Prenatal diagnosis and implications of microphthalmia and anophthalmia with a review of current ultrasound guidelines: two case reports

Microphthalmia and anophthalmia are rare congenital fetal abnormalities. The combined incidence is estimated at 1 in 10,000 births. These two conditions arise from complex and incompletely understood genetic a...

https://ift.tt/2oielKL

Ankylosing spondylitis, chronic fatigue and depression improved after stromal vascular fraction treatment for osteoarthritis: a case report

Osteoarthritis is a prevalent chronic disease that impacts quality of life and imposes a heavy economic burden. Despite this there is no confirmed treatment that could prevent progressive destruction of osteoa...

https://ift.tt/2ws7rGx

“We're Going to Leave You for Last, Because of How You Are”: Transgender Women's Experiences of Gender-Based Violence in Healthcare, Education, and Police Encounters in Latin America and the Caribbean

Violence and Gender, Ahead of Print.


https://ift.tt/2BVkw1a

Icariin inhibits inflammation via immunomodulation of the cutaneous hypothalamus–pituitary–adrenal axis in vitro

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2LC3yUO

Laser therapy for ocular lesions of naevus of Ota

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2MWaBws

Associated factors of widespread pattern of dermatitis among patch test population: 12‐Year retrospective study

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2NtbWrs

Severe cutaneous eruptions following the topical use of preparations containing bufexamac: Is it time to reconsider its registration in Australia?

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2ojeX2I

Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study

British Journal of Dermatology, EarlyView.


https://ift.tt/2NqIvGF

A 10‐year longitudinal follow‐up study of a U.K. paediatric transplant population to assess for skin cancer

British Journal of Dermatology, EarlyView.


https://ift.tt/2MYha1G

Dermatology on the General Practice Bookshelf

British Journal of Dermatology, EarlyView.


https://ift.tt/2NtYCmQ

Kidney Transplant Outcomes in Recipients with Cognitive Impairment: A National Registry and Prospective Cohort Study

Background Cognitive impairment is common in patients with end-stage renal disease and is associated with poor outcomes on dialysis. We hypothesized that cognitive impairment might be associated with an increased risk of all-cause graft loss (ACGL) in kidney transplant (KT) recipients. Methods Using the Modified Mini-Mental State (3MS) examination, we measured global cognitive function at KT hospital admission in a prospective, two-center cohort of 864 KT candidates (8/2009-7/2016). We estimated the association between pre-KT cognitive impairment and ACGL using Cox regression, adjusting for recipient, donor, and transplant factors. Results In living donor KT (LDKT) recipients, the prevalence was 3.3% for mild impairment (60≤3MS

https://ift.tt/2BWU2w5

International Liver Transplantation Consensus Statement on end-stage liver disease due to nonalcoholic steatohepatitis and liver transplantation

Nonalcoholic steatohepatitis (NASH)-related cirrhosis has become one of the most common indications for liver transplantation (LT), particularly in candidates over the age of 65 years. Typically, NASH candidates have concurrent obesity, metabolic and cardiovascular risks, which directly impact patient evaluation and selection, waitlist morbidity and mortality and eventually posttransplant outcomes. The purpose of these guidelines is to highlight specific features commonly observed in NASH candidates and strategies to optimize pretransplant evaluation and waitlist survival. More specifically, the working group addressed the following clinically-relevant questions providing recommendations based on the GRADE system supported by rigorous systematic reviews and consensus: (1) Is the outcome after LT similar to that of other etiologies of liver disease? (2) Is the natural history of NASH-related cirrhosis different from other etiologies of end-stage liver disease? (3) How should cardiovascular risk be assessed in the candidate for LT? Should the assessment differ from that done in other etiologies? (4) How should comorbidities (hypertension, diabetes, dyslipidemia, obesity, renal dysfunction, etc.) be treated in the candidate for LT? Should treatment and monitoring of these comorbidities differ from that applied in other etiologies? (5) What are the therapeutic strategies recommended to improve the cardiovascular and nutritional status of a NASH patient in the waiting list for LT? (6) Is there any circumstance where obesity should contraindicate LT? (7) What is the optimal time for bariatric surgery: before, during, or after LT? and (8) Donor steatosis: how much relevant is it for LT in NASH patients Contributions: All authors drafted sections of the manuscript and revised the final manuscript for important intellectual content. In addition, MB and ET also drafted some of the sections, combined all the sections in a single manuscript, and revised the final before submission. Conflict of interest: ET: none SN: none YT: none YL: Speaker for Gilead. Grants and Speaker for Novartis. MG: none JK: none MB: Speaker for Novartis, Astellas, Gilead. Grant from Gilead. Correspondence information: Marina Berenguer – MD, La Fe University Hospital, Avenida Fernando Abril Martorell, 106 (Torre F5) – 46026 Valencia (Spain), e-mail: marina.berenguer@uv.es Ciberehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas) is partially funded by the Instituto de Salud Carlos III. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2oiJGwR

Recipient age and mortality after liver transplantation: a population-based cohort tudy

Background The feasibility of liver transplantation (LT) in elderly recipients remains a topic of debate. Methods This cohort study evaluated the impact of recipient's age on LT outcome between January 2007 and May 2016 covered by the Korean National Health Insurance system (n = 9415). Multilevel regression models were used to determine the impact of recipient's age on in-hospital and long-term mortality after LT. Results All patients had a first LT, with 2,473 transplanted with liver from deceased donors (DD) and 6,942 from living donors (LD). The mean age was 52.2±9.0 years. The majority of LT was performed on patients in their 50s (n=4290, 45.6%) and 0.9% (n=84) of the LT was performed on patients aged over 70 years. The overall in-hospital mortality was 6.3%, and the 3-year mortality was 11.3%. The in-hospital mortality included, 13.5% associated with DDLT and 3.7% involved LDLT. When compared with that for patients aged 51 to 55 years, the risk of death among recipients aged over 70 years was about four-fold higher after adjusting for baseline liver disease (OR 4.1; 95% CI 2.21-7.58), and was nearly 3 fold higher after adjusting for baseline liver disease and perioperative complications (OR 2.92; 95% CI 1.37-6.24). And the cost of LT increased significantly with age. Conclusions The data shows that age remains an important risk factor for LT, suggesting that LT should be considered with caution in elderly recipients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Address for Correspondence: Jinkyeong Park, M.D. Ph.D. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, E-mail: pjk3318@gmail.com Authorship E.Gil participated in its design and drafted the manuscript. JM. Kim, K.Jeon and GY. Seo participated in its design and coordination. H.Park and D.Kang performed the statistical analysis and helped to draft the manuscript. And J.Cho directed the statistical analysis form the HIRA database. J.Park participated in its design and coordination and contributed as a corresponding author. Disclosure: none Ethics approval and consent to participate The study was reviewed by the Institutional Review Board (IRB) of Samsung Medical Center (IRB SMC 2017-01-001) and was exempted because it involved only deidentified administrative data collected previously. Availability of data and materials We cannot share our data because of administrative data of Korean government Funding: This study was supported by Samsung Medical Center grant [#SMX1151381] Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LzS0BK

Influence of induced infection in medication-related osteonecrosis of the jaw development after tooth extraction: a study in rats

The mechanisms underlying the pathophysiology of medication-related osteonecrosis of the jaw (MRONJ) development have not yet been fully elucidated. MRONJ is described as a multi-factorial process in which bacterial infection seems to play an important role. The purpose of the present study was to investigate the influence of a primary installed infectious disease in the development of MRONJ after dental extraction.

https://ift.tt/2wmeotB

Giants in Allergy-Immunology Dr. Henry N. Claman

Dr. Henry Claman recruited me to move to Denver and was my primary mentor during my early years at the University of Colorado School of Medicine. I knew Henry from 1988 until his death in 2017 first as a mentee and then as a colleague and friend. When I first met Henry, I was aware of his importance to the field of immunology as the first to demonstrate that small lymphocytes from the bone marrow (B cells) were responsible for antibody production and those from the thymus (T cells) provided necessary "help".

https://ift.tt/2wohDRj

Improving allergy office scheduling increases patient follow up and reduces asthma readmission after pediatric asthma hospitalization

Pediatric asthma is a major contributor to emergency room utilization and hospital readmission rates.

https://ift.tt/2wsLyH2

Disease in a Nutshell Sarcoidosis

Sarcoidosis is a granulomatous disease of unknown etiology which can affect any organ system. It may cause respiratory tract, cardiac, ocular, neurologic, and cutaneous manifestations in isolation or in combination. The etiology of sarcoidosis is poorly understood but since exposure to certain environmental antigens in genetically susceptible individuals can lead to granulomatous inflammation mediated by a predominant T helper-1 (Th1) mediated response, that mechanism is possible. Several disease clusters have been reported in response to environmental events such as exposures to industrial chemicals or dust such as observed in the World Trade Center (WTC) disaster.

https://ift.tt/2wlq5AI

Surgical Management of Postparalysis Facial Palsy and Synkinesis

Modified selective neurectomy of the distal branches of the buccal, zygomatic, and cervical branches of the facial nerve in addition to platysmal myotomy is an effective surgical procedure for the treatment of postfacial paralysis synkinesis. Success of this procedure depends on identification of the peripheral facial nerve branches, preservation of zygomatic and marginal mandibular branches that innervate key smile muscles, and ablation of buccal and cervical branches that cause lateral and/or inferior excursion of the oral commissure. Results are long-lasting; objective improvements in electronic clinician-graded facial function scale score, House-Brackmann score, and decreased botulinum toxin-A requirements have been observed.

https://ift.tt/2MVznwG

Management of Long-Standing Flaccid Facial Palsy

Ineffective eyelid closure can pose a serious risk of injury to the ocular surface and eye. In cases of eyelid paresis, systematic examination of the eye and ocular adnexa will direct appropriate interventions. Specifically, 4 distinct periorbital regions should be independently assessed: eyebrow, upper eyelid, ocular surface, and lower eyelid. Corneal exposure can lead to dehydration, thinning, scarring, infection, perforation, and blindness. Long-term sequelae following facial nerve palsy may also include epiphora, gustatory lacrimation, and synkinesis.

https://ift.tt/2NseuX0

Surgical Management of Acute Facial Palsy

Bell palsy and traumatic facial nerve injury are two common causes of acute facial palsy. Most patients with Bell palsy recover favorably with medical therapy alone. However, those with complete paralysis (House-Brackmann 6/6), greater than 90% degeneration on electroneurography, and absent electromyography activity may benefit from surgical decompression via a middle cranial fossa (MCF) approach. Patients with acute facial palsy from traumatic temporal bone fracture who meet these same criteria may be candidates for decompression via an MCF or translabyrinthine approach based on hearing status.

https://ift.tt/2MUrB6k

Melanotic neuroectodermal tumour of infancy of the jaws: an analysis of diagnostic features and treatment

The purpose of this study was to integrate the available published data on melanotic neuroectodermal tumour of infancy (MNTI) of the jaws into a comprehensive analysis of its clinical/radiological features, with emphasis on the predictive factors associated with recurrence. Eligibility criteria included publications with sufficient clinical/radiological/histological information to confirm the diagnosis. A total of 288 publications reporting 429 MNTI cases were included. MNTIs were slightly more prevalent in males and markedly more prevalent in the maxilla.

https://ift.tt/2LvFxio

Autotransplantation of premolars: does surgeon experience matter?

