National Analysis of Risk Factors for Nasal Fractures and Associated Injuries in Trauma

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0039-1677724

Nasal fractures account for up to 58% of facial fractures. However, the literature characterizing associated injuries and risk factors for nasal fractures is sparse and is mostly composed of single-center experiences. This study sought to provide a large descriptive analysis and identify associated injuries and risk factors for nasal fractures in trauma using a national database. A retrospective analysis of the National Trauma Data Bank (NTDB) from 2007 to 2015 was performed. Patients ≥18 years of age with nasal fractures were included. A multivariable logistic regression model was used to identify predictors for nasal fracture in trauma. Of 5,494,609 trauma patients in the NTDB, 255,533 (4.6%) had a nasal fracture. Most were male (74.8%) with a mean age of 45.6 years. Blunt trauma accounted for 90.5% of fractures, with motor vehicle accident being the most common mechanism (27.5%). Closed fractures occurred in 93.0% of patients. Concomitant injuries included traumatic brain injury (TBI; 56.9%), malar/maxillary fracture (27.9%), and open wound of the face (38.6%) and nose (9.5%). Of all patients, 10.1% underwent closed or open reductions at index hospitalization. The strongest associated injuries with nasal fracture included open wound of the nose (odds ratio [OR]: 8.71, 95% confidence interval [CI]: 8.49–8.94, p < 0.001), epistaxis (OR: 5.26, 95% CI: 4.59–6.02, p < 0.001), malar/maxillary fracture (OR: 4.38, 95% CI: 4.30–4.45, p < 0.001), and orbital fracture (OR: 3.99, 95% CI: 3.91–4.06, p < 0.001). Nasal fractures are common traumatic injuries with more than 90% occurring by blunt mechanism and over half suffering from a concomitant TBI. The strongest associated injury with nasal fracture is an open wound of the nose.
[...]

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

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

http://bit.ly/2TdKp08

Einseitige schmerzhafte Schwellung der Leiste nach ungeschütztem Geschlechtsverkehr

http://bit.ly/2HyjI4V

Raynaud-Phänomen

Zusammenfassung

Das Raynaud-Phänomen (RP) ist eine häufige akrale Durchblutungsstörung bei der es durch eine pathologische Kontraktion kleiner arterieller Gefäße zu einem schmerzhaften Abblassen einzelner Akren (am häufigsten der Finger) kommt. Bei dem häufigen sog. primären RP liegt lediglich eine funktionelle Störung des Gefäßtonus vor, beim seltenen sekundären RP kommen zusätzlich strukturelle Änderungen im Bereich der Gefäße hinzu. Die Kenntnis dieser Erkrankung ist für den Dermatologen wichtig, da das sekundäre RP mit dem Vorliegen oder der Entwicklung schwerwiegender Grunderkrankungen, insbesondere einer systemischen Sklerose, assoziiert sein kann. Das diagnostische Vorgehen sowie die wichtigsten therapeutischen Ansätze werden in diesem Überblick zusammengefasst.

http://bit.ly/2SbT2v4

Suitable Alternative for Human Cadaver Temporal Bone Dissection: Comparative Micro Ear Anatomy of Cattle, Pig and Sheep with Human

Abstract

The study was undertaken to compare the micro ear anatomy of three commonly available animal models which are expected to have similar anatomy to human and to find out suitable model among them as an alternative for human cadaver temporal bone dissection. This is an observational study of comparison of micro ear anatomy of the three animal models with human. Decapitated heads of cattle, pig and sheep were collected from slaughter houses, soft tissues along with brain were removed and preserved in commercially available formalin preservative. CT scan was taken for the three specimens and 3D reconstructions were done. Each specimen was subjected to micro dissection and the anatomical features were studied and compared with human. Among the three animal models sheep is found to be an ideal model for a beginner because of ease of exposure of bone, very thin cortical bone, and no cellularity, good exposure of all the middle ear structures and similar interrelations of middle ear structures with human. Pig may not be an ideal model because of abundant fatty soft tissues, thick periosteum very narrow space occupied by the middle ear, difficulty in accessing cellularity small fragile ossicular chain and overhanging facial nerve.

http://bit.ly/2FMC6ES

Neural Switch Asymmetry in Feature-Based Auditory Attention Tasks

Abstract

Active listening involves dynamically switching attention between competing talkers and is essential to following conversations in everyday environments. Previous investigations in human listeners have examined the neural mechanisms that support switching auditory attention within the acoustic featural cues of pitch and auditory space. Here, we explored the cortical circuitry underlying endogenous switching of auditory attention between pitch and spatial cues necessary to discern target from masker words. Because these tasks are of unequal difficulty, we expected an asymmetry in behavioral switch costs for hard-to-easy versus easy-to-hard switches, mirroring prior evidence from vision-based cognitive task-switching paradigms. We investigated the neural correlates of this behavioral switch asymmetry and associated cognitive control operations in the present auditory paradigm. Behaviorally, we observed no switch-cost asymmetry, i.e., no performance difference for switching from the more difficult attend-pitch to the easier attend-space condition (P→S) versus switching from easy-to-hard (S→P). However, left lateral prefrontal cortex activity, correlated with improved performance, was observed during a silent gap period when listeners switched attention from P→S, relative to switching within pitch cues. No such differential activity was seen for the analogous easy-to-hard switch. We hypothesize that this neural switch asymmetry reflects proactive cognitive control mechanisms that successfully reconfigured neurally-specified task parameters and resolved competition from other such "task sets," thereby obviating the expected behavioral switch-cost asymmetry. The neural switch activity observed was generally consistent with that seen in cognitive paradigms, suggesting that established cognitive models of attention switching may be productively applied to better understand similar processes in audition.

http://bit.ly/2R90hiL

Kimura’s Disease: A Diagnostic and Therapeutic Challenge

Abstract

Kimura's disease, also known as Eosinophilic Granuloma, is a rare chronic condition seen mainly in Oriental population. It presents with subcutaneous nodules, lymphadenopathy, salivary gland hypertrophy with peripheral eosinophilia and raised serum IgE levels; rarely renal involvement may also be present. Its etiology mainly remains unknown. We present a case series of two patients. Our first case is a middle aged female which presented with a parotid swelling, mimicking a parotid neoplasm. Further investigations revealed associated intra-parotid and cervical lymphadenopathy. An excisional biopsy in the form of Superficial Parotidectomy with lymph node excision was done. Histopathological examination of the excised specimen revealed it to be a case of Kimura's disease. Our second case, a young adult, presented with a gradually increasing post-auricular swelling. Preliminary investigations in this case pointed towards Kimura's disease. Excision biopsy of the lesion was done. Histopathological studies confirmed the diagnosis for the same. Both the patients are under our regular follow up and remain disease-free at a follow up of 1 year and 8 months respectively.

http://bit.ly/2HqWP3e

An Immunohistochemical Study of HIF-1 Alpha in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma

Abstract

To evaluate and compare the expression of HIF-1 Alpha (HIF-1α) in oral epithelial dysplasia (OED) and various grades of Oral squamous cell carcinoma (OSCC). 30 cases each of OEDand OSCC were stained with HIF-1α antibody. Quantification of HIF-1α positive cellswas carried out and the data was statistically analysed. The mean % HIF-1α labeling index (HIF-1α LI) increased significantly from mild OED (32.11%), moderate OED (55.07%), to severe OED (64.58%). There was a statistically significant increase in the expression of HIF-1α as grades of OED increased. The mean HIF-1α LI % in well differentiated OSCC was 46.3%, Moderately differentiated OSCC—76.31% and Poorly differentiated OSCC—89.9%. The mean HIF-1α LI was found to increase with increasing grades of OSCC which was statistically significant (P < 0.05). Further a comparison of mean HIF-1α LI in OED with different histologic grades of OSCC by Independent samples t test was performed. We found statistically significant difference between OED and moderately differentiated OSCC and OED and poorly differentiated OSCC (P = 0.000). Progressive increase in expression of HIF-1α was noted from OED to OSCC. It can be postulated that epithelial dysplastic lesions with increased HIF-1α expression are at greater risk of malignant transformation, suggesting that the expression of HIF-1α is an early event in oral carcinogenesis.

http://bit.ly/2S4Uq2r

To Be Cautious or Not: Tension Pneumothorax After First Tracheostomy Tube Exchange

Abstract

Tracheostomy tube change is a relatively common procedure once a tracheo-cutaneous tract matures. Regular tracheostomy tube changes prevent the formation of granulation tissue and reduce bacterial colonization (Yaremchuk and Yaremchuk in Laryngoscope 113(1):1–10, 2003). However, serious complications such as subcutaneous emphysema, loss of airway and mediastinitis, can occur if the tube exchange is performed inappropriately. We present a rare association of tension pneumothorax following a tracheostomy tube exchange in a 50-year-old patient who underwent tracheotomy 3 days back. The patient was successfully managed conservatively with chest tube and supportive care.

http://bit.ly/2RWz3R1

Evaluation of Quality of Life and Pattern of Improvement of Bronchial Asthma in Chronic Rhinosinusitis Patients Treated by Functional Endoscopic Sinus Surgery

Abstract

Chronic inflammatory disorders of the upper airways are extremely prevalent and have a major impact on public health. Sinusitis and bronchial asthma are closely interrelated diseases and sinusitis is known to influence bronchial asthma in its severity and chronicity. Causal relationships have been proposed but not yet proved. The relationship between sinusitis and asthma is academically interesting and has important diagnostic and therapeutic implications. The present study is designed to evaluate the efficacy of functional endoscopic sinus surgery done as treatment for chronic rhinosinusitis on bronchial asthma patients, in terms of quality of life and pattern of improvement. Objectives of the study were to determine whether bronchial asthma and quality of life improved after functional endoscopic sinus surgery. This was an open labelled randomised control trial, done at ENT Department of Medical College, Thiruvananthapuram. Those in Group A underwent functional endoscopic sinus surgery and group B patients were given only medicines as per standard protocol. All of them received asthma treatment depending on asthma attacks and severity and followed up at specific intervals. Quality of life status and pattern of improvement of bronchial asthma among these patients were evaluated. Patients of chronic rhinosinusitis treated by functional endoscopic sinus surgery showed significant improvement in the mean asthma symptom score, asthma medication use score, pulmonary function test results, and quality of life assessment scores. Functional endoscopic sinus surgery could be considered early in the natural course of chronic rhinosinusitis with concomitant bronchial asthma.

