK14w

Glabellar Rejuvenation in Forehead Lift: Reversed Periosteum or Dermal Fat Graft to Cover Pedicled Glabellar Flap

Forehead aging is characterized by wrinkles, loss of skin elasticity, brow ptosis, and soft-tissue atrophy. For patients with prominent rhytids and marked brow ptosis, forehead lift is still the most effective treatment with a persisting result. In order to eliminate the glabellar wrinkles, forehead lift usually requires the removal of the corrugator supercilii muscle and procerus, which can lead to glabellar flattening or depression. Instead of muscle removal, the corrugator supercilii muscle, procerus, and the underlying galea were dissected as a pedicled glabellar flap. Then reversed periosteum or dermal fat graft was used to cover the glabellar flap to restore the glabellar volume. From January 2005 to November 2014, a total of 164 coronal and 42 trichophytic forehead lifts were performed. Reversed periosteum was used to cover the glabellar flap in 191 patients while dermal fat graft was applied in 15 patients with a follow-up period ranging from 6 months to 10 years. There was no irregularity or depression in the glabellar region in the group of reversed periosteal flap. The take of dermal fat graft placed over the glabellar flap was minimal. Complications from surgical procedures occurred in 2.91% of the patients. There was 1 asymmetry, 4 patients with higher than desired frontal hairline for implantation of autologous follicular units, and 1 patient with scar hyperplasia. There was no hematoma or nerve injury, no permanent numbness, and no alopecia. The techniques are simple and effective to eliminate the glabellar wrinkles and maintain or restore the glabellar volume. Address correspondence and reprint requests to Jia-Qi Wang, MD, The Third Department, Plastic Surgery Hospital, Peking Union Medical College and the Chinese Academy of Medical Sciences, No 33, Ba-Da-Chu Road, Shijingshan District, Beijing 100144, China; E-mail: dr_jiaqiwang@163.com Received 20 November, 2017 Accepted 16 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2H9uqcI

Adult Laryngeal Ossified Hemangioma: Difficulties in Differential Diagnosis

Adult laryngeal hemangiomas are uncommon and often poorly symptomatic. The authors describe a laryngeal hemangioma with acute airway obstruction and radiologic findings suggesting a chondrosarcoma-like neoplasm, while pathologic features were consistent with an ossified hemangioma. The presence of fields of bone metaplasia into a classical cavernous hemangioma is an unusual phenomenon which, to our knowledge, was never previously described in the larynx. Difficulties concerning the differential diagnosis and modality of treatment are also discussed. Address correspondence and reprint requests to Christel Gorris, MD, Department of Otorhinolaryngology, University of Piemonte Orientale "Amedeo Avogadro," Novara, Corso Mazzini 18, 28100 Novara Italy; E-mail: 20013737@studenti.uniupo.it Received 18 July, 2017 Accepted 25 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Surgical Treatment of Maxillary Antrum Neoplasms

Paranasal sinus cancers comprise about 0.3% of all cancers and 80% of these lesions arise in the maxillary sinus. A masquerading primary sinus tumour represents a therapeutic challenge as most patients with maxillary antrum cancer are diagnosed with advanced disease. However, distant metastases rarely occur. We examined the clinical outcome of patients with antrum neoplasms. Medical records were obtained for all patients diagnosed with a sinus malignancy between July 2009 and January 2014. During this period, 41 patients with maxillary tumours were treated, among which 9 patients received a maxillectomy. There were 21 male and 20 female patients. All patients underwent computed tomography or magnetic resonance imaging. The most common complications were postoperative epistaxis and swallowing difficulty. The treatment of maxillary antrum tumours is complicated and needs advancements to improve early presentation, timely diagnosis, and better management outcomes. Address correspondence and reprint requests to Dr Elham Hazeim Abdulkareem, BDS, MSc, PhD, Oral and Maxillofacial Surgery Department, College of Dentistry, University of Anbar, Street: Ceramic, P.O. Box 55431, Baghdad 55 Ramadi, Iraq; E-mail: elham.hazima@gmail.com Received 24 February, 2018 Accepted 1 April, 2018 The authors report no conflict of interest. © 2018 by Mutaz B. Habal, MD.