Autotransplantation of premolars is a well-established method to rehabilitate aplasia of premolars. Nevertheless, with the introduction of titanium implants, not all surgical units offer this procedure. The aim of this study was to examine the predictability of autotransplantation of premolars on orthodontic indication as suggested by Andreasen et al., when performed by surgeons with or without prior experience of this procedure. A prospective protocol was implemented in 2001. All patients treated with autotransplantation of premolars during the years 2001–2015 were recalled to evaluate the long-term status of the teeth.

https://ift.tt/2MBDnDd

Drug-induced oral lichenoid reaction during nivolumab therapy

Oral lichenoid reaction, an immune-related adverse event of immunotherapy, has been reported in very few patients receiving anti-programmed cell death receptor-1 (anti-PD-1) therapy. Here, we describe a case of severe stomatitis (grade ≥3 by the Common Terminology Criteria for Adverse Events, version 4.0) accompanied by pharyngolaryngitis that was observed in a patient receiving nivolumab therapy. The stomatitis was diagnosed as drug-induced lichenoid reaction. Nivolumab therapy was discontinued, and the patient was administered systemic prednisolone (1mg/kg).

https://ift.tt/2LAdDll

Optical coherence tomography for observation of the olfactory epithelium in mice

Optical coherence tomography (OCT) is an imaging tool that exploits the coherence of infrared light and is clinically utilized in the field of ophthalmology and dermatology. This study aimed to examine the feasibility of using OCT for diagnosing degeneration and regeneration of the olfactory epithelium in mice.

https://ift.tt/2Nt3GaY

Cancer of the mandibular gingiva metastasizing to the small intestine

Head and neck cancer metastasizing to the small intestine is very rare. Here we report a case of cancer of the mandibular gingiva metastasizing to the small intestine. The patient was an 82-year-old man who had squamous cell carcinoma of the mandibular gingiva staged as T2N2bM0. Two months after surgery, he presented with lower abdominal pain accompanied by signs of peritoneal irritation. Urgent abdominal surgery was performed, during which a crater-shaped perforation was noted on the wall of the ileum.

https://ift.tt/2MUmnHK

Advanced head and neck surgical techniques: A survey of US otolaryngology resident perspectives

To assess the perspectives of OHNS residents with regards to their training in the following advanced head and neck surgery techniques: transoral robotic surgery (TORS), transoral laser microsurgery (TLM), sialendoscopy, and surgeon-performed ultrasound (SP-US) for possible curricula development.

https://ift.tt/2NuLLkb

BrightOcular® Cosmetic Iris Implant: A Spectrum from Tolerability to Severe Morbidity

Purpose: The BrightOcular® implants are the newest model of cosmetic iris devices that are currently advertised as safe. The previous generation known as NewColorIris® have had severe ocular side effects and were subsequently withdrawn from the market. There is little literature on the safety profile of BrightOcular® implants. Case Report: Herein we describe two cases with varying degrees of ocular tolerability. The first case had a normal ocular exam 1 year after implantation, whereas the second case had unilateral severe corneal edema requiring explantation of the iris device and Descemet membrane endothelial keratoplasty 9 months after bilateral implantation. Conclusions: These two cases attest to the unpredictability of the results of these cosmetic surgeries. Patients should be counseled about the vision-threatening complications of iris implants.
Case Rep Ophthalmol 2018;9:395–400

https://ift.tt/2MZvIOy

A Case of Focal Choroidal Excavation Development Associated with Multiple Evanescent White Dot Syndrome

Focal choroidal excavation (FCE) is described as an excavated lesion of the choroid that can be detected by optical coherence tomography (OCT). While the exact pathogenesis of FCE remains unclear, it has been proposed in some cases that there is an association with the inflammation in the outer retina. We present a case of FCE development that was detected by spectral domain OCT (SD-OCT) and found to be associated with multiple evanescent white dot syndrome (MEWDS). A 40-year-old Japanese woman was diagnosed with MEWDS based on multiple white dots observed from the posterior pole to the midperiphery, along with yellow granularity in the fovea. SD-OCT revealed separation between the retinal pigment epithelium (RPE) and Bruch's membrane (BM) and discontinuations of the ellipsoid zone, RPE, and BM. At 4 weeks after onset, several of the white dots disappeared, the yellow granularity in the fovea became small, and we detected nonconforming choroidal excavation under the central fovea. The choroidal excavation gradually deepened and changed to a conforming pattern. These findings suggest that the degree of the impairment caused by inflammation and the plasticity of the BM and RPE complex may be associated with different types of acquired FCE.
Case Rep Ophthalmol 2018;9:388–394

https://ift.tt/2Lva67S

Radiologic/histologic discrepancies in tumor identification: The case of a “basketball‐sized” mandibular tumor in a woman from 17th century West Virginia

International Journal of Osteoarchaeology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2wjINbE

Europäische PanCare-Studien zu Spätfolgen nach Krebs im Kindes- und Jugendalter

https://ift.tt/2NsgY7C

Late adverse outcomes after treatment of testicular cancer

Abstract

Background

Modern oncological treatment has rendered testicular cancer (TC) a curative malignant disease but there is a risk of decreasing survival and reduced health-related quality of life (HR-QoL) related to long-term adverse health outcomes (AHOs).

Aim

To provide an overview on AHOs after oncological treatment of TC.

Material and methods

Summary of published studies and previous reviews.

Results

Relative survival rates decrease among TC survivors 25 years after diagnosis, mainly due to treatment-related second cancer and/or cardiovascular disease, the latter mediated by components of the metabolic syndrome. With increasing age cisplatin-induced ototoxicity becomes a clinical problem in patients, whereas reported peripheral neurotoxicity only exceptionally achieves major clinical relevance. Anxiety but not depression represents the dominating psychological problem. In most patients HR-QoL is good, but working ability may be reduced by very intensive treatment.

Conclusion

Awareness of long-term AHOs among TC survivors and health professionals can contribute to reduce long-term morbidity and mortality and to improve QoL by initiating early preventive and therapeutic measures. Radiotherapy should be avoided as much as possible during risk-adapted treatment of TC. Existing data indicate premature aging among strongly treated TC survivors but larger studies and longer follow-up in longitudinal studies are required to confirm these preliminary observations.

https://ift.tt/2MZwaw2

A Study of Guselkumab in Participants With Familial Adenomatous Polyposis

Condition:   Adenomatous Polyposis Coli
Interventions:   Drug: Guselkumab;   Drug: Placebo
Sponsor:   Janssen Research & Development, LLC
Not yet recruiting

https://ift.tt/2MDY9C8

Ketamine-ketorolac Versus Fentanyl- Ketorolac I.M in Children During Bone Marrow Biopsy

Condition:   Hematological Malignancy (Leukemia- Lymphoma)
Interventions:   Drug: ketamine-ketorolac;   Drug: fentanyl- ketorolac
Sponsor:   Mansoura University
Not yet recruiting

https://ift.tt/2LzxKjI

Low-Dose Weekly vs High-Dose Cisplatin

Condition:   Locally Advanced Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: High-Dose Cisplatin;   Drug: Low-Dose Cisplatin;   Radiation: Radiotherapy
Sponsor:   Lawson Health Research Institute
Not yet recruiting

https://ift.tt/2PL06e4

Endostatin Combined With Chemotherapy for Adjuvant Treatment of Esophageal Cancer

Condition:   Esophageal Cancer
Interventions:   Drug: Docetaxel;   Drug: Nedaplatin;   Drug: Endostar
Sponsor:   First Affiliated Hospital of Guangxi Medical University
Not yet recruiting

https://ift.tt/2Lzx7GS

Mutagenicity potential (affect) of new atraumatic restorative treatment (ART) material incorporated with Azadirachta indica (Neem) against Salmonella typhimurium

Publication date: Available online 28 August 2018

Source: Journal of Oral Biology and Craniofacial Research

Author(s): P. Divya Kumari, Dr A. Veena Shetty, Dr Shahnawaz Khijmatgar, Avidyuti Chowdhury, Edward Lynch, Chitta R. Chowdhury

Abstract

Background

The mutagenicity potential of a new atraumatic restorative treatment (ART) material against Salmonella typhimurium without metabolic activity using the Ames test (genotoxicity) was carried out.

Methods and materials

The potential mutagenicity of new atraumatic restorative treatment materials (ART-I and ART-II) was analyzed using the Ames test. The materials were eluted in dimethyl sulphoxide, 0.9% NaCl solution and sterilized de-ionized water and the aliquots were used after an incubation period of 24 h at 37 °C. Mutagenic effects of the materials were tested on Salmonella typhimurium strains TA 98 and TA 100 using the standard assay, and in absence of S9 fraction from rat liver.

