The Effect of Marked Nasal Septal Deviation on Left Ventricular Function and Blood Markers

Objectives: This study aimed to assess the effect of nasal septoplasty in patients with marked nasal septal deviation (MNSD) on subjective perception of nasal patency, echocardiography, and hematologic parameters. Methods: Seventy-nine consecutive patients (mean age, 29.9 ± 9.7 years; 57 men and 22 women) at least 18 years old were diagnosed as MNSD consistent with presenting symptom of chronic nasal obstruction lasting at least 3 months. Complete blood count measurement to assess mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR), the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and echocardiography were performed for all patients just before and at postoperative third month of septoplasty. Results: The MPV (0.021), NLR (

http://bit.ly/2RSuwyU

Reconstruction of a Large Orbital Floor Defect Using Autogenous Calvarial Bone Graft in a Young Patient

No abstract available

http://bit.ly/2HwbXMK

Right-Sided Complete Third Branchial Cleft Fistula

Branchial cleft anomalies occur due to insufficient closure of cavities during embryogenesis. These anomalies consist of cysts, sinuses, and fistulas, with the rarest type being fistulas. A 29-year-old male presented at the authors' clinic with a right-sided complete third branchial cleft fistula. Fistula track excision surgery was successfully performed and no recurrence was observed in the 12-month follow-up after the surgery. While second branchial cleft fistula is the most common, third and fourth brancial cleft fistulas are extremely rare. In addition, they are usually incomplete and almost always on the left side. Address correspondence and reprint requests to Ugur Yildirim, MD, Resident in Otolaryngology, Ondokuz Mayis Universitesi, Tip Fak. KBB Anabilim Dali, Atakum, Samsun 55139, Turkey; E-mail: uguryildirimkbb@gmail.com Received 22 February, 2018 Accepted 22 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Seizures Following Cranioplasty: Risk Factors and Prevention Exploration

Background: The aim of this study was to identify risk factors and explore the possible prevention measures for seizures following cranioplasty. Methods: The authors performed a retrospective review of 142 consecutive patients who underwent cranioplasty following craniectomy for trauma or cerebral hemorrhage in Dezhou People's Hospital between January 2010 and January 2017. Patients who were diagnosed with aneurysms, arteriovenous malformations, cerebral infarction, and tumors (14), had seizures prior to cranioplasty (9) and those lost to follow-up (7) were excluded. Patients did not use antiepilepsy drugs from treatment of postcranioplasty seizures. The median follow-up time was 51.11 ± 31.59 months (range: 17–98 months). Analyses were performed on a database tracking age, sex, reason for craniectomy, operative time, time between operations, presence of dural substitute, diabetic status, hypertensive status, tobacco use, alcohol use, location of cranioplasty, classification, time and times of seizures following cranioplasty development. Results: One hundred twelve patients met study criteria. The overall rate of seizures following cranioplasty was 35.7% (40 out of 112 patients). There were no statistically significant associations between postcranioplasty seizures and sex, age, location of cranioplasty, cranioplasty materials, or dural substitute used in craniectomy. Postcranioplasty seizure frequency differed significantly according to reasons for depressive craniectomy. The incidence of postcranioplasty seizures was significantly higher in the first year than in later years. Incidence decreased progressively in subsequent years. Conclusion: Incidence of seizures following cranioplasty was associated with the reason for depressive craniectomy. Address correspondence and reprint requests to Gang Li, MD, Department of Neurosurgery, Qi Lu Hospital, Shandong University, 107#, Wenhua Xi Road, Jinan 250012, China; E-mail: doctorligang1@126.com Received 24 February, 2018 Accepted 22 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Intraoperative Image-Guided Navigation in Craniofacial Surgery: Review and Grading of the Current Literature

Introduction: Image-guided navigation has existed for nearly 3 decades, but its adoption to craniofacial surgery has been slow. A systematic review of the literature was performed to assess the current status of navigation in craniofacial surgery. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) systematic review of the Medline and Web of Science databases was performed using a series of search terms related to Image-Guided Navigation and Craniofacial Surgery. Titles were then filtered for relevance and abstracts were reviewed for content. Single case reports were excluded as were animal, cadaver, and virtual data. Studies were categorized based on the type of study performed and graded using the Jadad scale and the Newcastle-Ottawa scales, when appropriate. Results: A total of 2030 titles were returned by our search criteria. Of these, 518 abstracts were reviewed, 208 full papers were evaluated, and 104 manuscripts were ultimately included in the study. A single randomized controlled trial was identified (Jadad score 3), and 12 studies were identified as being case control or case cohort studies (Average Newcastle-Ottawa score 6.8) The most common application of intraoperative surgical navigation cited was orbital surgery (n = 36), followed by maxillary surgery (n = 19). Higher quality studies more commonly pertained to the orbit (6/13), and consistently show improved results. Conclusion: Image guided surgical navigation improves outcomes in orbital reconstruction. Although image guided navigation has promise in many aspects of craniofacial surgery, current literature is lacking and future studies addressing this paucity of data are needed before universal adoption can be recommended. Address correspondence and reprint requests to Reza Jarrahy, MD, Associate Clinical Professor, Division of Plastic & Reconstructive Surgery, Department of Pediatrics, David Geffen School of Medicine at UCLA, Co-Director, UCLA Craniofacial Clinic, Co-Director, UCLA Face Transplant Program, Assistant Chief of Plastic Surgery, Olive View-UCLA Medical Center, 200 UCLA Medical Plaza, Suite 465, Los Angeles, CA 90095; E-mail: rjarrahy@mednet.ucla.edu Received 24 June, 2018 Accepted 2 October, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Anatomical Characteristics of the Perpendicular Plate of the Ethmoid: An Analysis of Paranasal Sinus Computed Tomography via Three-Dimensional Reconstruction

In recent years, the perpendicular plate of the ethmoid (PPE) has emerged as a new autogenous grafting material in rhinoplasty and septoplasty of nasal deviation. However, no studies have outlined the precise size, shape, and morphologic features of the PPE. Therefore, this study aimed to provide detailed information on the anatomical and morphologic characteristics of the PPE to assist surgeons in performing surgeries that are more precise. About 104 Chinese patients who underwent paranasal computed tomography were assessed in this study. By analyzing the features of the PPE reconstructed with 3-dimensional models, the characteristics of the PPE at different stages of development and according to sex were observed. The PPE had a flat shape, and its lower part was relatively thin. It usually developed horizontally with age, which contributed to expansion of the PPE area. The dimensions of the PPE were significantly larger in male patients than in female patients. Through the reconstruction and measurement of Chinese patients' PPE, the authors have established precise information about the PPE's anatomical and morphologic features. The flat shape and proper size, which are similar to those of nasal septum cartilage, make the PPE an ideal alternative to conventional autogenous grafting materials. The findings might be useful to surgeons in helping them perform surgeries that are more precise. Address correspondence and reprint requests to Yang An, MD, Department of Plastic Surgery, Peking University Third Hospital, No 49, Huayuanbei Road, Haidian District, Beijing 100191, China; E-mail: anyangdoctor@163.com Received 24 June, 2018 Accepted 1 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Rapidly Growing and Asymptomatic Skull Base Lesion

Trochlear schwannomas typically present with diplopia and are extremely rare benign intracranial neoplasms that require the combined expertise of neurotologists and neurosurgeons for surgical excision. A combined petrosal approach offers a surgical route for removal of growing and/or symptomatic tumors. A study of a trochlear nerve schwannoma that demonstrated rapid growth but was otherwise asymptomatic was presented in this study. Address correspondence and reprint requests to Anthony M. Tolisano, MD, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; E-mail: anthony.tolisano@utsouthwestern.edu Received 5 July, 2018 Accepted 16 October, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2S22alE

Debunking a Surgical Myth: Do Not Touch the Temporalis

Background: A longstanding dictum exists to avoid surgical manipulation of the temporalis muscle out of concern for an exceedingly high rate of muscle atrophy and recurrent temporal hollowing. The authors challenge this surgical myth, considering such advice to be erroneous. The authors hypothesize that elevation of the temporalis muscle, if performed using standard muscle flap principles, will demonstrate excellent results. Methods: To assess temporalis response to surgical manipulation, the authors reviewed patients who underwent calvarial vault remodeling by the senior author for craniosynostosis between 1988 and 2011. Nonsyndromic patients with single-suture synostosis and 5 years of follow-up were eligible for inclusion. The medical record was used to measure rates of reoperation, recurrent temporal hollowing, and persistent temporalis overcorrection. Results: Of the cohort reviewed, 196 patients met inclusion criteria. Ten patients (5.1%) exhibited recurrent bitemporal constriction. One patient (0.5%) underwent a revision temporalis turnover flap, and 2 patients (1.0%) underwent soft tissue augmentation. The overall reoperation rate was 1.5%. Temporalis overcorrection, in an attempt to prophylactically rectify the expected atrophy after temporalis manipulation, persisted in 11 patients (5.6%). Three of these patients required treatment with steroid injections, Botox injections, or operative muscle debulking. The overall reoperation rate for temporalis overcorrection was 1.5%. Conclusions: The authors' low reoperation rates for recurrent deformity, in combination with persistent temporalis overcorrection in 5.6% of patients, should dispel the myth that manipulation of the temporalis invariably results in atrophy. The muscle may be surgically manipulated, as long as plastic surgery principles are followed. Address correspondence and reprint requests to Steven R. Buchman, MD, 1540 E. Medical Center Drive, Mott Children's Hospital, Craniofacial Surgery Offices 4730, Ann Arbor, MI 48109; E-mail: sbuchman@med.umich.edu Received 13 July, 2018 Accepted 19 September, 2018 KGB is currently supported by the National Institute of Dental and Craniofacial Research (1F32DE027604-01). The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2Hmkgei

