Dental injuries in patients associated with fracture of facial bones

Abstract

Purpose

To assess different types of dental injuries associated with facial bone fractures.

Method

One hundred dentate patients were selected randomly of all age and gender who had maxillofacial trauma only and having dental injury in association with facial bones fractures were included. They were thoroughly examined for injury/fracture to facial region as well as for dental injuries (teeth). Tooth injuries were noted according to Ellis classification. The data was collected, compiled, and put to statistical analysis.

Results

Dental injuries were more in females than males found to be statistically significant with (p < 0.05).Crown fracture of maxillary teeth was more as compared to mandibular except molars found to be statistically significant (p < 0.05). Root fracture was more in maxillary incisors followed by canine as compared to mandibular incisors and canines found to be insignificant. Avulsion, extrusion and luxation were more in maxilla as compared to mandible found to be significant.

Conclusion

Different types of tooth injuries associated with facial bone fracture found more in females and maxillary teeth.

http://bit.ly/2ShDMgS

Deep Neck Space Infection: Study of 52 Cases

Abstract

Deep neck spaces are still common in developing countries like India, even though its less prevalent in developed nations. It can lead to serious complications like jugular vein thrombosis and dissemination of infection if not diagnosed early and intervened. This is a retrospective chart review of 52 patients from 2014 to 2017 in a tertiary care hospital. Only patients with infection deeper to the superficial fascia of neck were included. Submandibular space infection was the most common and precipitating factor being dental infection. Most common comorbid condition was diabetes mellitus. Klebsiella pneumoniae was the most common isolated organism and few patients had mixed culture with anaerobes. Injectable cephalosporin with metronidazole was the most effective antibiotic combination against such infections. Low threshold for early surgical intervention reduce hospital stay and enable quick recovery of patients. Usage of over the counter antibiotics masks the conditions and complicate diagnosis and treatment of this condition.

http://bit.ly/2SHy3Ak

Errors according to the number of registered markers used in navigation-assisted surgery of the mandible

Abstract

Background

The aim of this study was to evaluate the accuracy of navigation according to the number of markers in terms of target registration errors (TREs) at each anatomical location during the registration process of the navigation system for the mandible.

Methods

The TREs were measured in five different experiments, varying only in the number of registration reference markers, which ranged from three to seven. To measure the TREs according to the number of registration reference markers, two experimental navigation devices were used: 1) Cbyon navigation surgery equipment 2) Polaris optical tracker. Both experiments were conducted to obtain the TREs at the anatomical locations of the mandible according to the number of registration markers during the navigation process. Statistical analysis was performed using the SPSS 23.0 software.

Results

At all anatomical locations, errors were 2 mm or less. Further, significant differences in the target errors measured by the Cbyon system were found according to the number of registration markers. Significant differences in the target errors measured by the Polaris optical tracker were found according to the registration markers at the posterior border only. In both groups, the target errors did not decrease as the number of registration markers increased.

Conclusions

This study demonstrates that an increase in the number of registration markers is not associated with a decrease in the TRE, and that a specific number of registration markers could reduce the TREs at each anatomical site. It is important to determine the minimum number of image registration markers at which the smallest TRE would be observed for different surgical sites.

http://bit.ly/2SlSGmr

Ectoine lozenges in the treatment of acute viral pharyngitis: a prospective, active-controlled clinical study

Abstract

Purpose

Acute pharyngitis is an uncomfortable disorder mostly caused by viruses and for which antibiotics are unwarranted. This study compared lozenges containing ectoine, a natural extremolyte, with hyaluronic acid lozenges and hypertonic saline gargle for symptomatic treatment of acute viral pharyngitis.

Methods

This prospective, controlled clinical study, recruited 90 patients with moderate-to-severe pharyngitis symptoms who chose to use either ectoine (n = 35), hyaluronic acid (n = 35), or saline gargle (n = 20). Patients applied their 7-day treatment from the inclusion visit (V1) until the end-of-study visit (V2). Patients' pharyngitis symptoms, general health, general treatment effectiveness and tolerability, and patient compliance were assessed by investigators and patients.