Result

No mutagenic effects were detected for these new ART materials on S. typhimurium TA100. The incubated DMSO extract and 0.9% NaCl extract (50 μl/plate) of the ART-I exhibited a weak mutagenic potential on S. typhimurium TA 98. In particular, Aqua extract (50 μl/plate) of ART-II, was associated with a weak mutagenic potential on S. typhimurium TA98.

Conclusion

Both ART materials (ART–I and II) exhibited weak mutagenic effects on S. typhimurium TA98 whereas no mutagenic effect was detected on S. typhimurium TA100. ART-II is safer than ART-I.

https://ift.tt/2NqeKpt

TCR repertoire profiling of tumors, adjacent normal tissues, and peripheral blood predicts survival in nasopharyngeal carcinoma

Abstract

The T-cell immune responses in nasopharyngeal carcinoma patients have been extensively investigated recently for designing adoptive immunotherapy or immune checkpoint blockade therapy. However, the distribution characteristics of T cells associated with NPC pathogenesis are largely unknown. We performed deep sequencing for TCR repertoire profiling on matched tumor/adjacent normal tissue from 15 NPC patients and peripheral blood from 39 NPC patients, 39 patients with other nasopharyngeal diseases, and 33 healthy controls. We found that a lower diversity of TCR repertoire in tumors than paired tissues or a low similarity between the paired tissues was associated with a poor prognosis in NPC. A more diverse TCR repertoire was identified in the peripheral blood of NPC patients relative to the controls; this was related to a significant decrease in the proportion of high-frequency TCR clones in NPC. Higher diversity in peripheral blood of NPC patients was associated with a worse prognosis. Due to the peculiarity of the Vβ gene usage patterns in the peripheral blood of NPC patients, 15 Vβ genes were selected to distinguish NPC patients from controls by the least absolute shrinkage and selection operator analysis. We identified 11 clonotypes shared by tumors and peripheral blood samples from different NPC patients, defined as "NPC-associated" that might have value in adoptive immunotherapy. In conclusion, we here report the systematic and overall characteristics of the TCR repertoire in tumors, adjacent normal tissues, and peripheral blood of NPC patients. The data obtained may be relevant to future clinical studies in the setting of immunotherapy for NPC patients.

https://ift.tt/2NpVDMi

VV-ECMO during subsequent segmentectomy after right pneumonectomy

Abstract

Several reports have described subsequent pulmonary surgery after pneumonectomy. We herein report the case of an 82-year-old woman with metachronous multiple lung cancer who had undergone surgery for adenocarcinoma of the right upper lobe 17 years earlier. Completion pneumonectomy had been performed for residual lung adenocarcinoma 11 years before the presentation in question. The patient was elderly and had a poor pulmonary function, although her performance status and her cardiac function were good. Therefore, we decided to improve the safety of surgery with venovenous extracorporeal membrane oxygenation (VV-ECMO). Segmentectomy of S6 + S10a was performed under VV-ECMO support. The 30 months after surgery, the patient has had no complications but continues home oxygen therapy. Imaging has shown no evidence of recurrence.

https://ift.tt/2BPUsEx

NFkB mutations in humans: The devil is in the details

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Manfred Fliegauf, Bodo Grimbacher

https://ift.tt/2wnOqWt

A New Spin on Mast Cells and Cysteinyl Leukotrienes: Leukotriene E4 Activates Mast Cells in vivo

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Lora G. Bankova, Joshua A. Boyce

https://ift.tt/2Lzjx6m

The value of urgent care dermatology

International Journal of Dermatology, EarlyView.


https://ift.tt/2wo6YF6

Indoleamine-2,3-dioxygenase in murine and human systemic lupus erythematosus: Down-regulation by the tolerogeneic peptide hCDR1

Publication date: Available online 28 August 2018

Source: Clinical Immunology

Author(s): Zev Sthoeger, Amir Sharabi, Heidy Zinger, Ilan Asher, Edna Mozes

Abstract

וֹndoleamine-2,3-dioxygenase (IDO) plays a role in immune regulation. Increased IDO activity was reported in systemic lupus erythematosus (SLE). We investigated the effects of the tolerogenic peptide hCDR1, shown to ameliorate lupus manifestations, on IDO gene expression. mRNA was prepared from splenocytes of hCDR1- treated SLE-afflicted (NZBxNZW)F1 mice, from blood samples of lupus patients, collected before and after their in vivo treatment with hCDR1 and from peripheral blood mononuclear cells (PBMC) of patients incubated with hCDR1. IDO gene expression was determined by real-time RT-PCR. hCDR1 significantly down-regulated IDO expression in SLE-affected mice and in lupus patients (treated in vivo and in vitro). No effects were observed in healthy donors or following treatment with a control peptide. Diminished IDO gene expression was associated with hCDR1 beneficial effects. Our results suggest that the hCDR1-induced FOXP3 expressing regulatory T cells in lupus are not driven by IDO but rather by other hCDR1 regulated pathways.

https://ift.tt/2MyBxmy

Iatrogenic Neurological Injury in Children with Trisomy 21

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Renata E. Husnudinov, George M. Ibrahim, Evan J. Propst, Nikolaus E. Wolter

Abstract

Purpose

Children with trisomy 21 are at a greater risk for craniocervical junction instability than the general population. These children frequently require administration of anesthesia due to surgical (including otolaryngological) interventions and are at risk for neurological injury. We reviewed the current literature describing iatrogenic neurological injury in children with trisomy 21 undergoing anesthesia in order to facilitate the development of safety recommendations.

Methods

A systematic review of the literature was performed using Medline, Embase, Scopus, and Google Scholar, following the PRISMA statement. All cases of perioperative neurological injury in children with trisomy 21, aged 18 and under were identified. Clinical and radiographic data were extracted for each report. The data were synthesized to develop recommendations regarding perioperative management.

Results

Of 348 articles screened, 16 cases of iatrogenic neurological injury (in children ages 0.7 to 18 years) were identified. Three injuries occurred during otolaryngological surgeries, nine during sedation for intubation for non-otolaryngological surgery, one during sedation for neuroimaging, one while restraining a child, and two were due to intraoperative head and neck positioning while anesthetized. Preoperative screening was reported in four cases. A diagnosis of atlantoaxial instability (AAI) or atlantooccipital instability (AOI) was made immediately following symptom presentation in three cases but was often delayed by a median (IQR) of 30(11.5-912.5) days. No cases resolved spontaneously, with 2 patients progressing to brain death and 12 requiring surgical stabilization. Of the latter, seven showed improvement, whereas one died 5 months later. No intraoperative precautions during the index procedure were reported in any of the 16 cases.

Conclusion

Iatrogenic neurological injury in children with trisomy 21 are rare but severe and likely under reported. Although the role of preoperative screening remains controversial, all children with trisomy 21 undergoing surgery should be considered at risk for neurological injury due to confirmed or undiagnosed AAI or AOI and should be transferred and positioned with appropriate caution. Children with instability should be referred for neurosurgical attention for preoperative stabilization to mitigate perioperative risk. It is imperative to consider the possibility of neurological injury secondary to medical procedures, as it is clear that neck manipulation of any sort places these children at risk.

https://ift.tt/2og5Obl

Influence of infancy care strategy on hearing in children and adolescents: a longitudinal study of children with unilateral lip and /or cleft palate

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Maryna Kapitanova, Jean-François Knebel, Oumama El Ezzi, Melody Artaz, Anthony S. de Buys Roessingh, Céline Richard

Abstract

Objectives

To evaluate the relation between ventilation tube insertion, otitis media with effusion duration and otologic outcomes in unilateral cleft lip and/or cleft palate children from infancy to teenage age.

Design and Population

Retrospective longitudinal charts review of patients from the multidisciplinary cleft team of the University Hospital of Lausanne over a 30-year period. 146 charts from consecutive patients with non-syndromic unilateral cleft lip and/or cleft palate who were born between January 1986 and January 2003 were included.

Results

The earlier in life a cleft child experience his first otitis media with effusion (OME), the worse his long-term hearing will be. Along with the age of onset of OME, we disclosed an influence of the duration of OME without ventilation tube (VT) insertion on short and long-term hearing outcomes. Different patterns were observed between cleft palate (CP) and cleft lip palate children (CLP), with a higher incidence of otitis media with effusion for the CLP group than the CP group. Direct positive relationship between VT insertion and hearing were disclosed and evaluation of long-term complications did not reveal significant relation with VT insertion. Of note, OME in CLP children led to a higher rate (but not statistically significant) of chronic ear complications than in the CP group, that may indicate more persistent OME or different adverse effect on the middle ear mucosa between CP and CLP children.

Conclusions

Individualized counseling should take into account different factors such as the type of cleft, the age of onset of OME and duration of OME, keeping in mind the adverse effect of persistent middle ear fluid. In the present report, results prone an early ventilation tube insertion to prevent short and long-term injury to the middle ear homeostasis, hearing loss and related issues.

https://ift.tt/2NqW7BA

Transmastoid access in branchio-oto-renal syndrome: A reappraisal of computed tomography imaging

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): William J. Parkes, Sharon L. Cushing, Susan I. Blaser, Blake C. Papsin

Abstract

Objective

To evaluate for temporal bone abnormalities that might affect transmastoid surgery such as cochlear implantation in cases of branchio-oto-renal syndrome (BOR).

Study design

Retrospective review.

Methods

Qualitative assessment of temporal bone computed tomography imaging was performed by a neuroradiologist for 30 individuals with BOR (60 ears) and 20 controls with normal hearing (20 ears). Transmastoid access was assessed categorically across 4 features: tip development, cortex pneumatization, tegmen height, and facial recess pneumatization. The appearance of 4 standard landmarks (Koerner's septum, antrum, prominence of the horizontal semicircular canal, incudal short process) was also dichotomized as normal or abnormal. Data were compared using Fisher's exact testing.