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Resorbable Material for Pediatric Orbital Floor Reconstruction

Introduction: The use of resorbable materials is becoming more popular for pediatric orbital floor reconstruction. The purpose of this systematic review is to evaluate the effectiveness and safety of the various materials used in pediatric orbital floor reconstruction. Methods: A systematic literature search was performed to identify all relevant articles reporting complications following pediatric orbital floor reconstruction. The search included published articles in three electronic databases—Ovid MEDLINE, EMBASE, and PubMed starting from database establishment to July 2017. Primary endpoints were enophthalmos, diplopia, and infection. Resorbable material was compared to autologous grafts and nonresorbable material. Results: A total of 14 studies containing 248 patients were included in this review. Fifty-four (21.8%) patients had reconstruction performed with autologous grafts, 72 (29.0%) patients with resorbable material, and 122 (49.2%) patients with nonresorbable material. Resorbable materials had the lowest rate of postoperative enophthalmos (3/52; 5.8%) and the highest rate of postoperative diplopia (19/72; 26.4%). In contrast, nonresorbable materials had the lowest rate of postoperative diplopia (5/122; 4.1%), the highest rate of postoperative enophthalmos (14/102; 13.7%). Autologous reconstruction was associated with an 11.1% (4/36) rate of postoperative enophthalmos and a 22.2% (12/54) rate of postoperative diplopia. Nine cases (8.8%) of postoperative infection were documented with nonresorbable materials. No cases of infection were reported with autologous grafts or resorbable materials. Conclusion: Newer resorbable implants are safe and have a similar complication profile as traditional autologous grafts in pediatric orbital floor reconstruction. Address correspondence and reprint requests to Dr Sabrina Cugno, MD, MSc, FRCSC, Department of Plastic Surgery, Montreal Children's Hospital, 1001 boul Decarie, Montreal, Quebec H4A 3J1, Canada; E-mail: sabrina.cugno@muhc.mcgill.ca Received 12 January, 2018 Accepted 1 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Speech Therapy in Velocardiofacial Syndrome After Palatopharyngeal Pharyngoplasty

Velocardiofacial syndrome (VCFs) is a rare congenital disease with an incidence of 1:4000 to 1:6000. Previous studies have found that the abnormality is associated with 22qDS. As reported at the international VCFs conference held in 2006, >180 phenotypes have been identified with this syndrome. Accordingly, there is a wide range of clinical manifestations including congenital defects of the heart and palate, immune deficiencies, psychiatric illness, and speech, learning, and cognitive disabilities Among all the symptoms above, however, pharyngopalatine dysplasia has been observed in nearly every patient. Patients with VCFs often have velopharyngeal insufficiency, which may cause serious disorders in functional speech, with poor intelligibility, a glottal stop with hypernasality and a pharyngeal fricative, and dropping and weakening of consonants. Most also show defects in language learning. Therefore, specialized speech therapy is essential for patients with VCFs, mainly focused on correction of abnormal pronunciation. Long-term clinical experience has shown that speech therapy is based on 2 components: velopharyngeal function and behavior therapy. Our study focused mainly on establishing a corrective behavior guidance model of pronunciation for patients with VCFs. Correspondence to: YuSheng Yang, Associate Professor, Cleft Lip and Palate Center, Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, ZhiZaoJu Rd., 200011 Shanghai, People's Republic of China; E-mail: yysdj4829@163.com Received 29 October, 2017 Accepted 1 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Three-Dimensional Printed Model and Transantral Endoscopy to Orbital Fracture Repair

Orbital fractures are high prevalent and result in several complications such as diplopia, muscular entrapment, visual impairment, and enophthalmos. The goal of orbital reconstruction is to restore orbital anatomy, volume, and globe symmetry. This case report aims to describe the use of transantral endoscopy and 3D printed model for treatment of an orbital floor fracture. A 54-year-old woman presented orbital floor fracture with diplopia and extraocular muscle entrapment. The surgical treatment was performed using a standard titanium mesh bended over 3D printed model, and transantral endoscopy to verify fracture extension and implant adaptation. The postoperative evaluation demonstrates correction of diplopia and ocular motility restriction. Computed tomography scan showed reestablishment of the orbital anatomy. The association of transantral endoscopy and 3D printed models is a feasible technique to improve orbital reconstruction. Address correspondence and reprint requests to Lucas Borin Moura, DDS, PhD, Department of Diagnosis and Surgery, School of Dentistry, Araraquara, São Paulo State University (UNESP), Humaitá St. 1680, 14801-903, Araraquara, São Paulo, Brazil; E-mail: lucasbmoura@gmail.com Received 29 January, 2018 Accepted 4 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Post-Neurosurgical Temporal Deformities: Various Techniques for Correction and Associated Complications