Results

The sum score for three primary symptoms (pain on swallowing, urge to cough, and hoarseness) decreased by 79.5% (ectoine), 72.2% (hyaluronic acid), and 44.8% (saline gargle). Both lozenges were significantly superior to saline gargle (P < 0.05). Regarding general health improvement, ectoine was significantly superior to saline gargle (72.5% vs. 45.2%, P < 0.05), but hyaluronic acid (63.3%) was not. At V2, 65.7% of patients receiving ectoine reported "very good" general health vs. 48.6% of those receiving hyaluronic acid and 20.0% using saline gargle. Ectoine was significantly superior (P < 0.05) to both hyaluronic acid and saline gargle in terms of tolerability and patient compliance. No patients taking ectoine reported unpleasant sensations while applying their treatment, whereas almost half of patients using hyaluronic acid lozenges and saline gargle did.

Conclusion

Treatment with ectoine lozenges significantly relieves moderate-to-severe symptoms of acute viral pharyngitis and is more effective and tolerable than treatments with hyaluronic acid lozenges and hypertonic saline gargle.

http://bit.ly/2Bsrgk6

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

Abstract

To find out parental expectations regarding outcomes of unilateral cochlear implantation prior to surgery and experience received by them after cochlear implantation and 1 year of regular auditory verbal therapy, with respect to the communication abilities, social skills and participation. Total of 200 parents of hearing impaired children participated in the study. A closed ended questionnaire containing 13 questions were used to collect the data. The participants were instructed to complete all the questions provided based on their expectations and experiences. The descriptive statistics were used to determine the frequency and percentage. Among 200 parents, almost all (95%) of the parents expected to have improvement in all the subscale of communication abilities, social skills and participation. 68.5% of the parents experienced improvement in their child's communication abilities, such as, response to quiet sounds, repetition of words without seeing speaker's face, elimination of use of gestures, easy communication and verbal expression for needs, thoughts and feelings. 76% of the parents experienced improvement in social skills and participations, such as, good relationship with elders, siblings and peers, making friends outside the family, actively participating in the activity done by other children and easily accepted by peers in the classroom. A large number of parents met with their expectations and a small proportion of families were found to be disappointed due to high hopes and unrealistic expectation before implantation, which had adverse effect on the children's performance.

http://bit.ly/2SJDfUi

Polymerization pattern characterization within a resin-based composite cured using different curing units at two distances

Abstract

Objectives

To investigate the relationship of the irradiance-beam-profile areas from six different light-curing units (LCUs) with the degree of conversion (DC), microhardness (KH), and cross-link density (CLD) throughout a resin-based composite (RBC) cured at two clinically relevant distances, and to explore the correlations among them.

Materials and methods

A mapping approach was used to measure DC using micro-Raman spectroscopy, KH using a Knoop indentor on a hardness tester, and %KH reduction after ethanol exposure, as an indicator for CLD within a nano-hybrid RBC increment (n = 3) at various depths. These sample composites were cured from two distances while maintaining the radiant exposure, using six different light-curing units: one quartz-tungsten-halogen; two single and three multiple-emission-peak light-emitting-diode units. Irradiance beam profiles were generated for each LCU at both distances, and localized irradiance values were calculated. Points across each depth were analyzed using repeated measures ANOVA. Correlations across multiple specimen locations and associations between beam uniformity corresponding with polymerization measurements were calculated using linear mixed models and Pearson correlation coefficients.

Results

Significant non-uniform polymerization patterns occurred within the specimens at various locations and depths. At 2-mm curing distance, the localized DC = 52.7–76.8%, KH = 39.0–66.7 kg/mm², and %KH reduction = 26.7–57.9%. At 8-mm curing distance, the localized DC = 50.4–78.6%, KH = 40.3–73.7 kg/mm², and %KH reduction = 28.2–56.8%. The localized irradiance values were weakly correlated with the corresponding DC, KH, and %KH reduction, with only a few significant correlations (p < 0.05).

