Head and Neck Medicine by Alexandros G.Sfakianakis: 01/30/19

Τετάρτη 30 Ιανουαρίου 2019

Vitamin D deficiency in solid‐organ transplant recipients from a Spanish Mediterranean population

Summary

Background

Solid‐organ transplant recipients (SOTRs) are at risk of developing vitamin D deficiency, mainly caused by reduced sunlight exposure with subsequent low vitamin D synthesis in the skin.

Aim

To analyse whether SOTRs from a Spanish Mediterranean region were vitamin D‐deficient.

Methods

This was a cross‐sectional, descriptive and observational study in a transplantation‐specialized Dermatological Unit from a Mediterranean area to determine the calcidiol levels of a cohort of 78 consecutively attending patients not receiving vitamin D supplements. Serum 25(OH)D₃ levels were determined and clinical characteristics were collected. Logistic regression analysis was used to analyse variables associated with dichotomized 25(OH)D₃ levels (≤ or > 10 ng/mL).

Results

The cohort comprised 30 lung, 29 kidney and 19 liver transplant recipients. Mean calcidiol was 18 ± 9 ng/mL. Deficiency of 25(OH)D₃ was present in 19% of patients, while 68% had insufficient levels and 13% had sufficient levels. Following multivariate logistic regression analysis, the season of blood sampling remained the only predictor of deficient 25(OH)D₃ levels.

Conclusion

Despite living in a mid‐latitude country with sunny weather, our SOTR population was at high risk of developing hypovitaminosis D, especially in autumn/winter. Avoiding sun exposure is important to prevent skin cancer, but careful monitoring of vitamin D status is recommended, with supplementation if hypovitaminosis D is detected.

http://bit.ly/2HEBdRa

Periorbital Trauma: A New Classification

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0039-1677808

Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients' visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and functional status were evaluated. The periorbital region was identified. Anatomical categorization of periorbital injuries included periocular, frontal, temporal, and malar regions. Injuries/deficits were categorized into simple, composite, complex, and isolated bony injuries according to the depth and involved tissues. Subsequently, the classification was formulated. In the retrospective study, the incidence of extended simple injuries was the highest, while the least was the extended complex injuries. Functional deficits occurred in 24 patients (9.23%) and aesthetic deficits occurred in 55 patients (21.15%). Required secondary operations for this group included redo of fixation, correction of medial canthal ligament, repair of canalicular system, scar revisions, fat grafting, and creation of natural creases. The results of this study demonstrated that unsatisfactory aesthetic and functional results occurred when injuries of important structures were overlooked, aesthetic units were not respected, and when management was delayed. A three-dimensional, oriented, new classification of periorbital trauma based on anatomical and clinical categorization is proposed to help in identifying injured structures, stimulate the search for other injuries, structure preoperative evaluation, and recommend a surgical plan that would ultimately achieve precise primary repair with best aesthetic and functional outcome.
[...]

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

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Transdermal absorption of active substances from cosmetic vehicles

Summary

Background

Cosmetic products mean any substance or mixture intended to be placed in contact with the external parts of the human body (eg, epidermis, lips) and should not pass to the lower parts and penetrate to the skin. As a part of evaluation of cosmetic safety, the transdermal absorption of substances should be investigated.

Materials and Methods

In vitro absorption was investigated with Franz diffusion cells on untreated porcine skin and specimens of the same treated with 15%wt. SLS. The integrity of the skin was discerned by gauging transdermal electrical conductivity (TEC), the concentration of caffeine absorbed by the samples of skin membrane by liquid chromatography, which took place by applying an emulsion and/or a gel containing active hydration agents (urea, sodium hyaluronate, and sericin).

Results

The greatest extent of caffeine penetration was seen for pretreatment with just SLS; similar results were in skin treated with the base gel with 10%wt. urea. In the skin treated with the base emulsion only, the amount of caffeine absorbed was twofold less; this increased after adding the active hydration substances. The values measured for TEC corresponded with the amount of caffeine absorbed.

Conclusion

The gel proved to be the more potent vehicle for the active ingredient, as it demonstrated greater transdermal caffeine penetration than the emulsions, correlating with the degree of damage to the skin as detected by TEC.

http://bit.ly/2sTBm9a

Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review

Abstract

Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.

http://bit.ly/2FZue3A

Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review

Abstract

http://bit.ly/2FZue3A

Check out the ten Top-viewed articles in 2018 – Clinical Thyroidology for the Public

1. THYROID HORMONE THERAPY Taking levothyroxine with breakfast may be fine for many patients
Volume 6 Issue 11
Heather Hofflich, DO
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2. THYROID NODULES Risk of thyroid cancer based on thyroid ultrasound findings
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3. HYPOTHYROIDISM Desiccated thyroid extract vs Levothyroxine in the treatment of hypothyroidism
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5. HYPOTHYROIDISM When is the best time to take thyroid hormone?
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6. THYROID AND PREGNANCY First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss
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7. THYROID HORMONE TESTS Determination of optimal TSH ranges for reflex Free T4 testing
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8. HYPERTHYROIDISM Thyroid tests on newborns within the first five days will detect neonatal hyperthyroidism
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9. THYROID AND PREGNANCY Low TSH levels early on in pregnancy may be normal
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10. THYROID AND PREGNANCY Increasing levothyroxine doses early in pregnancy is associated with a lower risk for pregnancy loss in hypothyroid women
Volume 9 Issue 10
Shirin Haddady, MD
20,502 views

The post Check out the ten Top-viewed articles in 2018 – Clinical Thyroidology for the Public appeared first on American Thyroid Association.

http://bit.ly/2RsRY1w

Topical rapamycin in superficial lymphatic malformation: microcystic lymphatic malformation or verrucous venous malformation?

http://bit.ly/2RssdhN

Tissue-sparing properties of Mohs micrographic surgery for infiltrative basal cell carcinoma

Mohs micrographic surgery (MMS) should lead to tissue sparing of healthy skin compared to standard surgical excision, because smaller surgical margins are used.

http://bit.ly/2WuNgUI

Patients Believe Cosmetic Procedures Affect Their Quality of Life: An Interview Study of Patient-Reported Motivations

While treatments to address cosmetic concerns are common, patients' self-reported motives for considering such procedures have not been systematically explored.

http://bit.ly/2RswtO0

Using gauze to evenly spread starch for hyperhidrosis testing

http://bit.ly/2WuNc7q

The Etiology, Diagnosis and Management of Hyperhidrosis: A Comprehensive Review. Part II. Therapeutic Options

After completing this learning activity, participants should be able to describe the treatment options available for hyperhidrosis including topical antiperspirants, oral medications, injectable therapies, iontophoresis, sweat reduction medical devices, and surgical procedures; and determine the best treatment modality based on the severity and location of symptoms.

http://bit.ly/2RuKECq

The Etiology, Diagnosis and Management of Hyperhidrosis: A Comprehensive Review. Part I. Etiology and Clinical Work-Up

After completing this learning activity, participants should be able to discuss the epidemiological, clinical, and pathophysiological features of hyperhidrosis; describe the classification and diagnosis of hyperhidrosis, as well as the quantitative and qualitative tests that exist; recognize the burden and psychosocial effects of hyperhidrosis; and list resources available for hyperhidrosis patients and health-care professionals.

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Severe Rhinophyma. Tips and Tricks in Carbon Dioxide Laser Decortication

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Pityriasis Rubra Pilaris: A Study Evaluating Patient Quality of Life in Two Populations

http://bit.ly/2WwVwTS

Gender and Age Differences of Temporomandibular Joint Disc Perforation: A Cross-Sectional Study in a Population of Patients With Temporomandibular Disorders

The presence or absence of disc perforation (DP) has great value for the treatment planning of temporomandibular disorders (TMDs). Epidemiologic features of DP are limited in the literature. The present study investigated the epidemiologic features of DP by retrospectively reviewing 13,556 temporomandibular joint arthrographic examinations. Pearson Chi-squared test demonstrated that the rate of male patients who received the examinations more than once was significantly lower than that of female patients and the rate of DP in males was significantly lower than that in females. The age of all patients showed a bimodal distribution, with a 1st peak around 21 years of age, and a 2nd peak around 53 years of age. Linear regression analysis showed that the rate of DP was positively correlated with ages. The DP rate was increased by 0.3% for every 1 year of age. This retrospective cross-sectional study validated some findings about the gender and age differences of temporomandibular joint DP in the literature, and more importantly uncovered the exact relationship between the DP rate and the age in a large TMD patient population. Address correspondence and reprint requests to Bo Li, PhD, DDS and Hongyu Zheng, MD, School and Hospital of Stomatology, Wuhan University, #237 Luo Yu Road, Wuhan, Hubei 430079, China; E-mails: libocn@whu.edu.cn; yu_mengwei@whu.edu.cn Received 26 August, 2018 Accepted 6 October, 2018 This work was supported by the National Natural Science Foundation of China (grant nos: 81801001, 81570995, and 81500878). The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Cervical Thymic Cyst Around Hypoglossal Nerve

Cervical thymic cyst is rare lesions leading to cervical mass. As it is a rare entity, it might be confused with other congenital neck masses or neoplastic lesions. Preoperative diagnosis is almost impossible. In the present study, a patient who was operated with prediagnosis of branchial cyst and diagnosed with thymic cyst according to the histopathologic examination was presented. A 16-month-old girl was admitted to our clinic with the complaint of growing right neck mass that was realized about 4 months ago. Magnetic resonance imaging (MRI) of the neck demonstrated a rim-enhanced hypointense cystic lesion in the posterior aspect of the submandibular gland, without tracheal right lateral and mid plane on MRI, curving common carotid artery to the medial. Patients underwent surgery under general anesthesia in company with existing findings. Hypoglossal nerve was surrounded by the mass, and the mass was totally resected. The final pathology result was reported as thymic cyst. Cervical thymic masses might be unnoticed in the differential diagnosis of the cervical mass as they are rarely seen entities. Histopathologic examination of the thymus tissue was performed for diagnosis. Surgical excision is the ideal treatment approach and no postoperative recurrence has been reported. Address correspondence and reprint requests to Fatma Atalay, MD, Oltu State Hospital, Otorhinolaryngology Clinics, Erzurum, Turkey, Erzurum 25240, Turkey; E-mail: fatmatalay_88@hotmail.com Received 22 September, 2018 Accepted 16 October, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Fat Grafting in the Management of War Injuries