http://bit.ly/2FHHo58

Leiomyosarcoma of Mandible: A Diagnostic Dilemma; Case Report and Review of Literature

Abstract

Leiomyosarcoma and its pleomorphic variant are rare entities in the head and neck region. Since they usually present as slow growing, discrete firm, and non-ulcerated painless mass, they seem to be deceptively benign and are thus misdiagnosed. Histopathological and immunohistochemical studies are the ways of getting a definitive diagnosis. Till date surgery has been the primary treatment but effectiveness of radiotherapy/chemotherapy is still questionable. Here, we describe a case of leiomyosarcoma in mandible along with discussion about the ways of diagnosis, its differentiation with its pleomorphic variant and their managements.

http://bit.ly/2CxPUQ7

Complications of Paediatric Cochlear Implantation in the Population of Uttarakhand

Abstract

Cochlear implants surgery is now routinely done at this center. Complications which have been experienced in cochlear implant surgery at our center are discussed, as a detailed knowledge about the complications and their early anticipation can save an expensive device and most importantly patients morbidity. To discuss the complications of the paediatric cochlear implantation in the population of Uttarakhand. The total of 60 patients were included in this study (age group 1–5 years) who had undergone the cochlear implantation surgery between Sept. 2015 and Sept. 2016. These patients were regularly monitored and followed up for 1 year. All the surgeries were performed by same team of surgeons. Rate of minor complications is 8.33% (reversible facial nerve paresis, injury to chorda tympani nerve, local skin reaction, perilymph gussher) and major complications is 5% (implant rejection and flap necrosis). The various complications should be closely monitored by the surgeon so that these can be avoided.

http://bit.ly/2RDtXd5

A Study on Deep Neck Space Infections

Abstract

Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. These are commonly seen in low socioeconomic group with poor oral hygiene, and nutritional disorders. These are bacterial infections originating from the upper aerodigestive tract. The incidence of this disease was relatively high before the advent of antibiotics. Treatment of DNSI includes antibiotic therapy, airway management and surgical intervention. Management of DNSI is traditionally based on prompt surgical drainage of the abscess followed by antibiotics or nonsurgical treatment using appropriate antibiotics in the case of cellulitis. This study was conducted to investigate the age and gender, clinical symptoms, site involved, etiology, co-morbidities, bacteriology, complications and outcomes in the patients of DNSI. A prospective study of deep neck space infections was conducted during the period July 2017 to July 2018 on the patients who attended the outpatient department and were admitted as inpatient in Safdarjung hospital, New Delhi. 40 Cases with DNSI all ages and both genders were included in the study. Patients who didn't require surgical intervention to drain pus were excluded. All parameters including age, gender, co-morbidities, presentation, site, bacteriology, complications, and investigations were studied. Due to advent of antibiotics, deep neck space infections are in decreasing trend. The common age group found to be affected is in 2nd and 3rd decade in our study. Out of all deep neck space infections, submandibular space infections were common (37.5%) followed by peritonsillar infections (12.5%). Infection of deep neck space remains fairly common and challenging disease for clinicians. Prompt recognition and treatment of DNSI are essential for an improved prognosis. Odontogenic and tonsillopharyngitis are the commonest cause. Key elements for improved results are the prompt recognition and early intervention. Special attention is required to high-risk groups such as diabetics, the elderly and patients with underlying systemic diseases as the condition may progress to life-threatening complications.

http://bit.ly/2FFiwLh

Teaching Ear Examination Skill to Undergraduate Students Using Check List

Abstract

For examination of ear, proper illumination is a pre requisite. Diseases related to ear may lead to altered sense of hearing and may affect normal balance system. If students are taught to examine ear using a check list, they may perform better. To teach ear examination to undergraduate students using a check list. Total 50 undergraduate students of M.B.B.S. attending E.N.T. clinic in Chirayu Medical College and Hospital were included in the study. They were given enrolment no. 1 to 50 and were divided into two groups. Group 1, enroll. no. 1 to 25 and group 2, enroll. no. 26 to 50. Group 1 was taught using check list and the Group 2 was taught without use of checklist. Both the groups were evaluated using check list. The group B students were again taught, using check list and were again evaluated using check list. Use of check list showed that there was statistically significant improvement in learning by students using check list in group 1 students compared to group 2 students who were taught without use of check list. The group 2 students also had improvement on evaluation, after they were taught using check list. Study suggests that use of check list for ear examination skill to undergraduate students has significant role and students learn better than when taught without use of checklist. Inclusion of checklist for teaching ear examination to undergraduate students may be considered.

http://bit.ly/2FLzHKp

Early Intratympanic Methylprednisolone in Sudden SNHL: A Frequency-wise Analysis

Abstract

Sudden sensorineural hearing loss is a dire medical emergency which must be treated at the earliest to get better long term hearing results. Our study aims to determine the efficacy of intratympanic steroid (Methylprednisolone) on auditory outcomes in patients of sudden sensorineural hearing loss and study the relation between time of onset of hearing loss to start of therapy and frequency-wise recovery of hearing loss. A prospective cohort clinical study with 33 patients with sudden hearing loss of 30 dB or more were treated with the intratympanic injection of methylprednisolone and the effect of the drug was observed. In this study, 33 patients with sudden onset (unilateral or bilateral) of hearing loss were treated with intratympanic methylprednisolone. The duration at which the drug was administered and the age of the participants was taken into consideration. Main outcome measures included audiometry results at low, medium and high hearing loss frequencies. The specific frequency at which the hearing improvement took place was tabulated. It was observed that hearing improved significantly if the steroid is injected within the first 4 days of onset (p < 0.05) at all the frequencies. A gain of 15 dB or more was achieved in more than 78% patients after injecting methylprednisolone intratympanically. A statistically significant association was found between recovery rate and frequency of hearing loss with patients showing greater improvement at low hearing loss frequency in comparison to mid and high frequencies (p < 0.05). The drug efficacy does not change with the age of the patient.

http://bit.ly/2RVKxnH

Reconstructive Ladder for Transoral Resections of Oropharyngeal Cancers

Abstract

Purpose of Review

Transoral robotic surgery (TORS) now offers extended reach and capability to the head and neck oncologic surgeon, but in doing so, provides a reconstructive dilemma. The objective of this manuscript is to discuss the most recent advances and options available after resection with TORS.

Recent Findings

The latest research provides a common framework for surgeons to classify the type of oropharyngeal defect. A variety of reconstructive options described include secondary intent, modifications to existing local and regional flaps, and advances utilizing robotic assistance in free flap reconstruction.

Summary

There exists a multitude of reconstructive options with appropriate considerations for a stepwise approach based on patient-specific factors, surgeon capability, and the extent of the oropharyngeal defect. Just as robotic resection extends the capability in extirpation, it is now being used to refine free flap inset in the appropriate case.

http://bit.ly/2G0G0tU

Technical Challenges in Temporal Bone Paraganglioma Surgery: a Clinical Review

Abstract

Purpose of the Review

Temporal bone paragangliomas have always presented the otologist with their ultimate challenge. Surgical management is difficult, dangerous and demanding. It is also often associated with increased cranial nerve deficits and decreased quality of life for the patient. Management protocols for patients with temporal bone paragangliomas are changing as a result of advances in knowledge and technical developments. Multi-disciplinary care is now recommended for most patients with surgical intervention becoming restricted for the most difficult tumours.

Recent Findings

Previously considered unresponsive or resistant to radiotherapy, recent experiences using stereotactic radiosurgery techniques suggest that this is not correct. Tumour growth can be halted in some and slowed down in others. Advances in molecular medicine have defined a number of paraganglioma predisposition syndromes. Recognition of these syndromes is essential. Paragangliomas are now considered to be pioneer models of genetic-based personalised medical care.

Summary

This review aims to define the best current management plan for paragangliomas arising in, or involving, the temporal bone. It alerts surgeons to critical phases of surgical technique.

http://bit.ly/2FRV7Xj

Consumer Technology for Sleep-Disordered Breathing: a Review of the Landscape

Abstract

Purpose of Review

The consumer market for devices that quantify sleep is quickly evolving. We conducted a review of the consumer technology available for sleep disorders, including its potential and limitations to screen obstructive sleep apnea (OSA).

Recent Findings

There are many commercial devices claiming to objectively measure sleep, but only a few are tested rigorously in research. We critically review the technology available, including its overall ability to provide objective measures of sleep (total sleep time (TST), sleep efficiency (SE), sleep latency (SL), wake after sleep onset (WASO)), and to estimate apnea-hypopnea indexes in OSA patients.

Summary

Although consumer devices performed similarly to standard actigraphy, they still overestimated TST and SE, and underestimated WASO and SL. Biomotion sensors and mattress-based devices showed potential for use as an OSA screening tool. However, research in the sleep-disordered breathing (SDB) population is limited, needs further external validation, and should be implemented in the course of multiple days.

http://bit.ly/2G2Pdle

Drug-Induced Sleep Endoscopy as a Tool for Surgical Planning

Abstract

Purpose of Review

To review whether drug-induced sleep endoscopy (DISE) aids in obstructive sleep apnea surgical planning, if it changes the initial proposal, and if so, does it contribute to increased surgical success or unnecessary morbidity?

Recent Findings

A DISE and surgical outcomes multicenter cohort study (n = 275) reported no association for surgical outcomes with velopharyngeal and epiglottic collapse. Oropharyngeal and tongue base collapse on the other hand were associated with lower odds of surgical response.

Summary

DISE changes surgical planning mainly in regard to the approach of the tongue base and epiglottis, as these structures usually do not collapse in the awake state. The decision of velopharyngeal surgery usually does not change, as the vast majority demonstrate velopharyngeal collapse in DISE. Whether DISE increases or not, surgical success is controversial, with conflicting published data. However, poorer surgical outcomes have been associated with velopharyngeal concentric, oropharyngeal lateral wall, and tongue base collapse.

http://bit.ly/2FP5RFP

Clinical Outcomes in OSA—SLEEP GOAL—a More Holistic Approach

Abstract

Purpose of Review

Obstructive sleep apnea (OSA) is a systemic disease that is due to a narrow upper airway that collapses and obstructs during sleep, which results in frequent nocturnal hypoxemia, sympathetic overdrive, tachycardia, nocturnal hypertension, and oxidative metabolic stress. Symptoms include unrefreshed sleep, daytime tiredness, loss of memory, irritability, lack of concentration, poor work productivity, poor quality of life (QOL), mood swings, and even depression. This upper airway disorder can lead to systemic diseases such as hypertension, cardiovascular events, myocardial infarct, and fatal arrhythmias.