Conclusions

Although significant differences were observed at each depth within the specimens, the localized irradiance values for all LCUs did not reflect the polymerization pattern and did not seem to have a major influence on polymerization patterns within the RBC, regardless of the curing distance.

Clinical relevance

Commonly used LCUs do not produce uniform polymerization regardless of the curing distance, which may contribute to the risk of RBC fracture.

http://bit.ly/2WRehBP

Visibility, location, and morphology of the primary maxillary sinus ostium and presence of accessory ostia: a retrospective analysis using cone beam computed tomography (CBCT)

Abstract

Objectives

This retrospective study evaluated the visibility, location, and morphology of the primary maxillary ostium (PMO), as well as the presence and number of accessory maxillary ostia (AMO) in the maxillary sinus using cone beam computed tomography (CBCT).

Materials and methods

CBCT scans with a large field of view with both maxillary sinuses entirely visible, acquired from February 2016 to February 2018, were initially screened. Patients were included if there was no history of surgical intervention/trauma in the sinus region. Two observers evaluated the CBCTs for PMO and AMOs independently. PMO and AMOs were evaluated in axial, coronal, and sagittal CBCT views. In case of disagreement, a third observer served as a referee. The findings were correlated with age, gender, condition of the sinus mucosa, and status of the dentition to assess for potential influencing factors.

Results

A total of 184 patients (368 maxillary sinuses) were included. PMO was present and patent in 346 (94.0%) of the 368 analyzed sinuses. Most of the PMOs were located above the attachment of and in the middle third of the inferior turbinate (76.1%) and exhibited a slit shape (71.1%). An AMO was present in 167 (45.5%) of the 368 analyzed sinuses, and 66 (17.9%) sinuses had multiple AMOs. Gender and sinus mucosa morphology were found to be influencing factors for the patency of the PMO. Furthermore, gender seems to be influencing the presence of an AMO.

Conclusions

Most of the analyzed maxillary sinus cavities in the present population had a patent PMO. Being male and having morphological changes of the sinus mucosa were factors associated with a reduced prevalence of a patent PMO.

Clinical relevance

A maxillary sinus with pathological findings of the mucosa seems to have a reduced prevalence of patent PMOs. Therefore, clinicians should take care to assess any clinical and radiographical sign indicating a potential maxillary sinusitis prior to surgical interventions in this region, especially in cases with planned sinus floor elevation.

http://bit.ly/2RPBKzo

The prevalence of hearing loss and use of hearing aids among adults in Germany: a systematic review

Abstract

Background

Worldwide approximately 360 million people suffer from hearing impairment, 328 million of whom are adults. Up to now there has been no systematic evaluation of any representative epidemiological data on the prevalence of hearing loss among adults in Germany. The present paper is intended to investigate this within the framework of a systematic review.

Methods

A systematic literature search was carried out in electronic databases as well as by means of hand-searching. Studies published after 1975 and indicating the prevalence or incidence of hearing impairment among German adults were included. Study selection, data extraction and additional quality assessments were made by two independent reviewers.

Results

By means of a systematic literature search it was possible to identify 6 sources, which provided solely cross-sectional data, whereby the reported data are based on a study population of between some hundred and 10 million people living in Germany. The prevalences ascertained showed a broad range of between 16% and 25% and varied according to age, study setting, definition of hearing loss and method of data capture. At present there are no utilizable data on the extent of the use of hearing aids.