Results

Mastoid height differed between the groups with tip underdevelopment noted in 72% of BOR ears vs. 40% of controls (p = 0.02), and a low tegmen was seen in 68% of BOR ears and 25% of controls (p < 0.01). Significant differences in pneumatization were also found for the mastoid cortex (28% non-pneumatized in BOR vs. 5% in controls; p = 0.03) and the facial recess (27% non-pneumatized in BOR vs. 0% in controls; p = 0.01). Standard landmarks were easily identified in all of the control mastoids. In the BOR group, Koerner's septum was abnormally located or absent in 45%, and the antrum was severely hypoplastic or absent in 50%. Similarly, the prominence of the horizontal semicircular canal and the short process of the incus were dysplastic in 73% (44/60) and 62% (37/60), respectively.

Conclusions

Mastoid abnormalities are common in BOR syndrome. Restricted transmastoid access and abnormal or absent mastoid landmarks should be anticipated in those patients with BOR who become cochlear implant candidates.

Level of evidence

4.

https://ift.tt/2MYbmVR

Safety of Radiofrequency Ablation for Adenotonsillectomy after Cochlear Implantation

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Matthew C. Gropler, Brittany A. Leader, David J. Brown, James R. Benke, Stephen P. Bowditch, Stacey L. Ishman

Abstract

Objective

While a cadaveric animal study has suggested that radiofrequency ablation can be safely used in patients with cochlear implants, no in vivo studies have been published to confirm that radiofrequency ablation does not alter the integrity of the cochlear implant device.

Methods

Cochlear implant impedance and functional performance were studied through a prospective case series in five children with seven functioning multichannel implants before and after radiofrequency ablation adenotonsillectomy.

Results

There were 4 females and 1 male patient, aged 6 to 10 years (mean 8.5 ± 1.95 years) with 7 functioning implants. Pre- and post-surgical impedance testing revealed all electrodes were within normal operating limits. There was no statistically significant difference between the mean pre and post-operative impedances in 5 of the 7 tested implants (P=0.2-0.8). The other two implants showed statistically significant improvement in impedance values which were not clinically significant (P=0.02 and P<0.001). Speech perception was unchanged as was functional performance for all 7 tested implants.

Conclusions

We found that radiofrequency ablation used in the oropharynx during adenotonsillectomy did not alter the integrity of the cochlear implant devices when assessed using electrode impedance testing, audiometry and speech perception evaluation. These results confirm those reported in previous in vitro studies and confirm the safety of radiofrequency ablation adenotonsillectomy for children who have undergone previous cochlear implant placement.

https://ift.tt/2NqVQyy

Outcomes of cochlear implantations for mumps deafness: A report of four pediatric cases

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Masako Katsushika, Akinori Kashio, Erika Ogata, Yusuke Akamatsu, Yujirou Hoshi, Shinichi Iwasaki, Tatsuya Yamasoba

Abstract

Mumps virus occasionally causes bilateral hearing loss. We report 4 cases of bilateral mumps deafness in whom cochlear implantations (CI) were performed. The age at the onset of hearing loss was 1–9 years. CI surgery was performed within 6 months from the onset of hearing loss in 3 cases and after 9 years in the other case, showing good speech perception in the early intervention cases and a poor outcome after later implantation. Early CI surgery is highly recommended in sudden onset deafness by mumps in childhood.

https://ift.tt/2MPWsB5

Laryngopharyngeal reflux disease in singers: Pathophysiology, clinical findings and perspectives of a new patient-reported outcome instrument

Publication date: Available online 27 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): J.R. Lechien, A. Schindler, C. Robotti, L. Lejeune, C. Finck

Abstract

Purpose of review

Laryngopharyngeal reflux (LPR) is an inflammatory disease associated with the development of voice disorder and vocal fold lesions. The occurrence of LPR in professional voice users as singers can have a dramatic impact of daily life. The aims of this paper is to review the current literature about the pathophysiological mechanisms underlying the development of voice disorder, especially in singers, and to propose a new patient-reported outcome instrument to assess complaints of these patients.

Recent findings

Many clinical and experimental studies reported that LPR leads to the development of significant macroscopic and microscopic histological changes in the mucosa of the vibratory margin of the vocal folds. Epithelial cell dehiscence, microtraumas, Reinke's space modifications, inflammatory infiltrates, mucosal drying, and epithelial thickening are associated with LPR. These histological changes may modify the biomechanical properties of the vocal fold tissue leading to hoarseness. In practice, singers with LPR may have normal or discretely pathological speaking voice but impaired singing voice (vocal fatigue, hoarseness, and loss of range). To date, the literature about the specific LPR signs and symptoms in singers is almost non-existent. However, singers are at high risk to present LPR because of necessary air support involving higher intra-abdominal pressure, increased stress due to career management and uncomfortable schedules, late meals just before sleep, bad nutrition habits like increased intake of citrus products, fats foods and spicy foods.

Perspectives

The lack of clinical singer-reported outcome instrument may decrease the management of LPR in singers. In this context, the LPR Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) developed a new instrument to precisely assess symptoms related to LPR in singing voice. This instrument will be validated and could be used in clinical practice in voice centers.

https://ift.tt/2PHIXlg

Rhinological observations during a humanitarian mission in a rural sub-Saharan African setting

Publication date: Available online 27 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): R. Késmárszky, T. Hannington, A. Jakkel, G. Szabó

Abstract

Aims

Patients with rhinological symptoms and pathologies represent an important population. Their prevalence in developing areas without ENT care is not well documented. Due to various factors like migration, they may have an influence out of these territories. Our objective was to determine the prevalence and epidemiology of the main rhinological symptoms and pathologies during a humanitarian mission.

Material and methods

Six hundred and seventy nine patients presenting to our general medical consultations were examined. All of them had careful interrogation and a basic ENT check-up. Patient data and correlating photos were registered to be analyzed retrospectively.

Results

The ethnic origins of the patients were different. Most of them were younger than 50 years old. The rhinological problems were amongst the most frequent reasons to consult, the prevalence was higher when secondary findings and complaints were also considered, representing altogether 44 (6.48%) cases.

Conclusion

A high prevalence of rhinological pathologies showing the importance of public health issues, screening and an important need of adapted treatments was found. Due to migration, climatic changes and humanitarian missions, their presentation and incidence may vary. Health care providers and rhinologists need a thorough knowledge of community acquired and tropical pathologies.

https://ift.tt/2wsoF6t

History of Eczema is Associated with More Severe Hospital Course in Children Hospitalized for Asthma

Publication date: Available online 27 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Mona Liu, Jay P. Patel, Evie Huang, Peck Y. Ong

https://ift.tt/2LzIwX0

Trichotillomania (hair pulling disorder): Clinical characteristics, psychosocial aspects, treatment approaches, and ethical considerations

Dermatologic Therapy, EarlyView.


https://ift.tt/2BUrd3v

Cyclosporine for corticosteroid‐refractory acute generalized exanthematous pustulosis due to hydroxychloroquine

Dermatologic Therapy, EarlyView.


https://ift.tt/2PP0AzU

Role of whole saliva in the efficacy of sublingual immunotherapy in seasonal allergic rhinitis

Publication date: Available online 27 August 2018

Source: Allergology International

Author(s): Takenori Haruna, Shin Kariya, Tazuko Fujiwara, Atsushi Yuta, Takaya Higaki, Pengfei Zhao, Yukiko Ogawa, Kengo Kanai, Yuji Hirata, Aiko Oka, Kazunori Nishizaki, Mitsuhiro Okano

Abstract

Background

The development of methods to predict the clinical effectiveness of sublingual immunotherapy (SLIT) for allergic diseases is a crucial matter. We sought to determine whether whole saliva, which is the first body component that contacts allergen extracts during SLIT, is associated with the clinical effectiveness of SLIT in Japanese cedar pollinosis.

Methods

Blood monocytes or monocytic THP-1 cells were cultured in the presence or absence of either whole saliva or pure saliva with or without treatments including filtration and blockade of TLR2 and/or TLR4 signaling. IL-10 levels in the supernatants were then measured. Whole saliva-induced IL-10 production by THP-1 cells was compared between asymptomatic and disease-onset patients during peak pollen dispersal after SLIT.

Results

Both monocytes and THP-1 cells produced substantial amounts of IL-10 in response to whole saliva. IL-10 production was significantly reduced in response to pure saliva and 0.2 μm-filtered saliva. Simultaneous treatment with polymyxin B and TL2.1, a neutralizing antibody against TLR2, also reduced IL-10 production. IL-10 levels produced by THP-1 cells in response to whole saliva collected prior to SLIT were significantly higher in asymptomatic patients determined by symptom-medication scores than disease-onset patients following SLIT. Such differences were not seen in saliva collected 3 months after the initiation of SLIT or saliva collected during peak pollen dispersal.

Conclusions

Our results provide a basis for why the sublingual route is effective and preferable in allergen immunotherapy. Saliva-induced IL-10 levels produced by THP-1 cells may be a predictive marker for clinical remission after SLIT.

https://ift.tt/2MYAQlV

Zoledronic Acid Induces Site-Specific Structural Changes and Decreases Vascular Area in the Alveolar Bone

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Mariana Quirino Silveira Soares, Jeroen Van Dessel, Reinhilde Jacobs, Paulo Sérgio da Silva Santos, Tania Mary Cestari, Gustavo Pompermaier Garlet, Marco Antonio Hungaro Duarte, Thaís Sumie Nozu Imada, Ivo Lambrichts, Izabel Regina Fischer Rubira-Bullen

Purpose

The aim was to assess the effect of a relevant regimen of zoledronic acid (ZA) treatment for the study of bisphosphonate-related osteonecrosis of the jaw on alveolar bone microstructure and vasculature. A sub-objective was to use 3-dimensional imaging to describe site-specific changes induced by ZA in the alveolar bone.