The healing potential of fat grafting was empirically noted by the surgeons who were confronted with the dramatic facial disfigurements resulting from World War 1. Fat was transplanted into the wounds either en bloc or in parcels to promote the healing capacity or to correct the uneven, depressed scars from gunshot wounds, enabling the poor soldiers to step back to society and families in a shorter period of time. The idea of transplanting fat into the wound of the facially disfigured started with Hippolyte Morestin (1869–1919), surgeon in chief at Val-de Grace Military Hospital in Paris and was widely adopted by HD Gillies (1882–1960), Erich Lexer (1867–1937), Gustavo Sanvenero Rosselli (1897–1974), and others, achieving amazing results. Successful treatment of facially injured individuals showed the importance of plastic surgical procedures, the social role of the discipline, basis for obtaining the official recognition as surgical specialty. Address correspondence and reprint requests to Riccardo F. Mazzola, MD, University of Milan, via Marchiondi 7, 20122 Milan, Italy; E-mail: riccardo.mazzola@fastwebnet.it Received 17 September, 2018 Accepted 2 October, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2MLq1RO

Improved Tumor Resection on the Palpebral Margin

Objective: To resect benign tumors on the palpebral margin using an improved minimally invasive surgery, and to observe the outcome and analyze the possible healing mechanism of this improved surgical technique. Methods: Fifty-five patients with a benign tumor on the palpebral margin measuring 2- to 10 mm in diameter were included in this study. The tumors were resected along their edge and basal layer, causing minimal damage to the surrounding structures. Postoperative outcome measures included the following: the wound status, epithelial healing, eyelash growth, recurrence, and complications. Postoperative follow-up time points were 1 day, 7 days, 14 days, 1 month, 3 months, and 12 months. Results: The wound status ranged from edema to contraction in the early stage postoperatively. The eyelashes that were excised during the operation began to grow from 7 to 14 days postoperatively, and the epithelium began to close simultaneously. From 14 days to 3 months postoperatively, the eyelash and epithelium grew completely, and the scar disappear gradually. Except in 1 patient with trichiasis at 3 months and one patient with tumor recurrence at 12 months postoperatively, there were no other complications, such as ablepharon deformities, alopecia palpebralis, etc. Conclusion: Our improved minimally invasive technique not only resected the tumor effectively but also preserved the important anatomical structure of the palpebral margin. The favorable outcomes resulted from the mechanism of wound healing. This new surgical method is worth implementing in clinical practice. Address correspondence and reprint requests to Yuanyuan Du, MD, Mylike Medical Cosmetic Hospital, Mylike Tower, 789 West Yan'an Rd, Changning District, Shanghai 200050, China; E-mail: 18686623812@163.com Received 7 September, 2018 Accepted 9 October, 2018 The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://bit.ly/2iuFjMi). © 2019 by Mutaz B. Habal, MD.

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Surgical Implications of the Anteriorly Displaced Segments of the Anterior Cerebral Artery in the Management of Frontoethmoidal Meningoencephalocele

Background: Preservation of the anterior cerebral arteries (ACAs) is important in the surgical management of frontoethmoidal meningoencephalocele (FEME). This would avoid complications related to the loss of blood supply to the part of the brain supplied by the ACA. Previous reports have identified hydrocephalus, microcephaly, cerebral dysplasias amounting to a 15% to 20% prevalence of brain anomalies in patients with FEME. What has not been previously reported are cerebral vasculature changes in the frontal region in FEME and how these may impact on the surgical correction and clinical outcome. Methods: Two patients of FEME that demonstrate cautionary radiologic findings in relation to the ACAs and anterior fossa anatomy are discussed. Results: The ACA in a 4-year-old boy with FEME was displaced anteriorly with the long A1 segments that extend into the defect. In the 2nd patient, a 4-year-old girl, we report on the complications related to the injury of ACAs from a previously partially resected FEME. Conclusion: The importance of the anterior cerebral vasculature around the FEME during surgery is crucial to prevent complications resulting from damage to a looping A1 segment of the ACA. Address correspondence and reprint requests to Dr Vani Prasad, MBBS, FRACS, Australian Craniofacial Unit, Level 1, 72 King William Street, North Adelaide, SA 5006, Australia; E-mail: drvaniprasad@yahoo.com Received 24 August, 2017 Accepted 31 October, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Correction of Microstomia Reconstruction With the Use of Acellular Dermal Matrix for Buccal Reconstruction

Correction of microstomia is challenging with a high rate of recurrence. We report the successful treatment of microstomia using acellular dermal matrix (ADM) as an adjunct for intraoral lining with >1 year of follow-up. A 9-year-old international patient with severe immunodeficiency presented with severe microstomia because of recurrent oral infections. She had undergone 3 previous failed attempts to re-establish an adequate oral opening and was dependent on enteral nutrition via gastrostomy tube. She underwent release of the oral commissure scar contracture and orbicularis oris and the resultant mucosal defect was lined with ADM. A postoperative splint was used for 8 weeks. One-year follow-up demonstrated maintenance of the oral aperture with complete mucosalization of the ADM; the patient was able to resume oral diet and regular dental hygiene. Mucosal reconstruction with ADM is a viable alternative to local flaps and in this case exhibited minimal soft tissue contraction. Address correspondence and reprint request to Gary F. Rogers, MD, JD, MBA, MPH, Chief, Division of Plastic Surgery, Children's National Medical Center, 111 Michigan Ave., N.W., Washington, D.C., 20010; E-mail: grogers@childrensnational.org Received 3 August, 2018 Accepted 4 November, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Perioperative Outcomes of Secondary Frontal Orbital Advancement After Posterior Vault Distraction Osteogenesis

Background: Posterior cranial vault distraction osteogenesis (PVDO) has gained popularity as the initial intervention in patients with syndromic craniosynostosis. Patients may require secondary frontal orbital advancement (FOA) following PVDO, but little is known about the perioperative risks associated with this staged management. The purpose of this study is to compare the perioperative morbidity profile of secondary FOA (study) to that of primary FOA (control). Methods: A retrospective review was conducted for patients with syndromic or complex craniosynostosis undergoing FOA between 2004 and 2017. Univariate and multivariate analysis of demographic and perioperative data were performed. Results: Forty-three subjects met inclusion criteria, 17 in the study cohort and 26 in the control cohort. The 2 cohorts were similar with regards to diagnosis and suture involvement, as well as weight-adjusted estimated blood loss, blood transfusion volume, and length of hospital stay (P > 0.050). Secondary FOA procedures required longer operating time (231 ± 58 versus 264 ± 62 min, P = 0.031) and anesthesia time (341 ± 60 versus 403 ± 56 min, P = 0.002). The secondary FOA cohort had a significantly greater proportion of procedures with difficult wound closure (19% versus 59%, P = 0.008). Two subjects in the study cohort developed a wound dehiscence, compared with 1 subject in the control cohort (P = 0.552). Frontal orbital advancement as a secondary procedure after PVDO was a predictor variable in multivariate analysis for wound difficulties (odds ratio 8.6, P = 0.038). Conclusion: Syndromic and complex craniosynostosis may safely be managed with initial PVDO followed by FOA, with some increased wound closure difficulty. Address correspondence and reprint requests to Jesse A. Taylor, MD, 3615 Civic Center Boulevard, 1st floor, Abramson Research Center, Philadelphia, PA 19104; E-mail: jataylor@gmail.com Received 19 September, 2018 Accepted 27 November, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2MJ6L7l

Craniometric Analysis of Skullbase With Magnetic Resonance Imaging in Patients With Chiari Malformation

Basilar invagination, Platibasi, increased tentorium angle, and posterior fossa hypoplasia are the anomalies associated with Chiari malformation. When Chiari is symptomatic; tonsillary ectopenia appears to be a definitive criterion for diagnosis and treatment, the detection of additional anomaly may alter the surgical outcome. The aim of this study is to investigate the relationship between tonsillar ectopia and other anomalies. The authors retrospectively reviewed 31 cases which had Chiari Malformation at our Hospital. There were 8 men (25.8%) and 23 female (74.2%). Average age of the samples is 37.93 ± 12.93 years. Seventeen patients (54.8%) had tonsillar ectopia 0 to 5 mm, 14 patients had tonsillar ectopia over 5 mm. Seven patients had syrinx (22.6%), 2 patients had mild hydrocephalus (6.5%). Six patients had surgery for the treatment. The mean length of the clivus was 39.3 mm, supraoksiput length was 40.4 mm, cerebellar hemisphere length was 61.08 mm, Mc Rae line was 33.14 mm, Twinning Line was 79.4mm, and Tentorium-Twinning line angle was 40.35°. There was no significant difference between Tonsillar ectopia, syrinks, and hydrocephalus. Basilar invagination had relationship between platibasi (6 patients had platibasi according to 2 mm criteria, 2 patients had platibasi according to 5 mm criteria (P

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Innovator and Surgeon: Milton Edgerton's Influence and Legacy

No abstract available

http://bit.ly/2MEedR4

The Use of Patient-Specific Three-Dimensional Printed Surgical Models Enhances Plastic Surgery Resident Education in Craniofacial Surgery