Discussion

The present review demonstrates clearly that evidence-based information relating to Germany can only be made on the basis of a clear definition of hearing loss within the framework of an up-to-date and representative epidemiological study carried out with appropriate methodology. In view of the high prevalence of illnesses causing hearing impairment and of the risks to health associated with untreated hearing impairment as well as of socio-economic costs, such an epidemiological study is of great social significance.

http://bit.ly/2UNmWmQ

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

Abstract

To find out parental expectations regarding outcomes of unilateral cochlear implantation prior to surgery and experience received by them after cochlear implantation and 1 year of regular auditory verbal therapy, with respect to the communication abilities, social skills and participation. Total of 200 parents of hearing impaired children participated in the study. A closed ended questionnaire containing 13 questions were used to collect the data. The participants were instructed to complete all the questions provided based on their expectations and experiences. The descriptive statistics were used to determine the frequency and percentage. Among 200 parents, almost all (95%) of the parents expected to have improvement in all the subscale of communication abilities, social skills and participation. 68.5% of the parents experienced improvement in their child's communication abilities, such as, response to quiet sounds, repetition of words without seeing speaker's face, elimination of use of gestures, easy communication and verbal expression for needs, thoughts and feelings. 76% of the parents experienced improvement in social skills and participations, such as, good relationship with elders, siblings and peers, making friends outside the family, actively participating in the activity done by other children and easily accepted by peers in the classroom. A large number of parents met with their expectations and a small proportion of families were found to be disappointed due to high hopes and unrealistic expectation before implantation, which had adverse effect on the children's performance.

http://bit.ly/2SJDfUi

Editorial Board

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Table of Contents

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CME examination

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Trends in the dermatology residency match from 2007 to 2018: Implications for the dermatology workforce

To the Editor: Dermatology services remain undersupplied in the United States, stemming from both the limited number and geographic distribution of dermatologists.1,2 As an important determinant of workforce growth, the quantity of dermatology residency positions may be a constraining factor.

http://bit.ly/2tg0EyC

Dermatologic care for lesbian, gay, bisexual, and transgender persons

More than 10 million lesbian, gay, bisexual, and transgender (LGBT) persons live in the United States. Improving their health is a public health priority. LGBT persons have specific health concerns and face health care disparities. Awareness of those issues and disparities can enable dermatologists to provide medically appropriate and culturally competent care to LGBT patients. This review highlights terminology important in caring for LGBT persons, LGBT demographics in the United States, health care disparities faced by LGBT persons, and approaches to caring for LGBT patients.

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Bundled payment for actinic keratosis management: Pilot evaluation of developed models

There is an opportunity to explore alternate payment models in dermatology.

http://bit.ly/2UIT9M6

Answers to CME examination

http://bit.ly/2tc5Fb8

Sunburn prevalence among US adults, National Health Interview Survey 2005, 2010, and 2015

To the Editor: Sunburn is a biologic indicator of acute overexposure to ultraviolet (UV) radiation, and sunburn at any age is associated with an increased risk for melanoma.1 Tracking changes in the national prevalence of sunburn over time can provide insight to our nation's progress toward increasing adequate use of sun protection and reducing skin cancer risk at a population level.2 We examined changes over time in sunburn among US adults during 2005-2015.

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February iotaderma (#300)

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Journal Based CME Instructions and Information

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Topical use of mammalian target of rapamycin inhibitors in dermatology: A systematic review with meta-analysis

Systemic mammalian target of rapamycin (mTOR) inhibitors are currently used in many dermatologic indications. Their topical use is recent and poorly codified.

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CME examination

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Dermatology Calendar

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JAAD Case Reports Article List

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Dermatologic care for lesbian, gay, bisexual, and transgender persons

Lesbian, gay, bisexual, and transgender (LGBT) persons face important health issues relevant to dermatologists. Men who have sex with men (MSM) are at higher risk of certain infectious diseases, including HIV, syphilis and other sexually transmitted diseases (STDs), methicillin-resistant Staphylococcus aureus infections, and invasive meningococcal disease, and might be at higher risk of non-infectious conditions, including skin cancer. Recommendations for preventive health care, including screening for HIV and other STDs, sexual health-related vaccinations, and HIV pre-exposure prophylaxis, differ for MSM compared with non-MSM.