Management of Craniopharyngioma

Objective: Craniopharyngiomas are one of the most challenging problems for neurosurgeons because of the high recurrence rates due to their localization and associated endocrinological disorders. This study reports the outcomes of surgeries and recurrence rates of 45 craniopharyngioma cases. Method: Patients who were diagnosed with craniopharyngioma in the authors' clinic between 1998 and 2016 evaluated retrospectively. Results: A total of 45 patients (25 males and 20 females; age, 3–56 years) who had previously undergone surgery for craniopharyngioma were enrolled and followed up for 12 to 222 months (mean follow-up duration, 73.5 ± 55.2 months). Among these, 25 were children (55.5%) with a mean age of 9.5 ± 4.6 years and 20 were adults (45.5%) with a mean age of 37.2 ± 12.7 years. A total of 39 (86.6%) patients underwent total tumor resection, while 6 (13.4%) underwent subtotal tumor removal. During 12 to 30 months of follow-up, the progression of residual tumor was recorded in 4 patients, 3 of whom underwent surgery and postoperative radiotherapy. Despite the total resection of tumor in their first surgery, 3 patients showed tumor recurrence during 15 to 34 months of the follow-up. Conclusion: Our findings suggest that the total resection of craniopharyngiomas, when possible, results in a favorable quality of life, with acceptable mortality and morbidity rates. Address correspondence and reprint requests to Mustafa Kiliç, MD, Şişli Hamidiye Etfal Eğitim Araştirma Hastanesi, Şişli, Istanbul, Turkey; E-mail: kilicnrs@gmail.com Received 12 August, 2018 Accepted 8 October, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Short- and Long-Term Outcomes by Procedure Type for Nonsagittal Single-Suture Craniosynostosis

Background: Minimally invasive approaches for the treatment of single-suture craniosynostosis are sometimes touted as equivalent to cranial vault reconstruction. While techniques for sagittal synostosis have been reviewed previously, evidence regarding open and less invasive surgical techniques for metopic, coronal, and lambdoid synostosis has yet to be reviewed. Methods: Systematic searches were performed using Embase.com and PubMed. Included studies reported short- or long-term outcomes, compared at least 2 standard techniques, discussed single-suture coronal, metopic, or lambdoid craniosynostosis, and enrolled at least 20 study participants. Two authors screened titles and abstracts, and also performed full text review and data extraction. Given heterogeneous outcomes, qualitative synthesis was performed after data extraction. Results: The search strategy yielded 2348 articles. Of these, 313 were removed as duplicates, and 1935 were excluded during title/abstract review. After full text review of 100 articles, 19 were selected for data extraction. The heterogeneity of outcomes precluded meta-analysis and required qualitative synthesis. While short-term outcomes indicated decreased morbidity of minimally invasive techniques, only 2 articles presented long-term reoperation rates. One study reported higher reoperation rates in the less invasive technique, and the second reported no reoperations in the median follow-up period of 33 months. Conclusion: Studies comparing long-term outcomes between different surgical techniques for single-suture craniosynostosis remain deficient. The development of standardized outcome measures is essential, and prospective, multicenter studies are necessary to assess the long-term efficacy of these procedures. Address correspondence and reprint requests to Steven R. Buchman, MD, 1540 E Medical Center Drive, Mott Children's Hospital, Craniofacial Surgery Offices 4730, Ann Arbor, MI 48109; E-mail: sbuchman@med.umich.edu Received 14 August, 2018 Accepted 30 September, 2018 Katelyn G. Bennett is currently supported by the National Institute of Dental and Craniofacial Research (1F32DE027604). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Reconstruction of Mohs Defects Located in the Head and Neck

Background: Defects following Mohs micrographic surgery (MMS) can range in size from small defects requiring linear closure to large defects needing flap coverage. Reconstruction is dependent on defect size and facial aesthetic unit involvement. The aim of this study was to review the types of facial reconstruction per aesthetic unit involvement and describe their outcomes. Methods: All data were retrieved for patients ≥18 years who underwent multidisciplinary treatment including dermatological MMS and plastic surgical reconstruction at a single tertiary hospital center (2001–2017). Patient characteristics, tumor pathology, surgical specifics, reconstructive modalities, and surgical outcomes were analyzed. Results: A total of 418 patients were included. Patients were predominantly White, non-Hispanic (97%) and female (58%) with a mean age of 60 ± 13.9 years. Tumor pathology was predominantly basal cell carcinoma in 73% of all cases followed by squamous cell carcinoma in 14%. The nasal aesthetic unit was mostly affected (50%). Local advancement flaps and different types of grafts were used in 51% and 25% of reconstructions, respectively. Complications were observed in 3% and local cancer recurrence in 4% of the patients. Scar revision was needed in 6% of the patients. Conclusion: Reconstruction of facial defects after Mohs micrographic surgery can be challenging due to its technical complexity and aesthetic implications. There were differences in complications in reconstructions performed within the same day versus 1 week, with a majority of complications occurring within same-day Mohs reconstructions. A multidisciplinary structured approach, which incorporates patient-reported outcomes, may be needed to optimize surgical results. Address correspondence and reprint requests to Bernard T. Lee, MD, MPH, 110 Francis St, Suite 5A, Boston, MA 02215; E-mail: blee3@bidmc.harvard.edu Received 29 August, 2018 Accepted 4 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2S0tkcA

Triple Premasseteric Branches of Facial Artery

Facial artery is known to show variations in its origin, course, termination, and branching pattern. One of its reported variant branch is called premasseteric branch. During our dissection classes, it was observed that an elderly male cadaver had 3 premasseteic branches arising from the facial artery. The first and second premasseteric branches passed deep to masseter under its anterior border, whereas the third premasseteric branch terminated by anastomosing with the infraorbital artery. This case could be of importance to maxillofacial surgeons, craniofacial surgeons, and plastic surgeons. Address correspondence and reprint requests to Satheesha B. Nayak, MSc, PhD, Professor of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka 576104; India E-mail: sathish.nayak@gmail.com Received 17 August, 2018 Accepted 8 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Atraumatic Delayed Orbital Hematoma Sixteen Years After Orbital Floor Fracture Repair With Porous Polyethylene Implant

Porous alloplastic materials such as titanium mesh and porous polyethylene allow for the ingrowth of fibrovascular tissues into the implant; stabilizing the implant and reducing the risk of extrusion and extrusion-related complications (such as hematoma formation). The literature contains 2 specific reports of delayed atraumatic orbital hematomas occurring 8 months and 3 years after orbital floor reconstruction with porous polyethylene implants. In this study, an atraumatic orbital hematoma occurring 16 years after orbital floor reconstruction with a porous polyethylene implant was presented. The hematoma was evacuated and the implant was removed without replacement of a secondary implant. The remaining fibrovascular tissue on the underside of the implant provided enough support of the orbital soft tissues to achieve excellent anatomic and physiologic outcomes. Address correspondence and reprint requests to Mark Domanski, MD, 8316 Arlington Blvd Ste 360, Fairfax, VA 22031; E-mail: dr.d@bluemontmd.com Received 17 August, 2018 Accepted 6 October, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Analysis of Surgical Approaches to Skull Base Tumors Involving the Pterygopalatine and Infratemporal Fossa

Selecting an appropriate surgical approach for resection of huge skull base tumors involving pterygopalatine and infratemporal fossa is challenging because of their rarity and high possibility of vital anatomical structure injuries. To suggest the guidance of selecting the appropriate approach by analyzing outcomes and satisfactions of known surgical approaches with our previous experience, the authors retrospectively analyzed skull base tumor cases experienced for 24 years, and condensed to 4 well-known surgical approaches: maxillary swing, infratemporal fossa type C, transzygomatic, and a combined transzygomatic–midfacial degloving approach: to review indications, advantages, and limitations of these approaches. Maxillary swing approach was useful in large-sized tumors as it provided wide surgical field; however, inevitable facial scar was the main drawbacks, especially in adolescents. Infratemporal fossa approach type C was helpful in the involvement of vital vascular structures; however, long incision scar with temporal area depression and permanent conductive hearing loss were the factors of patients' dissatisfaction. Transzygomatic approach could be the good alternative to the infratemporal fossa approach type C; however, en bloc tumor resection was impossible due to its limited operative space. To overcome limitations of these approaches, transzygomatic approach was combined with midfacial degloving approach, and it enabled lateral and anterior access without prominent facial scar and/or deformity while providing wide surgical space. Based on our 24 years of surgical experience in managing huge skull base tumors, the authors recommend the combined transzygomatic–midfacial degloving approach, which enables complete resection with short postoperative healing periods and no disfiguring facial incisions. Address correspondence and reprint requests to Joo-Heon Yoon, MD, PhD, Department of Otorhinolaryngology—Head and Neck Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Institute for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea; E-mail: jhyoon@yuhs.ac Received 4 March, 2018 Accepted 19 September, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://bit.ly/2iuFjMi). © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2HmkdiC

Three-Dimensional Computed Tomography Analysis of Stability Following Two- and Three-Point Fixation With Biodegradable Plates Among Patients With Zygomatic Fracture

Background: Open reduction followed by internal fixation has been regarded as the most effective technique for the surgical repair of zygomatic fractures. However, the ideal number and locations of internal fixation points to maintain stable reduction remain controversial. Using 3-dimensional computed tomography, we aimed to compare the stability of 2-point and 3-point fixation among patients who had undergone surgical repair of zygomatic bone fractures. Methods: The study included 22 patients (17 men, 5 women) with unilateral zygomatic bone fractures who had undergone open reduction with 2-point or three-point fixation using biodegradable materials (11 patients in each group). The authors measured the lateral projection and height of the zygoma at 2 landmark points (zygomaticofacial foramen and frontozygomatic suture). In each group, bony displacement was analyzed between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. Differences in stability between the 2 groups were analyzed by comparing values between the immediate postoperative and follow-up phases. Results: The 2-point group exhibited a lower rate of complex fractures at the frontozygomatic suture than the 3-point group (18.2%, 63.6%, respectively). In both groups, the authors observed significant differences in the lateral projection of the zygomaticofacial foramen between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. No significant differences in stability were observed between the groups. Conclusion: Our findings demonstrated that 2-point fixation of the zygoma with biodegradable materials is as stable as 3-point fixation. It could be initially considered when open reduction of frontozygomatic suture was not essential. Address correspondence and reprint requests to Hyoseob Lim, MD, PhD, Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea; E-mail: hyoseob.lim@gmail.com Received 13 April, 2018 Accepted 6 October, 2018 The author reports no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Management of Mandibular Fractures Using Locking and Nonlocking Miniplates