Purpose: A significant challenge in surgical education is to provide a meaningful hands-on experience with the pathology the trainee will see in independent practice. Craniofacial anatomy is challenging and unfamiliar to the learner. Methods: Using preoperative computed tomography data, the authors produced an accurately sized, three-dimensional (3D) printed model of the congenital craniofacial anatomy of patients treated by the same attending surgeon–PGY4 resident surgeon pair over the course of a 6-month rotation. A preoperative stepwise surgical plan was written by the attending and resident, and the plan was marked on the 3D model by the attending and resident separately. The written and marked plans were measured for accuracy and time to completion. The resident surgeon's applicable milestone levels were assessed. Results: Seven congenital craniofacial anomalies met criteria for inclusion: 4 craniosynostosis cases, 2 mandibular distractions, and 1 LeFort I distraction. The number of inaccuracies of the written plan improved from 5 to 0 for sagittal synostosis and 4 to 0 for mandibular distraction. The time to complete the written plan decreased by 22% for sagittal synostosis and 45% for mandibular distraction. The number of inaccuracies of the marked plan decreased from 5 to 0 for sagittal synostosis and 2 to 0 for mandibular distraction. Time to completion of the marked plan decreased by 76% for sagittal synostosis and 50% for mandibular distraction. Milestone scores increased an average of 1.875 levels. Conclusion: Three-dimensional printed craniofacial models are a positive addition to resident training and have been objectively quantified to improve the accuracy and time to completion of the surgical plan as well as progression in the plastic surgery milestones. Address correspondence and reprint requests to Jonathan S. Black, MD, FACS, Department of Plastic and Maxillofacial Surgery, University of Virginia Health Systems, West Complex, Fourth Floor, 1300 Jefferson Park Ave., Charlottesville, VA 22908; E-mail: jsb8r@virginia.edu Received 17 July, 2018 Accepted 24 December, 2018 Sources of funding: University of Virginia Graduate, Medical Education Innovation 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/2sTEOk9

Facial Resurfacing With Prefabricated Induced Expanded Skin Flap

Massive facial damages extremely affect the facial appearance and function. In existing publications, the surgical flap transfer was still prior to other methods in repairing the facial injury. Among them, the prefabricated induced expanded skin flap seems more effective based on the facial specific features and damage range. In this study, a literature research was carried out in the database of PubMed. A total of 85 patients were included and all of them underwent the method of prefabricated expanded flap to reconstruct the massive facial defects. The prefabricated induced expanded skin flaps harvested from the neck and chest area have prominent advantage in resetting massive facial deformities. All the flaps survived demonstrated an excellent texture and color match with the facial defects areas. However, the unsolved problems are still existed in these flaps and further research is necessary to obtain a satisfactory outcome for both patients and surgeons. Address correspondence and reprint requests to Dr Da-Ping Yang, MD, Department of Plastic Surgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, China; E-mail: dapingyang@hotmail.com Received 13 January, 2017 Accepted 16 October, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://bit.ly/2iuFjMi). © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2MI4QQC

Cranioplasty Using Polymethylmethacrylate Cement Following Retrosigmoid Craniectomy Decreases the Rate of Cerebrospinal Fluid Leak and Pseudomeningocele

Objective: Cerebrospinal fluid (CSF) leak frequently occurs after retrosigmoid craniectomy. The present study investigated the effects of cranioplasty using polymethylmethacrylate (PMMA) cement to reduce the incidence of CSF leak following retrosigmoid craniectomy as compared with the autologous bone flap combined with titanium plates. Methods: Two hundred forty-three patients underwent surgeries via retrosigmoid approach for microvascular decompression or tumor resection. Of these, 107 patients underwent craniotomy, and incomplete cranioplasty was performed with autologous bone flap fixed with titanium plates, while 136 patients underwent craniectomy and complete cranioplasty was performed with PMMA cement. Variables including the incidence of CSF leak, pseudomeningocele formation, wound infection, rejection reaction were compared retrospectively based on the clinical data between the 2 groups. Results: In the autologous bone group, 9 patients had postoperative CSF leaks, and 11 patients had pseudomeningoceles, while 3 CSF leaks and 2 pseudomeningoceles were found in the PMMA group. Statistical analysis showed that PMMA significantly decreased the incidence of postoperative CSF leaks (P = 0.03) and pseudomeningocele formation (P = 0.002). Wound infections were observed in 2 and 1 patients between the autologous bone and PMMA group, respectively, which did not differ significantly (P = 0.58). None of the patients in both groups developed a rejection reaction of artificial materials. Conclusions: Complete cranioplasty with PMMA cement following retrosigmoid craniectomy could decrease the incidence of CSF leak and pseudomeningocele formation as compared with the autologous bone flap combined with titanium plates. Thus, PMMA cement is preferable for bone reconstruction with excellent biocompatibility and without increasing the rate of wound infection. Address correspondence and reprint requests to Yili Chen, MD, PhD, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, China; E-mail: 3194086@zju.edu.cn Received 10 June, 2018 Accepted 31 October, 2018 This work was supported by the basic and public research project of Zhejiang province [grant numbers: LGF18H090010] and Yiwu Municipal Science and Technology Foundation of China [grant numbers: 2016-S-11]. 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/2sVLUVe

Review of Endoscopic Repair of Mandible Fractures

Introduction: Fractures of the mandibular condyle represent more than 30% of all mandible fractures. If required, reduction has been performed using either a closed or an open technique with similar outcomes. Endoscopic fracture repair is a minimally invasive approach for open reduction, but there is limited data regarding indications and outcomes. This study aims to systematically review the demographics, features, and outcomes following endoscopic repair of mandibular fractures in adult patients. Methods: The following databases were searched from their inception to December 31, 2016: PubMed, Cochrane, Web of Science, and the WHO Global Health Library, using terms related to endoscopy and mandibular fractures. Articles were screened and data were extracted by 2 independent reviewers. Disagreements arbitrated by discussion or a 3rd reviewer. Results: Twenty-two manuscripts were included, representing 509 adult patients who had endoscopic repair of a mandibular fracture over 18 years. All endoscopic repairs were of the mandibular condyle, including both subcondylar and condylar neck fractures. The sample-sized weighted mean age was 33.5 years with 74.5% males in the study population. Permanent facial nerve injury was reported once (0.24%) and occlusive complications reported in 31 patients (6.5%). Conclusion: This systematic review identifies a large cohort of patients who underwent endoscopic repair of their mandibular fractures. Complications were rare and usually temporary, with permanent complications occurring at a respectable rate. The demographics and outcomes identified in this study can be used as an epidemiologic baseline for future research on endoscopic repair of mandibular fractures. Address correspondence and reprint requests to Rami D. Sherif, BA, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, 15th Floor, New York, NY 10029; E-mail: Rami.sherif@icahn.mssm.edu Received 6 June, 2018 Accepted 8 November, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://bit.ly/2iuFjMi). © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2MHKu9V

Syndromes that predispose to epistaxis

Abstract

Purpose

Our aim was to evaluate if epistaxis is directly associated with the etiology or pathophysiological mechanism which results in the syndrome itself or arises as a secondary effect.

Methods

We performed an extensive literature review of the web-based PubMed database from the National Library of Medicine to ascertain syndromes related to this condition. Etiology, pathophysiological mechanisms, occurrence, clinical features and management were noted for each of these syndromes.

Results

Epistaxis is commonly seen in syndromes that are usually directly related to vascular abnormalities or coagulation defects. However, in some cases, it is not.

Discussion and conclusion

Since a number of these syndromes are rare and elaborate tests are not carried out in the absence of a positive family history or until other specific clinical features appear, a risk of underdiagnosis and the dilemma of whether epistaxis is specifically related to the syndrome or a secondary effect still remains.

http://bit.ly/2UorUGo

Methotrexate for Chinese Adults With Psoriasis With and Without Psoriatic Arthritis

This cohort study compares the effectiveness and adverse effects of methotrexate in Chinese patients with psoriasis with and without psoriatic arthritis.

http://bit.ly/2WvjY8k

Prevalence and Disclosure of Conflicts of Interest in Dermatology Patient Advocacy Organizations

This cross-sectional study uses the Kaiser Health News database to examine the current state of industry-related conflicts of interest and disclosure practices among patient advocacy organizations with dermatology.

http://bit.ly/2Ruay9o

Decreased Anti-DSG3, Not Anti-DSG1 Antibody, After Cessation of Sitagliptin Treatment for Pemphigus Vulgaris

This case report describes the occurrence of a decrease of anti-DSG3, but not anti-DSG1, after cessation of sitagliptin treatment in a patient with pemphigus vulgaris.

http://bit.ly/2WrHNOi

Narrowband UV-B vs Psoralen–UV-A for Early-Stage Mycosis Fungoides

This systematic review and meta-analysis compares response and adverse effects of psoralen–UV-A with narrowband UV-B phototherapy in patients with early-stage mycosis fungoides.

http://bit.ly/2Ruatm6

Further Consideration of the Pigmented Lesion Assay—Reply

In Reply We appreciate the comments by Beatson and Weinstock on our analysis of the pigmented lesion assay (PLA). We agree that it is important to develop tools that have the potential to help decrease biopsies of benign pigmented skin lesions such as the PLA, a gene expression melanoma rule-out test based on obtaining skin samples noninvasively via adhesive patches. We believe that it is important to view the PLA's performance relative to the performance of histopathologic diagnosis. In a large and recent study based on data from 10 US states, the sensitivity of standard histopathologic assessment in comparable in situ and early invasive melanomas was 65% ([Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis [MPATH-Dx] classes III and IV; 908 + 113 + 11+717 + 928 + 198 = 2875; 2875 of 4416 = 0.65). Even the best dermatopathologist cannot see and describe molecular changes that have yet to develop morphological correlates, thereby highlighting the limitations of our current care standard. Thus, the authors' concerns that the PLA sensitivity is low at 91% should be viewed in this comparative context. In light of this concern, it is also helpful to mention recent follow-up studies that support a PLA sensitivity in real-world settings of 95%.

http://bit.ly/2BdTzmr

Further Consideration of the Pigmented Lesion Assay

To the Editor We read with interest the article by Hornberger and Siegel, which suggested that the pigmented lesion assay (PLA) may reduce costs and improve the care of patients with skin lesions suspicious for melanoma. The noninvasive sampling of RNA is a promising approach for the diagnosis of melanoma, especially considering the intrinsic limitations of visual inspection and the cost and morbidity of histologic evaluation. It is important that we continue to develop and test instruments, such as the PLA, that have potential to decrease unnecessary biopsies of benign pigmented skin lesions.

http://bit.ly/2TmdwP7

Association Between Hidradenitis Suppurativa and Lymphoma

This cohort analysis evaluates the risk of lymphoma in adult patients with hydradenitis suppurativa in the United States.

http://bit.ly/2RrZbi0

Komplementärmedizinische Behandlungsansätze bei oraler Mukositis und Xerostomie

Zusammenfassung

Hintergrund

Patienten mit Tumoren im Kopf-Hals-Bereich leiden oft an einer iatrogenen Mukositis und Mundtrockenheit, die auch langfristig zu einer erheblichen Beeinträchtigung der Ernährung führen können.