Materials and Methods

Five Wistar rats received ZA (0.6 mg/kg) and five (controls) received saline solution in the same volume. The compounds were administered intraperitoneally in 5 doses every 28 days. The rats were euthanized 150 days after therapy onset. The mandibles were scanned using high-resolution (14-μm) micro–computed tomography (micro-CT), decalcified, cut into slices for histologic analysis (5 μm), and stained with hematoxylin-eosin. Bone quality parameters were calculated using CT-Analyser software (Bruker, Kontich, Belgium) in 2 different volumes of interest (VOIs): the region between the first molar roots (VOI-1) and the periapical region under the first and second molars' apex (VOI-2). Blood vessel density and bone histomorphometric parameters were calculated only for the region between the roots of the first molar using AxioVision Imaging software (version 4.8; Carl Zeiss, Gottingen, Germany).

Results

ZA-treated rats showed a significant increase in percentage of bone volume and density (P < .05), with thicker and more connected trabeculae. Furthermore, the ZA group showed a significant decrease in the size of the marrow spaces and nutritive canals and in blood vessel density (P < .05). In the micro-CT evaluation, VOI-2 showed better outcomes in measuring the effect of ZA on alveolar bone.

Conclusions

ZA treatment induced bone corticalization and decreased alveolar bone vascularization. VOI-2 should be preferred for micro-CT evaluation of the effect of bisphosphonates on alveolar bone. This analysis allowed the effect of ZA on alveolar bone and its vascularization to be characterized. The results of this analysis may add further knowledge to the understanding of the physiopathology of osteonecrosis of the jaw.

https://ift.tt/2MTSbwi

Orbital Floor Reconstruction: 3-Dimensional Analysis Shows Comparable Morphology of Scapular and Iliac Crest Bone Grafts

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Joel C. Davies, Harley H.L. Chan, Jonathan M. Bernstein, David P. Goldstein, Jonathan C. Irish, Ralph W. Gilbert

Purpose

Current nonvascular osseous reconstructive options for reconstruction of the orbital floor after maxillectomy include options such as scapular tip and iliac crest bone grafts. The aim of this study was to determine whether these donor sites were morphologically comparable with the orbital floor.

Materials and Methods

A retrospective cross-sectional study design was selected. By use of a pre-existing melanoma database (January 1, 2005, through September 20, 2015), computed tomography scans of the head, neck, thorax, and pelvis were obtained from patients without evidence of bony metastases. With the use of 3-dimensional software (Mimics; Materialise, Leuven, Belgium), grafts from the scapulae and iliac crests, the predictor variables, were digitally harvested, co-registered with the orbital floors bilaterally, and analyzed. The primary outcome was conformance. Data were analyzed using descriptive statistics and tests of statistical significance. The significance level was set at P<.05.

Results

The study sample included 10 patients (6 men and 4 women; mean age, 55 ± 18 years). Close conformance was observed when we analyzed the morphology of the orbital floor to the scapular (2.23 ± 0.31 mm) and iliac crest (2.13 ± 0.30 mm) bone grafts, with no significant difference between sites. Conformance mapping showed maximum conformance centrally (scapula, 0.001 ± 0.001 mm; iliac crest, 0.001 ± 0.001 mm), with decreased morphologic similarity peripherally (scapula, 6.09 ± 0.94 mm; iliac crest, 5.74 ± 0.88 mm). There was no significant difference in conformance between sides of graft harvest.

Conclusions

When considering nonvascularized bone grafts for reconstruction of the orbital floor, both the scapula and iliac crest offer nearly complete conformance to the orbital floor structure and represent reasonable reconstructive options.

https://ift.tt/2Nt6Knw

Preservation of Salivary Function Following Extracapsular Dissection for Tumors of the Parotid Gland

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Sung Joon Park, Sungjun Han, Hyo-Jung Lee, Soon-Hyun Ahn, Woo-Jin Jeong

Purpose

This study evaluated salivary function after extracapsular dissection (ECD) compared with partial superficial parotidectomy (PSP) and classic superficial parotidectomy (CSP) of benign parotid gland tumors. The authors hypothesized that ECD would be superior to PSP and CSP in preserving postoperative salivary function.

Materials and Methods

Retrospective analyses were performed for 43 consecutive patients who underwent parotidectomies of benign parotid tumors performed by a single experienced surgeon. Clinical data and pre- and postoperative whole salivary flow rates were compared among the operative procedures. Pearson χ² and Fisher exact tests were used to compare categorical variables. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests were used to compare means. A P value less than .05 was considered significant throughout the study.

Results

Tumor sizes did not differ among groups. Operative times, amounts of drainage, and hospital days for ECD were markedly decreased compared with CSP and tended to be decreased compared with PSP. Resection margins were exposed in 0, 12.5, and 6.7% of patients who underwent ECD, PSP, and CSP, respectively. Postoperative complications occurred less often (but not meaningfully) after ECD. Postoperative basal salivary flow rates in the ECD, PSP, and CSP groups were 0.39, 0.32, and 0.14 mL/minute, respectively (P = .05). Stimulated salivary flow rates remained stable for the ECD and PSP groups but decreased in the CSP group.

Conclusion

ECD is a safe and time-efficient surgical approach, offering early recovery from parotid tumors and better preservation of salivary function. ECD should be considered a surgical approach for parotid tumors, especially those in the parotid tail region, such as Warthin tumors.

https://ift.tt/2MTS0kC

Osseous Loading by a Volume-Reduced Tongue During Muscle Contractions

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Meng-Zhao Deng, Yi-Han Liu, Aaron Huang, Zi-Jun Liu

Purpose

To investigate how tongue volume reduction affects loads on surrounding bone surfaces produced by neuromuscular stimulation of the tongue.

Materials and Methods

Of each pair of same-gender minipig siblings, 1 received tongue reduction and 1 underwent sham surgery. Either immediately (acute, 6 pairs) or 1 month (chronic, 5 pairs) after surgery, bone surface and/or suture strains and pressures were recorded from the following locations when the hypoglossal nerve trunk, hypoglossal nerve medial branch, hypoglossal nerve lateral branch, genioglossus, and styloglossus (SG) were electrically stimulated: 1) three rosette strain gauges on the premaxillary palatal surface (premaxilla [PM]) and lingual surfaces of the mandibular alveolus at anterior (mandibular incisor [MI]) and posterior (mandibular molar [MM]) locations; 2) two single-element strain gauges over the palatal surface of the premaxillary-maxillary suture and the lingual surface of the mandibular symphysis; and 3) two pressure transducers on the palatal surface of the maxilla (palatal process) and the lingual surface of the mandibular alveolus (mandibular corpus).

Results

Compared with the sham animals in the acute study, reduction animals showed significantly decreased PM and MI strains, as well as palatal process pressure. With muscle contractions, mandibular symphysis and MM strains were enhanced significantly with a more dorsal orientation. In the chronic study, reduction animals showed decreased PM and increased MM strains. On comparison of chronic versus acute studies, PM, MI, and MM strains under SG stimulation were significantly smaller whereas MM strain was significantly larger under hypoglossal nerve trunk, hypoglossal nerve lateral branch, and SG stimulations.

Conclusions

Muscle contractions from a volume-reduced tongue produce lower and higher loads in the anterior and posterior mouth, respectively. However, although the effects on reducing loads in the anterior mouth are persisting over time, compensatory load enhancement in the posterior mouth diminishes owing to surgical healing.

https://ift.tt/2PcLXFc

Le Fort II Distraction With Zygomatic Repositioning: A Technique for Differential Correction of Midface Hypoplasia

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Richard A. Hopper, Hitesh Kapadia, Srinivas M. Susarla

Severe midface hypoplasia is frequently addressed with subcranial midface advancement at the Le Fort II or Le Fort III level. Le Fort II advancement has a predominant affect on the vertical and sagittal positioning of the nasomaxillary complex; in contrast, the Le Fort III advancement allows for correction of zygomatic position and exorbitism. In this report, the authors described a technique for correction of exorbitism which concomitantly addresses central midface vertical and sagittal deficiency. The technique involves a combination of a Le Fort III osteotomy with a Le Fort II distraction. The Le Fort III osteotomy allows repositioning and fixation of the zygomas to correct lateral hypoplasia and exorbitism, maintaining the globes in a more functional position. The Le Fort II distraction allows for movement of the central midface independent of the lateral orbits and zygomas, correcting the sagittal and vertical position without orbital distortion. With the medial canthal apparatus attached to the Le Fort II segment and the lateral canthus attached to the stabilized lateral orbits, the differential movement achieved can also have a favorable effect on palpebral fissure orientation.

https://ift.tt/2MU5oFj

Temporomandibular Joint Ankylosis After Ramus Construction With Free Fibula Flaps in Children With Hemifacial Microsomia

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Cory M. Resnick, Joshua Genuth, Carly E. Calabrese, Amir Taghinia, Brian I. Labow, Bonnie L. Padwa

Purpose

Patients with hemifacial microsomia (HFM) and Kaban-Pruzansky type III mandibular deformities require ramus construction with autologous tissue. The free fibula flap, an alternative to the costochondral graft, has favorable characteristics for this construction but may be associated with temporomandibular joint ankylosis. The purposes of this study were to present a series of patients with HFM who underwent free fibula flap ramus construction, to determine the incidence of ankylosis, and to identify perioperative factors associated with ankylosis.

Materials and Methods

We performed a retrospective cohort study of patients with HFM who underwent ramus construction with a free fibula flap at Boston Children's Hospital from 2003 to 2015. Patients who had at least 1 year of follow-up and complete medical records were included. The predictor variables included demographic information, HFM severity, surgical history, and operative details. The primary outcome variable was the occurrence of ankylosis. Descriptive statistics were calculated, and significance was set at P < .05.