Recent Findings

The standard diagnostic test for OSA is commonly assumed to be the overnight polysomnography (PSG); however, it is widely known that there is discordance between the levels of AHI (apnea–hypopnea index) used to denote outcomes/success of therapy and real-world clinical outcomes such as QOL, patient perception of disease, cardiovascular measures, and/or survival.

Summary

Hence, the use of a single parameter AHI is inadequate and unrealistic; sleep specialists need more holistic and less biased parameters to assess treatment outcomes. Some of these parameters include snoring level, sleep satency, execution time, Epworth Sleepiness Scale, blood pressure, gross weight (BMI), oxygen duration below 90%, AHI, and QOL scores.

http://bit.ly/2G3jRv1

Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa

Abstract

White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. This review will focus exclusively on reactive white oral lesions. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Leukoedema and hereditary genodermatoses that may enter in the clinical differential diagnoses of frictional keratoses including white sponge nevus and hereditary benign intraepithelial dyskeratosis will be reviewed. Many products can result in contact stomatitis. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. Each of these lesions have microscopic findings that can assist in patient management.

http://bit.ly/2U9yVL4

A Rare Presentation of Inflammatory Myofibroblastic Tumor in the Nasolabial Fold

Inflammatory myofibroblastic tumor (IMT) is a benign lesion that occurs most frequently in the soft tissues and viscera. In the head and neck region, the tumor has been reported to occur in the orbit, tongue, nasopharynx, larynx, and paranasal sinuses and the central nervous system. Despite being a benign lesion, it exhibits infiltrative and destructive behaviours, making histopathological examination necessary to confirm the diagnosis. We report the case of a 38-year-old female presented with a right nasolabial fold mass, which was confirmed histologically to be an IMT. Surgical excision of the mass was achieved through a sublabial approach with an uneventful postoperative period. To the best of our knowledge, this is the first reported case of an IMT in the nasolabial fold.

http://bit.ly/2AX43X8

A Case of Respiratory Epithelial Adenomatoid Hamartoma (REAH) in a Patient with History of Radiation Exposure

Respiratory epithelial adenomatoid hamartomas (REAHs) are becoming a more commonly recognized otolaryngologic tumor and are often misdiagnosed as inverted papilloma. Here, we present such a case in a patient with history of previous radiation exposure. Otolaryngologists and pathologists should be aware of the mucinous histological appearance of REAH to help differentiate from other growths. Given our patient's history, an association between REAH and previous radiation exposure is worth consideration.

http://bit.ly/2Dppt0Y

Operative Therapie des frühen und fortgeschrittenen Ovarialkarzinoms

Zusammenfassung

Hintergrund

Die operative Therapie des Ovarialkarzinoms ist neben der systemischen Therapie ein grundlegender Pfeiler in der Behandlungsstrategie. Grundsätzlich hat die Operation eine duale Bedeutung: Sie dient zum einen als Grundlage des FIGO-Stagings und ist demnach die wichtigste diagnostische Methode. Andererseits hat sie unmittelbaren Einfluss auf die Prognose und ist Teil eines meist multimodalen und interdisziplinären Therapiekonzepts beim primären Ovarial‑, Tuben- und Peritonealkarzinom.

Ergebnisse

Während es sich in den frühen Stadien bis FIGO IIA mehrheitlich um Komplettierungs- sowie Staging-Operationen handelt, sollte das Ziel der Operation beim fortgeschrittenen Karzinom die maximale Tumorreduktion sein, häufig verbunden mit der Notwendigkeit multiviszeraler Eingriffe. Das operative Staging im Frühstadium bis FIGO IIA sollte adäquat sowie komplett durchgeführt werden und definierte Operationsschritte beinhalten. Da der verbleibende, makroskopisch sichtbare Tumorrest ein entscheidender Prognosefaktor für das Gesamtüberleben ist, sollte das Ziel der Operation im fortgeschrittenen Stadium immer eine makroskopische Komplettresektion sein. Bei Patientinnen mit fortgeschrittenem Ovarialkarzinom ab dem Stadium FIGO IIIC sollte bei klinisch unauffälligen Lymphknoten und einer makrokoskopischen Komplettresektion auf eine systematische pelvine und paraaortale Lymphonodektomie unbedingt verzichtet werden. Die primäre Operation gilt auch in der aktuellen interdisziplinär und interprofessionell abgestimmten S3-Leitlinie als Standardtherapie. Methoden wie PIPAC oder HIPEC sollten nicht außerhalb klinischer Studien zur Anwendung kommen.

Diskussion

Der postoperative Tumorrest ist der entscheidendste Prognosefaktor für das progressionsfreie und Gesamtüberleben. In den Frühstadien sollte ein adäquates Staging erfolgen, wohingegen in den häufigeren fortgeschrittenen Stadien multiviszerale Resektionen erforderlich sind, welche eine interdisziplinäre Zusammenarbeit erforderlich machen.

http://bit.ly/2FUgzuG

Therapieoptionen zum Ovarialkarzinom

http://bit.ly/2UdOsts

Anästhesiologische Aspekte beim Ovarialkarzinom

Zusammenfassung

Hintergrund

Die perioperative, anästhesiologische Betreuung von Ovarialkarzinompatientinnen im Rahmen von zytoreduktiven Operationen ist durch erkrankungsspezifische Komorbiditäten und therapieimmanente anästhesiologische Besonderheiten gekennzeichnet. Hierzu gehören z. B. eine mögliche präoperative Anämie, die perioperative Hypothermie oder eine mögliche Verdünnungskoagulopathie. Dabei stellen die intraoperative Flüssigkeits- und Volumensubstitution, Transfusion und Katecholamintherapie eine besondere anästhesiologische Herausforderung bei zytoreduktiven Operationen dar.

Ergebnisse

Bereits im Rahmen der präoperativen Evaluierung sollten erkrankungsspezifische Komorbiditäten wie Darmpassagehindernisse, maligner Aszites, Pleuraergüsse sowie präoperative Anämien diagnostiziert und ggf. therapiert werden. Ein präoperatives Vorwärmen der Patienten mindert das Risiko einer Redistributionshypothermie bei Narkoseeinleitung und damit das Risiko einer perioperativen Hypothermie und Nachbeatmung. Bei mangelnder Evidenz für oder gegen die ausschließliche Nutzung balancierter Vollelektrolytlösung empfiehlt sich eine bedarfsadaptierte Flüssigkeitssubstitution in Verbindung mit dem Einsatz von kolloidalen Infusionslösungen und ggf. Substitution von gefrorenem Frischplasma (GFP) und Applikation von Antifibrinolytika. Insbesondere bei präoperativ bestehendem malignem Aszites und im Rahmen einer intraoperativen Deperitonealisierung mit zu erwartenden großen Volumenverlusten kann der Einsatz eines erweiterten hämodynamischen Monitorings zur zielgerichteten Volumentherapie indiziert sein.

Schlussfolgerungen

Die perioperative anästhesiologische Versorgung sollte dem individuellen und für das Ovarialkarzinom typischen Risikoprofil angepasst werden. Um dem u. a. durch ausgeprägte operative Deperitonealisierung und Aszites ausgelösten Proteinverlust Rechnung zu tragen, empfiehlt sich eine präoperative Optimierung des Allgemeinzustands der Patientinnen. Eine bedarfsgerechte Volumentherapie und der perioperative Wärmeerhalt spielen hierbei eine zentrale Rolle.

http://bit.ly/2DCtq2j

Behandlung ausgedehnter Lokalrezidive der Mundhöhle und des Oropharynx

Zusammenfassung

Hintergrund

Die Behandlung ausgedehnter Lokalrezidive der Mundhöhle und des Oropharynx gehört zu den größten Herausforderungen in der onkologischen Therapie der Kopf-Hals-Region. In der Regel erhielten diese Patienten im Rahmen der Therapie ihres Primärtumors neben einer chirurgischen Resektion bereits eine adjuvante Radiotherapie. Aus diesem Grund ist eine erneute Bestrahlung der rezidivierenden Karzinome häufig nur noch in palliativer Intention möglich. Da trotz erstaunlicher Fortschritte in der Entwicklung moderner Wirkstoffe aktuell auch die medikamentöse Systemtherapie lediglich der Symptomkontrolle dienen kann, hat die Rettungschirurgie in diesen Fällen den bedeutendsten Stellenwert.

Schlussfolgerungen

Die wichtigste Voraussetzung für die Durchführung einer solchen radikalen rettungschirurgischen Operation ist allerdings, dass es in der Tumorumfelddiagnostik keine Hinweise auf das Vorliegen von Fernmetastasen gibt. Darüber hinaus ist prätherapeutisch unbedingt zu klären, ob eine R0-Resektion mit ausreichendem Sicherheitsabstand möglich sein wird, ohne vital notwendige Strukturen wie das Hirngewebe versorgende Endarterien oder essenziell zu erhaltende Anteile des Neurokraniums zu gefährden. Auch ist darauf zu achten, dass bei der ablativen Therapie der Erhalt oder die Wiederherstellung von wichtigen Funktionen wie Sprechen und Schlucken berücksichtigt wird. Daher ist eine solche radikal-chirurgische Maßnahme nur durch die sofortige Rekonstruktion des entfernten Gewebes durch z. T. ausgedehnte osteomyokutane Transplantate gerechtfertigt. Hier ist das gesamte Spektrum der rekonstruktiven Kopf-Hals-Chirurgie inklusive diversifizierter mikrovaskulärer Techniken vorzuhalten, um dem individuellen Patient sowohl eine langfristige Prognose zu schaffen als auch eine angemessene Lebensqualität zu erhalten.