Purpose: The study proposed to determine the superiority between locking plate and nonlocking miniplate for mandibular fractures (MFs) treatment. Methods: A comprehensive electronic search examining Medline-Ovid, Embase, and PubMed databases language without date was performed in February 2018. Inclusion criteria were studies in humans, including randomized controlled trials, controlled clinical trials, with the aim of comparing the 2 techniques. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. Results: Thirteen publications were enrolled into the analysis. The results showed that there were significant differences in overall complications (RR, 0.62; 95% CI, 0.351–1.094; P = 0.06), postoperative infection (RR, 0.503, 95% CI, 0.223–1.136) when comparing locking miniplates with nonlocking miniplates in treating mandible fractures. The incidence of malocclusion showed a statistically significant difference in the outcome favoring locking miniplates (fixed: RR, 0.503; 95% CI, 0.125–2.030; P = 0.06). In addition, the use of locking miniplates had a lower postoperative maxillomandibular fixation rate than the use of nonlocking miniplates (RR, 0.414; 95% CI, 0.196–0.872; P = 0.002). Conclusion: The result of meta-analysis revealed that use of locking plate is superior to the nonlocking plate in the reducing of postoperative complication rates in the management of MFs. Address correspondence and reprint requests to Adili Moming, DDS, MD, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Xinjiang Medical University, No 137, South Li Yu-shan Road, New City District 830054 Urumqi, Xinjiang Uyghur Autonomous Region, China; E-mail: adili928@hotmail.com Received 16 April, 2018 Accepted 22 September, 2018 Financial support by the National Natural Science Funding of China. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://bit.ly/2iuFjMi). © 2019 by Mutaz B. Habal, MD.

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Evaluation of Endoscopic Strip Craniectomy and Orthotic Therapy for Bilateral Coronal Craniosynostosis

Background: Bilateral coronal craniosynostosis is the premature fusion of both coronal sutures. Traditionally, this condition is treated by frontal–orbital advancement (FOA). Endoscopic strip craniectomy with cranial orthotic therapy, which has gained popularity in treating single suture craniosynostosis, has recently been adapted for the treatment of bicoronal synostosis. There have been few studies documenting the outcomes of this treatment. The objective of this study is to compare the morphological outcomes of endoscopic strip craniectomy and FOA in patients with bicoronal synostosis. Methods: A retrospective case series was done on 24 patients with bilateral coronal synostosis treated with endoscopic strip craniectomy or FOA at 2 institutions. Patients with preoperative and 1-year postoperative computed tomography scans were included. Multiple measures of cranial shape and size were assessed: cephalic index, turricephaly index, basofrontal angle, circumference Z-score, and cranial vault volume Z-score. Results: The 2 groups were similar statistically in terms of morphology at preoperative scan. There were no statistical differences between the FOA group and endoscopic group at postoperative scan in any of the morphologic outcomes measured. Cranial vault volume Z-scores increased postoperatively in both the endoscopic (P 

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En-Bloc U-Shaped Osteotomy of the Mandible and Chin for the Correction of a Prominent Mandibular Angle With Long Chin

Background: Lower face contouring surgery has become a popular aesthetic surgery in East Asian countries. Various surgical methods have been used to improve lower face aesthetics. When a patient has a wide as well as long lower face, procedures like chin polishing or T-type osteotomy are traditionally performed, but these surgical methods have several disadvantages. The authors devised a simple and reliable method to correct the wide and long lower face, without the complications associated with the traditional methods. Methods: From July 2015 to January 2018, 30 patients with a prominent mandibular angle, long chin, and no malocclusion underwent en-bloc mandibular U-shaped osteotomy through an oral incision, in order to shorten the mandibular angle, body of the mandible, and the chin, and to improve the facial contour. The authors assessed the effectiveness of surgery through comparisons between pre- and postoperative radiographs, patient satisfaction, and surgical complications in the postoperative period. Results: : It was observed that all oral incisions healed by primary intention, and did not develop hematoma, infection, or osteonecrosis. Lower lip numbness occurred in 16 patients. After 6 to 12 months, all patients showed complete recovery from the numbness. All the patients were satisfied with their appearance after surgery. Conclusions: En-bloc mandibular U-shaped osteotomy is an improved form of mandibular surgery. The osteotomy line involves the whole mandible, which makes the length and width of the mandible considerably smaller. This surgery can effectively correct a prominent mandibular angle with long chin. Address correspondence and reprint requests to Xiaolei Jin, MD, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, 33 Badachu Road, Shijingshan District, Beijing, People's Republic of China; E-mail: professor.jin@yahoo.com Received 15 July, 2018 Accepted 26 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Cone-Beam Computed Tomography Study on Morphologic Characteristics of the Posterior Region in Hard Palate

Background: The goal of this study is to evaluate the morphologic characteristics of the posterior palatine region among the Chinese population, more specifically, the greater palatine grooves, crests, bridges, and torus palatinus structures and make comparisons between different ethnic groups and minorities. Methods: A total of 323 cone-beam computed tomography (CBCT) scans were collected for analysis on the presence of grooves, crests, bridges, or torus palatinus (TP). Data were collected through recognizing the grooves, crests, bridges, and TPs and calculating the number of those anatomy structures. The statistics index, including average, standard deviation, were adopted to describe the subjects and Wilcoxon test, Mann–Whitney test, and Chi-squared test were all carried out by SPSS. Results: Three different morphologic manifestations of the greater palatine groove (GPG) found in the upper 1st and 2nd molar regions are as follows: no groove, 1 groove, and 2 grooves. The number of crests ranged from 0 to 3. And the incidence of torus palatines was 29%. Moreover, a positive correlation was found between the presence of crests/GPGs and age in the 2nd molar region. Conclusion: The results in this study reveal that GPGs in the upper 1st and 2nd molar regions have 3 different morphologic manifestations among Chinese people and the number of crests can vary from 0 to 3 crests. Although the proportion of GPG or crest and the incidence of TP are different from the proportions of other studies, this may be due to the fact that different ethnic groups and sample sizes were used in the course of this study. Information about the anatomy structures of the posterior region in hard palate directly contributed to a decrease in potential complications during palatal implant surgery and periodontal surgery. Address correspondence and reprint requests to Xiaojun Ding, PhD, Department of Stomatology, Zhongshan Hospital, Shanghai Medical School, Fudan University, 111 Yixueyuan Road, Shanghai 200032, China; E-mail: ding.xiaojun@zs-hospital.sh.cn Received 17 May, 2018 Accepted 2 October, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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A Biographical Journey Through the History of Ear Reconstruction

This historical literature review of ear reconstruction differs from much of the published literature in that it focuses on the biographies of the innovators and evangelists of ear reconstruction rather than specific techniques. A biographical account of ear reconstruction demonstrates the importance of surgeons as artists, scientists, technicians, politicians, and most importantly carers of this special and fascinating group of patients who benefit from this technically challenging form of reconstruction. Address correspondence and reprint requests to Mark S. Lloyd, MPhil, FRCS(Plast), Birmingham Women's and Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B4 6NH, West Midlands, United Kingdom; E-mail: mark.lloyd73@btinternet.com Received 12 June, 2018 Accepted 6 October, 2018 The authors have no conflicts of interest to disclose. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2RWcpI9

The Impact of Immunodeficiency on NK Cell Maturation and Function

Abstract

Purpose of Review

Natural killer cells are innate lymphoid cells (ILCs) that play critical roles in human host defense and are especially useful in combating viral pathogens and malignancy.

Recent Findings

The NK cell deficiency (NKD) is particularly underscored in patients with a congenital immunodeficiency in which NK cell development or function is affected. The classical NK cell deficiency (cNKD) is a result of absent or a profound decrease in the number of circulating NK cells. In contrast, functional NKD (fNKD) is characterized by abnormal NK cell function but with normal number of NK cells. The combined immune deficiencies with significant impact on NK cells are not considered classical or functional NK cell deficiencies. In these disorders, the impairment of NK cells represents an important aspect of the overall immunodeficiency. In turn, this leads to improved insights on the NK cell development and function.

Summary

Here, we detail the NK cell biology based upon recent natural killer cell defects described in combined immune deficiencies.

http://bit.ly/2T6b0ME

Direct to Consumer Telemedicine

Abstract

Purpose of Review

Telemedicine uses technology to connect patients and data with providers at a distance. Direct to consumer telemedicine is a rapidly growing segment of the industry.

Recent Findings

The telehealth market has skyrocketed in recent years, making it a multi-billion dollar industry. Direct to consumer telehealth, dominated by the for-profit private sector, is the most popular form.

Summary

Direct to consumer telemedicine is a subset of telehealth that shows promise in increasing access to and engagement in medical care. Quality assurance, reimbursement, and regulatory oversight are important factors in assuring appropriate widespread adoption.

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Low-Income Children with Neonatal Hypothyroidism Are at Increased Risk for Intellectual Disability

Clinical Thyroidology, Volume 31, Issue 1, Page 14-16, January 2019.


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How Can Levothyroxine Overuse Be Reduced?

Clinical Thyroidology, Volume 31, Issue 1, Page 5-7, January 2019.