Results

We included 8 patients (75% of whom were female patients) in the study sample. Patients underwent construction at a mean age of 11.4 ± 5.9 years (range, 5 to 21 years). In 5 patients (63%), ankylosis developed during the follow-up period of 7.3 ± 4.8 years. The average time from construction to ankylosis was 4.2 ± 3.7 years. The only predictor variable statistically significantly associated with ankylosis was the use of a contralateral releasing osteotomy, which reduced the rate of ankylosis (P = .035). There was a trend toward a younger age in patients in whom ankylosis developed (8.8 ± 2.6 years) compared with those without ankylosis (15.5 ± 8.1 years, P = .392).

Conclusions

The free fibula flap can be associated with a high rate of ankylosis when used for ramus construction in patients with HFM. Passive flap insertion and/or use of a contralateral releasing osteotomy may reduce this risk.

https://ift.tt/2Pdxc55

Aerosolized Fibrin Sealant Is Effective for Postoperative Edema and Ecchymosis in Open Rhinoplasty Without Osteotomy

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Myeong Sang Yu, Moon Sik Jung, Bo-Hyung Kim, Sung-Ho Kang, Dae Jun Lim

Purpose

Fibrin sealant (FS) was approved as a hemostatic agent, sealant, and adhesive by the Food and Drug Administration in 1998. Our study sought to determine whether FS also reduced edema and pain in rhinoplasty without osteotomy.

Materials and Methods

We conducted a prospective randomized trial involving patients who underwent open rhinoplasty without osteotomy. The patients were randomly assigned to 1 of 2 groups: those treated with aerosolized FS (FS group) and those not treated (control group). The effect of FS on edema of the eyelid, edema of the dorsum and tip of the nose, and periorbital ecchymosis was separately rated postoperatively using a scale of 0 to 4 or 0 to 3. Postoperative pain was evaluated using questionnaires quantified with a visual analog scale. The Mann-Whitney U and Wilcoxon tests were used to compare parameters between the groups.

Results

A total of 41 patients were included in this study. The FS group (n = 20) consisted of 13 male and 7 female patients with a mean age of 34.8 ± 5.8 years. The control group (n = 21) consisted of 15 male and 6 female patients with a mean age of 32.4 ± 4.8 years. There were no statistically significant differences between the 2 groups with respect to age, gender, or combined surgical techniques (P > .05). Aerosolized FS significantly reduced not only ecchymosis and swelling in the periorbital area but also edema of the nasal dorsum (P < .05).

Conclusions

Aerosolized FS can be effective for reducing eyelid edema, dorsal edema, and periorbital ecchymosis after open rhinoplasty. FS may serve as an adhesive for minimizing dead space by promoting adherence of the skin flap and as a hemostatic agent in reducing the amount of postoperative bleeding by sealing capillary vessels.

https://ift.tt/2MY4B6l

Does the Medical Comorbidity Profile of Obstructive Sleep Apnea Patients Treated With Maxillomandibular Advancement Differ From That of Obstructive Sleep Apnea Patients Managed Nonsurgically?

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Richard Ngo, Elaina Pullano, Zachary S. Peacock, Edward T. Lahey, Meredith August

Purpose

Obstructive sleep apnea (OSA) patients with retrognathia and measurable anatomic airway determinants may represent a subset of OSA patients and have distinct comorbidity profiles. Our aim was to compare the medical comorbidities of OSA patients managed surgically with maxillomandibular advancement with those of nonsurgical patients.

Patients and Methods

In this cross-sectional retrospective study, patients for both cohorts were identified through the Massachusetts General Hospital oral and maxillofacial surgery data registry and the Massachusetts General Hospital Research Patient Data Registry. The inclusion criteria consisted of clinical records documenting body mass index (BMI), apnea-hypopnea index, respiratory disturbance index, and/or oxygen nadir. The primary predictor variable was the treatment modality chosen: surgical (maxillomandibular advancement) or nonsurgical. Demographic information and OSA parameters were evaluated. The primary outcome variable was the number of documented comorbidities in each group. Two-sample t tests were used for continuous variables, whereas χ² or Fisher exact tests were used for categorical variables.

Results

The nonsurgical cohort consisted of 71 patients (67.6% men), and the surgical cohort consisted of 51 patients (84.3% men). Comparison of descriptive characteristics showed that the nonsurgical cohort had a higher average age (49 ± 9.4 years) than the surgical cohort (41 ± 10.7 years, P < .001). In addition, a higher average BMI was present in the nonsurgical group (42.3 ± 11.9 in nonsurgical group vs 29.7 ± 5.5 in surgical group, P < .001). Polysomnogram parameters were comparable with the exception of a higher Epworth Sleepiness Scale score in the surgical cohort (15.5 ± 5.30 in surgical group vs 9.90 ± 6.80 in nonsurgical group, P = .005). The nonsurgical cohort had a higher total number of comorbidities (7 ± 4 in nonsurgical group vs 4 ± 3 in surgical group, P < .001). Hypertension, cardiovascular disease, hyperlipidemia, pulmonary hypertension, obstructive pulmonary disease, and type 2 diabetes mellitus had higher prevalences within the nonsurgical group.

Conclusions

The results of this study suggest that nonsurgically managed OSA patients tend to have more complex medical comorbidity profiles than those managed surgically. Obesity (BMI >30) was more prevalent in the nonsurgical cohort, which may be contributory. The additive contribution of OSA needs to be further elucidated.

https://ift.tt/2NomjwR

Height Changes of Tutoplast-Processed Fascia Lata Over Time After Dorsal Augmentation During Rhinoplasty

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Jae Hwan Oh, Seon Tae Kim, Joo Hyun Jung, Ji Hye Han, Ji Yun Choi, Il Gyu Kang

Purpose

Tutoplast (Tutogen Medical, Neunkirchen am Brand, Germany)–processed fascia lata (TPFL) has been used for dorsal augmentation in rhinoplasty in the Republic of Korea for approximately 10 years, but few studies have described changes in TPFL in terms of dorsal height over time. We investigated changes in dorsal height after TPFL use as a dorsal implant material during rhinoplasty.

Materials and Methods

The records of 18 rhinoplasty patients who had undergone dorsal augmentation with TPFL were examined retrospectively. The patients had undergone rhinoplasty from March 2008 to June 2012. Two different ear, nose, and throat doctors analyzed the first follow-up photographs (2 lateral views and 2 oblique views) taken at approximately 1 month postoperatively and the last follow-up photographs taken from 18 to 75 months after surgery. The last follow-up photographs were classified as showing no nasal dorsal height change, slight change, and marked change compared with the first follow-up photographs.

Results

Of the 18 patients enrolled, 50% (n = 9) showed no change in the nasal dorsum whereas 33% (n = 6) showed mild depression and 17% (n = 3) showed marked depression of the nasal dorsum at last follow-up.

Conclusions

About half of the patients who had undergone dorsal augmentation using TPFL during rhinoplasty showed mild or marked dorsal depression over time. It is recommended that TPFL be used with another implant during augmentation rhinoplasty or TPFL be used only for a slightly depressed nose. In addition, patients should be informed that TPFL could be resorbed over time.

https://ift.tt/2MSgavZ

Volumetric Cleft Changes in Treatment With Bone Morphogenic Protein/β-Tricalcium Phosphate Versus Grafts From the Iliac Crest or Symphysis

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Robert L. Trujillo, Onur Kadioglu, G. Fräns Currier, Kevin S. Smith, Enver Yetkiner

Purpose

To compare the volumetric changes in successfully treated clefts with secondary alveolar grafting using recombinant human bone morphogenic protein-2 (rhBMP-2) delivered in β-tricalcium phosphate (βTCP) scaffold versus autogenous grafts obtained from the iliac crest and mandibular symphysis.

Patients and Methods

We performed a retrospective cohort study of cone-beam computed tomography scans of 25 subjects with unilateral or bilateral clefts. Of the 25 patients, 7 received an iliac crest bone graft, 9 received a mandibular symphyseal bone graft, and 9 subjects received the rhBMP-2/βTCP bone substitute. Volumetric rendering software was used to calculate the amount of new bone formation and residual bone defect present in the cleft area. The data were analyzed using Wilcoxon and Kruskal-Wallis tests and Pearson's correlation coefficient.

Results

The mean percentage of new bone formation for the iliac crest, symphysis, and rhBMP-2/βTCP was 85.47, 80.56, and 81.22%, respectively (P = .0854). The initial cleft volume had a weak positive correlation with the percentage of new bone formation (r = 0.18), but the postoperative residual cleft volume had a strong negative correlation (r = 0.71).

Conclusions

rhBMP2 delivered in a βTCP scaffold in alveolar cleft patients can be a viable alternative to autogenous iliac crest and symphysis grafts, eliminating donor site morbidity.

https://ift.tt/2PdwSTV

Is Counterclockwise Rotation With Double Jaw Orthognathic Surgery Stable in the Long-Term in Hyperdivergent Class III Patients?

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Yasemin Bahar Acar, Necip Fazıl Erdem, Ahmet Hüseyin Acar, Ahmet Nejat Erverdi, Kemal Ugurlu

Purpose

To evaluate the long-term postsurgical stability of counterclockwise rotation of the occlusal plane (OP) in double-jaw orthognathic surgery in patients with hyperdivergent Class III malocclusion.

Materials and Methods

This retrospective cohort study evaluated the postsurgical stability of orthognathic surgery in patients with skeletal Class III malocclusion and counterclockwise rotation of the maxillomandibular complex with an OP change of at least −2°. Patients were evaluated with lateral cephalometric analysis before surgery, immediately after surgery, and at longest follow-up. The primary predictor variable was the change in angle of the OP and the Frankfort horizontal (FH) after surgery. The primary outcome variable was stability of the OP at longest follow-up. Other study variables were age, gender, and the following cephalometric measurements: mandibular plane angle; gonial angle; angle formed by the sella, nasion, and B point; maxillary height; angle of the palatal plane to the line connecting the sella and nasion; and distances of the posterior nasal spine and A point to the FH and of the A point to the vertical line passing from the nasion. The Mann-Whitney U test was used to compare stability between groups because the variables were not normally distributed. Bonferroni correction was used to evaluate P values. The χ² test and Fisher exact test, where appropriate, were used to compare the proportions of groups. A P value less than .05 was accepted as statistically significant.