http://bit.ly/2Uhj0KX

Hypoparathyreoidismus – eine Belastung für die Patienten

Zusammenfassung

Hypoparathyreoidismus (HPT) ist eine der häufigsten Komplikationen einer Schilddrüsenkrebsoperation. Die Lebensqualität von Patienten mit HPT ist im Vergleich zu Normpopulationen oder gematchten Kontrollindividuen stark eingeschränkt. Eine reduzierte Lebensqualität zeigt sich gleichermaßen in physischen und psychischen Bereichen. Wenige Studien haben bisher die Lebensqualität von Schilddrüsenkrebsüberlebenden mit postoperativem HPT erhoben. Einschränkungen der Lebensqualität von Patienten mit postoperativem HPT nach Schilddrüsenkrebs lassen sich nicht nur durch die Erkrankung Krebs und ihre Behandlung erklären, sondern auch durch HPT selbst. Weitere Forschung in Bezug auf die Therapie von HPT in Deutschland und die Lebensqualität von HPT-Patienten nach Schilddrüsenkrebs ist erforderlich. HPT ist die einzige endokrine Funktionsstörung, bei der das fehlende Hormon im Rahmen der Standardtherapie nicht ersetzt werden kann. Die aktuelle Therapie besteht aus Kalzium- und Vitamin-D-Analogen unter regelmäßiger Überprüfung von Laborwerten. Die empfohlene Überprüfung der Blutwerte muss häufiger durchgeführt werden als es im Rahmen von regulären Krebsnachsorgeuntersuchungen möglich wäre. Es gibt aktuell keine systematischen Erhebungen, wie HPT-Patienten in Deutschland behandelt werden.

http://bit.ly/2DAG5Tg

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.

http://bit.ly/2AS1sOg

VideoEndocrinology™ New Open Access Video

Parapharyngeal Dissection for Papillary Thyroid Cancer
Justin Tran, Mark Zafereo 

The post VideoEndocrinology™ New Open Access Video appeared first on American Thyroid Association.

http://bit.ly/2T4XFEg

Oxford Handbook of Oral and Maxillofacial Surgery, 2nd ed., L. Cascarini, C. Schilling, B. Gurney, P. Brennan, (2018). ISBN: 978-0-19-876781-7

Publication date: Available online 25 January 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): Callum Wemyss

http://bit.ly/2WlsEOD

Evaluation of the surface damage of dental implants caused by different surgical protocols: an in vitro study

Publication date: Available online 26 January 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): P. Streckbein, J.-F. Wilbrand, C. Kähling, J. Pons-Kühnemann, P. Rehmann, B. Wöstmann, H.-P. Howaldt, S.C. Möhlhenrich

Abstract

The implant surface must withstand high insertion torque during implant insertion. The aim of this study was to investigate the damage to implant surfaces caused by two different insertion protocols in vitro. Fifteen titanium implants per group were inserted in standardized polyurethane foam models, group 1 according to a non-threaded surgical protocol and group 2 according to a threaded surgical protocol. Before and after insertion, the surfaces were visualized by scanning electron microscopy (SEM) and non-contact laser profilometry. Different surface area parameters were evaluated and maximum torque during insertion was determined. SEM detected topographical changes such as deposition of the test block and smoothening of the surface in the region of the thread crests in both groups. The laser profilometry analysis revealed significant changes in the surface topography of the implants in both groups, but no differences between the groups. Insertion torque was significantly decreased in the threaded group. Both types of surgical intervention resulted in surface damage. Less damage was detected to the thread crests with the use of a thread cutter, and most of the surface was not visibly affected by the surgical protocol at the microscopic level. The surgical protocol seems to have a minor influence on preservation of the implant surface.

http://bit.ly/2DBxboH

Augmented reality for temporomandibular joint arthrocentesis: a cadaver study

Publication date: Available online 26 January 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y.-Y. Wang, H.-P. Liu, F.-L. Hsiao, A. Kumar

Abstract

Temporomandibular joint (TMJ) arthroscopic procedures require the identification of a skin puncture point. The puncture point is conventionally estimated using the surface anatomy of the canthal-tragus line. However, the conventional puncture technique has been reported to fail at the first attempt in 18% of cases. We propose an augmented reality (AR) system-based method to identify the puncture point on the skin. A three-dimensional virtual model was reconstructed from computed tomography images of a cadaver head, and its rendered image was superimposed on the cadaver head before skin puncture. The skin puncture point was marked on the skin under the guidance of the AR system. The TMJ was punctured through the mark and the endoscope was introduced through the puncture point. The outcome of the procedure was classified as successful or unsuccessful based on the visualization of the TMJ. The system was applied on the left and right sides of three cadaver heads. Puncture with the AR method was successful in all six cases. This study presents a system to provide AR visualization during TMJ arthrocentesis to increase the precision of skin puncture. However, a comparative study of the AR method with the conventional method is required to evaluate its advantages.

http://bit.ly/2UjEQxo

Announcements

Publication date: February 2019

Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 2

Author(s):

http://bit.ly/2Hz7itK

Editorial Board

Publication date: February 2019

Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 2

Author(s):

http://bit.ly/2S7pdvy

EACMFS Prizes & Awards

Publication date: February 2019

Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 2

Author(s):

http://bit.ly/2Hz7bOQ

New Insights into the Utility of Omalizumab

Publication date: Available online 26 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Juan Carlos Cardet, Thomas B. Casale

http://bit.ly/2RgsN27

Comparison of intrasocket bupivacaine administration versus oral mefenamic acid capsule for postoperative pain management following removal of impacted mandibular third molars

Publication date: Available online 26 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Ideh Talimkhani, Mohammad Reza Jamalpour, Hamed Babaei, Javad Faradmal

Abstract

Introduction

Surgical removal of impacted third molar teeth is one of the most common surgical procedures performed in oral and maxillofacial surgery. Postoperative pain is a common and predictable occurrence following maxillofacial surgery.

Materials and methods

This is a randomized double-blind clinical trial that was conducted with a crossover design in which each patient served as his or her own control. Forty-six patients with similar bilateral impacted lower third molars were selected. In each patient, the intervention and control sides of the mandible were randomly determined at the end of the surgery. If the removed tooth was in the intervention side, the patient would receive bupivacaine and placebo of mefenamic acid. If the impacted tooth was in the control side, the patient would receive mefenamic acid capsule and a placebo of bupivacaine. Pain severity was assessed using a Visual Analogue Scale (VAS). Data were analyzed using Paired sample t-test and P <0.05 was considered statistically significant.

Results

Of 46 participants originally recruited, 43 were included in the current study. The mean of post-operative pain score in the patients who received bupivacaine was increased to a maximum 4 hours, with significant improvements after this time. The mean intensity of pain following administration of bupivacaine was lower than mefenamic acid capsules in the different time points. Statistical analysis showed that there was a significant difference in pain intensity between two studied groups.

Conclusion

The results of the current study showed that local administration of bupivacaine improves the postoperative pain following surgical removal of impacted third molar teeth.

http://bit.ly/2UgJqfL

Prognostic impact of postoperative complications on overall survival in 287 patients with oral cancer A retrospective single-institution study

Publication date: Available online 26 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Chao Zhang, Meng Ying Xi, Jie Zeng, Yong Li, Cong Yu

Abstract

Objective

To investigate the relationship between postoperative complications and long-term survival in patients with oral cancer after surgery and to explore the methods improving the survival rate through analyzing risk factors for the postoperative complications.

Methods

We conducted a retrospective, single-institution study with a cohort of 287 patients with oral cancer who had undergone surgery at the Stomatological Hospital of Chongqing Medical University between January 1, 2007 and December 31, 2012.

Results

Postoperative complications occurred in 80 patients (27.9%). Patients with pulmonary complications or delirium had worse overall survival than those without these complications, whereas other postoperative complications, such as surgical site infection, postoperative bleeding, salivary fistula, and chylothorax, were not associated with overall survival. American Society of Anesthesiologists (ASA) status and tracheostomy were the risk factors for postoperative pulmonary complications according to the Pearson χ² test or multivariate analysis. Using the Pearson χ² test, we found that age, comorbidity, and ASA status were the risk factors for the incidence of postoperative delirium. However, in the multivariate analysis, only two risk factors were identified: comorbidity and ASA status.

Conclusions

Postoperative pulmonary complications and postoperative delirium may be independent predictors of poorer long-term survival in patients with oral cancer. The risk factors for postoperative pulmonary complications and postoperative delirium could help us to identify patients who are at high risk and help us to take some actions to prevent them.

http://bit.ly/2DzIZHU

Regarding “Integrity of a Single Superior Border Plate Repair in Mandibular Angle Fracture: A Novel Cadaveric Human Mandible Model”

Publication date: Available online 25 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Joshua Segal

http://bit.ly/2UgegVV

Effects of continuous and intermittent parathyroid hormone administration on midpalatal suture expansion in rats

Publication date: Available online 25 January 2019

Source: Archives of Oral Biology

Author(s): Jianru Yi, Li Mei, Xue Li, Wei Zheng, Yu Li, Zhihe Zhao

Abstracts

Objectives

The aim of this study was to investigate the effects of continuous parathyroid hormone (cPTH) and intermittent parathyroid hormone (iPTH) on bone formation and bone resorption in midpalatal suture during maxillary expansion.

Methods

Forty-eight male SD rats were randomly divided into four groups (n = 12 each), including the control, the expansion (E), the E + cPTH, and the E + iPTH. A thermosensitive controlled-release hydrogel was synthesized for cPTH administration. All animals were sacrificed after seven days. Microcomputed tomography, histochemical staining and real-time PCR were used to investigate the bone remodeling of midpalatal suture. Serum chemistry was adopted to evaluate the systemic condition of experimental animals.

Results

The suture width was increased by the expansion, and further elevated by cPTH and iPTH administration. Both regimes improved bone volume fraction and trabecular thickness of suture bone region. Moreover, both cPTH and iPTH decreased SOST expression and enhanced the expression of β-catenin and Col-I. cPTH increased RANKL expression, inhibited OPG expression, and resulted in an increment of osteoclasts, while iPTH had no influence on osteoclastogenesis. The serum calcium concentration was enhanced by PTH administration.

Conclusion

Both cPTH and iPTH promote midpalatal suture expansion by enhancing bone formation, probably via SOST downregulation and the resulting β-catenin activation. Our results demonstrated that PTH administration may have potential to be an adjunctive approach for maxillary expansion treatment.

http://bit.ly/2ROJAOX

Effects of continuous and intermittent parathyroid hormone administration on midpalatal suture expansion in rats

Publication date: Available online 25 January 2019

Source: Archives of Oral Biology

Author(s): Jianru Yi, Li Mei, Xue Li, Wei Zheng, Yu Li, Zhihe Zhao

Abstracts

Objectives

The aim of this study was to investigate the effects of continuous parathyroid hormone (cPTH) and intermittent parathyroid hormone (iPTH) on bone formation and bone resorption in midpalatal suture during maxillary expansion.