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An Increased Relative but Small Absolute Risk of Leukemia Can Be Attributed to I-131 Ablation

Clinical Thyroidology, Volume 31, Issue 1, Page 30-32, January 2019.


http://bit.ly/2szTJ2L

New miRNA-Based Classifier Test Uses FNA Cytology to Evaluate Cytologically Indeterminate Thyroid Nodules

Clinical Thyroidology, Volume 31, Issue 1, Page 23-26, January 2019.


http://bit.ly/2MoRQ28

Fear of Recurrence Affects Health-Related Quality of Life in Thyroid Cancer Patients

Clinical Thyroidology, Volume 31, Issue 1, Page 27-29, January 2019.


http://bit.ly/2sB9DtN

Clinical Validation of ThyroSeq V3 Shows High Sensitivity and Specificity

Clinical Thyroidology, Volume 31, Issue 1, Page 20-22, January 2019.


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A Mild Risk of Neonatal Hyperthyroidism Follows Preconception Radioactive Iodine Treatment for Graves’ Disease

Clinical Thyroidology, Volume 31, Issue 1, Page 11-13, January 2019.


http://bit.ly/2sKl2Yt

More Hürthle-Cell Aspirations Will Be Identified as Benign by the New Afirma GSC Test

Clinical Thyroidology, Volume 31, Issue 1, Page 17-19, January 2019.


http://bit.ly/2MmKaNz

Dyslipidemia Is Common in Patients with Hypothyroidism Despite Correction of Abnormal TSH: A Systematic Review and Meta-Analysis

Clinical Thyroidology, Volume 31, Issue 1, Page 8-10, January 2019.


http://bit.ly/2sB3ein

The Difficult to Access “Right-To-Try” U.S. Health Care Law

Clinical Thyroidology, Volume 31, Issue 1, Page 33-36, January 2019.


http://bit.ly/2MoJ5VS

Greetings From the New Editor of Clinical Thyroidology

Clinical Thyroidology, Volume 31, Issue 1, Page 4-4, January 2019.


http://bit.ly/2szOb8B

A Systematic Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain

Abstract

Background

Chronic pain of the lower extremity remains challenging to manage. Radiofrequency treatment applies heat to nerve fibers with the goal of mitigating chronic pain conditions. The clinical efficacy has not yet been adequately established for pathologies of the ankle and foot. In this review paper, we report the use and efficacy of radiofrequency treatment applied to foot and ankle pain.

Recent Findings

PubMed and the Cochrane Controlled Trials Register were searched (final search 30 March 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," "plantar heel pain," "plantar fascitis," and "chronic pain" in the English literature. Of the 23 papers screened, 18 were further investigated for relevance. Our final search methodology yielded 15 studies that investigated the use of radiofrequency treatment at the ankle. Of these 15 studies, there were three randomized control trials, four prospective studies, three retrospective studies, and five case reports. The quality of selected publications was assessed using the Cochrane risk of bias instrument.

Summary

The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.

Conclusion

The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.

http://bit.ly/2MldDro

Adherence to Behavioral Therapy for Migraine: Knowledge to Date, Mechanisms for Assessing Adherence, and Methods for Improving Adherence

Abstract

Purpose of Review

In other disease states, adherence to behavioral therapies has gained attention, with a greater amount of studies discussing, defining, and optimizing adherence. For example, a meta-analysis formally discussed adherence in 25 studies of CBT for 11 different disorders, with only 6 of the 25 omitting addressing or defining adherence. Many studies have discussed the use of text messages, graph-based adherence rates, and email/telephone reminders to improve adherence. This paper examined the available literature regarding adherence to behavioral therapy for migraine as well as adherence to similar therapies in other disease states. The goal of this research is to apply lessons learned from adherence to behavioral therapy for other diseases in better understanding how we can improve adherence to behavioral therapy for migraine.

Recent Findings

Treatment for migraine typically includes both pharmacologic and non-pharmacologic therapies, including progressive muscle relaxation (PMR), cognitive behavioral therapy (CBT), and biofeedback. Behavioral therapies have been shown to significantly reduce headache frequency and intensity, but high attrition rates and suboptimal adherence can undermine their efficacy. Traditionally, adherence to behavioral therapy has been defined by self-report, including paper headache diaries and assignments. In person attendance has also been employed as a method of defining and monitoring adherence. With the advent of personal electronics, measurements of adherence have shifted to include electronic-based methods such as computer-based programs and mobile-based therapies. Furthermore, some studies have taken advantage of electronic methods such as email reminders, push notifications, and other mobile-based reminders to optimize adherence. The JITA-I, a novel method of engaging individual patient adherence, has also been suggested as a possible method to improve adherence by tailoring engagement with a mobile health app-based on patient input. These novel methods may be utilized in behavioral therapy for migraine for further optimizing adherence.

Summary

Few intervention studies to date have addressed the optimal ways to impact adherence to migraine behavioral therapy. Further research is required regarding adherence with behavioral therapies, specifically via mobile health interventions to better understand how to define and improve adherence via this novel forum. Once we are able to understand optimal methods of tracking adherence, we will be better equipped to understand the role of adherence in shaping outcomes for behavioral therapy in migraine.

http://bit.ly/2szdOGz

The Status of Pain Research in Academia and how We Are Doing in the United States

http://bit.ly/2MoRPv6

Imaging of Carotid Dissection

Abstract

Purpose of Review

Here, we describe the four primary imaging modalities for identification of carotid artery dissection, advantages, limitations, and clinical considerations. In addition, imaging characteristics of carotid dissection associated with each modality will be described.

Recent Findings

Recent advances in etiopathogenesis describe the genetic factors implicated in cervical artery dissection. MRI/MRA (magnetic resonance angiography) with fat suppression is regarded as the best initial screening test to detect dissection. Advances in magnetic resonance imaging for the diagnosis of dissection include the use of susceptibility-weighted imaging (SWI) for the detection of intramural hematoma and multisection motion-sensitized driven equilibrium (MSDE), which causes phase dispersion of blood spin using a magnetic field to suppress blood flow signal and obtain 3D T1- or T2*-weighted images. Digital subtraction angiography (DSA) remains the gold standard for identifying and characterizing carotid artery dissections.

Summary

Carotid artery dissection is the result of a tear in the intimal layer of the carotid artery. This leads to a "double lumen" sign comprised of the true vessel lumen and the false lumen created by the tear. The most common presentation of carotid artery dissection is cranial and/or cervical pain ipsilateral to the dissection. However, severe neurological sequelae such as embolic ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage can also result from carotid artery dissection. Carotid artery dissection can be identified by a variety of different imaging modalities including computed tomographic angiography (CTA), MRI, carotid duplex imaging (CDI), and digital subtraction angiography (DSA).

http://bit.ly/2szdKGP

Different Types of Maculopathy in Eyes after a High-Voltage Electrical Shock Injury

Background: We report a case of different types of maculopathy in eyes after a high-voltage electrical shock injury. Case Report: A 43-year-old male suffered high-voltage electrical injury through his left arm. He underwent cataract surgery in both eyes 3 months after the injury, but there was no vision improvement. Ocular examination, including spectral domain optical coherence tomography, revealed diffuse retinal atrophy in the left eye which did not change until the final visit. In the right eye, an impending macular hole was observed but regressed spontaneously 9 months after the injury, and the visual acuity improved to 20/32 at the final visit. Conclusion: Two different types of maculopathy can occur in each eye after high-voltage electrical shock injury, and this might be due to asymmetric pathogenesis of the eyes according to the proximity to the route of electrical current.
Case Rep Ophthalmol 2019;10:19–23

http://bit.ly/2RYYXDx

The Difficulty of Diagnosing Invasive Aspergillosis Initially Manifesting as Optic Neuropathy

Background: Invasive aspergillosis is often fatal. Here, we report a patient with invasive aspergillosis primarily involving the optic nerve diagnosed on autopsy. Case Presentation: A 77-year-old female with underlying diabetes mellitus, hyperlipidemia, and hypertension presented with disc swelling of the left eye. Although mini-pulse steroid therapy improved visual acuity (VA) of the left eye, it abruptly decreased to no light perception within a month, followed by a decrease in VA of the right eye to 0.5. At referral, VA was 0.3 in the right eye, and there was no light perception in the left eye. Results: Fundus examination revealed optic disc swelling of both eyes. Goldmann perimetry showed irregular visual field defects, whereas magnetic resonance imaging (MRI), general, and cerebrospinal fluid (CSF) examinations revealed no distinct abnormalities. We suspected anterior ischemic optic neuropathy and invasive optic neuropathy. As with the left eye, steroid pulse therapy temporarily improved VA of the right eye and then decreased to 0.2. Additional anticoagulant therapy did not improve VA. Concurrent to therapy, the patient became febrile with depressed consciousness. Repeat MRI identified suspected midbrain infarction, and CSF examination indicated cerebral meningitis. In spite of administering transfusions and antibiotics, she died on hospital day 40. Autopsy revealed large amounts of Aspergillus hyphae mainly localized in the dura mater of the optic nerve and destruction of the cerebral artery wall, suggesting an etiology of subarachnoid hemorrhage. Conclusions: When examining refractory and persistent disc swelling, we should rule out fungal infections of the optic nerve.
Case Rep Ophthalmol 2019;10:11–18

http://bit.ly/2Hn8ksN

Tonsillectomy plus steroid pulse therapy is the most effective treatment in adult patients with C-Grade I IgA nephropathy, and the weight of the extracted palatine tonsils and Yamamoto scale have no significant correlation with the effects of this treatment

Publication date: Available online 18 January 2019

Source: Auris Nasus Larynx

Author(s): Norio Kondo, Takahito Moriyama, Mayako Tachikawa, Erika Tomita, Ai Hattori, Yukie Yamamura, Manabu Nonaka

Abstract

Objective

We studied patients who underwent tonsillectomy plus steroid pulse therapy (TSP) for immunoglobulin A nephropathy (IgAN), in order to investigate the clinical factors associated with a positive response to this treatment.