Results

The sample was composed of 15 adult patients (mean age at surgery, 23.5 yr; 40% men). The median duration of follow-up was 48 months (interquartile range, 36 to 60 months). The groups had similar demographic properties and similar surgical changes. Ten patients showed very stable results with an OP-FH change no greater than 1°. Four patients showed unstable results with an OP-FH change of 2.25 ± 0.5° during the follow-up period. The change in the mandibular plane angle was notable between patients with stability and those with instability, which was the variable most affected by relapse of the OP.

Conclusion

This study found long-term postsurgical skeletal stability of counterclockwise rotation of the OP during double-jaw orthognathic surgery in patients with high angle Class III malocclusion after a median follow-up of 48 months.

https://ift.tt/2MU4xo5

Primary Maxillary Deficiency Dentofacial Deformities: Occlusion and Facial Esthetic Surgical Outcomes

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Jeffrey C. Posnick, Sirish Makan, Daniel Bostock, Timothy J. Tremont

Purpose

The purpose of this study was to document the malocclusion and facial dysmorphology in patients with primary maxillary deficiency (PMD) and chronic obstructive nasal breathing before treatment and the outcomes after bimaxillary orthognathic, genioplasty, and intranasal surgery.

Materials and Methods

A retrospective cohort study of patients with PMD undergoing bimaxillary orthognathic, chin, and intranasal surgery was implemented. The predictor variables were grouped into demographic, anatomic, operative, and longitudinal follow-up categories. The primary outcome variables were the initial postoperative occlusion achieved (T₂; 5 weeks postoperatively) and that maintained long-term (T₃ or T₄; >2 years after surgery). Six occlusion parameters were assessed: overjet, overbite, coincidence of dental midlines, Angle classification, and molar vertical and transverse positions. A second outcome variable was facial esthetic results. Photographs were analyzed to document 7 facial contour characteristics.

Results

Sixty-six patients met the inclusion criteria. Age at operation averaged 22 years (15 to 55 yr). The study included 18 women (27%). Most patients (57 of 66; 86%) achieved and maintained a favorable occlusion for each parameter studied long-term (mean, 5 yr). The need for a 3-segment Le Fort I was strongly associated with long-term posterior malocclusion. Facial dysmorphology before surgery included the appearance of a prominent chin (56%), flat labiomental fold (61%), prominent lower lip (88%), prominent nose (77%), sunken midface (100%), flat cheekbones (82%), and recessed upper lip (73%). Before surgery, 82% of patients exhibited at least 5 of the 7 key facial contour deformities. Correction of all 7 facial contour deformities was confirmed in 92% of patients in the long-term. In 8% of patients, an overly prominent-appearing chin persisted.

Conclusion

Using orthognathic techniques, most patients with PMD achieved and maintained a corrected occlusion long-term. In unoperated patients, a "facial esthetic type" was identified. Bimaxillary orthognathic and chin surgery proved effective in correcting associated facial dysmorphology in most patients.

https://ift.tt/2NwofmQ

Predictors of Failure in Infant Mandibular Distraction Osteogenesis

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Jeffrey A. Hammoudeh, Artur Fahradyan, Colin Brady, Michaela Tsuha, Beina Azadgoli, Sally Ward, Mark M. Urata

Purpose

Mandibular distraction osteogenesis (MDO) has been shown to be successful in treating upper airway obstruction caused by micrognathia in pediatric patients. The purpose of this study was to assess the success rate of MDO and possible predictors of failure.

Patients and Methods

The records of all neonates and infants who underwent MDO from 2008 to 2015 were retrospectively reviewed. Procedural failure was defined as patient death or the need for tracheostomy postoperatively. Details of distraction, length of stay, and failures were captured and elucidated.

Results

Of the 82 patients, 47 (57.3%) were male; 46 (56.1%) had sporadic Pierre Robin sequence; 33 (40.3%) had syndromic Pierre Robin sequence; and 3 (3.7%) had micrognathia, not otherwise specified. The average distraction length was 27.5 mm (range, 15 to 30 mm; SD, 4.4 mm), the average age at operation was 63.3 days (range, 3 to 342 days; SD, 71.4 days), and the average length of post-MDO hospital stay was 43 days (range, 9 to 219 days; SD, 35 days) with an average follow-up period of 4.3 years (range, 1.1 to 9.6 years; SD, 2.6 years). There were 7 failures (8.5%) (5 tracheostomies and 2 deaths) resulting in a 91.5% success rate. Regression analysis showed that the predicted probability of the need for tracheostomy was 45% (P = .02) when the patient had a central nervous system (CNS) anomaly. The predicted probability of the need for tracheostomy and death combined was 99.6% when the patient had laryngomalacia and a CNS anomaly and was preoperatively intubated (P < .05).

Conclusions

This review confirms that MDO is an effective method of treating the upper airway obstruction caused by micrognathia with a high success rate. In our sample the presence of CNS abnormalities, laryngomalacia, and preoperative intubation had a significant impact on the failure rate.

https://ift.tt/2MSg3k3

Knotless Suture for Wound Closure in Intraoral Surgery—A Report of 2 Cases

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Sriraam Kasi Ganesh, Elavenil Panneerselvam, Abhinav K. Sharma, Krishnakumar Raja VB

Suturing is the most commonly used method of wound closure in intraoral surgery, whose objectives include anatomic reapproximation of tissues, hemostasis, and prevention of wound contamination by providing an adequate tissue seal. Conventional suturing in the oral cavity is difficult because of the restricted space for instrumentation. Further, knots act as a nidus to food entrapment and microbial colonization. The knotless (barbed) suture could be considered an ideal alternative to eliminate these limitations. This report describes the effectiveness of the intraoral use of the knotless suture after open reduction and internal fixation of maxillofacial fractures.

https://ift.tt/2PdJrOZ

Aggression Using a Knife or Other Sharp Instruments and Oral-Maxillofacial Trauma: Incidence, Risk Factors, and Epidemiologic Trends

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Luzia Michelle Santos, Italo M. Bernardino, Alysson Vinicius Ferreira Porto, Kevan Guilherme Nórbrega Barbosa, Lorena Marques da Nóbrega, Sérgio d'Avila

Purpose

The aim of the present study was to characterize the profile of victims of interpersonal physical violence (IPV) caused by a knife or other sharp instrument, identify the factors associated with maxillofacial trauma, and examine the incidence of maxillofacial trauma over time.

Patients and Methods

In a retrospective cohort study, we evaluated 569 medicolegal and social records of IPV victims by knife or other sharp instruments treated at a forensic medicine and dentistry center in Brazil during a 4-year consecutive period. The variables investigated were related to the sociodemographic characteristics of the victims, circumstances of the aggression, and trauma patterns. Descriptive and multivariate statistics through Poisson regression and trend analysis with the creation of polynomial regression models were used.

Results

The cumulative incidence of oral-maxillofacial trauma was 19.3%. The mean age of the victims was 31.29 ± 13.82 years. Cases of trauma affecting more than one region of the face prevailed (45.5%). Based on the final Poisson regression model, unemployed people were more likely to exhibit maxillofacial trauma (relative risk [RR] 1.86; 95% confidence interval [CI] 1.03-3.35; P = .039). In addition, individuals were more likely to experience maxillofacial trauma on Wednesdays (RR 1.85; 95% CI 1.01-3.37; P = .045). The trend analysis revealed a significant increase in oral-maxillofacial injuries over time (P < .05).

Conclusions

The incidence of oral-maxillofacial trauma was high, and the main factors associated with trauma were the victim's employment status and day of occurrence. Future studies will focus on assessing the effect of maxillofacial trauma on the quality of life and well-being of violence victims.

https://ift.tt/2MXK1D1

Reconstructing a Traumatic Empty Orbit: Principles, Difficulties of Treatment, and Literature Review

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Panagiotis Stathopoulos, Philip Ameerally

Purpose

This report describes the case of a serious orbital injury in which the globe was completely displaced into the nasal cavity and the orbit was clinically empty. The authors discuss the difficulties encountered in the management of this patient and their principles in the reconstruction of a complex defect.

Materials and Methods

In this rare case of severe injury, the authors used a combined transconjunctival and ethmoidal approach to retrieve the displaced globe from the nasal cavity. This approach allowed ample access to the floor and the medial wall of the orbit; therefore, a single 0.5-mm titanium mesh was bent to fit the combined defect for reconstruction.

Results

Early combined maxillofacial and oculoplastic surgical intervention resulted in salvage and restoration of the eye with preservation of vision.

Conclusions

Stable reconstruction of the maxillo-ethmoidal buttress is of great importance in patients with comminuted injuries. This strut determines the appropriate orbital volume and defines the position of the eye in space. Patients with insufficient restoration of the buttress are always at risk of developing enophthalmos. To replicate the contour of the S-shape of the orbital floor and the slope of the medial wall, the authors support the use of thin implants with rigid fixation on the bony orbit as the most suitable materials to achieve this. Thick implants can be rather difficult to bend, and when this is attempted several times they are more prone to fractures. Conversely, very thin and flexible implants can always be dislodged and cause late enophthalmos.

https://ift.tt/2Pc7az0

Preserving the Fibrous Layer of the Mandibular Condyle Reduces the Risk of Ankylosis in a Sheep Model of Intracapsular Condylar Fracture

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Hua-Lun Wang, Pei-Pei Zhang, Li Meng, Su-Xia Liang, Hao Liu, Ying-Bin Yan

Purpose

The aim of this experimental study was to investigate the role of the fibrous layer of the condylar head in the formation of temporomandibular joint (TMJ) ankylosis in a sheep model of intracapsular condylar fracture.