Introduction: An irregular craniofacial contour along the temporal fossa, known commonly as "temporal hollowing deformity," (THD) can arise from multiple etiologies. In fact, up to half of all patients who undergo neurosurgical pterional dissections develop some form of temporal contour deformities. Unfortunately, temporal hollowing correction remains surgically challenging with many techniques resulting in high rates of failure and/or morbidity. Methods: Herein, we describe anatomy contributing to postsurgical temporal deformity as well as time-tested prevention and surgical correction techniques. In addition, a review of 25 articles summarizing various techniques and complication profiles associated with temporal hollowing correction are presented. Results: Complications included infection, implant malposition, revision surgery, pain, and implant removal because of implant-related complications Augmentation with either autologous fat or dermal filler is associated with the highest number of reported complications, including catastrophic events such as stroke, pulmonary embolism, and death. No such complications were reported with use of alloplastic material, use of autologous bone, or free tissue transfer. Furthermore, careful attention to adequate temporalis muscle resuspension and position remain paramount for stable restoration of craniofacial symmetry. Conclusions: Catastrophic complications were associated with injection augmentation of both fat and dermal filler in the temporal region. In contrast, use of alloplastic materials was not found to be associated with any catastrophic complications. As such, for the most severe cases of THD, we prefer to employ alloplastic reconstruction. Address correspondence and reprint requests to Gabriel F. Santiago, MD Fellow, Neuroplastic and Reconstructive Surgery, Assistant in Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, JHOC, 8th Floor, 601 N. Caroline Street, Baltimore, MD 21287; E-mail: gsantia2@jhmi.edu Received 24 January, 2018 Accepted 5 April, 2018 This study was presented, in part, at the American Society of Plastic Surgeons Instructional Course, Orlando, Florida. October, 2017 CRG is a consultant for Stryker CMF. GFS is a recipient of the Synthes Future Leaders Grant which supports the fellowship program. The remaining authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Mesenchymal Chondrosarcoma of the Orbit Attached to the Optic Nerve

Mesenchymal chondrosarcoma (MCS) is a rare tumor in the orbit. Although optic nerve displacement is a common finding in intraorbital MCS, optic nerve tissue involvement in tumor has rarely been reported in huge tumors associated with intracranial extension. Herein the authors report a patient with MCS involving optic nerve tissue without intracranial extension. A 59-year-old woman with a 2-month history of progressive proptosis and normal vision presented to us. Computed tomography revealed a clearly outlined heterogeneous mass with calcified foci in its center, which was attached to the optic nerve, magnetic resonance imaging showed the mass to be isointense to gray matter on T1- and T2-weighted images. She underwent lateral orbitotomy and partial tumor excision. Histopathologic study confirmed MCS. She refused exenteration till 1 year but the tumor recurred and her vision decreased to no light perception. Then exenteration was performed with obtaining free margin and she is now free of tumor after 6 months without radiotherapy or chemotherapy. Mesenchymal chondrosarcoma must be differentiated from more common calcified tumors attached to optic nerve like meningioma. Address correspondence and reprint requests to Abbas Bagheri, MD, Labbafinejad Medical Center, Boostan 9 St Pasdaran Avenue, Tehran 16666, Iran; E-mail: abbasbagheri@yahoo.com Received 29 January, 2018 Accepted 4 April, 2018 Presented at the 27th Iranian Congress of Ophthalmology 2017 Tehran, Iran. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Effects of Craniofacial Morphology on Nasal Respiratory Function and Upper Airway Morphology