Methode

Es erfolgte eine Zusammenstellung klinisch bereits geprüfter komplementärmedizinischer Behandlungsansätze und eine ergänzende Auflistung phytotherapeutischer Möglichkeiten aus dem Kanon der Traditionellen Europäischen Medizin.

Ergebnisse

Sowohl zur Behandlung der akuten Stomatitis und Mukositis als auch der akuten Xerostomie gibt es eine Reihe medikamentöser und nichtmedikamentöser Behandlungsansätze, die der Onkologe kennen und beachten sollte. Europäische Phytotherapeutika sind bisher relativ selten einer klinischen Prüfung unterzogen worden.

Schlussfolgerungen

Die Nutzung komplementärmedizinischer Maßnahmen kann für die Behandlung der Mukositis und der Xerostomie im Einzelfall sinnvoll sein. Forschungsbedarf besteht insbesondere auf dem Gebiet der traditionellen europäischen Heilkräuter, da diese eine hohe Akzeptanz bei den Patienten haben.

http://bit.ly/2B9mE2w

Dietary behaviors and survival in people with head and neck cancer: Results from Head and Neck 5000

Abstract

Background

The association between diet and head and neck cancer (HNC) survival is unclear.

Methods

Cox proportional hazard models measured the association between fruit, vegetable, and deep‐fried food intake and HNC overall survival adjusting for clinical, social and lifestyle variables including smoking, alcohol, and HPV status.

Results

Fruit and vegetable intake and improved survival were associated in minimally adjusted analyses. Following adjustment for smoking and alcohol consumption (fully adjusted analyses), the association with survival disappeared for fruit (HR 0.91, 95% CI 0.67, 1.23; P for trend = .55) and attenuated for vegetables (HR 0.79, 95% CI 0.61, 1.03; P for trend = .04). We observed no association between survival and deep‐fried food intake in minimally adjusted or fully adjusted analyses (HR 0.88 95% CI 0.72, 1.07; P for trend = .13).

Conclusions

Vegetable intake and HNC survival are modestly associated. There is some confounding by tobacco and alcohol consumption.

http://bit.ly/2WuQ1oP

Patient‐defined duration of benefit from juvederm (hyaluronic acid) used in injection laryngoplasty

Objectives/Hypothesis

Injection laryngoplasty has become valuable in treating laryngologic disorders including vocal cord atrophy, paralysis, and paresis. Although materials such as carboxymethylcellulose and calcium hydroxylapatite are Food and Drug Administration (FDA) approved, they are not without limitations. Juvederm (hyaluronic acid) is an alternative treatment that is not FDA approved. Although studies have examined Juvederm's longevity in cutaneous injections, there are limited data examining durability of Juvederm used in laryngoplasty. We aimed to determine the longevity and effectiveness of Juvederm used in injection laryngoplasty.

Study Design

Retrospective cohort study.

Methods

Subjects who underwent injection laryngoplasty using Juvederm were reviewed. Longevity was defined as the time between injection and the date that a patient first noted subjective deterioration of their voice. All subjects were subsequently followed using videostroboscopy to evaluate for Juvederm resorption. Longevity was analyzed using a Kaplan‐Meier survival model, and effectiveness of laryngoplasty was determined using the Voice‐Related Quality of Life index scores and analyzed using a Wilcoxon signed ranks test.

Results

Fifty‐nine subjects met inclusion criteria and underwent Juvederm injection laryngoplasty. Kaplan‐Meier survival analysis revealed a mean longevity of 10.6 months (95% confidence interval: 9.1‐12.0 months). Wilcoxon signed ranks analysis of the pre‐ and postinjection Voice Related Quality of Life (VRQOL) scores revealed improvement, with a mean preinjection VRQOL of 49.2 (standard deviation [SD] = 25.8) and mean postinjection VRQOL of 68.2 (SD = 27.5) (P < .001).

Conclusions

Injection laryngoplasty using Juvederm is an effective treatment for vocal cord atrophy, paralysis, and paresis. Knowledge of the patient‐defined duration of benefit following laryngoplasty using Juvederm plays an important role in counseling patients as well as in the planning of future interventions.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2FYZShN

Lymphomes cutanés primitifs : actualités thérapeutiques

Publication date: Available online 30 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): O. Dereure

Résumé

L'actualité thérapeutique des lymphomes cutanés primitifs continue à être largement dominée par les lymphomes T, qui concentrent la grande majorité des nombreuses innovations thérapeutiques récentes. Celles-ci comprennent des traitements locaux, soit relativement anciens, mais « revisités » en utilisant des formes galéniques différentes (gel de chlorméthine) ou des dosages plus faibles (électronthérapie), soit plus innovants (UVA-1, photothérapie dynamique, imiquimod et résimiquimod, etc.). Toutefois ce sont surtout les traitements systémiques qui ont fait des progrès significatifs avec l'apparition de molécules « ciblées » agissant directement et spécifiquement sur les cellules tumorales (anticorps monoclonaux anti-CD30, anti-CCR4 ou anti-CD158k) et le développement de « petites » molécules telles les inhibiteurs d'histone désacétylase et de nouveaux cytostatiques. Les immunothérapies, si efficaces dans d'autres domaines de l'onco-dermatologie, sont également l'objet d'un grand intérêt tandis que l'allogreffe de cellules souches hématopoïétiques a définitivement démontré sa supériorité par rapport à l'autogreffe et fait désormais partie intégrante de l'arsenal thérapeutique. Les innovations sont certainement moins nombreuses dans les lymphomes B, mais on peut citer l'association rituximab-polychimiothérapie de type CHOP et le lénalidomide (en seconde ligne) dans les formes à grandes cellules de type « jambe » ; ainsi que là encore le développement de l'électronthérapie localisée à (très) faible dose dans les formes indolentes uni- ou paucilésionnelles.

Summary

Therapeutic progress in primary cutaneous lymphomas continues to be largely dominated by the T-cell lymphomas, towards which the great majority of recent therapeutic innovations have been directed. The latter include local treatments consisting either of relatively classical but "revamped" approaches involving different pharmaceutical forms (example: chlormethine gel) or else lower but seemingly equally effective dosages (electron therapy), or of more innovative approaches (example: UVA-1, dynamic phototherapy, imiquimod, resimiquimod). However, significant progress has been made chiefly in terms of systemic treatments with the emergence of "targeted" drugs that directly and specifically target tumour cells (monoclonal antibodies directed against CD30, CCR4 or CD158k) and the further development of "small" molecules such as histone deacetylase inhibitors and new cytostatics. Immunotherapies, which have proven so effective in other areas of oncodermatology, are also of great interest, while allogeneic haematopoietic stem-cell transplantation has clearly shown its superiority over autologous transplantation and now constitutes a significant component of the therapeutic arsenal in advanced disease. While the innovations in terms of B-cell lymphomas are certainly less significant, mention must also be made of the value of rituximab combined with polychemotherapy (CHOP) and of lenalidomide (as second-line therapy) in primary cutaneous diffuse large B-cell lymphoma, leg type, along with the development of localized (very) low-dose radiotherapy in unilesional or paucilesional indolent forms.

http://bit.ly/2SdPkRG

Lambeau myocutané en îlot du dorsum nasal pour la reconstruction d’une perte de substance de la pointe nasale

Publication date: Available online 30 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): L. Nespoulous, O. Cogrel

http://bit.ly/2HIldO6

Porphyries cutanées

Publication date: Available online 30 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): J.-F. Cuny

Résumé

Les porphyries sont des maladies métaboliques consécutives à une anomalie innée de la biosynthèse de l'hème dont les tableaux cliniques sont variés en fonction de l'anomalie génétique enzymatique en cause. Il s'agit d'affections génétiques ayant une transmission autosomique dominante ou récessive à pénétrance variable, dont l'expression clinique diffère en fonction de la localisation préférentielle d'accumulation des précurseurs de l'hème. Différentes classifications ont été proposées en fonction de la transmission génétique, l'anomalie enzymatique en cause, l'expression clinique. La classification clinique distingue les porphyries aiguës (porphyrie aiguë intermittente, porphyrie variegata, coproporphyrie héréditaire), les porphyries cutanées bulleuses (porphyrie cutanée tardive, porphyrie variegata et coproporphyrie héréditaire), les porphyries aiguës cutanées douloureuses photosensibles (protoporphyrie érythropoïétique et protoporphyrie dominante liée à l'X), et des porphyries récessives rares (porphyrie érythropoïétique congénitale, porphyrie de Doss, porphyrie hépatoérythropoïétique et hardéroporphyrie). Le traitement est fonction de l'expression clinique.