Methods

We analyzed 118 IgAN patients who underwent TSP. We collected patients' data retrospectively, including age, sex, blood pressure, onset of IgAN, pathological findings of a renal biopsy, serum concentration of creatinine, estimated glomerular filtration rate, serum concentration of protein, urinary protein, hematuria, past history of tonsillitis, the Yamamoto scale, the weight and pathological findings of the extracted palatine tonsils, and the presence or absence of anti-platelet drugs and renin-angiotensin system inhibitors (RAS-I) usage. This study included participants who were over 18 years of age, had undergone tonsillectomy within three months of steroid pulse therapy administered thrice, in whom renal biopsy was performed within a year before treatment, and with follow-up period of over 3 years. Clinical remission (CR) of urinary abnormalities was defined as remission of both proteinuria and hematuria: three consecutive negative results over a 6-month period, with a urinary sediment red blood cell count of <5/HPF, and a proteinuria qualitative reaction of (−) to (±).

Results

The CR rate of all cases was 56.8% and statistical significance was observed with respect to the C-Grade (P =  0.0003, P =  0.028) using both univariate and multivariate analysis. The CR rate of C-Grade І (73.4%) patients was significantly higher than that of C-Grade II patients (39.0%; P =  0.0004) and C-Grade III patients (30.8%; P =  0.003). We analyzed clinical factors in each C-Grade patient. No statistical significance was observed with respect to any of the factors using univariate analysis in C-Grade I patients. The weight of the extracted palatine tonsils and Yamamoto scale showed no statistical significance in every analysis. Fibrosis or hyalinization of the stroma of the palatine tonsils showed statistical significance (P =  0.026) only in the univariate analysis of C-Grade III patients. However, the patient number of C-Grade III was small.

Conclusion

Our results indicate that TSP is mostly effective in patients with of C-Grade I IgAN and that the C-Grade reflects the clinical indication for TSP. The weight of the extracted palatine tonsils and Yamamoto scale did not show obvious correlations with the clinical effect of TSP.

http://bit.ly/2T4QDiO

Production, purification, and evaluation of quail immunoglobulin Y against Salmonella typhimurium and Salmonella enteritidis

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s): Atefeh Esmailnejad, Bahman Abdi-Hachesoo, Elhamsadat Hosseini Nasab, Maryam Shakoori

Abstract

Salmonella species have been the major foodborne problems in food production systems, with Salmonella enterica serovars typhimurium (S. typhimurium) and enteritidis (S. enteritidis) being among the more common isolates. The oral administration of chicken egg yolk specific antibodies (IgYs) has been established as an efficient alternative for treatment and prevention of gastrointestinal pathogens including Salmonella. The present study was aimed to investigate the possible production of specific IgYs against Salmonella typhimurium and Salmonella enteritidis in quail egg yolks. Salmonella spp.-free female Japanese quails (Coturnix coturnix japonica) were intramuscularly immunized with formalin or heat-inactivated Salmonella immunogens (1.0 × 10⁹ CFU/mL) emulsified with Freund adjuvants. Egg yolk IgYs were purified using ammonium sulfate precipitation method. Anti-Salmonella IgYs titer and specificity were determined using enzyme-linked immunosorbent assay (ELISA) and western blot analysis. Salmonella specific IgYs detected in the immunized quails were significantly higher than those of the control group, which confirmed the immunization procedure. Specific IgYs against S. typhimurium and S. enteritidis were identified in both groups immunized with heat or formalin-inactivated immunogens. However, formalin-inactivated immunogens induced relatively higher immune responses over the heat-inactivated ones. Quail anti-Salmonella IgYs showed a high specificity to their corresponding immunogens, with moderate cross-reactivity to other members of Enterobacteriaceae family. Quail can be regarded as a valuable and inexpensive source for producing large-scale of specific antibodies that can be used for immunodiagnostic and immunotherapeutic purposes.

http://bit.ly/2RVIoZf

Role of interleukin-17 in acute myocardial infarction

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s): Mónica Daniela Mora-Ruíz, Francisco Blanco-Favela, Adriana Karina Chávez Rueda, María Victoria Legorreta-Haquet, Luis Chávez-Sánchez

Abstract

Acute myocardial infarction (AMI) is a leading cause of death worldwide. Myocardial necrosis generates damage signals and triggers an intense inflammatory response. Many cytokines that contribute to repair tissue can also cause adverse left ventricular remodeling and heart failure. Several studies have revealed that interleukin-17 (IL-17) is a cytokine with a potential role in AMI. IL-17 plays an important role in the immune response and affects the production of different inflammatory mediators in several types of cells, involved in the damage or scar process in myocardial tissue. In this review, we will discuss the current knowledge of the role of IL-17 in AMI and the effect of IL-17 in different cells, such as cardiomyocytes, smooth muscle cells and immune system cells, in AMI pathogenesis.

http://bit.ly/2HmA5S8

Adverse events need for hospitalization and systemic immunosuppression in very elderly patients (over 80 years) treated with ipilimumab for metastatic melanoma

Abstract

Background

Checkpoint inhibitors are first-line therapies in melanoma, but safety in older adults has not yet been assessed. Ipilimumab improves survival, but immunologic-related adverse events (AEs) can be threatening, and its use in elderly people raises questions.

Aim

To assess safety in a cohort of very elderly patients treated with ipilimumab.

Methods

All patients over 80 years treated with ipilimumab for melanoma were retrospectively included. AE occurrence, management, and outcome, as well as response rate at week 16 and overall survival were recorded, and compared to data for a group of younger patients treated in our institution during the same period.

Results

In the elderly group, 23 patients were included with a median age of 82 years [80–90]. AEs amounting to 23 occurred in 15 patients (65%) with 5 grade 3 (22%) and 1 grade 5 (opportunistic infection) AEs. Corticosteroids were required for five (22%) patients, additive immunosuppressive therapy for two, hospitalization for four, and definitive interruption of ipilimumab for three. Median overall survival was 14 months. In the younger group, 29 patients were included with a median age of 58 years. AEs occurred in 15/29 (52%) with 4 grade 3 (19%) and 1 grade 4 (7%). Median OS was 17 months.

Conclusion

Serious AEs occurred in 80 + adults at the same rate as observed in our younger patients and as previously reported in younger populations. Ipilimumab can be an option in elderly patients, as patients may benefit from therapy and safety seems to be manageable.

http://bit.ly/2Taeiyg

The effect of everolimus and low-dose cyclophosphamide on immune cell subsets in patients with metastatic renal cell carcinoma: results from a phase I clinical trial

Abstract

For the treatment of metastatic renal cell cancer several strategies are used among which the mTOR inhibitor everolimus. As mTOR plays an important role in the immune system, e.g., by controlling the expression of the transcription factor FoxP3 thereby regulating regulatory T cells (Tregs), it plays a key role in the balance between tolerance and inflammation. Previous reports showed stimulatory effects of mTOR inhibition on the expansion of Tregs, an effect that can be considered detrimental in terms of cancer control. Since metronomic cyclophosphamide (CTX) was shown to selectively deplete Tregs, a phase 1 clinical trial was conducted to comprehensively investigate the immune-modulating effects of several dosages and schedules of CTX in combination with the standard dose of everolimus, with the explicit aim to achieve selective Treg depletion. Our data show that 50 mg of CTX once daily and continuously administered, in combination with the standard dose of 10 mg everolimus once daily, not only results in depletion of Tregs, but also leads to a reduction in MDSC, a sustained level of the CD8⁺ T-cell population accompanied by an increased effector to suppressor ratio, and reversal of negative effects on three peripheral blood DC subsets. These positive effects on the immune response may contribute to improved survival, and therefore this combination therapy is further evaluated in a phase II clinical trial.

http://bit.ly/2QUmxN5

Strong antigen-specific T-cell immunity induced by a recombinant human TERT measles virus vaccine and amplified by a DNA/viral vector prime boost in IFNAR/CD46 mice

Abstract

Cancer immunotherapy is seeing an increasing focus on vaccination with tumor-associated antigens (TAAs). Human telomerase (hTERT) is a TAA expressed by most tumors to overcome telomere shortening. Tolerance to hTERT can be easily broken both naturally and experimentally and hTERT DNA vaccine candidates have been introduced in clinical trials. DNA prime/boost strategies have been widely developed to immunize efficiently against infectious diseases. We explored the use of a recombinant measles virus (MV) hTERT vector to boost DNA priming as recombinant live attenuated measles virus has an impressive safety and efficacy record. Here, we show that a MV-TERT vector can rapidly and strongly boost DNA hTERT priming in MV susceptible IFNAR/CD46 mouse models. The cellular immune responses were Th1 polarized. No humoral responses were elicited. The 4 kb hTERT transgene did not impact MV replication or induction of cell-mediated responses. These findings validate the MV-TERT vector to boost cell-mediated responses following DNA priming in humans.

http://bit.ly/2RU1ezP

STAT3 inhibition specifically in human monocytes and macrophages by CD163-targeted corosolic acid-containing liposomes

Abstract

Tumor-associated macrophages (TAMs) are of major importance in cancer-related immune suppression, and tumor infiltration by CD163^pos TAMs is associated with poor outcome in most human cancers. Therefore, therapeutic strategies for reprogramming TAMs from a tumor-supporting (M2-like) phenotype towards a tumoricidal (M1-like) phenotype are of great interest. Activation of the transcription factor STAT3 within the tumor microenvironment is associated with worse prognosis, and STAT3 activation promotes the immunosuppressive phenotype of TAMs. Therefore, we aimed to develop a drug for inhibition of STAT3 specifically within human TAMs by targeting the endocytic CD163 scavenger receptor, which is highly expressed on TAMs. Here, we report the first data on a CD163-targeted STAT3-inhibitory drug consisting of corosolic acid (CA) packaged within long-circulating liposomes (LCLs), which are CD163-targeted by modification with monoclonal anti-CD163 antibodies (αCD163)—CA-LCL-αCD163. We show, that activation of STAT3 (by phosphorylation) was inhibited by CA-LCL-αCD163 specifically within CD163^pos cells, with minor effect on CD163^neg cells. Furthermore, CA-LCL-αCD163 inhibited STAT3-regulated gene expression of IL-10, and increased expression of TNFα, thus indicating a pro-inflammatory effect of the drug on human macrophages. This M1-like reprogramming at the mRNA level was confirmed by significantly elevated levels of pro-inflammatory cytokines (IFNγ, IL-12, TNFα, IL-2) in the culture medium. Since liposomes are attractive vehicles for novel anti-cancer drugs, and since direct TAM-targeting may decrease adverse effects of systemic inhibition of STAT3, the present results encourage future investigation of CA-LCL-αCD163 in the in vivo setting.

http://bit.ly/2RKg6ki

First in Houston to Offer a New Treatment for Obtructive Sleep Apnea

UT Physicians is now offering an alternative therapy for obstructive sleep apnea (OSA) when traditional approaches fail. The first six...

http://bit.ly/2ASN74f

Head and Neck Surgical Oncology: How Do We Make the Experience Better for the Patient?