Background: Craniofacial skeletal patterns change after orthognathic surgery. The present study aimed to investigate the effects of different craniofacial patterns on nasal respiratory function and the upper airway. Methods: Forty-seven healthy subjects were selected and divided into 3 groups according to their mandibular position. Sixteen were in the skeletal Class I group, 15 were in the skeletal Class II group, and 16 were in the skeletal Class III group. Cone beam computed tomography was performed, and nasal airflow and nasal resistance were measured. Differences in nasal respiratory functions and upper airway were compared among the groups. A correlation analysis was conducted for nasal respiratory function, upper airway, and skeletal patterns. Results: There were significant differences among the 3 groups regarding dominant-side nasal inspiratory capacity (P = 0.001), bilateral nasal inspiratory capacity (P = 0.005), nasal partitioning ratio-inspiration (P = 0.007), and velopharyngeal minimum cross-sectional area (P = 0.029). The values were significantly higher for the skeletal Class III group than the skeletal Class I and II groups. A correlation analysis showed that the nasal partitioning ratio and nasal airway resistance were mostly negatively correlated with SNA, but the upper airway volume and cross-sectional area were positively correlated with SNB and negatively correlated with ANB. The dominant-side nasal expiratory capacity was mainly negatively correlated with the mean velopharyngeal cross-sectional area (r = −0.324, P = 0.026), mean glossopharyngeal cross-sectional area (Glosso-A mean) (r = −0.293, P = 0.046), and mean total airway cross-sectional area (Total-A mean) (r = −0.307, P = 0.036). Conclusion: Craniofacial skeletal morphology may affect nasal respiratory function and the upper airway. Address correspondence and reprint requests to Xuemei Gao, MD, PhD, Professor, Department of Orthodontics, Peking University School and Hospital of Stomatology, 22 South Zhongguancun Avenue, Haidian District, Beijing 100081, China; E-mail: xmgao@263.net Received 23 January, 2018 Accepted 5 April, 2018 This study was supported by the National Natural Science Foundation of China (81400062, 81470272); and Chinese Sleep Research Society Youth Scientific Research Fund (2014-03). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Outcome Analysis of Traumatic Facial Nerve Palsy Treated With Systemic Steroid Therapy

Purpose: Although facial nerve palsy is uncommon after a blunt craniofacial injury, it will result in functional and aesthetic disability if full recovery is not achieved. Currently, the management is still controversial and mainly through systemic steroid therapy or surgical decompression. However, current studies mainly focus on the surgical intervention, and only a few of these studies discuss the details of the steroid treatments. Thus, the purpose of this study is to analyze possible prognosis factors of systemic steroid in managing traumatic facial nerve palsy after a blunt craniofacial injury retrospectively. Methods: During the period from May 2005 to April 2015 at Chang Gung Memorial Hospital, a total of 26 patients who suffered from post-traumatic facial nerve palsy receiving steroid therapy were enrolled in the study. All the patient's charts were reviewed, recorded, and analyzed including the general data, temporal bone fracture type, hospital courses, trauma-related data from emergency room records, and initial and final facial nerve palsy grading. The facial nerve palsy was graded using the House-Brackmann (HB) system; the final HB grade I was set as full recovery. Results: The outcome showed steroid therapy onset within 24 hours (odds ratio [OR] = 10.111; 95% confidence interval [CI] = 1.597–64.005; P = 0.014) and steroid therapeutic duration for longer than 14 days (OR = 11.571; 95% CI = 1.172–114.262; P = 0.036) possessed a significantly better recovery rate. Conclusion: This study recommends to apply steroids within 24 hours once post-traumatic facial palsy occurs and the therapy should persist longer than 14 days. Address correspondence and reprint requests to Han-Tsung Liao, MD, PhD, Associate Professor, Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial research center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 5, Fu-Shing Street, Taoyuan 333, Taiwan; E-mail: lia01211@gmail.com Received 29 July, 2017 Accepted 7 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Anatomic Study of Craniocervical Junction and Its Surrounding Structures in Endoscopic Transoral-Transpharyngeal Approach