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Information for Readers

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Answers to CME examination

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March iotaderma (#301)

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Virtual Surgical Planning and Hardware Fabrication Prior to Open Reduction and Internal Fixation of Atrophic Edentulous Mandible Fractures

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0039-1677723

Mandibular fractures are a common injury encountered by facial trauma surgeons. A majority of these cases are in dentate patients and can predictably be treated with several different open or closed techniques. Edentulous mandible fractures can be challenging as maxillomandibular fixation, either as the sole treatment or used for fracture reduction and stabilization prior to internal fixation, is not possible. The atrophic edentulous mandible fracture poses an even greater challenge, as there is more sclerotic bone present and less bone volume for bony contact, both of which can impair healing. In addition, with less bone mass, available plate adaptation and fixation are difficult. In recent years, virtual surgical planning (VSP) has been increasingly used in craniofacial and maxillofacial surgeries as well as in dentistry. Utilizing VSP to fabricate the necessary hardware prior to open reduction and internal fixation of atrophic edentulous mandible fractures can be helpful in treating these cases. Two cases where this method was used are presented.
[...]

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Nachruf Prof. Dr. Heinz R. Stammberger

Laryngo-Rhino-Otol 2019; 98: 76-76
DOI: 10.1055/a-0828-5454

© Georg Thieme Verlag KG Stuttgart · New York

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Sonografie von Schilddrüsenknoten

Laryngo-Rhino-Otol 2019; 98: 79-84
DOI: 10.1055/a-0790-0849

Die Sonografie gehört zu den Standardverfahren bei der Evaluation von Schilddrüsenknoten. Verschiedene sonografische Veränderungen sind mit einem erhöhten Malignitätsrisiko assoziiert. Basierend hierauf wurden in den letzten Jahren Klassifizierungssysteme entwickelt, um leichter diejenigen Knoten zu selektieren, welche einer weiteren Abklärung bedürfen (TI-RADS: thyroid imaging and reporting systems). Bis jetzt werden in diesen Systemen nur morphologische Kriterien eingeschlossen. Resultate einer Farbdoppler-Sonografie als ergänzendem Verfahren werden in diesen Klassifizierungen nicht berücksichtigt, obwohl eine erhöhte intranoduläre Vaskularisation bei follikulären Neoplasien mit einem erhöhten Malignitätsrisiko assoziiert ist. Aktuell werden die neuen Systeme evaluiert und müssen gegebenenfalls für die klinische Praxis optimiert werden. Außerdem gibt es erste Ansätze, die Dokumentation der Ultraschallergebnisse weiter zu standardisieren, um die diagnostischen Möglichkeiten der Ultraschalluntersuchung im Sinne der Verbesserung der Patientenversorgung zu optimieren.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2019; 98: 68-69
DOI: 10.1055/a-0784-9800

© Georg Thieme Verlag KG Stuttgart · New York

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Kehlkopf-Karzinom: Wundbettbiopsien nach TLM-Behandlung sinnvoll

Laryngo-Rhino-Otol 2019; 98: 71-72
DOI: 10.1055/a-0785-0981

Hendriksma M et al. Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control. Eur Arch Otorhinolaryngol 2018; 275: 2333–2340 Bei Patienten mit primärem Kehlkopf-Plattenepithelkarzinom (Tis-T2) beurteilten niederländische Kopf- und Hals-Chirurgen den Effekt des Resektionsrand-Status auf die lokale Kontrollrate nach Behandlung mit transoraler CO2-Laser-Mikrochirurgie (TLM). Darüber hinaus überprüften die Bedeutung zusätzlicher Wundbettbiopsien.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Assoziation von allergischer Rhinitis und Hypertonie untersucht

Laryngo-Rhino-Otol 2019; 98: 74-75
DOI: 10.1055/a-0651-4041

Sakallioglu O et al. Allergic rhinitis and arterial blood pressure: a population-based study. J Laryngol Otol 2018; 132: 418–422 Gibt es einen Zusammenhang von allergischer Rhinitis und arteriellem Blutdruck sowie Bluthochdruck? In einer bevölkerungsbasierten Untersuchung wollten türkische Ärzte diese Frage klären.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Beurteilung der Tubenfunktionsstörung mit dem ETDQ-7