By asking cancer patients what they want, physicians in the Head and Neck Surgical Oncology Program at Memorial Hermann and...

http://bit.ly/2T68Bl6

On a Mission: Dr. Yuksel Returns to Nicaragua

Pediatric otolaryngologist Sancak Yuksel, MD joined a team of otolaryngologists, nurses, audiologists, and speech pathologists supported by Oklahoma-based Mayflower Medical Outreach...

http://bit.ly/2ATqkFk

Radioguided Surgery of Non-palpable Neck Lymph Node in Lymphoma Patients

Abstract

Lymphomas have frequent relapses; early diagnosis is important to treat and improve outcomes. Clinical exam and imaging are useful but confirmation with biopsy is always required. Minimally exploratory surgery is a tool to take good samples with precision and safety. Evaluate the use of ROLL technique to track non-palpable lesions on the neck which were suspicious of recurrence in lymphoma patients. A retrospective review of the patients with high probability of lymphoma relapse who were biopsied using ROLL technique. Suspicious lesions on the neck where identified on the follow up of five lymphoma patients. Roll technique was used successfully to guide the biopsy. There were no complications. Relapse was confirmed in two patients; the other three was reactive follicular hyperplasia. Management was redirected on relapsing patients. ROLL technique proved to be a simple, safe and effective method to detect and biopsy non- palpable lesions on the neck of patients with suspicious relapsing lymphoma.

http://bit.ly/2R1fN0a

Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report

Abstract

Fourth branchial pouch anomalies represent one of the rarest types of all branchial apparatus anomalies. They appear in the first lifedecade in a form of recurrent left-sided neck masses which demands surgical treatment. Accidental finding, appearance later in life and spontaneous resolving are really rare. We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spontaneously and that conservative approach is an alternative to multiple surgical procedures.

http://bit.ly/2DjX8ZQ

CNPAS: A Differential to Choanal Atresia

Abstract

A case of 7 day old male child, born at 36 weeks, presented with feeding difficulties, hypothermia and failure to thrive. After clinical examination to rule out any gross congenital anomalies, CT scan was done which was suggestive of pyriform aperture stenosis. It was surgically dilated and stented successfully.

http://bit.ly/2Mjur1U

“Sinus Headache”: Diagnosis and Dilemma?? An Analytical and Prospective Study

Abstract

To evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosis.

http://bit.ly/2RCF8Cv

Reconstruction of Orbital Suprastructure Maxillectomy Defects by Temporalis Myofascial Flap

Abstract

Oncological surgery being radical is often mutilating in form and function especially in the maxillary/orbit region reconstruction of maxillo-orbit defects are challenging due to the complex three dimensional anatomy. Free flaps are de-rigueur but a technical resource with constraints. The temporalis myofascial flap (TMFF) is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. To study the use of the temporalis myofascial flap in the reconstruction of various orbital and supramaxillary facial defects. Temporalis myofascial flap was harvested and successfully used in reconstruction of three patients who had undergone orbital exenteration with or without suprastructural maxillectomy. There was no morbidity related to flap loss. Temporalis flap (TMFF) can be considered as a first line reconstructive option for limited resection of upper maxilla with palatal preservation. Its proximity to the oral cavity, palate and mid third face and the technical ease makes the TMFF valuable for reconstruction. The techniques and outcomes of TMFF are discussed.

http://bit.ly/2sz246Z

Ewing’s Sarcoma of the Sinonasal Tract: A Report of Two Challenging Cases

Abstract

Ewing's sarcoma (ES) is a malignant small round cell tumor that belongs to the primitive neuroectodermal tumor class. ES generally arises in the long bones of the extremities (skeletal form) and less frequently in the soft tissue of the trunk and extremities (extra-skeletal form). Sinonasal localization of ES is an extremely rare event. About 80% of the patients are less than 20 years old with the highest incidence in the second decade of life. The combination of histopathological examination and ancillary methods (such as immunohistochemistry and molecular genetics) is extremely important to establish the diagnosis of ES. The most effective treatment plan for ES includes a multidisciplinary approach with surgery, radiotherapy and chemotherapy. This is a report of two challenging cases of sinonasal ES in two different age groups. The first case is a 13-years old female patient who presented with right nasal obstruction, anosmia, intermittent epistaxis and hearing loss. The second case is a 24-years old male patient who presented with a history of right nasal obstruction, right eye pain and periorbital edema. We present these cases due to the rarity of the disease and the difficulty of diagnosis.

http://bit.ly/2ARXrcJ

The effect of low-level laser radiation on improving inferior alveolar nerve damage after sagittal split osteotomy: a systematic review

Abstract

Inferior alveolar nerve (IAN) damage is a common complication occurring after sagittal split osteotomy (SSO) and results in sensory disorders of the jaw region. In recent years, published experimental and clinical evidence suggests that low-level laser (LLL) radiation is effective in nerve recovery. Therefore, the aim of the present study was to review clinical trial studies investigating the effect of LLL radiation on improving the sensory defects of IAN after SSO. The keywords associated with SSO and LLL were searched in PubMed, Medline (via Ovid), Web of Science (WOS), Scopus, and Cochrane Library databases. Then, controlled clinical trial studies published before November 2017 regarding LLL radiation conducted on patients with IAN neuropathy due to SSO were investigated. The articles fulfilling the study criteria were further scrutinized and the necessary information was extracted from them. A total of seven papers were included in the study. The diode laser used had a wavelength range of 760–930 nm, radiation power of 20–200 mw, and radiation energy of 10.2–95 J (per point of radiation). In the mentioned studies, the patients underwent 3–20 sessions of laser irradiation and were monitored for an additional 0–23 months after completion of the laser intervention. The tests performed in the mentioned studies dealt with examining the perceptions of superficial touch and pressure, two-point discrimination, stimulus movement on skin, temperature, and pain. Furthermore, the patients' general awareness regarding sensory perception in the mandibular region was gauged. In six studies, laser irradiation caused relative improvement in the IAN sensory disorder for a subjective test as well as for one or more objective tests. In the reviewed clinical trial studies, LLL was generally found to be effective in improving the IAN sensory disturbance resulting from SSO, though there was no placebo effect.

http://bit.ly/2U4kYOM

In vivo detection of oral precancer using a fluorescence-based, in-house-fabricated device: a Mahalanobis distance-based classification

Abstract

In vivo detection of oral precancer has been carried out by a fluorescence-based, in-house-developed handheld probe on three groups: oral squamous cell carcinoma (OSCC), dysplastic (precancer), and control (normal). Measurements have been performed on a total of 141 patients and volunteers of different age groups. Excitation wavelength of 405 nm was used and fluorescence emission spectra were recorded in the scan range of 450.14 to 763.41 nm at very low incident power (122 μW) from different oral sites buccal mucosa (BM), lateral boarder of tongue (LBT), and dorsal surface of tongue (DST). Spectral profiles are found to vary among the three groups as well as among the different oral sites. Major and minor bands of flavin adenine dinucleotide (FAD) and porphyrins near 500, 634, 676, 689, and 703 nm have been obtained. Porphyrin contribution is found to be more dominant than the FAD in OSCC and dysplastic groups as compared to the control group. A better classification has been observed using the entire spectral range rather than restricting to individual bands, by application of principal component analysis (PCA), Mahalanobis distance model, and receiver operating characteristic analysis (ROC). ROC on Mahalanobis distance differentiates OSCC to normal, dysplastic to normal, and OSCC to dysplastic with sensitivities from 71% to 98%, 92% to 94% and 81% to 93% and specificities 91% to 100%, 86% to 100% and 79% to 97% for oral sites BM, LBT and DST. LBT and DST appear to be more sensitive to dysplasia detection as compared to BM.

http://bit.ly/2Dmkyxx

Impact of lens density and lens thickness on cumulative dissipated energy in femtosecond laser–assisted cataract surgery

Abstract

To evaluate the required cumulative dissipated energy (CDE) to fragment the crystalline lens in femtosecond laser–assisted cataract surgery (FLACS) in relation to lens density and lens thickness. Consecutive eyes that underwent FLACS between September 2014 and March 2017 by a single surgeon using in all cases the same femtosecond laser and phacoemulsification platform were included in our retrospective study. Prior to surgery, corrected distance visual acuity (CDVA), optical biometry corneal, and crystalline lens tomographies were performed to assess anterior chamber depth (ACD), axial length (AL), and crystalline lens parameters (i.e., lens density, thickness, and nucleus staging (NS)). After surgery, CDE was calculated and analyzed in relation to lens density (LD) and lens thickness (LT). Zero ultrasound expenditure cases were recorded and their occurrence analyzed. The chart review identified 236 eyes of 200 patients, 98 males and 102 females aged 65± 15 years which were included in the study. Mean LD was 11.26 ± 2.05 pixel intensity units (range 7.30–18.80), and the mean LT was 3417 ± 405.17 μm (range 2545–4701). LD and LT correlated moderately (r = 0.50, p < 0.001) and weakly (r = 0.23, p < 0.001), with post-laser CDE. Higher LD and LT were also associated with lower rates of zero phaco (eyes in which no phacoemulsification energy was necessary). Furthermore, NS (r = 0.528, p < 0.001) and CDVA (r = − 0.3524, p < 0.001) also correlated with CDE. Higher LD, LT, NS values, and low CDVA are associated with higher ultrasound expenditure (CDE—cumulative dissipated energy) and with lower rates of zero ultrasound expenditure during FLACS.