Methods

Forty-eight male SD rats were randomly divided into four groups (n = 12 each), including the control, the expansion (E), the E + cPTH, and the E + iPTH. A thermosensitive controlled-release hydrogel was synthesized for cPTH administration. All animals were sacrificed after seven days. Microcomputed tomography, histochemical staining and real-time PCR were used to investigate the bone remodeling of midpalatal suture. Serum chemistry was adopted to evaluate the systemic condition of experimental animals.

Results

The suture width was increased by the expansion, and further elevated by cPTH and iPTH administration. Both regimes improved bone volume fraction and trabecular thickness of suture bone region. Moreover, both cPTH and iPTH decreased SOST expression and enhanced the expression of β-catenin and Col-I. cPTH increased RANKL expression, inhibited OPG expression, and resulted in an increment of osteoclasts, while iPTH had no influence on osteoclastogenesis. The serum calcium concentration was enhanced by PTH administration.

Conclusion

Both cPTH and iPTH promote midpalatal suture expansion by enhancing bone formation, probably via SOST downregulation and the resulting β-catenin activation. Our results demonstrated that PTH administration may have potential to be an adjunctive approach for maxillary expansion treatment.

http://bit.ly/2ROJAOX

Traitement des kystes épidermoïdes du scrotum par laser CO2 : deux cas et revue de la littérature

Publication date: Available online 26 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): E. Bahloul, M. Mseddi, F. Hammemi, K. Souid, M. Amouri, H. Turki

Résumé

Introduction

Les kystes épidermiques scrotaux sont des tumeurs bénignes du scrotum. Le caractère chronique de ces lésions, leur aspect inesthétique et leur survenue chez des sujets jeunes s'accompagnent souvent d'un retentissement psychologique. Nous rapportons deux cas de kystes épidermoïdes scrotaux traités par le laser CO₂ en mode superpulsé.

Observations

Les paramètres utilisés étaient une puissance de respectivement 10 et 10,8 W pour une durée de pulse de 20 ms avec une durée de pause similaire. Les séances étaient réalisées après anesthésie locale par lidocaïne. Une à deux séances de 10 minutes étaient nécessaires pour traiter tous les kystes. Des soins locaux à base de corps gras et d'antibiotique local étaient prescrits après la séance laser. Les résultats esthétiques étaient excellents, satisfaisant nos patients. Aucune complication ou récidive n'a été notée. Nous avons également traité de la même manière un patient ayant un kyste scrotal unique, avec des résultats excellents et sans complication ni récidive.

Discussion

Une revue exhaustive de la littérature a été réalisée à partir du moteur de recherche PubMed^® avec les mots clés « EpidermalCyst », « lasers » et « scrotum ». Seuls deux cas cliniques de kystes scrotaux traités par laser étaient rapportés, un avec un laser Nd-YAG et l'autre avec un laser Diode. L'utilisation du laser CO₂ n'a pas été rapportée dans le traitement des kystes épidermoïdes scrotaux, alors qu'elle semble permettre un traitement efficace et sans récidive.

Summary

Background

Epidermal cyst is a common cutaneous lesion that may be located in the scrotum and is seen especially in young and middle-aged men. This entity is not only chronic but can also affect the patient's appearance, thus having an impact on their quality of life. Surgical excision is the classical procedure to remove such cysts, but it can be time-consuming and leave unpleasant scars. In this report, we included patients with scrotal cysts treated with the CO₂ laser.

Patients and methods

This study reports on two patients referred with epidermal scrotal cysts in whom CO₂ laser was used in superpulse mode at 10 to 10.8 W and with a pulse duration of 20 ms. The session was performed after local anesthesia with lidocaine. One to two 10-minute sessions were required to treat all cysts. All the patients were satisfied with the cosmetic results and no complications or recurrences were observed at follow-up. We also treated a patient with a single scrotal cyst in the same way, with excellent results.

Discussion

A literature review was performed using the Medline database. It revealed only two case reports involving scrotal cysts treated with laser using Nd-YAG laser and Diode Laser. There is no reported use of CO₂ laser in the treatment of scrotal cysts. Its use in superpulsed mode in the cases we describe is innovative. This procedure appears to be a safe, tolerable, and efficacious approach for the removal of epidermal scrotal cysts resulting in excellent cosmetic results and without recurrence.

http://bit.ly/2Re206s

Érythème généralisé fébrile et choc : choc toxinique staphylococcique

Publication date: Available online 26 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): P.-M. Dugourd, A. Dupont, T. Hubiche, C. Chiaverini, A. Alkhalifa, L. Roudiere, A. Tristan, C.-A. Gustave, P. Del Giudice

Résumé

Introduction

Le toxic shock syndrome (TSS) a été décrit pour la première fois par Todd en 1978. Cette publication du Lancet rapportait 7 cas d'enfants présentant une fièvre, un exanthème, une hypotension et une diarrhée associés à une défaillance multiviscérale. C'est dans les années 1980 qu'une association entre TSS et femmes en période de menstruation utilisant des tampons hyperabsorbants a été découverte. Après le retrait du marché de ce type de tampon, le TSS a quasiment disparu. Nous rapportons un nouveau cas de TSS survenu chez une adolescente.

Observation

Une jeune fille de 15 ans était hospitalisée en réanimation pour un tableau brutal de choc septique avec troubles de la vigilance et douleurs abdominales diffuses. L'examen dermatologique trouvait un exanthème maculeux diffus. Le bilan biologique montrait une cytolyse hépatique (ASAT 101 U/L, ALAT 167 U/L, bilirubine totale 68 μmol/L) et un syndrome inflammatoire. La ponction lombaire et les hémocultures étaient stériles. La tomodensitométrie cérébrale et thoraco-abdomino-pelvienne était normale. Dans un contexte de menstruation, la patiente avait utilisé un tampon hygiénique plus de 24 h. Le prélèvement vaginal et la culture du tampon mettaient en évidence un S. aureus producteur de la toxine TSST-1. La prise en charge consistait en mesures de réanimation et traitement par une association amoxicilline-acide clavulanique et clindamycine pendant 10 jours.

Conclusion

Un tableau de choc septique associé à un exanthème maculeux diffus doit faire évoquer le diagnostic de TSS, surtout dans un contexte menstruel.

Summary

Background

Toxic shock syndrome (TSS) was first described by Todd in 1978. The relevant Lancet publication reported 7 cases of children with fever, exanthema, hypotension and diarrhoea associated with multiple organ failure. An association between TSS and use of hyper-absorbent tampons in menstruating women was discovered in the 1980s. Following the market withdrawal of such tampons, TSS virtually disappeared. Herein we report a new case of TSS in a 15-year-old girl.

Patients and methods

A 15-year-old patient was admitted to intensive care for severe sepsis and impaired consciousness associated with diffuse abdominal pain. Dermatological examination revealed diffuse macular exanthema. Laboratory tests showed hepatic cytolysis (ASAT 101 U/L, ALAT 167 U/L, total bilirubin 68 μmol/L) and an inflammatory syndrome. Lumbar puncture and blood cultures were sterile while thoraco-abdomino-pelvic and brain scans were normal. The patient was menstruating and had been using a tampon over the previous 24 hours. Vaginal sampling and tampon culture revealed TSST-1 toxin-producing S. aureus. Management consisted of intensive care measures and treatment with amoxicillin-clavulanic acid and clindamycin for 10 days.

Conclusion

In case of septic shock associated with diffuse macular exanthema a diagnosis of TSS must be envisaged, particularly in menstruating women.

http://bit.ly/2WllVE8

Hamartome folliculaire basaloïde : étude anatomoclinique

Publication date: Available online 26 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): G. Hazemann, C. Michel, A. Mahé, D. Lipsker, B. Cribier

Résumé

Introduction

L'hamartome folliculaire basaloïde (HFB) est une tumeur rare décrite en 1985. Elle possède des similarités cliniques et histologiques avec le carcinome basocellulaire (CBC), notamment infundibulo-kystique. Nous avons effectué une étude anatomoclinique monocentrique de cette entité de diagnostic parfois difficile.

Patients et méthodes

Les cas classés HFB au laboratoire de dermatopathologie de Strasbourg ont été inclus et analysés en coloration hématoxyline-éosine et avec les immunomarquages Ber-EP4 et PHLDA1. Le diagnostic était retenu lorsqu'il existait des formations épithéliales arborescentes développées à partir d'un follicule pileux. Les renseignements cliniques ont été collectés à partir des demandes d'analyse et des dossiers cliniques.

Résultats

Nous avons retenu 15 cas survenus chez 13 patients. L'âge moyen était de 44,8 ans et le sex-ratio de 5/8. Il s'agissait de papules de couleur chair, rose ou brune, mesurant 0,3 à 1,2 cm, sans localisation préférentielle. Trois patientes avaient des lésions multiples, groupées sur un sein dans un cas, diffuses sur le dos dans un cas et hémicorporelles et linéaires, associés à des anomalies squelettiques, réalisant le tableau du syndrome de Happle-Tinschert dans un cas. Tous les HFB étaient limités au derme superficiel et moyen, formés d'éléments épithéliaux basophiles arborescents, verticaux dans deux tiers des cas et connectés à l'épiderme dans 14 cas. Des zones périphériques plus basophiles et centrales plus éosinophiles, une organisation palissadique et des fentes de rétraction à distance, entre le stroma et le derme, étaient fréquemment observées. Il y avait toujours des kystes épidermoïdes ou des structures sébacées orientant vers une origine folliculaire. L'immunomarquage Ber-EP4 était positif uniquement en périphérie des lobules tumoraux et PHLDA1 n'était que très peu exprimé.

Discussion

L'HFB est une entité unique et distincte du CBC. Il peut être solitaire, isolé. Il peut aussi être multiple, à disposition linéaire unilatérale, éventuellement associé à des manifestations extracutanées homolatérales dans le cadre du syndrome d'Happle-Tinschert. Il peut enfin être multiple et généralisé, parfois accompagné de maladies auto-immunes. Il est important de le différencier du CBC, car il est bénin.

Summary

Introduction

Basaloid follicular hamartoma (BFH) is a rare tumor first described in 1985. It bears clinical and histologic similarities with basal cell carcinoma (BCC), in particular the so-called infundibulocystic form. We performed a single-center clinicopathological study of a series of typical cases of this entity that is occasionally difficult to diagnose.

Materials and methods

All cases of BFH seen at the Dermatopathology Laboratory of Strasbourg University Hospital were included and analyzed by means of HE staining and Ber-EP4 and PHLDA1 immunolabelling. Diagnosis was made in the event of basaloid proliferation with anastomosing cords developed from a hair follicle. Clinical data were collected from clinical files.