Purpose: This study aims to provide accurate and comprehensive data of craniocervical junction and its peripheral structures in order to provide a profound insight of craniocervical junction as well as to avoid complications during surgical procedures related to it. Methods: Computed tomographic angiography (CTA) images of 120 individuals were reviewed, the measurements were performed on coronal, sagittal, and axial planes after 3-dimensional volume reconstruction. The authors measured pharyngeal tubercle, foramen magnum, and tuberculum anterius atlantis, which located based on the position of incisor. The anatomic features of other important bony landmarks, internal carotid artery, and vertebral artery were also fully studied so as to avoid being injured during the transoral-transpharyngeal procedure. Results: During the endoscopic surgery to craniocervical junction, the bending angle of neuroendoscopy should be 14.27 ± 4.51° and the entering depth should be about 72.57 ± 8.72 mm. It is safe to work within the angle of 77.73 ± 3.15° in axial plane and the safe penetration width from the axial midline is 20.05 ± 3.11 mm in the level of foramina magnum. The distance from axial middle line to hypoglossal canal, external opening of carotid canal, and inner edge of jugular foramen was 9.78 ± 0.72, 24.50 ± 1.26, and 24.33 ± 1.68 mm, respectively. Conclusions: These data in this study are valuable for neurosurgeons in clinical practice to reduce the possibility of complications and maximize the safety of surgeries; these data also contribute to the understanding of the anatomy of craniocervical junction and its surrounding structures. Address correspondence and reprint requests to Ye Cheng, MD, PhD, Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Street Changchun 45, Beijing, China; E-mail: chengye_jdyy@126.com Received 8 February, 2018 Accepted 7 April, 2018 This study was supported by grants from the National Natural Science Foundation of China (Nos. 21401072 and 81302173), the S&T Development Planning Program of Jilin Province (Nos. 20160101086JC, 20150520045JH, 20130206039SF, and 20130522029JH), and Bethune project of Jilin University (No. 2013205022). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Minimally Invasive Approach for Resection of Masseteric Vascular Malformations

Objective: Vascular malformations (VMs) in the head and neck region often cause esthetic as well as functional problems for patients. Intramuscular VMs (IVM), such as those in the masseter, can cause severe facial asymmetry and typically are excised transcutaneously to facilitate wide exposure and safe dissection from the facial nerve. This requires extensive dissection, prolonged healing, and can lead to suboptimal facial scarring. Methods: We describe the technique of resecting large IVMs of the masseter muscle in 3 patients using an entirely intraoral approach with continuous nerve monitoring and without visible facial scarring or secondary deformity. Preoperative injection of sclerotherapy was performed to reduce intra-operative bleeding and optimize resection. Results: Successful excision was performed without complication in 3 patients to date. Total average operating room time was 120 minutes (range 95–145 minutes). Estimated blood loss was 213 mL (range 180–240 mL). The patients were discharged home either post-operative day (POD) 1 or 2, with 1 returning to work POD 4. Facial nerve function was normal postoperatively and no hematomas developed. Subjective masticatory function was equivalent to preoperative levels in all patients. Conclusions: Intraoral excision of VMs of the masseter muscle can be safely performed without added risk or complication. Continuous facial nerve monitoring allows minimally invasive approaches to be considered with less risk of iatrogenic facial nerve injury. We purport that this is a safe and effective method with substantially better esthetic outcomes compared with traditional transcutaneous approaches. Address correspondence and reprint requests to Nicholas Bastidas, MD, Assistant Professor, Hofstra Northwell Health System, 1991 Marcus Ave, Suite 102, Lake Success, NY 11042; E-mail: nbastidas@northwell.edu Received 24 December, 2016 Accepted 7 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Virtual Surgical Planning Assisted Management for Three-Dimensional Dentomaxillofacial Deformities