Materials and Methods

Six growing Xiao-wei Han sheep were used in the study, and bilateral TMJ surgery was performed in each sheep. In the left TMJ, sagittal fracture of the condyle, removal of the fibrous layer of the condylar head, excision of two thirds of the disc, and removal of the fibrous zone of the glenoid fossa were performed. In the right TMJ, the same surgical management was performed, except that in each sheep, the fibrous layer of the condylar head was preserved. Three sheep were killed humanely at 1 month postoperatively, and the other 3 sheep were killed humanely at 3 months postoperatively. The TMJ complexes were examined by histologic evaluation.

Results

Fibrous ankylosis was observed on the left side in 3 sheep at 1 month postoperatively and in 2 of 3 sheep at 3 months postoperatively. Fibro-osseous ankylosis was achieved on the left side in 1 sheep at 3 months postoperatively. In the right TMJ, the main postoperative histologic findings included condylar fracture healing, topical rupture or exfoliation of the fibrous layer of the condyle, and fissure between the fibrous layer and the proliferative zone of the condyle. However, no evidence of ankylosis was observed. The TMJ ankylosis scores on the right side were significantly lower than those on the left side at different time points (P < .05).

Conclusions

This study showed that the presence of the fibrous layer of the condylar head prevented the development of TMJ ankylosis in a sheep model of intracapsular condylar fracture.

https://ift.tt/2MY4zeJ

On-Site 3-Dimensional Printing and Preoperative Adaptation Decrease Operative Time for Mandibular Fracture Repair

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Brett J. King, Earl Peter Park, Brian J. Christensen, Raman Danrad

Purpose

The purpose of this study was to compare the intraoperative time and operating room costs between patients with mandibular fractures treated with traditional adaptation and fixation and patients treated with preadapted plates created with on-site 3-dimensionally printed models.

Patients and Methods

We designed a prospective comparative cohort study for patients with mandibular fractures. The control group received traditional open reduction and internal fixation of their mandibular fractures. For the patients in the experimental group, a 3-dimensional (3D) model of the fractured mandible was made using an on-site 3D printer. The model then underwent osteotomy, if needed, and the plate was adapted to the model, submitted to sterilization, and implanted in the patient. The primary outcome variable was intraoperative plating time, and the secondary outcome variable was operating room cost. The groups were compared by the Wilcoxon signed rank test.

Results

The 38 patients included in the study had a mean age of 39.6 years, and male patients comprised 81.6%. The mean time for intraoperative plate adaptation was 22.8 ± 2.1 minutes in the control group and 6.9 ± 0.3 minutes in the experimental, 3D printed group (P < .0001). In the experimental group, 4 patients (21%) required a single intraoperative corrective bend. The calculated average cost per patient based on the average operating costs at our institution was $2,306.45 in the control group and $698.00 in the experimental group.

Conclusions

This study shows that the use of 3D printers for fabrication of models to prebend maxillofacial reconstruction plates is associated with decreased operating room time and costs. Using an on-site 3D printer requires minor start-up and use costs and results in a significant reduction in operating room time, which remains one of the most expensive aspects of facial trauma care.

https://ift.tt/2Pb9AOs

Conflicts of Interest in Clinical Guidelines: Lack of Authors and Disclosures in the AAOMS White Papers

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Yisi D. Ji, Edward T. Lahey

Purpose

The purpose of this study was to evaluate current state of authorship, financial disclosures, and conflicts of interest in position papers published by the American Association of Oral and Maxillofacial Surgeons (AAOMS).

Materials and Methods

This is a cross-sectional review of the position papers published by the AAOMS from 2013 to 2017. Primary outcome variables include position papers published by the AAOMS. Secondary outcome variables include declaration of authorship, financial disclosures, and financial payments. The Open Payments Database for financial disclosures was reviewed for the year the position paper was published and the immediate preceding year.

Results

Ten position papers were published by the AAOMS from 2013 to 2017. Of the 10 papers, authorship was listed in 3, and none explicitly addressed the presence or absence of financial disclosures or conflicts of interest. Contributors to 3 of the 3 authored papers were found at review of the Open Payments Database to have received industry funding in the year the position paper was published and the immediate preceding year. The remuneration ranged from less than $1,000 to $554,006.02.

Conclusion

Position papers published by the AAOMS lack standardization for authorship and statements on potential financial disclosure. The authors suggest full disclosures of authorship and authors' conflicts of interest should be stated on all position papers to provide transparency to the process.

https://ift.tt/2MUI5LH

Correction of Delayed Traumatic Enophthalmos Using Customized Orbital Implants

Publication date: September 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 9

Author(s): Christian Pedemonte Trewhela, Marlene Díaz Reiher, Tamara Muñoz Zavala, L. Edgardo González Mora, Ilich Vargas Farren

Purpose

To determine the relation between overcorrection of orbital volume and ocular projection in patients with orbital trauma.

Materials and Methods

A prospective cohort study was performed of patients with enophthalmos as a side effect of orbital trauma. The sample included patients older than 18 years who required reconstruction using customized implants to treat enophthalmos with or without diplopia. The exclusion criteria were patients who had multiple or extended fractures and patients with amaurosis or a prosthetic eye. Orbital volumes were calculated and the position of the eyeball in the healthy and traumatized sockets was determined before and after installing the implant and the ratio between these variables was calculated. Two variables were identified: 1) orbital volume and 2) enophthalmos. Analysis of the estimator variables was performed, defining 3 groups: 1) healthy eye socket, 2) traumatized eye socket without implant, and 3) traumatized eye socket with implant. The Shapiro-Wilk test, paired t test, and linear regression analysis were performed. A P value less than .05 (95% confidence interval) indicated significant differences.

Results

Of 294 patients who underwent orbital zygomatic complex reconstruction surgery, 13 required customized implants and only 5 met the inclusion criteria. The average volumetric variation in the groups of traumatized eye sockets with and without implants was statistically significant (P < .05), overcorrecting by an average of 4.2 cm³. The average enophthalmos variation in the groups of traumatized eye sockets with and without implants was statistically significant (P < .05), projecting the eyeball by an average 1.80 mm. The ratio between the average orbital volume and projection of the eyeball was determined to be 1:0.721 (correlation, 45.6%).

Conclusion

This study concluded that the eyeball is projected 0.7 mm for every 1 cm³ of volume added in customized orbital implants. However, additional clinical studies with larger samples should be conducted.

https://ift.tt/2Ntpdk6

Contact hypersensitivity in adolescents

Pediatric Dermatology, EarlyView.


https://ift.tt/2PLBp12

Traumatic Epiglottitis following a Blind Insertion of the Hand during Convulsion

Traditionally, it has been recommended that first-responders should place chopsticks or their hand in a child's mouth to prevent the child from biting their tongue during convulsion. The practice persists locally in parts of Japan and can cause adverse events. We report a traumatic epiglottitis following the thrusting of a guardians' hand into a 13-month-old girl's mouth to prevent her from biting her tongue.

https://ift.tt/2BVza8A

Evaluating the effect of different voice prostheses on alaryngeal voice quality

The Laryngoscope, EarlyView.


https://ift.tt/2PL7OVE

Mobile app technology is associated with improved otolaryngology resident in‐service performance

The Laryngoscope, EarlyView.


https://ift.tt/2LwAChf

Gastrin‐Releasing Peptide Is Involved in the Establishment of Allergic Rhinitis in Mice

The Laryngoscope, EarlyView.


https://ift.tt/2PL7CFU

The Impact of Resident and Fellow Participation in Transsphenoidal Pituitary Surgery

The Laryngoscope, EarlyView.


https://ift.tt/2wrCZMQ

Racial disparities in tumor features and outcomes of patients with squamous cell carcinoma of the tonsil

The Laryngoscope, EarlyView.


https://ift.tt/2PGigO9

One‐Year symptom outcomes after sialolithiasis treatment with sialendoscopy‐assisted salivary duct surgery

The Laryngoscope, EarlyView.


https://ift.tt/2Lyvlpa

Utility of intraoral ultrasound in managing oral tongue squamous cell carcinoma: Systematic review

The Laryngoscope, EarlyView.


https://ift.tt/2PLIXB5

Permeability and Weibel–Palade Bodies of the Blood Vessels in the Human Vocal Fold Mucosa

The Laryngoscope, EarlyView.


https://ift.tt/2wqEkmZ

Management and Follow‐up Results of Salivary Fistulas Treated With Botulinum Toxin

The Laryngoscope, EarlyView.


https://ift.tt/2PKcSt3

One‐year outcomes of sialendoscopic‐assisted salivary duct surgery for sialadenitis without sialolithiasis

The Laryngoscope, EarlyView.


https://ift.tt/2wtwLfm

In Reference to Upper Airway Stimulation Therapy and Prior Airway Surgery for Obstructive Sleep Apnea

The Laryngoscope, EarlyView.


https://ift.tt/2PKEqP1

Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

The Laryngoscope, EarlyView.


https://ift.tt/2LA1CfT

Regionalization of Head and Neck Cancer Surgery May Fragment Care and Impact Overall Survival

The Laryngoscope, EarlyView.


https://ift.tt/2PJQDU3

Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement

The Laryngoscope, EarlyView.


https://ift.tt/2LAPoDs

Adjuvant Chemotherapy Is Associated With Improved Survival for Late‐Stage Salivary Squamous Cell Carcinoma

The Laryngoscope, EarlyView.


https://ift.tt/2PHJLqv

Objectively Measuring Observer Attention in Severe Thyroid‐Associated Orbitopathy: A 3D Study

The Laryngoscope, EarlyView.


https://ift.tt/2LwznP4

Compensation of Otolaryngologists in the Veterans Health Administration: Is There a Gender Gap?

The Laryngoscope, EarlyView.


https://ift.tt/2PJAGgI

The effect of inferior turbinate surgery on ciliated epithelium: A randomized, blinded study

The Laryngoscope, EarlyView.


https://ift.tt/2wuhuL1