Summary

The porphyrias are a group of metabolic disorders resulting from an innate abnormality in haem biosynthesis, and the clinical settings of which vary according to the genetic enzyme abnormality in question. These are genetic disorders with autosomal dominant or recessive inheritance of varying penetrance, and whose clinical expression differs according to the preferential location of haem precursors. Different classifications have been proposed according to genetic inheritance, the enzyme anomaly at issue, and clinical expression. The clinical classification distinguishes between acute porphyria (acute intermittent porphyria, porphyria variegata, hereditary coproporphyria), bullous cutaneous porphyrias (porphyria cutanea tarda, porphyria variegata and hereditary coproporphyria), painful photosensitive acute cutaneous porphyrias (erythropoietic protoporphyria and X-linked dominant protoporphyria), and rare recessive porphyrias (congenital erythropoietic porphyria, Doss porphyria, hepatoerythropoietic porphyria and harderoporphyria). Treatment depends on the clinical expression of the disorder.

http://bit.ly/2SaDmbq

The Biaxial Double-Barrel Fibula Flap—A Simplified Technique for Fibula Maxillary Reconstruction

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s): Baber Khatib, Ashish Patel, Eric J. Dierks, R. Bryan Bell, Allen Cheng

Purpose

Previously described techniques for microvascular fibula reconstruction of Brown Class II to IV maxillectomy defects are complex, require multiple osteotomies, result in a short pedicle, and inadequately reconstruct the dental alveolus in preparation for endosseous implants. This report describes a simplified technique for Brown Class II to IV defects that re-creates facial support, allows for dental reconstruction with appropriately positioned implants, and maintains adequate pedicle length.

Materials and Methods

A retrospective chart review was performed of all patients with Brown Class II to IV maxillectomy defects immediately reconstructed with a biaxial double-barrel fibula flap technique. The reconstructive surgeon evaluated each patient at least 1 month after reconstruction for enophthalmos, facial symmetry, nasal patency, satisfactory jaw position, deglutition, intelligible speech, and intraoperative need for vein grafting.

Results

The sample was composed of 6 patients (mean age, 54 yr; range, 33 to 78 yr; 67% women) who underwent reconstruction with the biaxial double-barrel fibula flap technique for Brown Class II to IV defects. None of these patients required vein grafting. None of these patients had flap failure. Diagnoses for these patients were a hybrid odontogenic tumor (n = 1), squamous cell carcinoma (n = 3), adenoid cystic carcinoma (n = 1), and sinonasal melanoma (n = 1). All 6 patients had excellent facial contour and malar projection, regular oral intake, 100% intelligible speech, and a new maxillary skeletal Class I relation without need for intraoperative vein grafting. One patient developed enophthalmos related to inferior rectus sacrifice and removal of orbital fat. Complications included development of nasal synechia and occlusion of the maxillary sinus ostium (n = 1).

Conclusions

The biaxial double-barrel fibula flap technique achieves the goals of providing adequate facial support and an alveolar segment amenable to implant dentistry. It allows for intelligible speech, deglutition, orbital support, and separation of the oronasal, orbital, and sinus cavities. In addition, it minimizes the need for vein grafting.

http://bit.ly/2RtdfI8

Dentofacial Deformities and Implications on Quality of Life: A Presurgical Multifactorial Analysis in Patients Seeking Orthognathic Surgical Treatment

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s): Adrielle Mendes de Paula Gomes, Cléa Adas Saliba Garbin, Flávio Wellington da Silva Ferraz, Tânia Adas Saliba, Artênio José Isper Garbin

Purpose

The purpose was to perform a quality-of-life survey in patients with skeletal malocclusion before undergoing orthognathic surgery, as well as delineate the sociodemographic profile and detect factors that may alter the quality of life.

Patients and Methods

This cross-sectional study was carried out in patients who sought care at the Hospital das Clínicas of the University of São Paulo Medical School (N = 106; average age, 27.2 years). Participants answered the Oral Health Impact Profile 14 (OHIP-14) questionnaire and Orthognathic Quality of Life Questionnaire (OQLQ). The χ² or Fisher test was used to verify the association between impact and sociodemographic variables.

Results

On the Oral Health Impact Profile 14 (OHIP-14) questionnaire, the "psychological incapacity" dimension (64.15%) presented a higher prevalence of impact. The marital status of the interviewees had a statistically significant effect on the impact of quality of life (P = .0119). On the Orthognathic Quality of Life Questionnaire (OQLQ), the "facial esthetics" dimension represented 81.13% in the prevalence of impact on quality of life. The "gender" variable had a statistically significant effect on the quality of life of the respondents (P = .0005), with women having an 11.78 times greater chance of having this impact.

Conclusions

In this study, psychological factors and esthetics exerted a strong influence on the quality of life of patients with dentofacial deformities, overlapping with functional aspects.

http://bit.ly/2Wt4uSi

Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s): Sofie Téblick, Maarten Ruymaekers, Elke Van de Casteele, Nasser Nadjmi

Purpose

Otitis media with effusion and disturbed speech are highly prevalent in children after cleft palate repair. Although many techniques for palatal closure have been described, no consensus has been reached on the most effective technique for these issues. The aim of this systematic review was to provide evidence-based information related to the effectiveness of different palatal closure techniques on middle ear and speech outcomes.

Materials and Methods

A literature search in multiple electronic databases was performed: National Guidelines Clearinghouse, Trip Database, Cochrane Library, and Medline (PubMed). Potentially relevant articles were selected according to title and abstract and full-text eligibility. Then, quality control on the included articles was executed.

Results

Twenty-three retrospective and prospective cohort studies were included in this systematic review. These studies compared at least 2 of the following techniques: von Langenbeck palatoplasty, 2-flap palatoplasty, Veau-Wardill-Kilner V-to-Y pushback technique, Kriens intravelar veloplasty, Sommerlad technique, Furlow double-opposing Z-plasties, and the Nadjmi modification of the Furlow palatoplasty. Their outcomes on the prevalence of otitis media with effusion, number of tympanostomy tubes placed, rates of hearing loss, and speech development were compared.

Conclusions

The Sommerlad and Furlow palatoplasties were associated with the lowest prevalence of otitis media with effusion and the smallest number tympanostomy tubes needed. For hearing outcomes, the Furlow palatoplasty generated the best audiometric outcome. For speech outcomes, the Sommerlad and Furlow palatoplasties were more beneficial than the 2-flap palatoplasty, the Veau-Wardill-Kilner V-to-Y pushback technique, and the von Langenbeck palatoplasty. Additional randomized controlled trials are recommended to obtain evidence that can support these findings.

http://bit.ly/2RpapnK

The Influence of Dissection Range of the Facial Nerve on Transient Postoperative Facial Palsy in Mandibular Condyle Fractures

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s): Jeongmin Yoon, Hyonsurk Kim, Eul-Sik Yoon, Seung-Ha Park, Byung-il Lee

Purpose

This study examined the relation between dissection range of facial nerve branches and transient postoperative facial palsy caused by nerve traction for open treatment of mandibular condyle fractures using a preauricular approach.

Materials and Methods

This retrospective study included 58 patients who underwent rigid fixation of condylar head and upper neck fractures. Patients were divided into 3 groups based on dissection range of the frontal and zygomatic branches. For group 1 (n = 22), the dissection range was extended anteriorly and posteriorly from the condylar borders through the retroparotid approach. The transparotid approach was used in groups 2 (n = 19) and 3 (n = 17) in which nerve dissection was limited to the condylar borders and was extended only anteriorly, respectively. Using multivariate correlation and multiple regression analyses, differences in duration of nerve traction and angle difference by traction from the natural course of the nerve were analyzed according to dissection range, and the recovery period for facial palsy was evaluated.

Results

The duration of nerve traction for group 2 was 77.53 minutes, which was longer than that for groups 1 (66.00 minutes) and 3 (65.41 minutes). The angle differences by traction were 62.42° and 58.00° for the frontal and zygomatic branches in group 2, respectively, which were considerably greater than those in groups 1 (23.32° and 20.14°) and 3 (37.24° and 28.88°). In consequence, group 2 showed the longest recovery, requiring 64.47 days for the frontal branch and 51.63 days for the zygomatic branch. The angle difference by traction had a greater influence on the recovery period than duration of nerve traction.

Conclusions

Duration of nerve traction and angle difference by traction were quantitatively dependent on the dissection range of facial nerve branches and were related to the recovery period for transient facial palsy.

http://bit.ly/2Wt4vFQ

Evidence-Based Clinical Criteria for Computed Tomography Imaging in Odontogenic Infections

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s): Brian J. Christensen, Earl Peter Park, Salvador Suau, David Beran, Brett J. King

Purpose

Odontogenic infections are a common problem in emergency departments and impose a burden on hospital budgets and provider time. Compounding this is the lack of evidence guiding the patient's initial evaluation. The purpose of this study was to derive evidence-based guidelines for the use of computed tomographic (CT) imaging in the management of odontogenic infections.

Materials and Methods

A prospective cohort study was designed. Patients with an odontogenic infection presenting to the emergency department from November 1, 2016 to November 30, 2017 were eligible for inclusion. The outcome variable was need for CT imaging, which was based on the location of the abscess. The potential predictor variables were demographics, history items, examination findings, and laboratory values. The association between the outcome and predictor variables was determined using classification and regression tree analysis and standard logistic regression analysis.

Results

There were 129 patients who met the inclusion criteria and consented to participation. The patients were 53.5% men and the mean age was 42.5 years. The most common fascial spaces involved were vestibular (58.2%), submandibular (18.6%), pterygomandibular (6.2%), buccal (5.4%), and lateral pharyngeal (5.4%). The classification and regression tree analysis identified mandibular inferior border blunting at the body as the best predictor for necessitating a CT scan and identified a mouth opening smaller than 25 mm as the second best predictor. These 2 predictors had an accuracy of 96.9% for needing a CT scan. The logistic regression analysis identified these 2 variables and odynophagia, floor of mouth induration, and white blood cell count as relevant predictors for needing CT imaging.