Laryngo-Rhino-Otol 2019; 98: 72-74
DOI: 10.1055/a-0621-2000

Harju T et al. Eustachian Tube Dysfunction–Related Symptoms in Chronic Nasal Obstruction Caused by Inferior Turbinate Enlargement. Ann Otol Rhinol Laryngol 2017; 126: 798–803 Ärzte des Universitätskrankenhauses von Tampere, Finnland, beurteilten den Zusammenhang zwischen chronischer Nasenverstopfung durch Vergrößerung der unteren Nasenmuschel und Symptomen, die durch eine Eustachi-Tubendysfunktion bedingt sind, mit Hilfe des „Eustachian Tube Dysfunction Questionnaire" (ETDQ-7) als Instrument zur Evaluation einer Tubenfunktionsstörung.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Spiegeluntersuchung in der HNO

Laryngo-Rhino-Otol 2019; 98: 77-78
DOI: 10.1055/a-0784-9833

© Georg Thieme Verlag KG Stuttgart · New York

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Wenn gehörlose Kinder hörend werden – Auswirkungen der CI-Versorgung von gehörlosen Kindern gehörloser Eltern auf deren Familiensituation

Laryngo-Rhino-Otol 2019; 98: 85-90
DOI: 10.1055/a-0790-0934

1993 wurden erstmalig gehörlose Kinder von gehörlosen Eltern mit CI versorgt. Die Situation dieser Kinder und ihrer Eltern ist immer wieder Gegenstand von Forschungen des seit 2000 bestehenden Münchner Forschungsprogramms „Gehörlose Eltern und Kinder mit CI". Zu diesem gehört die Teilstudie „Familiensituation von gehörlosen Eltern mit CI-Kindern". Eines der Ergebnisse dieser Studie ist, dass die implantierten Kinder die Rolle von Codas übernehmen. Das zeigt sich insbesondere in der Übernahme von Dolmetschleistungen für die Eltern.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Faziale Hauttumore: Resektion und plastische Defektrekonstruktion – Teil 1

Laryngo-Rhino-Otol 2019; 98: 117-128
DOI: 10.1055/a-0784-9844

Die Häufigkeit von Tumoren der Gesichtshaut nimmt aufgrund der steigenden UV-Exposition und der zunehmenden Alterung der Bevölkerung zu. Gleichzeitig steigen die Ansprüche an die Funktion und Ästhetik der rekonstruktiven Chirurgie im Gesicht. Die In-sano-Resektion mit Sicherheitsabstand ist der entscheidende erste Schritt eines operativen Vorgehens. Die anschließende Rekonstruktion ist von patientenspezifischen und weiteren Faktoren abhängig.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Retinovaskuläre Zeichen des Susac-Syndroms

Laryngo-Rhino-Otol 2019; 98: 108-113
DOI: 10.1055/a-0747-6968

Hintergrund Das Susac-Syndrom ist eine Vaskulopathie mit Manifestationen am zentralen Nervensystem, an der Retina und am Innenohr und ist gekennzeichnet durch die klinische Trias aus Enzephalopathie und/oder fokalen neurologischen Symptomen, Hörminderung und retinalen Arterienastverschlüssen. Bisher wurden nur etwa 300 Fälle in der medizinischen Literatur beschrieben. Patienten/Methoden Drei Patienten mit gesichertem Susac-Syndrom wurden retrospektiv auf das Vorhandensein krankheitstypischer retinaler Veränderungen untersucht. Ergänzend wurde der Krankheitsverlauf analysiert mit der Zielsetzung, ein besseres Krankheitsverständnis zu erreichen. Ergebnisse In allen 3 beschriebenen Fällen besteht eine okklusive retinale Mikroangiopathie mit einhergehenden Arterienastverschlüssen. In der cMRT zeigen sich bei 2 von 3 Fällen krankheitstypische, umschriebene „snowball"-artige Läsionen des Corpus callosum, die gemeinsam mit dem Netzhautbefund die diagnostische Zuordnung ermöglichten. Die klassische Trias aus Innenohrschwerhörigkeit, retinalen Arterienastverschlüssen und ZNS-Symptomatik war allerdings in keinem der Fälle bei ärztlichem Erstkontakt vollständig ausgeprägt. Schlussfolgerung Die Diagnosesicherung setzt eine enge interdisziplinäre Zusammenarbeit zwischen Neurologen, Psychiatern, HNO- und Augenärzten voraus. Die typischen okulären Zeichen einer segmentalen Mikrovaskulopathie mit Okklusion kleiner Arterien sollten auch bei isoliertem Auftreten Anlass dazu geben, das Krankheitsbild in die Differenzialdiagnose einer okklusiven retinalen Vaskulopathie mit einzubeziehen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Mindestmengen: Die Qual der Zahl oder Mittel der Qualitätssicherung?