http://bit.ly/2U4biUb

Symptom-based patient-reported outcomes in adults with eosinophilic esophagitis: value for treatment monitoring and randomized controlled trial design

Purpose of review In adults with eosinophilic esophagitis (EoE), a chronic, inflammatory immune-mediated condition of the esophagus, both inflammation and fibrosis are likely associated with symptom generation. Therefore, assessing symptom-based patient-reported outcomes (PROs), defined by US Food and Drug Administration as 'any report of the status of a patient's health condition that comes directly from the patients, without interpretation of the patient's response by a clinician or anyone else', is important in the context of trials and observational studies of emerging therapies. Recent findings For purposes of treatment monitoring, lack of symptoms does not predict the absence of biologic inflammation; hence, endoscopy with esophageal biopsies should be performed to check for residual inflammation. Lack of inflammation does not predict lack of symptoms, and the presence of subepithelial fibrosis cannot be excluded. No published instrument currently measures the frequency of dysphagia described all possible ways, strategies of living with this symptom and various pain types. In randomized controlled trials, in which symptom response was detected using validated PRO measures, only modest decreases in symptom scores were observed. Summary Accessing full EoE symptom spectrum and optimizing PRO measures remains a challenge that should be tackled to reliably assess response to existing and emerging therapies. Correspondence to Ekaterina Safroneeva, PhD, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland. E-mail: ekaterina.safroneeva@ispm.unibe.ch Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2QZ7SQY

Diagnosis of occupational hypersensitivity pneumonitis

Purpose of review To discuss the diagnostic methods currently used in the study of patients with hypersensitivity pneumonitis, with special emphasis on the most recent contributions published in the medical literature regarding the diagnosis of occupational hypersensitivity pneumonitis (OHP). This review presents an update of the use of these diagnostic tests, a controversial issue among experts. Recent findings In spite of the multiple attempts at systematization and the publication of expert consensus statements, standardizing and diagnostic methods and criteria remain particularly difficult. As a result, centers tend to rely on their own experience and establish diagnosis by consensus among their multidisciplinary teams. Though recommendable in many ways, this method presents significant limitations. Summary Diagnosis of OHP should be made with a thorough clinical history of the symptoms and clinical signs as well as a meticulous review, if possible by an expert, of possible exposures in the working environment; a meticulous physical examination; high-resolution computed tomography of the thorax; serum determination of specific immunoglobuline Gs; bronchoalveolar lavage and possibly cryobiopsy; fungal culture; and, when appropriate, a specific inhalation challenge test with the suspected antigen. Correspondence to Ferran Morell, MD, PhD, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Catalonia, Spain. Tel: +34 932746157; fax: +34 932746083; e-mail: fmorell@vhebron.net Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2W4pFtO

Management of acute loss of asthma control: yellow zone strategies

Purpose of review Asthma exacerbations are associated with a significant burden to both the individual patient and to the healthcare system. Patients often step-up home therapies in response to increased asthma symptoms, and the asthma action plan was created to empower patients to self-manage their asthma care. The yellow (intermediate) zone of the asthma action plan is frequently poorly defined, and current Expert Panel Report 3 guideline recommendations are not effective for all patients. This article reviews the evidence behind various recommended yellow zone intervention strategies. Recent findings There are many potential methods of delivering yellow zone therapy, and recent studies have assessed preventive efficacy of a scheduled increase in controller medication(s), reliever medication(s), or a symptom-driven combination of both. The literature suggests that, in certain asthma subpopulations, some methods may be more efficacious than others. Summary Multiple yellow zone approaches may be beneficial, and the yellow zone is not a 'one size fits all' narrative. Correspondence to Brooke I. Polk, MD, Division of Allergy, Immunology, and Pulmonary Medicine, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, Campus Box 8116, St. Louis, MO 63110, USA. Tel: +1 314 454 2694; fax: +1 314 454 2694; e-mail: bpolk@wustl.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2R0AGIz

Precision medicine in childhood asthma

Purpose of review Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma. Recent findings It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Reduced lung function growth and early decline is a prevalent finding in children with persistent asthma. Pharmacogenetic studies have identified children at risk for cortisol suppression when using inhaled corticosteroids. Summary Clinical characteristics and simple biomarkers like eosinophils, IgE, and the fraction of exhaled nitric oxide may be used in clinical practice for a basic precision medicine approach, deciding which children will have the best chance to respond to inhaled corticosteroids and to the biologicals omalizumab and mepolizumab. Further application of pharmacogenomics and breathomics needs additional studies before they can be applied as tools for precision medicine in individual children with asthma. Correspondence to Mariëlle W. Pijnenburg, MD, PhD, Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC – Sophia, University Medical Center Rotterdam, PO Box 2060, 3000 CB Rotterdam, The Netherlands. Tel: +31 107036263; e-mail: m.pijnenburg@erasmusmc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2W4pAX2

Eine seltene Ursache der peripheren Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/a-0821-5850

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2sEtesQ

Referrals for head and neck cancer in England and The Netherlands: an international qualitative study of the views of secondary-care surgical specialists

Publication date: Available online 17 January 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): S. Langton, J.A. Rijken, C.R. Bankhead, A. Plüddemann, C.R. Leemans

Abstract

One-year survival after head and neck cancer in England has been reported to be worse than that in Europe, despite five-year conditional survival being similar, which implies that patients present later in England. One country with better rates is The Netherlands. There are many possible causes, one of which may be the system of referral from primary to secondary care. We have compared the views of secondary care specialists in the two countries about their systems for referral, and identified aspects that might have an impact on outcomes. We organised semistructured qualitative interviews of surgical specialists in head and neck cancer in England and The Netherlands (n = 12 in each). The most common theme was communication between primary care and specialists. Surgeons in England identified this as the aspect most lacking under the English "two-week" rule, while Dutch specialists felt that the good communication in their system was one of its best points. Other themes included the educational needs of primary care practitioners, criticism of "tick box" referrals in England, and too many patients referred who do not have cancer. Overall, specialists in both countries identified good aspects of their respective referral systems, but those in England felt strongly that the "two-week" rule/NICE guidance system could be improved with better direct communication between primary and secondary care, which might improve the speed and quality of referrals, reduce unnecessary ones, and assist in educating primary care physicians. It is not clear whether such improvements would improve survival, but further research and piloting of such a system should be considered in England.

http://bit.ly/2Hn1T8P

Importance of activity and recreation for the quality of life of patients treated for cancer of the head and neck

Publication date: Available online 15 January 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): S.N. Rogers, A. Travers, D. Lowe, A.R. Levy, A.W. Midgely

Abstract

The ability of patients to participate in recreational activities is an important facet of health-related quality of life (HRQoL) after treatment for cancer of the head and neck. The aim of this study was to analyse patients' responses to the activity and recreation domains of the University of Washington quality of life questionnaire (UW-QoL), and to relate them to clinical characteristics, the intensity of leisure-time exercise/week, perceived barriers that interfere with exercise, and feeling able to participate in an exercise programme. Other questionnaires used were the Godin Leisure-Time Exercise questionnaire, the Perceived Exercise Barriers questionnaire, and the Exercise Preferences questionnaire. The survey sample comprised 1021 patients of whom 437 responded (43%). Of them, 9% reported a serious problem with activity and 8% with recreation. The main influencing factors were site (oropharynx), advanced stage, radiotherapy and chemotherapy, composite flap, gastrostomy tube, and coexisting conditions. Low (worse) scores in the UW-QoL activity and recreation domains were associated with little time spent exercising, low-intensity exercise, more barriers to exercising, and a lack of preference. The use of the UW-QoL in follow-up assessments can help to identify patients who are having difficulties in these two domains, as well as those who feel able to participate in an exercise programme. Further research is required to optimise the interventions that will promote exercise and improve recovery and wellbeing.

http://bit.ly/2RVYvFZ

Evaluating societal outcomes of orthognathic surgery: an innovative application of the Social Return on Investment methodology to patients after orthognathic treatment

Outcomes after orthognathic treatment are complex, and include improvements to mental and physical health, and psychosocial adjustments. The Social Return on Investment (SROI), a framework that is recognised by the government, explores the wider social value of interventions, but has not yet, to our knowledge, been used to measure the value of surgical procedures. To test its feasibility in a surgical setting and to begin to understand the wider nature of the changes experienced by patients after orthognathic surgery, we designed a pilot study that focused on the first two stages of the six-stage model.

http://bit.ly/2RU87kS

Incision to the sagittal temporalis tendon to optimise access to the ramus

Since Trauner and Obwegeser1 developed the intraoral sagittal ramus split osteotomy in 1953 it has become a mainstay of orthognathic surgery. The techniques have evolved over many years, with Dal Pont2 adding the advancement and rotation of the lower horizontal cut to the buccal cortex (with a vertical cut between the first and second molars) and Hunsuck3 shortening the lingual cut. The approach and access have, however, remained largely the same. All three techniques require access to the ramus and tunneling of the lingual pterygomandibular space.

http://bit.ly/2HmIPaW

Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years

The treatment of oropharyngeal squamous cell carcinoma (SCC) has evolved over the last 25years, from open surgery to combined chemoradiotherapy, and now to the development of minimally invasive procedures, but evidence for the best treatment is lacking. We therefore did a systematic search of the MEDLINE database for studies published between 1992 and 2017 that reported oncological or functional outcomes, or both. Predefined inclusion and exclusion criteria were used for screening and selection, and 45 studies were chosen.

http://bit.ly/2RU848G

Referrals for head and neck cancer in England and The Netherlands: an international qualitative study of the views of secondary-care surgical specialists

One-year survival after head and neck cancer in England has been reported to be worse than that in Europe, despite five-year conditional survival being similar, which implies that patients present later in England. One country with better rates is The Netherlands. There are many possible causes, one of which may be the system of referral from primary to secondary care. We have compared the views of secondary care specialists in the two countries about their systems for referral, and identified aspects that might have an impact on outcomes.

http://bit.ly/2HmIKUG

Importance of activity and recreation for the quality of life of patients treated for cancer of the head and neck

The ability of patients to participate in recreational activities is an important facet of health-related quality of life (HRQoL) after treatment for cancer of the head and neck. The aim of this study was to analyse patients' responses to the activity and recreation domains of the University of Washington quality of life questionnaire (UW-QoL), and to relate them to clinical characteristics, the intensity of leisure-time exercise/week, perceived barriers that interfere with exercise, and feeling able to participate in an exercise programme.

http://bit.ly/2S3TOKF

Multiomic analysis of oral keratinocytes chronically exposed to shisha

Abstract

Background

Tobacco is smoked in different form including cigarettes and water pipes. One popular form of water pipe smoking especially in Middle Eastern countries is shisha smoking. Shisha has been associated with various diseases including oral cancer. However, genomic alterations and gene expression changes associated with chronic shisha exposure have not been previously investigated.