Conclusion

The 2 physical examination findings of mandibular inferior border blunting at the body and restricted mouth opening were found to be strongly associated with the need for CT imaging. Further studies should be directed at validating these criteria in larger multicenter studies.

http://bit.ly/2RrgIa6

Four-Step Chart of Percutaneous Approaches to the Mandibular Condyle: A Proposal of a Visualized System for Intuitive Comprehension

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s): Tomoaki Imai, Mitsuhiro Nakazawa, Narikazu Uzawa

http://bit.ly/2WtGiz0

The Resident Organization of the American Association of Oral and Maxillofacial Surgeons Debt Task Force Perspective on Educational Debt and the Impact on the Specialty of Oral and Maxillofacial Surgery

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s): Ehlie Bruno, Stephanie Zastrow, Paul Covello, Daniel Hammer

http://bit.ly/2Rrpy7U

Preparing for Ambulatory Care

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s): James R. Hupp

http://bit.ly/2WuSDmP

AAOMS Author Disclosure forms

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s):

http://bit.ly/2Rog8tP

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s):

http://bit.ly/2WtTBje

Editorial Board Page

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s):

http://bit.ly/2RnzZcN

Journal of Oral and Maxillofacial Surgery

Publication date: February 2019

Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2

Author(s):

http://bit.ly/2WuSCzh

Deep parotid lymph node metastasis is associated with recurrence in high-grade mucoepidermoid carcinoma of the parotid gland

Publication date: Available online 30 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Xue Shang, Qigen Fang, Fei Liu, Junfu Wu, Ruihua Luo, Jinxing Qi

Abstract

Purpose

Our goal was to assess the association between intraparotid lymph node (IPN) metastasis and prognosis in high-grade mucoepidermoid carcinoma (MEC) of the parotid gland.

Patients and Methods

Patients with surgically treated primary high-grade MEC of the parotid gland were retrospectively enrolled. The association between IPN metastasis and clinical-pathologic variables was analyzed by using Chi-square tests, and the recurrence-free survival (RFS) rate was calculated by the Kaplan-Meier method; independent prognostic factors were evaluated by the Cox proportional hazards method.

Results

IPN metastasis was noted in 59 (48.4%) patients, including 19 cases in the deep lobe and 47 cases in the superficial lobe of the parotid gland. IPN metastasis was significantly related to tumor stage and node stage regardless of the location of the metastasis in deep or superficial lobes. Patients with both superficial and deep lymph node metastasis had a low 5-year RFS rate of 11%. Cox model analysis reported that the status of IPN metastasis was an independent risk factor for recurrence.

Conclusions

IPN metastasis significantly decreases the RFS rate, especially when there is lymph node metastasis in the deep lobe of the parotid gland.

http://bit.ly/2RnAcwB

The Role of Anti-Fibrinolytics in Reducing Blood Loss during Craniofacial or Orthognathic Surgeries: A Meta-Analysis

Publication date: Available online 30 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Kalliopi Siotou, Charalampos Siotos, Armina Azizi, Michael A. Cheah, Stella M. Seal, Richard J. Redett, Gedge D. Rosson

Abstract

Purpose

Use of anti-fibrinolytic drugs in craniofacial and orthognathic surgery seems quite promising and has strong advocates. However, supporting evidence is controversial and limited by a small sample of individual studies. We sought to systematically review and meta-analyze the available data regarding the role of pre- or intra-operative anti-fibrinolytic drugs (e.g., tranexamic acid, aprotinin, aminocaproic acid) in craniofacial and orthognathic surgery.

Materials and Methods

We searched PubMed, Scopus, Embase, Cochrane Libray, and Web of Science through April 19, 2018, according to PRISMA guidelines. Outcomes of interest included the volume of blood loss, transfusions, and operative time. A meta-analysis was performed employing the Random Effects Model using the RevMan software.

Results

We identified 32 eligible studies with 749 patients undergoing craniofacial and 546 orthognathic surgery. Meta-analysis shows that anti-fibrinolytics use led to statistically significant decreases in blood loss and blood transfusions for craniofacial procedures in adult or pediatric patients, and significantly less blood loss during orthognathic surgeries. Operative time did not significantly differ for either type of surgery.

Conclusions

Anti-fibrinolytics can significantly reduce blood loss in craniofacial surgeries including pediatric craniosynostosis, adult rhinoplasties and orthognathic surgeries, and transfusion requirements in pediatric craniofacial surgeries. However, clinical significance of the medications is still questionable due to relative paucity of information on adverse effects and the usual small volume loss during those operations.

http://bit.ly/2Wriagy

Adalimumab-related dental implant infection.

Publication date: Available online 30 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Joseph E. Cillo., Nicholaus Barbosa

Abstract

Purpose

To present an adalimumab-related dental implant surgical site infection.

Subjects

and Methods: A single case report of a 55-year-old subject with a history of adalimumab biweekly subcutaneous injections for ulcerative colitis who had mandibular extractions and placement of five immediate dental implants.

Results

The subject experienced intra-oral purulent drainage from all five dental implant sites with submental and submandibular space infections two-weeks after surgery. Treatment consisted of extra-oral incision and drainage of involved fascial spaces, removal of all mandibular dental implants and debridement of necrotic mandibular bone. She went onto heal uneventfully.

Conclusion

Individuals taking adalimumab may develop severe infection with loss of implants and bone.

http://bit.ly/2Rnzdwp

Locking Miniplates Osteosynthesis of Anterior Mandibular Fractures – Quo Vadis?

Publication date: Available online 30 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Vyoma Desai, Manoj Kumar Jain

Abstract

Purpose

Compare the clinical stability and efficacy of locking with standard miniplates in the osteosynthesis of anterior mandibular fractures using bite force recordings and other clinical parameters.

Materials and Methods

A prospective randomized double blinded clinical trial was carried out in patients from various hospitals of Hassan. Patients were randomly divided into 2 groups of locking (test) and standard (control) miniplates osteosynthesis. The bite force measurements were performed preoperatively and postoperatively at weekly intervals for 6 weeks using a bite force recorder. As a secondary outcome, the patients also were assessed for other clinical parameters that might interfere with successful osteosynthesis at the fracture site. An appropriate statistical test for the intra and inter group measurements was carried out.

Results

48 male patients of 28±12.3years met the inclusion criteria, with 24 patients in each group. A statistically significant difference (p<0.05) was found in the incisor bite force between the two groups with values in locking exceeding those in standard at the 2^nd and 5^th postoperative weeks. Duration of surgery was also less in locking group (p=0.015). No significant difference was found in other clinical parameters.

Conclusions

Bite force had statistically increased at progressive follow-up visits compared with the pre operative recording in the locking group. Bite force recordings of the patients treated using locking plates were higher and statistically significant than those of the standard miniplates at the incisor region at 2^nd and the 5^th postoperative weeks. The clinical outcome of both miniplate systems in the present study were similar however following advantages with the use of locking miniplates can be highlighted:

http://bit.ly/2WrhQ1k

Wireless Monitoring for Office-Based Anesthesia

Publication date: Available online 30 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Nicholas P. Saggese, Stamatis Baronos, Vito A. Cardo

http://bit.ly/2RnyOtT

Hybrid Arch Bars Reduce Placement Time and Glove Perforations Compared to Erich Arch Bars during the Application of Maxillomandibular Fixation: a Randomized Controlled Trial

Publication date: Available online 30 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Brett J. King, Brian J. Christensen

Purpose

The purpose of the study is to compare the time for placement and removal, the effect on the gingiva, and the operator safety of the Stryker Universal SMARTLock Hybrid MMF system with traditional Erich arch bars.

Methods

The authors designed a parallel group, randomized controlled trial to compare the two types of arch bars. Patients with mandibular fractures presenting to the author's institution were enrolled in the study and randomized into one of two groups: the Erich arch bar group and the hybrid arch bar group. The primary outcome variable was arch bar placement time. Secondary outcomes were glove tears or penetrations during application, gingival appearance score at removal, loose hardware at removal, removal time and glove tears or penetrations at removal. The groups were compared using a t-test.

Results

Ninety patients were enrolled in the study. There were 43 patients randomized to the Erich arch bar group and 47 patients randomized to the hybrid arch bar group. The mean time for application of Erich arch bars was 31.3 ± 9.3 minutes and 6.9 ± 3.1 minutes for the Hybrid arch bars (p<0.0001). There were significantly more glove tears or penetrations during application for the Erich Arch Bar group (0.56 ± 0.91 per application) compared to the Hybrid group (0.11 ± 0.32 per application) (p=0.0025). At removal, there was no difference in overall gingival appearance or amount of loose hardware. The time for removal was significantly less for the Hybrid arch bar group (10.5 ± 5.1 vs 17.9 ± 10.7 minutes) (p=0.0007).

Conclusions

Hybrid arch bars with bone-borne locking screws offer a number of advantages over traditional Erich arch bars and circumdental wires, including placement and removal time and a greater margin of safety for the operating surgeons as demonstrated by significantly fewer glove tears and penetrations.

http://bit.ly/2Wx0zUG

Pedicled Tragal Chondral Flap for Irreparable Temporomandibular Joint Disc

Publication date: Available online 30 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Humberto Fernández-Olarte, Andrés Gómez-Delgado, Daniel Varón Cardona, James Vidal-Villamarín

Abstract

Several techniques have been proposed for the management of perforation or severe damage of the temporomandibular joint (TMJ) disc, with a wide range of success rates reported. In this article, we describe a new method, using a pedicled sliding flap of the tragal cartilage.

http://bit.ly/2RvlL9S

Clinicopathological significance of tumor cyclin D1 expression in oral cancer

Publication date: Available online 30 January 2019

Source: Archives of Oral Biology

Author(s): Pablo Ramos-García, Miguel Ángel González-Moles, Lucía González-Ruiz, Ángela Ayén, Isabel Ruiz-Ávila, Manuel Bravo, José Antonio Gil-Montoya

Abstract

Objective

To evaluate the association of cyclin D1 overexpression with clinicopathological parameters classically considered of prognostic value in OSCC (T, N, M, clinical stage, degree of differentiation, invasive morphology and, cellular proliferation index).