Laryngo-Rhino-Otol 2019; 98: 114-116
DOI: 10.1055/a-0784-9855

© Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2019; 98: 129-130
DOI: 10.1055/a-0784-9866

© Georg Thieme Verlag KG Stuttgart · New York

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Erratum: Stellenwert der Sialendoskopie an deutschen HNO-Kliniken im Jahr 2016

Laryngo-Rhino-Otol 2019; 98: E1-E1
DOI: 10.1055/a-0849-2046

© Georg Thieme Verlag KG Stuttgart · New York

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Fehlbildungschirurgie von Nase und Lippe

Laryngo-Rhino-Otol 2019; 98: 131-133
DOI: 10.1055/a-0784-9910

© Georg Thieme Verlag KG Stuttgart · New York

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Eliminating health disparities in asthma: are we at the end of the beginning?

Health equity, defined as "the attainment of the highest level of health for all people",1 continues to be a fundamental but difficult-to-achieve goal in the United States (U.S.), where some racial and ethnic minority groups are disproportionately affected by respiratory diseases such as asthma. Indeed, the prevalence of asthma is higher in Puerto Ricans (14.3%) and African Americans (11.6%) than in non-Hispanic whites (8.3%) or Mexican-Americans (5.7%).2 Moreover, Puerto Ricans and African Americans have higher morbidity and mortality from asthma than non-Hispanic whites2,3.

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Emerging Triggers of FPIES: Lessons from a Pediatric Cohort of 74 Children in the US

Food protein-induced enterocolitis syndrome (FPIES) is a rare non-IgE mediated gastrointestinal food-induced allergic disorder occurring predominantly in infants and young children. Common food triggers and the natural history of FPIES vary according to geographic location. It is a serious condition that is still under-recognized, resulting in a delay in diagnosis and appropriate management. FPIES is characterized by delayed onset of repetitive vomiting occurring approximately 1 to 4 hours after food ingestion.

http://bit.ly/2GgYqr1

Characteristics of Inner City Children with Life-Threatening Asthma

Poor children living in US inner cities have high prevalence of asthma as well as asthma related morbidity and mortality.(1-3) In 2013, there were 3,640 deaths due to asthma in the US; a rate of 1.1 deaths per 100,000 population.(4) Between 2007-2009, the death rate for African Americans aged 0–14 years was almost eight times greater than for whites in that age group(3). Several risk factors have been identified for fatal and near fatal asthma including a prior asthma admission to an intensive care unit (ICU), overuse of short acting beta agonists, underutilization of controller medication, poor recognition of asthma severity, psychosocial factors and multiple allergen sensitivity(5-8).

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Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy

As has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy.