Results

We identified 15 cases in 13 patients of mean age 44.8 years (range: 4 to 90) and the sex-ratio was 5/8. Lesions consisted of flesh-colored papules measuring 0.3 to 1.2 cm in diameter, without any preferential site. Three patients had multiple lesions consisting of several coalescent papules on a breast for one, sparse papules on the back for another, and hundreds of linear unilateral BFHs, associated with osseous abnormalities, characteristic of Happle-Tinschert syndrome, for the third. All tumors were limited to the superficial and mid dermis, with a vertical orientation and connection to the epidermis in 14 of the 15 patients. In some cases, the outermost cells were basophilic while the central cells were eosinophilic. Peripheral palisading and clefting were frequently observed. Keratin cysts or sebaceous ducts were consistently present, indicating follicular differentiation. Ber-EP4+ cells were restricted to the periphery of the cords and PHLDA1 was weakly expressed.

Discussion

BFH is a rare entity that must be differentiated from BCC. It presents as solitary or multiple lesions, either grouped in plaques or with a generalized or linear unilateral distribution. Generalized BFH may be associated with autoimmune diseases and linear unilateral BFH with osseous, dental and cerebral abnormalities in Happle-Tinschert syndrome. It is important to distinguish BFH from BCC to avoid inappropriate aggressive treatment.

http://bit.ly/2Rf7RIE

Un intérêt inédit pour le prurigo nodulaire

Publication date: Available online 26 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): L. Misery

http://bit.ly/2WnT3uS

Precursor B-cell development in bone marrow of Good syndrome patients

Publication date: Available online 25 January 2019

Source: Clinical Immunology

Author(s): Lucía del Pino Molina, Marjolein Wentink, Marcel van Deuren, Martin van Hagen, C.I. Edvard Smith, Mirjam van der Burg

Abstract

Good syndrome is an immunodeficiency presenting with thymoma, hypogammaglobulinemia and almost absent B cells. To investigate the origin of the B-cell lymphopenia in these patients, we studied B cell differentiation in the bone marrow of Good syndrome patients. We found very low numbers of precursor B cells in bone marrow of Good syndrome patients and a differentiation arrest after the pro-B-cell stage; this is different from other agammaglobulinemia patients with a defect in pre B-cell receptor signaling.

http://bit.ly/2TfUolD

The Role of Voice Therapy and Phonosurgery in Transgender Vocal Feminization

Objective: Nonsurgical and surgical options are available for transgender vocal feminization. This systematic review explores the efficacy of feminizing voice therapy and phonosurgery. Methods: A systematic review was performed using PubMed, Cinahl Plus, Ovid SP, Web of Science, Science Direct, and Google Scholar with terms related to transgender phonosurgery and voice therapy. Included studies were outcomes-based vocal feminization interventions for transgender women. Data were collected on pre- and postintervention fundamental frequency (F0), externally measured vocal femininity, patient satisfaction, and complications. Results: Two hundred twelve studies were identified and 20 met inclusion criteria. Postintervention patient satisfaction was approximately 80% to 85% for voice therapy, endoscopic shortening, and cricothyroid approximation. Complications were reported for each phonosurgery technique, most commonly decreased mean phonation time and loudness. Of the 20 studies, 17 were used for meta-analysis of F0 change. F0 increased by 31 Hz with voice therapy alone, 26 Hz with laser reduction glottoplasty, 39 Hz with cricothyroid approximation, and 72 Hz with endoscopic shortening. Conclusion: The literature supports both voice therapy and phonosurgery, depending on a patient's magnitude of desired pitch change and tolerance for cost and potential complications. Most will likely benefit from voice therapy, as it is highly satisfactory, raises vocal pitch, and is noninvasive. However, endoscopic shortening is also highly satisfactory and provides the greatest absolute increase in vocal pitch. If surgery is chosen, postoperative voice therapy may additionally increase F0, stabilize the voice, and create a more female timbre. However, further studies will be necessary to provide definitive clinical recommendations. Address correspondence and reprint requests to Shane D. Morrison, MD, MS, Division of Plastic Surgery, University of Washington Department of Surgery, 7CT73.1 Harborview Medicine Center, 325 9th Avenue, Mailstop #359796, Seattle, WA 98104; E-mail: shanedm@uw.edu; Ian T. Nolan, BM, New York University School of Medicine, New York, NY 98104; E-mail: ian.nolan@nyumc.org Received 30 July, 2018 Accepted 2 October, 2018 ITN and SDM contributed equally to this work. 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/2TbTrut

Milton Edgerton and Johns Hopkins, 1941–1970: Building the Foundations of Modern Plastic Surgery

No abstract available

http://bit.ly/2B5U5TD

Review of “Impact of a Novel Preoperative Patient-Centered Surgical Wellness Program” by Kelley KE in Ann Surg 268: 650-656, 2018

No abstract available

http://bit.ly/2Td0R0E

Successful Reconstruction of Agnathia by Intraoral Expansion and Free Vascularized Fibula Flap

A successful surgical reconstruction case of a 9-year-old boy with agnathia is presented. The reconstruction was preceded by intraoral expansion of the oral lining and submandibular skin. Four months after initiation of the expansion, the mandible was reconstructed by free vascularized fibula osteocutaneous flap. The 14.5 cm segment of harvested fibula was osteotomized in 4 places to build a replica of the mandible with 3 cm ascending ramus, 3.5 cm body and 1.5 cm symphysis, fixated by titanium micro plating system. The reconstructed mandible was placed between the expanded oral lining and the submandibular skin, with its condylar head placed under the glenoid fossa. After reconstruction, he looked more natural with a chin projection, which he never had. His mother was very happy to see his son being able to show his feeling with facial expression. At last follow-up, he is 14 years and 10 months old, 5 years and 2 months after surgery leading a happy life with his family. Address correspondence and reprint requests to Kunihiro Ishida, MD, PhD, Department of Plastic and Reconstructive Surgery, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, 904-2293 Japan; E-mail: ishida@plasticsurgery.jp Received 28 October, 2018 Accepted 25 November, 2018 Presented at the 16th Congress of the International Society of Craniofacial Surgery (ISCFS 2015) in Urayasu City, Chiba, Japan. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2B5U3uZ

A Novel Approach for Horizontal Augmentation of Posterior Maxilla Using Ridge Split Technique

Over the years, there have been a series of innovative approaches to the alveolar bone augmentation techniques. These have led to the modifications of the existing methods and the establishment of more efficient ways to obtain sufficient bone mass that is necessary for the implant procedure. The aim of this paper is to propose a novel augmentation technique, and to investigate its efficacy, particularly during the healing process of the maxillary alveolar bone prior to the implant treatment. During the application of the proposed methodology, first, the ridge-split technique was applied to the posterior maxilla. Then, a horizontal augmentation procedure was performed with an autogenous bone graft. Implants were placed at the second month of the surgery. Prosthetic rehabilitation was completed after the osseointegration of the implants. The technique was compared with the ridge-split method with simultaneous implant placement in 14 patients. The groups were divided into 2, the control group and the experimental group, each containing 7 patients. The aimed success criteria for the status of the endosteal implants were fulfilled and there were not any complications observed in the second year of follow-up. The basic practical innovation offered by the proposed surgical technique is to achieve the required horizontal dimension and to change the quality of the bone conveniently. The press-fit insertion leads to multipoint contact healing of the transported bone and the use of cortical block bone in posterior maxilla, led to a significantly advantageous higher stability level for both the placement and the survival of the implants. Address correspondence and reprint requests to Nazife Begüm Karan, DDS, PhD, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Recep Tayyip Erdogan University, Menderes Bulv No: 64. Fener Mah., Rize, Turkey; E-mail: karanbegum@gmail.com; Hüseyin Ozan Akinci, DDS, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Biskek Cd. 82. Sok 06550, Emek, Ankara, Turkey; E-mail: ozanakinci@gmail.com Received 22 January, 2018 Accepted 19 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2Tb33G1

Importance of Three-Dimensional Modeling in Cranioplasty

Cranioplasty is a reconstruction operation made to protect intracranial structures. It is applied for the closure of bone defects occurring due to causes such as trauma, tumor, infection, and infarct. Many different products changing from autologous bone grafts to synthetic materials are used for cranioplasty. Three-dimensional printers that are among the popular innovations of today are used gradually more in medical area as in every field of life and they make the surgical operation easier. When customizable materials are combined with technology, the authors come across successful results and less complications. The aim of the authors' study was to show a 3-dimensional modeling method in 2 patients the authors applied cranioplasty and the advantages provided by this method for the surgeon and the patient. Address correspondence and reprint requests to Ismail Kaya, MD, Department of Neurosurgery, Medical Faculty, Dumlupinar University, Kutahya, Turkey 43040; E-mail: dr.ikaya85@gmail.com Received 19 December, 2017 Accepted 26 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2B7vwFA

The Evaluation of Anthropometric Measurements of Young Polish Women's Faces

Face proportions are under constant evaluation during prosthetic or surgical diagnostics and treatment. The aim was to evaluate the proportions of the faces of young Polish women as compared with other ethnic groups. Materials and methods: The evaluation included 60 photographs of the faces of women, average age 17.9 years. En face images were made with the camera lens situated at the same distance from the photographed subjects. Using Adobe Photoshop software, midsaggital and even anthropometric points were determined in the photographs and then the distance between these points was measured. Four relationships between vertical measurements, 3 between horizontal measurements, and 4 proportions between vertical and horizontal measurements were calculated. The results were evaluated in comparison with the golden ratio (1.618) and the measurements performed for native Americans and Latin American beauty contests winners described in the relevant literature. Results: The result for the average vertical face proportion value of the examined women was close to the golden ratio (GR) and amounted to 1.592 for the proportions between nasion-stomion and stomion-gnation (98% of GR) and 1.372 for nasion-subnasale and subnasale-gnation (85% of GR). Average measurement results for young Polish women's faces were not statistically significantly different for 6 out of 11 relationships under evaluation as compared with the population of native American females and only 2 face proportions were the same as for beauty contests winners from Latin America. Conclusion: Face proportions of young Polish women were different from those of the females living in the American continent. Address correspondence and reprint requests to Jolanta E. Loster, DDS, PhD, Department of Prosthodontics, Institute of Dentistry, Jagiellonian University, ul. Montelupich 4, 31-155 Kraków, Poland; E-mail: jolanta.loster@uj.edu.pl Received 4 April, 2018 Accepted 22 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2Tb30dj