Design

A retrospective immunohistochemical study was conducted of cyclin D1 and ki-67 expression in 68 OSCCs from 54 patients. Cases were scanned using a digital pathology system. The tumor expression of markers was assessed in four randomly selected fields (40x), and a semi-automatized count was conducted of cyclin D1-positive and -negative cells.

Results

Cyclin D1 overexpression was found in 28.7% of the cases of OSCC. It was significantly and positively associated with the following clinicopathological parameters: low tumor differentiation degree (p = 0.030), invasive morphology (p = 0.045), and proliferative phenotype according to tumor cell ki-67 expression(p = 0.018).

Conclusions

Cyclin D1 overexpression is an event of oral carcinogenesis associated with clinicopathological parameters classically associated with a poor prognosis in patients with OSCC.

http://bit.ly/2UsJSrg

Deletion of cas3 gene in Streptococcus mutans affects biofilm formation and increases fluoride sensitivity

Publication date: Available online 29 January 2019

Source: Archives of Oral Biology

Author(s): Boyu Tang, Tao Gong, Xuedong Zhou, Miao Lu, Jumei Zeng, Xian Peng, Shida Wang, Yuqing Li

Abstract

Objective

The goal of this study was to analyze the impact of cas3 gene on the biofilm formation and virulence gene expression in S. mutans, since our previous studies have found a connection between CRISPR/Cas systems and biofilm formation in S. mutans.

Methods

The cas3 gene in-frame deletion strains of S. mutans UA159 was constructed by a two-step transformation procedure and the cas3 mutant strain was complemented in trans. The biofilm biomass was measured by crystal violet staining, and the synthesis of exopolysaccharides (EPS) was measured by the anthrone-sulfuric method. Biofilm analysis and structural imaging was using confocal laser scanning microscope (CLSM) and scanning electron microscope (SEM) assays. The fluorescence in situ hybridization (FISH) was used to analyze the spatiotemporal interactions between S. mutans and Streptococcus sanguinis. Fluoride sensitivity was determined using fluoride tolerance assays. The expression of biofilm formation related genes was evaluated by qRT-PCR.

Results

Our results showed that S. mutans cas3 deletion strain formed less biofilm and became less competitive when it was co-cultured with S. sanguinis under fluoride treatment. The expression levels of virulence genes including vicR, gtfC, smu0630 and comDE were significantly downregulated.

Conclusions

The cas3 gene in S. mutans could regulate biofilm formation and fluoride resistance, consequently affecting S. mutans competitiveness in a dual-species biofilm model under fluoride treatment. These results also provide a potential strategy for enhancing fluoride specificity, with cas3 gene as a potential genetic target in the modulation of oral microecology and the treatment of dental caries.

http://bit.ly/2DJ1NEA

Clinicopathological significance of tumor cyclin D1 expression in oral cancer

Publication date: Available online 30 January 2019

Source: Archives of Oral Biology

Author(s): Pablo Ramos-García, Miguel Ángel González-Moles, Lucía González-Ruiz, Ángela Ayén, Isabel Ruiz-Ávila, Manuel Bravo, José Antonio Gil-Montoya

Abstract

Objective

Design

Results

Conclusions

Cyclin D1 overexpression is an event of oral carcinogenesis associated with clinicopathological parameters classically associated with a poor prognosis in patients with OSCC.

http://bit.ly/2UsJSrg

Deletion of cas3 gene in Streptococcus mutans affects biofilm formation and increases fluoride sensitivity

Publication date: Available online 29 January 2019

Source: Archives of Oral Biology

Author(s): Boyu Tang, Tao Gong, Xuedong Zhou, Miao Lu, Jumei Zeng, Xian Peng, Shida Wang, Yuqing Li

Abstract

Objective

Methods

Results

Conclusions

http://bit.ly/2DJ1NEA

Bismuth supplements as the first‐line regimen for Helicobacter pylori eradication therapy: Systemic review and meta‐analysis

Abstract

Background and Aims

An increase in the use of antibiotics leads to increased antibiotic resistance of Helicobacter pylori (H pylori). Consequently, it has been considered that the first‐line standard regimen should be changed. The main purpose of this study was to evaluate the efficacy of nonantibiotic (bismuth) supplements as a first‐line regimen for H pylori eradication.

Methods

We searched PubMed, EMBASE, CINAHL, and the Cochrane Library databases for randomized controlled trials (RCTs) reported in English and undertaken up until August 2018. A meta‐analysis of all randomized controlled trials comparing bismuth supplements with non‐bismuth‐containing regimens in H pylori eradication was performed. RCTs of classic bismuth‐containing quadruple therapy as a first‐line regimen were excluded.

Results

We identified twenty‐five randomized trials (3990 patients), and the total H pylori eradication rate, according to per protocol analyzed, was 85.8%. The odds ratio was 1.83 (95% confidence interval (CI). 1.57‐2.13). Among these RCTs, there were 7 RCTs for bismuth add‐on therapy, and the odds ratio was 2.81 (95% CI. 2.03‐3.89). When the studies were performed in a high clarithromycin resistance area (≥15%) or included patients with clarithromycin resistance, bismuth‐containing regimens were superior to non‐bismuth regimens. Moreover, the incidence of total side effects was insignificant.

Conclusions

Bismuth supplements as a first‐line regimen could be effective, with bismuth add‐on regimens being the most effective. Particularly, bismuth supplements showed the potential efficacy for clarithromycin‐resistant strains and would be the most viable alternative in clinical practice.

http://bit.ly/2TlKkrt

Neuromyelitis optica spectrum disorder with increased aquaporin-4 microparticles prior to autoantibodies in cerebrospinal fluid: a case report

Neuromyelitis optica spectrum disorders are severe autoimmune inflammatory diseases of the central nervous system associated with the presence of immunoglobulin G antibodies against the water channel protein a...

http://bit.ly/2COIEiU

Severe Influenza A(H1N1) Virus Infection Complicated by Myositis, Refractory Rhabdomyolysis, and Compartment Syndrome

Myositis is a rare and morbid complication of influenza infection that can rapidly progress to rhabdomyolysis with acute renal failure. Here, we describe a 35-year-old obese woman with severe influenza A(H1N1) virus infection complicated by myositis, refractory rhabdomyolysis, and compartment syndrome.

http://bit.ly/2DJN1xz

Pain mechanism of oral ulcerative mucositis and the therapeutic traditional herbal medicine hangeshashinto

Publication date: Available online 30 January 2019

Source: Journal of Oral Biosciences

Author(s): Suzuro Hitomi, Izumi Ujihara, Kentaro Ono

Abstract

Background

Oral ulcerative mucositis causes severe pain during eating and speaking, resulting in poor quality of life for patients with cancer undergoing chemoradiotherapy. Recently, some basic and clinical studies demonstrated that hangeshashinto, a traditional Japanese herbal medicine, alleviated oral ulcerative mucositis-induced pain. Here, we review a recently revealed pain mechanism underlying oral ulcerative mucositis in a preclinical rat model and the pharmacological analgesic effect of hangeshashinto.

Highlight

In a rat model of experimentally induced oral ulcerative mucositis, the mucosal surface of the ulcerative region is damaged, which increases oral bacterial loading in the mucosa and prostanoid production. Chemotherapeutic drugs exaggerate the pathological condition and cause severe pain. The pain-related TRP channels, TRPV1, TRPA1, and/or TRPV4, mediate spontaneous and mechanical pain in oral ulcerative mucositis models. Swab application of hangeshashinto had a prolonged localized analgesic effect on oral ulcerative mucositis, even in a chemotherapy-treated oral ulcer model. Two ingredients of hangeshashinto, gingerol and shogaol, strongly inhibit voltage-activated sodium channels (though they have agonistic effects on TRPV1 and TRPA1), which confers hyposensitivity to the oral mucosa. Their analgesic effects on oral ulcerative mucositis are accompanied by accelerated delivery of drugs (other saponin-containing herbal extracts) into the ulcerative region.

Conclusion

Elucidation of the pain mechanism of oral ulcerative mucositis and analgesic mechanism of hangeshashinto will allow identification of novel therapeutic approaches against oral ulcerative mucositis-induced pain in patients. The traditional Japanese herbal medicine hangeshashinto is a reliable drug with supporting scientific evidence.

http://bit.ly/2FUPcRn

Webinars for continuing education in oral and maxillofacial surgery: The Austrian experience

Publication date: Available online 30 January 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): F. Wagner, C. Knipfer, D. Holzinger, O. Ploder, E. Nkenke

Summary

The aim of the present study was to evaluate the acceptance of a webinar series for continuing medical education hosted by the Austrian Society for Oral and Maxillofacial Surgery (ÖGMKG).

A series of twelve webinars was streamed via the Internet and the participants' satisfaction was evaluated by an online questionnaire.

51 out of 140 participants (36.4%) completed the questionnaire completely and were included into the study for further analysis. The mean age of the participants was 37.9 ± 8.9 and did not vary significantly between gender (p=0.53). The results of the questionnaire revealed a positive attitude of the participants towards this kind of webinar. The participants found that the webinars allowed for an adequate transfer of knowledge.

Continuing medical education by webinars in oral and maxillofacial surgery is well accepted by the participants. Although both male and female participants had a positive attitude towards the webinars, females gave even better ratings than their male counterparts did.

http://bit.ly/2MEPU5C

Issue Information ‐ TOC

http://bit.ly/2G8JB9k

In this Issue: Graphical Abstracts

http://bit.ly/2G21wPR

Issue Information ‐ Cover and Editorial Board

http://bit.ly/2G8JvhY

Detecting the recruitment phenomenon in adults using 80-Hz auditory steady-state response

Publication date: Available online 29 January 2019

Source: Auris Nasus Larynx

Author(s): Toshinori Kubota, Tsukasa Ito, Yasuhiro Abe, Hiroyuki Chiba, Yutaka Suzuki, Seiji Kakehata, Masaru Aoyagi

Abstract

Objectives

The ASSR is used widely as an objective measurement of hearing in clinical settings because of its high frequency specificity. The recruitment phenomenon is generally detected using subjective evaluations which require direct communication with the patient. If the recruitment phenomenon can be detected with ASSR, it would facilitate diagnosis in patients with developmental disorders and infants.