Objectives

Whole exome sequencing and gene expression profiling of immortalized human oral keratinocytes (OKF6/TERT1) cells chronically treated with 0.5% shisha extract for a period of 8 months was undertaken to characterize molecular alterations associated with shisha exposure.

Methods

Genomic DNA and RNA were extracted and preprocessed as per manufacturer's instruction and subjected to whole exome and transcriptome sequencing using Illumina HiSeq2500 platform. Exome was analyzed using GATK pipeline whereas RNA‐Seq data was analyzed using HiSat2 and HTSeq along with DESeq to elucidate differentially expressed genes.

Results

Whole exome sequence analysis led to identification of 521 somatic missense variants corresponding to 389 genes RNASeq data revealed 247 differentially expressed genes (≥2 fold, p value<0.01) in shisha treated cells compared to parental cells. Pathway analysis of differentially expressed genes revealed that interferon signaling pathway was significantly affected. We predict activation of MAPK1 pathway which is known to play a key role in oral cancer. We also observed allele specific expression of mutant LIMA1 based on RNA‐Seq dataset.

Conclusion

Our findings provide insights into genomic alterations and gene expression pattern associated with oral keratinocytes chronically exposed to shisha.

This article is protected by copyright. All rights reserved.

http://bit.ly/2RU7U14

Some methodological issues on the review of pathologic lesions and conditions

Abstract

There are many pathologic conditions which occur in the maxillofacial region. Some are rare with only isolated case reports in the literature. In order to get a general picture of such lesions, it is common practice to gather information described in the literature, analyze the data, and write systematic reviews.

This article is protected by copyright. All rights reserved.

http://bit.ly/2HmIwwO

Downregulated miR‐27b promotes keratinocyte proliferation by targeting PLK2 in oral lichen planus

Abstract

Background

MicroRNA‐27b (miR‐27b) was recently found to be significantly downregulated in oral lichen planus (OLP). However, evidence of the function of miR‐27b in OLP remains limited.

Methods

Initially, miR‐27b expression in OLP was verified using the quantitative real‐time polymerase chain reaction (qRT‐PCR). Functional, gain‐/loss‐of‐function studies were then conducted using miR‐27b mimics/inhibitor to investigate cell growth in human oral keratinocytes (HOKs). Mechanistically, subsequent miRNA target analyses including a starBase database analysis and a luciferase reporter assay were performed to predict and validate the direct target, respectively. In addition, overexpression/knockdown assays of target(s) of miR‐27b were performed to investigate its functional significance and qRT‐PCR and western blotting were used to evaluate the target(s) of miR‐27b mRNA and protein levels, respectively.

Results

miR‐27b was significantly downregulated in OLP tissues when compared with healthy control tissues. Bioinformatics predicted that Polo Like Kinase 2 (PLK2) might be a potential target of miR‐27b, while the luciferase reporter assay results showed the direct inhibition of the plk2‐3'untranslated region by miR‐27b. Moreover, functional analysis indicated that downregulated miR‐27b caused an increase of cell growth in HOKs, and correspondingly, overexpression of PLK2 promoted HOK proliferation.

Conclusions

There were aberrant expressions of miR‐27b and PLK2 in OLP tissues. Decreased miR‐27b may have induced cell proliferation by increasing the levels of PLK2 in HOKs, which provides a new perspective into the potential mechanisms underlying OLP development.

This article is protected by copyright. All rights reserved.

http://bit.ly/2RU7RlU

Radioguided Surgery of Non-palpable Neck Lymph Node in Lymphoma Patients

Abstract

Lymphomas have frequent relapses; early diagnosis is important to treat and improve outcomes. Clinical exam and imaging are useful but confirmation with biopsy is always required. Minimally exploratory surgery is a tool to take good samples with precision and safety. Evaluate the use of ROLL technique to track non-palpable lesions on the neck which were suspicious of recurrence in lymphoma patients. A retrospective review of the patients with high probability of lymphoma relapse who were biopsied using ROLL technique. Suspicious lesions on the neck where identified on the follow up of five lymphoma patients. Roll technique was used successfully to guide the biopsy. There were no complications. Relapse was confirmed in two patients; the other three was reactive follicular hyperplasia. Management was redirected on relapsing patients. ROLL technique proved to be a simple, safe and effective method to detect and biopsy non- palpable lesions on the neck of patients with suspicious relapsing lymphoma.

http://bit.ly/2R1fN0a

Frequency characteristics and speech recognition in cartilage conduction

Cartilage conduction (CC) is a new transduction form, and hearing devices that utilize CC present a new option for patients with aural atresia. However, in occluded ears, low-tone sounds are transmitted very effectively, resulting in excessive low-tone sound emphasis and speech recognition reduction. This study aimed to clarify low-tone speech recognition for CC in occluded ears, and determine if excessive low-tone sound emphasis decreases maximum speech recognition scores.

http://bit.ly/2U0GzHG

A novel approach to outpatient clinic management

Abstract

I read with great interest the study by Khoury et al¹ in the BJD on the safety of patient‐initiated care consultations (PICC) for psoriasis patients, though has wider implications for all patients with chronic conditions. There are over 15 million people in England with chronic conditions, accounting for 64% of outpatient appointments, and with future trends suggesting a further increase.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MjWaj0

Anti‐TNF‐associated cutaneous leishmaniasis: a single‐institution experience

Abstract

Leishmaniasis is an infection by protozoa Leishmania, vector‐transmitted by sandflies. There are three major forms: cutaneous (CL), mucocutaneous and visceral (VL). It is endemic on the European Mediterranean basin, where mostly Leishmania infantum produces CL. Over the last decade, cases in patients undergoing tumor necrosis factor (TNF) inhibitor (anti‐TNF) have been reported. This could result from increasingly widespread anti‐TNF use coupled with a rising global incidence¹. Notably, 80% of all reported cases are related to residence or travel to European Mediterranean countries, particularly Spain.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sK6Oqx

A re‐introduction of environmental mite allergen control strategies for asthma treatment and the debate on their effectiveness

Abstract

Asthma affects three hundred million people worldwide. The effectiveness of house dust mite allergen control for asthma treatment is debatable. One aspect that has been little discussed in existing meta‐analyses is the possible role of environmental strategies. Here, we re‐introduce the previously defined strategies for mite allergen control and discuss their importance to the debate on clinical effectiveness. The strategy of concurrent bedroom interventions is related to the combined use of a priori defined interventions, while the strategy of exposure‐based control relates to the treatment of relevant textiles after assessing exposure. The air purification strategy aims to purify the human breathing zone of airborne allergens. In Western European patient practice, the use of these strategies differs. A post hoc study of the dominant Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187) appears to indicate that a majority of the underlying trials reported on the strategy of concurrent bedroom interventions, which were mainly executed in a minimal manner. Some trials have reported on the air purification strategy and may potentially alter the debate on effectiveness. No trial has reported on the strategy of exposure‐based control. We therefore hypothesize that the absence of evidence for the effectiveness of mite allergen control for asthma treatment applies to the strategy of concurrent bedroom interventions. The evidence‐based effectiveness of the exposure‐based control strategy appears to be undetermined. The results of our post hoc re‐analysis urge that future meta‐analyses of mite allergen control should a priori define the environmental strategy under study. Future trials of mite allergen control are warranted to test the exposure‐based strategy as well as the sparsely tested strategy of air purification.

This article is protected by copyright. All rights reserved.

http://bit.ly/2ASB5b5

Skin lesions, differential diagnosis and practical approach to potential survivors of torture

Abstract

As the international refugee crisis has reached new proportions,¹ survivors of torture increasingly present to treating physicians with an array of acute or chronic skin lesions. Physicians should be aware of common presentations and likely differential diagnoses in order to avoid mislabeling or underrecognizing torture. Survivors of torture also frequently suffer from psychological sequelae, such as post‐ traumatic stress disorder, and appropriate referrals are essential in order to improve recovery trajectory. Skin sequelae are the most common physical findings of torture. Not all skin lesions seen in tortured survivors are due to perpetrator inflicted injuries, and many dermatological conditions can mimic lesions typical of torture, as can scars as a result of folk remedies or cultural practices specific to geographical regions. Medical documentation of torture includes injury and lesion description. While forensic dermatology and other forensic specialties use an injury description taxonomy, and the standard dermatologic taxonomy uses an anatomic description, they are complementary sciences for lesions inflicted by torture. This results in an opportunity for learning across disciplines in order to improve evidence documentation for survivors of torture. This article describes features of common skin lesions consistent with torture, including their clinical appearances, differential diagnoses, patterns of injury and appropriate clinical descriptions.

This article is protected by copyright. All rights reserved.

http://bit.ly/2U3PYhP