Study on Tooth Movement After the Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

Objectives: The aim of the study was to explore the effectiveness of the cleft-adjacent teeth moved into the grafted alveolar bone in unilateral cleft lip and palate (UCLP) patients, and to evaluate the alveolar bone support of the teeth. Methods: Twenty unilateral cleft lip and palate patients were recruited in this study. The average age was 12 years and 8 months. Periapical radiographs were taken for the cleft-adjacent teeth 3 months after bone grafting (T1) and after teeth moving into the grafted bone (T2), and for the contralateral teeth (T3) when teeth aligned. Alveolar bone support of the moved teeth and the contralateral teeth were measured using the ratio of bone support height to root length. Paired t test was performed for statistical analysis with SPSS17.0 software package. Results: All the cleft-adjacent teeth were bodily moved into the grafted area. Average alveolar bone support ratio for the moved teeth was 86.48% (T1), 87.11% (T2), and 90.81% (T3) for the contralateral teeth. There was no statistically significant difference between T1 and T2 (P > 0.05). Although the contralateral teeth had the highest alveolar bone support ratio, significant differences were found between T3 and T2 (P 

http://bit.ly/2B72IgG

Accelerated Return to Play for Professional Rugby Players After Facial Fractures

Background: Facial fractures may result in a significant time away from competition for professional rugby players. An understanding of the return-to-play times is an integral part of clinical decision making when treating professional athletes. A period of 8 to 12 weeks has been conventionally recommended for returning to collision sports after facial fractures. The conventional time to return to sports of 8 to 12 weeks is usually too long for professional players. However, the time of return to play after such facial fractures in elite athletes has not been well described. Purpose: To investigate the return to play after facial fractures in professional rugby players with an accelerated rehabilitation protocol. Methods: Ten professional rugby players with facial fractures were identified and analyzed. The authors investigated the number of days required to return to training and full-contact play according to the trauma type. The authors also determined the presence or absence of refractures and sequelae. Results: The average age of the patients was 26.9 years. Medial orbital wall fractures were the most represented pattern, followed by orbital floor fractures and zygomatic arch fractures. The players returned to jogging after 9.9 days, to sports-specific training after a mean of 10.8 days, and to full-contact training after 18.3 days. There were no cases of refractures and sequelae. Conclusion: Players were able to return to their regular rugby activities, earlier than the time commonly allowed to return to full activity. Address correspondence and reprint requests to Shinnosuke Hada, MD, PhD, Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan; 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421 Japan; Department of Orthopaedic Surgery, Tokyo Rosai Hospital, Tokyo, Japan; E-mail: shada@juntendo.ac.jp Received 25 May, 2018 Accepted 19 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2Tb2Z9f

Micro-Autologous Fat Transplantation Combined With Platelet-Rich Plasma for Facial Filling and Regeneration: A Clinical Perspective in the Shadow of Evidence-Based Medicine

Despite the popularity of lipofilling procedures in recent years, the presence of older habits still in fat graft harvesting and processing seems to be the biggest obstacle to the final better outcome of fat grafting. Our study is aimed to highlight some strategies what should be done in fat grafting in the shadow of evidence-based medicine and patient-reported outcomes which might be of interest to the clinicians. Between 2015 and 2017, 14 patients were included who underwent facial micro-autologous fat transplantation with platelet-rich plasma injection. The outcome was determined by the difference in presurgery and postsurgery FACE-Q modules, which were designed as patient-reported outcome instrument to evaluate the unique outcomes of patients undergoing facial cosmetic procedures. Surveys conducted were modules of satisfaction with facial appearance, satisfaction with cheeks, satisfaction with skin, psychological function, social function, aging appearance appraisal, and satisfaction with the outcome. All patients were followed up minimum 9 months. No major complications were recorded. The patient-reported FACE-Q satisfaction and FACE-Q quality-of-life presurgery and postsurgery results showed statistically significant improvement (

http://bit.ly/2Bfnpan

Ischemic Time in Free-Flap Surgery With Arteriovenous Bundle Interposition Graft: Comparison of Two Anastomosis Sequences

Background: During free-tissue transfer for scalp reconstruction, pedicle lengthening may be required when finding a recipient vessel is difficult because of defects from previous surgery. Arteriovenous (AV) bundle interposition grafting is a good option. This study compared 2 sequences of AV bundle interposition grafting when flap pedicle lengthening is needed. Methods: Two anastomosis methods were used. In the recipient lengthening type (R type), the flap was harvested and the AV bundle was harvested from a donor vessel for lengthening. In the flap lengthening type (F type), the flap was harvested first. Next, in contrast to that in the R type method, the authors performed anastomosis with a flap pedicle and bundle before the AV bundle was harvested. Results: The mean flap pedicle length was 8.75 cm (range, 5–11 cm). The AV bundle had a mean length of 9.25 cm (range, 6–13 cm), meaning that 13 cm of additional pedicle length can be added. The mean length of the extended vascular pedicle was 18 cm (range, 14–23 cm). Conclusion: This study compared the results of F type and R type AV bundle interposition grafting. The F type allowed easy monitoring of the anastomosis of the flap pedicle and ensured flap stability by reducing continuous ischemic time. Finally, this study confirmed the efficacy and safety of the AV bundle interposition graft in scalp reconstruction. Address correspondence and reprint requests to Tae-gon Kim, MD, PhD, Department of Plastic and Reconstructive Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea; E-mail: kimtg0919@daum.net Received 6 June, 2018 Accepted 31 October, 2018 Grant sponsor: Yeungnam University Research Grant. Grant number: 217A380077. This work was supported by the 2017 Yeungnam University Research Grant. 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/2TfSVM9

Postoperative Changes in Orbital Dysmorphology in Patients With Unicoronal Synostosis

Orbital asymmetry in unicoronal synostosis impacts craniofacial appearance and can potentiate functional visual disturbances, such as strabismus. Surgical treatment aims to normalize overall cranial morphology, including that of the orbits. The purpose of this study was to compare postoperative changes in orbital asymmetry following 2 common procedures. Preoperative and 1-year postoperative computed tomography scans for patients with isolated, nonsyndromic unicoronal synostosis treated from 2007 to 2012, at 2 academic institutions were analyzed. Only patients treated by endoscopic suturectomy and postoperative helmeting or bilateral fronto-orbital advancement were included. Orbital index, depth, and volume asymmetry were determined for each patient both pre- and 1-year postoperatively. Student's t-tests were used to compare pre- and postoperative asymmetries within each treatment group. Regression analyses were used to examine postoperative change in asymmetry between treatment groups. Scans from 12 patients treated by fronto-orbital advancement and 23 treated by endoscopic suturectomy were analyzed. Differences between synostotic and nonsynostotic orbital index, depth, and volume were statistically significant both pre- and postoperatively. Statistically significant postoperative improvements in asymmetry were observed for orbital index, depth, and volume following suturectomy. Regression analysis indicated that the amount of pre- to postoperative change in all measures of asymmetry did not depend on surgical technique. Residual asymmetry following both procedures was apparent at 1 year postoperatively. Orbital asymmetry is improved, but not resolved following both fronto-orbital advancement and endoscopic suturectomy. Degree of improvement in symmetry is independent of surgical technique used. Address correspondence and reprint requests to Kamlesh B. Patel, Campus Box 8238, 1150 Northwest Tower, 660 S Euclid Ave, St Louis, MO 63108; E-mail: kamlesh.patel@wustl.edu Received 10 June, 2018 Accepted 31 October, 2018 This research was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), the Children's Discovery Institute, and the Students and Teachers As Research Scientists (STARS) program. This study was presented at 73rd Annual Meeting of the American Cleft Palate-Craniofacial Association, in Atlanta, Georgia, April 4 to 9, 2016. Dr Patel is a consultant for Stryker CMF and Drs Patel and Naidoo are speakers for Hanger, Inc and Orthomerica. 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/2B3Xwu2

Effect of Platelet-Rich Fibrin and Bone Morphogenetic Protein on Dental Implant Stability

Recombinant human bone morphogenetic protein-2 (rhBMP-2) and platelet-rich fibrin (PRF) bioactive materials have been used to enhance healing and improve dental implant stability. This study aimed to compare the effect of rhBMP-2 and PRF bioactive materials on dental implant stability at different intervals and to evaluate the correlation of implant length and diameter with implant stability. Two bioactive materials were compared to evaluate their effect on dental implant stability. A total of 32 patients (102 dental implants) were divided into 3 groups: 24 dental implants with bone morphogenetic protein (BMP), 27 dental implants with PRF, and 51 dental implants without BMP or PRF (control group). Data were statistically analyzed to determine the bioactive material with the best effect on implant stability. Implant stability did not significantly differ between the groups immediately after implant insertion (first reading; P > 0.05). The implant stability of the rhBMP-2 group was significantly better than those of the PRF and control groups 6 weeks after implant insertion (second reading; P = 0.001). After 12 weeks, the effect of rhBMP-2 on implant stability was highly significant and better than that of the other groups (third reading; P 

http://bit.ly/2B31ymo

Corrigendum to “Long-term survival and late toxicities of elderly nasopharyngeal carcinoma (NPC) patients treated by high-total- and fractionated-dose simultaneous modulated accelerated radiotherapy with or without chemotherapy” [Oral Oncol. 89 (2019) 40–47]

Publication date: Available online 26 January 2019

Source: Oral Oncology

Author(s): Jingjing Miao, Lin Wang, Manyi Zhu, Weiwei Xiao, Haijun Wu, Muping Di, Yuqing Huang, Shaomin Huang, Fei Han, Xiaowu Deng, Xiang Guo, Chong Zhao

http://bit.ly/2RecqTv

Reprint of Long-term survival and late toxicities of elderly nasopharyngeal carcinoma (NPC) patients treated by high-total- and fractionated-dose simultaneous modulated accelerated radiotherapy with or without chemotherapy

Publication date: Available online 25 January 2019

Source: Oral Oncology

Author(s): Jingjing Miao, Lin Wang, Manyi Zhu, Weiwei Xiao, Haijun Wu, Muping Di, Yuqing Huang, Shaomin Huang, Fei Han, Xiaowu Deng, Xiang Guo, Chong Zhao

Abstract

Background

To analyse the survival and late toxicities of elderly nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT) with the high-total- and fractionated-dose simultaneous modulated accelerated radiation therapy (SMART) boost technique and to identify the effect of concurrent chemotherapy for these patients.