Subjects and methods

We examined 2 groups of subjects: 10 subjects with unilateral hearing impairment in whom the recruitment phenomenon was detected by the alternate binaural loudness balance test and 12 normal subjects. We compared the relationships between the ASSR response and the stimulus sound pressure level in the 2 groups using the 80-Hz ASSR.

Results

The amplitude of ASSR was significantly higher in the impaired ear in hearing-impaired subjects compared to a normal ear in normal subjects. The latency of ASSR was significantly shorter in the impaired ear in hearing-impaired subjects than in the normal ear in the normal subjects.

Conclusion

This study showed that the recruitment phenomenon caused the higher amplitude and the shorter latency observed in hearing-impaired subjects in the 80-Hz auditory steady-state response (ASSR) in comparison with normal subjects.

http://bit.ly/2HG9tM6

The Efficacy of Omalizumab in Cutaneous Mastocytosis: A Case Series

Abstract

Background

Mastocytosis describes a heterogeneous group of disorders arising from a clonal proliferation of mast cells. Given the lack of curative treatments for the cutaneous form, there is a significant need for superior therapies. Omalizumab is a recombinant DNA‐derived humanized IgG monoclonal antibody that selectively binds to human immunoglobulin E (IgE). It represents a potential treatment for the treatment of cutaneous mastocytosis, which currently has no standard treatment.

Methods

Two patients were treated with subcutaneous omalizumab 300 mg every four weeks.

Discussion

Patient one experienced 50% reduction in cutaneous infiltration and moderate improvement in pruritus. Patient two underwent 90% complete clearance of cutaneous lesions and reported full resolution of pruritus. The median duration of treatment was 24 weeks and time to response was eight weeks. No significant changes in tryptase levels were observed. Both patients experienced injection site reactions.

Conclusion

We provide evidence from two cases supporting the efficacy of IgE‐mediated therapy in the treatment of cutaneous mastocytosis. Even at a higher‐than‐standard dose (300mg versus 150mg), the drug was well‐tolerated. As we await the results of pivotal clinical trials, omalizumab appears to be a promising treatment option in patients with cutaneous mastocytosis unresponsive to traditional therapies.

http://bit.ly/2sUDTjB

Effectiveness and safety of switching to biosimilar infliximab and etanercept in patients with psoriasis

Abstract

Real‐life data on the effectiveness and safety of biosimilar and biologic drugs licensed for treatment of psoriasis is lacking. We retrospectively analysed patient records from 69 patients with moderate to severe psoriasis treated at the department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark in the period March 1st 2015 to October 1st 2017 who were administratively switched from the anti‐TNF biologics infliximab (Remicade) and etanercept (Enbrel) to the biosimilars Remsima and Benepali, respectively.

Approximately 25% of patients treated with infliximab and approximately 40% of patients treated with etanercept reported a worse effect after being switched from the original drug to its biosimilar. Quality of life was worse in approximately 30% after switching in both patient groups, respectively. The number of patients reporting adverse events increased in both groups.

http://bit.ly/2MDCrLe

Issue Information

http://bit.ly/2Gevuzn

Clinical Snippets

http://bit.ly/2FWJVZl

Merkelzellkarzinom

Zusammenfassung

Das Merkelzellkarzinom ist ein seltener, hoch aggressiver Hauttumor des älteren Menschen. Er besitzt neuroendokrine Eigenschaften. Die Pathogenese ist mit chronischer UV-Licht-Exposition und dem Merkelzell-Polyomavirus assoziiert. Klinisch fällt das Merkelzellkarzinom durch einen solitären, kutan oder subkutan gelegenen, roten bis bläulichen Knoten auf. Da der Tumor frühzeitig lymphogen metastasiert, sind zum Zeitpunkt der Diagnosestellung in etwa 30 % der Fälle bereits lokoregionäre Metastasen vorhanden. Die häufigen Lokalrezidive sowie die regionäre und ferne Metastasierung zeigen sich meist innerhalb der ersten 2 bis 3 Jahre nach Erstdiagnose. Die erste Therapie nach Diagnosestellung besteht in der vollständigen operativen Entfernung des Primärtumors mit weitem Sicherheitsabstand sowie einer Sentinellymphknotenbiopsie. Anschließend sollte eine adjuvante Radiatio des Tumorbetts erfolgen. Durch eine zusätzliche Bestrahlung der regionären Lymphknotenstationen kann die Rate lokoregionärer Rezidive gesenkt werden. Für die systemische Therapie des fortgeschrittenen Merkelzellkarzinoms haben sich gegen die PD-1/PD-L1-Achse gerichtete Checkpoint-Inhibitoren als gut und dauerhaft wirksam erwiesen. Die vormals häufig eingesetzte Chemotherapie zeigt hingegen zwar mäßige bis gute Ansprechraten, diese sind jedoch in der Regel von sehr kurzer Dauer.

http://bit.ly/2UnAx40

Soy isoflavones reduce asthma exacerbation in asthmatics with high PAI-1 producing genotypes

Publication date: Available online 29 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Seong H. Cho, A Ra Jo, Thomas Casale, Su J. Jeong, Seung-Jae Hong, Jonathan Cho, Janet T. Holbrook, Rajesh Kumar, Lewis J. Smith

Abstract

Background

The 4G4G genotype of plasminogen activator inhibitor-1 (PAI-1) is associated with increased plasma PAI-1 levels and poor asthma control. Previous studies suggest that soy isoflavones may reduce PAI-1 levels.

Objective

We sought to investigate PAI-1 genotype-specific differences of the soy isoflavone response in asthma outcomes.

Methods

A PAI-1 functional polymorphism (rs1799768, 4G5G) was characterized in subjects with poorly controlled asthma enrolled in a randomized clinical trial of soy isoflavones (n=265). Genotype-specific treatment responses on asthma outcomes were compared between soy isoflavones versus placebo. Normal human bronchial epithelial cells (NHBE) were cultured with or without TGF-β1 and/or genistein, and PAI-1 levels were measured.

Results

The 4G4G/4G5G genotype was associated with a higher risk for allergy-related worsened asthma symptoms and eczema at baseline compared to the 5G5G genotype. There was a significant interaction between the genotype and soy isoflavone intervention on oral corticosteroid use for asthma exacerbation (p=0.005). In a subgroup analysis, soy isoflavones significantly reduced the use of oral corticosteroids (number of events/person-year) by four-fold compared to the placebo in the 4G4G/4G5G genotype (0.2 vs 0.8, relative risk 0.28, p <0.001) but not in the 5G5G genotype. Soy isoflavones reduced plasma PAI-1 levels compared to the placebo. Genistein treatment reduced TGF-β1-induced PAI-1 production in NHBE.

Conclusions

This study demonstrates that soy isoflavone treatment provides a significant benefit in reducing the number of severe asthma exacerbations in asthmatic subjects with the high PAI-1 producing genotype. PAI-1 polymorphisms can be used as a genetic biomarker for soy isoflavone responsive subjects with asthma.

http://bit.ly/2HEaqEx

Non-atopic severe asthma might still be atopic: Sensitization towards Staphylococcus aureus enterotoxins

Publication date: Available online 29 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Jens Schreiber, Barbara M. Bröker, Rainer Ehmann, Claus Bachert

http://bit.ly/2SlDkxD

Selective IgA deficiency in humans is associated with reduced gut microbial diversity

Publication date: Available online 29 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Silje Fjellgård Jørgensen, Kristian Holm, Magnhild Eide Macpherson, Christopher Storm-Larsen, Martin Kummen, Børre Fevang, Pål Aukrust, Johannes Roksund Hov

http://bit.ly/2HEakg9

Differential effect of inhibitory strategies of the V617 mutant of JAK2 on cytokine receptor signaling

Publication date: Available online 29 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Emilie Leroy, Thomas Balligand, Christian Pecquet, Céline Mouton, Didier Colau, Andrew K. Shiau, Alexandra Dusa, Stefan N. Constantinescu

Abstract

Background

Janus Kinase 2 (JAK2) plays pivotal roles in signaling by several cytokine receptors. The mutant JAK2 V617F is the most common molecular event associated with myeloproliferative neoplasms. Selective targeting of the mutant would be ideal for treating these pathologies by sparing essential JAK2 functions.

Objective

We characterize inhibitory strategies for JAK2 V617F and assess their impact on physiological signaling by distinct cytokine receptors.

Methods

Via structure-guided mutagenesis, we assessed the role of key residues around F617 and used a combination of cellular and biochemical assays to measure the activity of JAKs in reconstituted cells. We also assessed the effect of several specific JAK2 V617F inhibitory mutations on receptor dimerization using the NanoBiT protein complementation approach.

Results

We identified a novel JH2 αC mutation, A598F, suggested to inhibit the aromatic stacking between F617 with F594 and F595. Like other JAK2 V617F inhibitory mutations, A598F decreased oncogenic activation and spared cytokine activation, while preventing JAK2 V617F-promoted EpoR dimerization.

Surprisingly, A598F and other V617F inhibiting mutations (F595A, E596R, F537A) significantly impaired IFNγ signaling. This was specific for IFNγ since the inhibitory mutations preserved responses to ligand of a series of receptor complexes. Similarly, homologous mutations in JAK1 prevented signaling by IFNγ.

Conclusions

The region of the JH2 αC, which is required for JAK2 V617F hyperactivation, is crucial for relaying cytokine-induced signaling of the interferon gamma receptor. We discuss how strategies aiming to inhibit JAK2 V617F could be used for identifying inhibitors of IFNγ signaling.

http://bit.ly/2SfVK2x

Αρχειοθήκη ιστολογίου

Τετάρτη 30 Ιανουαρίου 2019

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