Objective: Treatment of 3-dimensional dentomaxillofacial deformities remains a significant clinical challenge. This retrospective study aims to present the modalities of management for complex 3-dimensional dentomaxillofacial deformities with the assistance of virtual surgical planning (VSP) and 3-dimensional printed navigation templates. Study Design: Ten patients diagnosed with complex 3-dimensional dentomaxillofacial deformities received treatment of combined orthodontics and orthognathic surgery. Various surgical techniques as well as bone graft and distraction osteogenesis were used under the guidance of VSP and 3-dimensional printed navigation templates according to the characteristics of each patient. Follow-up included clinical examination and studies of spiral computed tomography preoperatively and for an average of 12 months postoperatively. Result: The clinical outcomes of patients showed that VSP was successfully transferred to actual surgery in all the 10 patients. Three-dimensional dentomaxillofacial deformities were corrected significantly. Satisfactory profiles and occlusion were achieved. Conclusion: The management of 3-dimensional dentomaxillofacial deformities required comprehensive consideration and detailed surgical planning. Virtual surgical planning serves as a reliable assistance in the management of 3-dimensional dentomaxillofacial deformities. Address correspondence and reprint requests to Jihua Li, MD, PhD, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; E-mail: leejimwa6698@sohu.com Received 31 January, 2018 Accepted 7 April, 2018 HH and YW are co-first authors. This study was supported by the Natural Science Foundation of China (81470720 and 31271032). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Radiologic Imaging of Ludwig Angina in a Pediatric Patient

Ludwig angina is an important disease with deadly consequences. Especially in the pediatric patient group, recognition of the disease may be difficult due to patient incompatibility. For this reason, radiologic imaging methods should be carefully selected. Diffusion-weighted magnetic resonance imaging and contrast-enhanced examinations are the most important methods for the diagnosis of the disease. Address correspondence and reprint requests to Gökhan Polat, MD, Department of Radiology, Faculty of Medicine, Ataturk University, 25040 Erzurum, Turkey; E-mail: dr.g.polat@gmail.com Received 7 February, 2018 Accepted 7 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Effect of Mandibular Distraction Osteogenesis on Weight Velocity in Infants With Severe Pierre Robin Syndrome

Mandibular distraction osteogenesis (MDO) effectively improves airway obstruction in Pierre Robin syndrome (PRS) patients. However, whether or not early MDO is beneficial to the development of children is still controversial. To observe the influence of PRS patient age at the time of MDO on their development, the authors retrospectively analyzed preoperative and postoperative body weight in 41 children with PRS who underwent MDO treatment from 2014 to 2016. The body weight of the infants at the time of birth, first visit, MDO surgery, distractor removal, and palatoplasty surgery was recorded. The body weight percentile significantly fell from 34.4 ± 5.8 at birth to 13.1 ± 3.6 at the time of MDO (P 

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Giant Epidermoid Cyst of the Maxillary Sinus: A Postoperative Complication?

Epidermoid cysts are benign lesions, which are usually detected on the floor of the mouth in the head and neck region. They can develop from abnormal epithelial components of an ectoderm tissue during the embryological life or alternatively they can arise from the implanted epithelium after trauma or surgery. The diagnosis of an epidermoid cyst in the maxillary sinus can be challenging and it could be easily mistaken for any benign or malign lesion of the nasal cavity and paranasal sinuses. In this case, we present a 44-year-old man with a giant epidermoid cyst in the right maxillary sinus with a previous history of paranasal sinus surgery. We present a very rare case of epidermoid cyst and also discuss the importance of radiological imaging modalities in differential diagnosis of a unilateral expansile mass in the maxillary sinus. Address correspondence and reprint requests to Eda Tuna Yalcinozan, MD, Department of Otorhinolaryngology, Near East University Faculty of Medicine Yakin Doğu Blv, Mersin 10, Nicosia 99138, Cyprus; E-mail: dr.etuna@gmail.com Received 18 December, 2017 Accepted 8 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Faciocervical Reconstruction Using a Large Expanded Forehead Island Flap Grafted Using a Microsurgical Technique for Burned Cicatricial Contracture Correction

Extrinsic cicatricial contracture is still one of the most common and frustrating complications in the faciocervical area after severe burns. Because of these contractured scars, patients not only suffer from aesthetic issues but also local dysfunction, especially when it comes to the faciocervical region. Esthetical and functional reconstruction of these regions remains a great challenge for reconstructive surgeons. This report presents a 28-year-old man with postburn mentocervical adhesion treated successfully with a large expanded forehead island flap. Cosmetic and functional results have been achieved in this patient during long-term follow-ups. Address correspondence and reprint requests to Jincai Fan, MD, PhD, Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, No. 33, Ba-Da-Chu Road, Beijing, China; E-mail: fanjincaimd@hotmail.com Received 17 December, 2017 Accepted 7 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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