Methods

Two hundred and fifty-four elderly patients (age ≥ 60.0) with newly diagnosed non-metastatic NPC were retrospectively analysed. Statistical analyses were performed using the SPSS software program.

Results

The actual mean total and fractionated doses delivered to the gross tumour volume of the nasopharynx (GTVnx) were 74.55 Gy and 2.49 Gy, respectively. The 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-specific survival (DSS) and overall survival (OS) of the whole cohort were 93.0%, 85.7%, 83.2% and 74.1%, respectively. No grade 4 acute or late radiotherapy-induced toxicities were observed. Of 247 patients with stage II–IVb disease, 89 patients received radiotherapy (RT) alone, and 158 patients received concurrent chemoradiotherapy (CCRT), and the 5-year LRRFS, DMFS, DSS and OS of the RT-alone group vs. the CCRT group were 94.0% vs. 92.2%, 83.5% vs. 86.2%, 81.8% vs. 83.1% and 74.0% vs. 72.8% (all P > 0.05), respectively. Multivariate analyses showed that CCRT was not an independent predictor for LRRFS, DMFS, DSS and OS (all P > 0.05).

Conclusion

High-total- and fractionated-dose SMART boost IMRT could obtain a satisfactory long-term outcome with mild late toxicity in elderly NPC patients. The role of CCRT needs to be further studied to optimize the treatment strategy and improve the overall survival.

http://bit.ly/2Wt5lT4

Health-related quality of life in patients with cleft palate: reproducibility, responsiveness and construct validity of the Dutch version of the VELO questionnaire

Publication date: Available online 26 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Laura Bruneel, Cassandra Alighieri, Sofie De Smet, Kim Bettens, Marc De Bodt, Kristiane Van Lierde

Abstract

Objectives

Recently, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire, which evaluates the impact of speech and swallowing difficulties on health-related quality of life (HRQoL) in patients with VPI (Skirko et al., 2012), was translated to Dutch (Bruneel et al., 2017). The purpose of this study was to evaluate the reproducibility, responsiveness and construct validity of this Dutch version of the questionnaire.

Methods

To evaluate the reproducibility, 50 parents and 14 children with cleft palate re-completed the questionnaire after two weeks. Thirty-five parents and 8 children with cleft palate completed the VELO questionnaire after one year for the evaluation of the responsiveness. The correlation between age and the VELO questionnaire (construct validity), and the internal consistency (Cronbach's α) were re-determined based on the responses of 73 parents and 24 children.

Results

Based on descriptive statistics, results of the Wilcoxon signed rank-test, and the absolute (SEM) and relative (ICC) consistency, the questionnaire showed good reproducibility. VELO scores did not significantly differ after one year, neither when performing separate analyses for the intervention (speech therapy) and the non-intervention group. Correlations indicated higher HRQoL, as perceived by the parents, with increasing age. The reverse was the case for the report. Cronbach's α showed excellent internal consistency for both reports.

Conclusions

The VELO questionnaire showed good reproducibility and internal consistency. Moreover, results reconfirmed the age effect on VELO scores. To understand the implications of the results regarding the questionnaire's responsiveness, future research should focus on the identification of factors influencing the patient's evolution in HRQoL.

http://bit.ly/2Rhmdbq

Complete Polysomnographic Parameters In Infants With Severe Laryngomalacia Prior To And After Supraglottoplasty. A Pilot Study

Publication date: Available online 26 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Cortes María Cristina, Villamor Perla, González C. de la Torre, Álvarez-Neri Hiram

Abstract

Introduction

Laryngomalacia is the most common congenital laryngeal anomaly. Because of supraglottic prolapse, laryngomalacia may be associated with obstructive sleep apnea (OSA) and sleep disturbances. The effects of OSA and sleep disorders in children include failure to thrive, cognitive and behavioral disturbances, cardiovascular compromise, and an association with sudden infant death syndrome.

Objective

To evaluate the presence of OSA and sleep disturbances in children with severe laryngomalacia through complete nocturnal polysomnography, as well as to establish the effects of supraglottoplasty in each of the polysomnographic parameters.

Results

Nine infants with severe laryngomalacia were included, all with a complete polysomnographic study prior to and after supraglottoplasty. The average age was 5.5 months. All patients presented an Apnea-Hypopnea Index (AHI) within the range of severe OSA. After supraglottoplasty, a significant reduction in AHI was found, from 34.87±20.34 to 9.44±5.28 after surgery (p: 0.022). Additionally, sleep efficiency had a significant increase, from 21.4% to 56.29% of total sleep time (p: 0.0013). All patients presented a significant decrease in obstructive apnea episodes (p <0.0001), as well as in hypopnea episodes (p: 0.0154). The mean and minimum peripheral oxygen saturation (SpO2) had a significant increase after supraglottoplasty from 88.2% to 94.09% (p: 0.0002), and from 81.01% to 89.33% (p <0.0001), respectively.

Conclusion

Polysomnography (PSG) may provide better surgical sustenance in infants with severe laryngomalacia and OSA, as well as, serving as a monitoring tool of success. However, the surgical decision should not be reduced to polysomnographic results, and a good history and examination remain as the fundamental criteria.

http://bit.ly/2WnR7D1

Simulation-based education to improve emergency management skills in caregivers of tracheostomy patients

Publication date: Available online 25 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Kara Prickett, Anita Deshpande, Heather Paschal, Dawn Simon, Kiran B. Hebbar

Abstract

Introduction

Children with tracheostomies are medically complex and may be discharged with limited and variably trained home nursing support. When faced with emergencies at home, caregivers must often take the lead role in management, and many lack experience with troubleshooting these emergencies prior to initial discharge.

Methods

A high-fidelity simulation-based tracheostomy education program was designed using a programmable mannequin (Gaumard HAL S3004 one-year-old pediatric simulator). At the conclusion of our standard education program, caregivers completed three simulation scenarios: desaturation, mucus plugging, and dislodgement. A trained simulation facilitator graded performance. A self-assessment tool was used to analyze comfort with emergency management at the beginning of training, before and after simulation. Caregivers rated confidence using a 10 cm visual analog scale. All participants completed a post-simulation debriefing session.

Results

39 caregivers completed all three scenarios and returned pre- and post-simulation self-assessments. Mean scores from the caregiver self-assessments increased for all three scenarios, with mean increases of 9.0 mm for desaturation, 16 mm for mucus plugging, and 10 mm for decannulation. Two patterns of responses emerged: caregivers with progressive increase in confidence through training, and caregivers who initially rated confidence highly, and had confidence decrease as the complexity of true emergency management became apparent. All participants found the simulations to be realistic and helpful.

Discussion

High-fidelity simulation training allows for realistic exposure to trach-related emergencies. Many caregivers overestimate their ability to handle emergencies and gain important insight through simulation.

Implications for Practice

Identification of skills and knowledge gaps prior to discharge allows for targeted re-education in emergency management.

http://bit.ly/2RebXkd

An update of spectrum and frequency of GJB2 mutations causing hearing loss in the south of Iran: A literature review

Publication date: Available online 25 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Mahbobeh koohiyan, Amirhossein Ahmadi, Farideh koohian, Shahrzad Aghaei, Beheshteh Amiri, Morteza Hashemzadeh-Chaleshtori

Abstract

Objective

Mutations in the GJB2 gene are a major cause of autosomal recessive non-syndromic HL (ARNSHL) in many populations. Previous studies have estimated the average frequency of GJB2 mutations to be between 16-18% in Iran, but would vary among different ethnic groups. Here, we have taken together and reviewed results from our three previous publications and data from search other published mutation reports to provide a comprehensive collection of data for GJB2 mutations and HL in the south of Iran.

Methods

In all, 447 unrelated families were included and analyzed for the prevalence and type of the GJB2 gene mutations.

Results

Totally, the frequency of GJB2 mutations was found to be 11.5% in the southern provinces studied which is significantly lower than that identified in Northern populations of Iran, and also a southwest to southeast Iranian gradient in the frequency of GJB2 mutations is suggested.

Conclusions

This study highlights the importance of establishing prevalence, based on the local population for screening and diagnostic programs of live births in Iran.

http://bit.ly/2WiS2UZ

Audiometric Findings in Children with Unilateral Enlarged Vestibular Aqueduct

Publication date: Available online 25 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Robert J. Macielak, Jameson K. Mattingly, Ursula M. Findlen, Aaron C. Moberly, Prashant S. Malhotra, Oliver F. Adunka

Abstract

Objective

To evaluate the prevalence of bilateral hearing loss in children with unilateral enlarged vestibular aqueduct (EVA) at a single institution.

Methods

A retrospective case review was performed at a tertiary care pediatric referral center involving children with radiologic findings of unilateral EVA and normal labyrinthine anatomy of the contralateral ear diagnosed via CT and/or MRI. The main outcome measure of interest is the number of patients with unilateral EVA who were diagnosed with bilateral hearing loss.

Results

Sixty-one pediatric patients were identified. The mean audiometric follow-up was 48.2 months (0-150). Three (4.9%) patients with unilateral EVA were noted to have bilateral hearing loss, and this rate was not significantly different (p=1.0) from the rate reported in a comparison group of patients with contralateral hearing loss (6.0%) without an EVA. The pure-tone average (defined as the average dB HL at 500, 1000, 2000, and 4000 Hz) in the group with bilateral hearing loss was 31.3 dB HL in the better hearing ear and 79.6 dB HL in the worse hearing ear, with the difference being statistically significant (p=0.02). In the unilateral EVA patients without contralateral hearing loss (n=56, 91.8%), the PTA was 9.4 dB HL in the better hearing ear and 51.9 dB HL in the worse hearing ear, with the difference being statistically significant (p<0.001). Two patients (3.3%) with unilateral EVA were found to have hearing within normal limits bilaterally. The EVA was ipsilateral to the worse hearing ear in all cases.

Conclusion

The prevalence of bilateral hearing loss in children with unilateral EVA appears to be low. Specifically, it may be no different than the rate of contralateral hearing loss in children with unilateral hearing loss without an EVA. The present report is somewhat different than the previously described prevalence in the literature. This difference could be related to the imaging type and diagnostic criteria used, the patients included, the source of the identified patents, and the overall population of patients studied.

http://bit.ly/2ReleIZ