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Adjunctive antimicrobial photodynamic therapy using methylene blue/ethanol formulation in experimental periodontitis in diabetic rats: short-term results

Abstract

The aim of this study was to evaluate the effect of an MB experimental formulation (ethanol 20%) in aPDT used as an adjuvant to scaling and root planing (SRP) in the periodontal treatment of diabetic rats. Forty male Wistar rats received streptozotocin-intraperitonial injections to induce diabetes. After 14 days, 5 animals were allocated in the non-ligate group (NLG), and 35 animals received ligature at the first right mandibular molar to induce periodontitis. After 7 days, the ligature was removed and the animals were randomized into 4 groups: LG (without treatment, n = 5), SRPG (SRP, n = 10), aPDTW (SRP+aPDT-MB/water, n = 10), and aPDTEt (SRP + aPDT-MB/water/ethanol/carboxymethylcellulose, n = 10). Animals were euthanized after 7 days. Data of bone loss (BL) area, degree of inflammatory cell response, and collagen fibers percentages were statistically analyzed (p < 0.05). Percentage of animals that presented mild and severe inflammatory infiltrate was 10% and 40% for SRPG, 20% and 30% for aPDTW, and 50% and 0% for aPDTEt, respectively. BL area (mm²) was statistically higher in the LG (0.39 ± 0.15) than NLG (0.05 ± 0.02). aPDTEt showed the lowest value of BL (0.08 ± 0.03), followed by aPDTW (0.21 ± 0.15) and SRPG (0.31 ± 0.18). Statistical differences were verified between aPDTEt and SRPG. In relation to the LG, aPDTEt, aPDTW, and SRPG recovered the equivalent 80%, 46%, and 20% of the BL. aPDTEt showed collagen content statistically higher than SRPG and LG, and presented higher mean values than NLG (p > 0.05). Our findings showed aPDTEt presented promising results. aPDT using MB/ethanol can have potential as an adjunctive periodontal treatment in diabetics.

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The Rationale for Endoscopic Inferior Meatal Antrostomy

Background: Complete removal of some maxillary sinus pathologies may be challenging. We describe our experience in performing endoscopic inferior meatal antrostomy (EIMA) when approaching certain chronic maxillary sinus disease. Methods: Retrospectively reviewing charts of all patients whose surgery included EIMA between the years 2012 and 2015. EIMA was performed either after routine endoscopic middle meatal antrostomy (EMMA) failed to completely resect the lesion, or as the sole selected approach for specific maxillary pathologies. Results: A total of 56 patients were included in the study. Indications for EIMA included antrochoanal polyps (ACP), maxillary sinus chronic inflammatory disease, maxillary sinus pathology before sinus lift, and odontogenic maxillary sinusitis. In nearly one third of the patients, sinus surgery included only EIMA, of which, the majority were resection of ACP. Follow-up time ranged between 12 and 34 months (mean 14). Residual EIMA opening was variable in size. In the vast majority of our patients, the maxillary sinus cavities were cleared of disease. No major complications and no recirculation were observed in any of the patients. Conclusion: EIMA should be considered for various maxillary sinus pathologies. It provides better access to anteroinferior lesions of the maxillary sinus. EMMA is not mandatory for every maxillary sinus disease.
ORL 2019;81:41–47

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Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study

The aim of this study was to compare the safety of tooth extraction in patients receiving direct oral anticoagulants (DOACs) or warfarin without cessation of their antithrombotic treatment. This prospective observational study included 367 patients undergoing tooth extraction (119 receiving DOACs and 248 receiving warfarin). All extractions in DOAC patients were performed 6–7h after taking DOACs in consideration of the half-life in blood under continued antithrombotic treatment. To examine the potential postoperative bleeding risk related to the time of extraction and the drug concentration of blood, activated partial thromboplastin time (APTT) in dabigatran and prothrombin time (PT) in rivaroxaban were measured three times after administration.

http://bit.ly/2Gl59QS

“Platelet-rich plasma and its utility in the treatment of acne scars - A systematic review”

The field of dermatology has seen numerous therapeutic innovations in the past decade with platelet-rich plasma recently garnering significant interest in acne scarring. This review consolidates the available evidence of platelet rich plasma for the practicing dermatologist and evaluates the current evidence up to May 31, 2018. A search was conducted in the PubMed database for "platelet rich plasma" or "platelet releasate" or "platelet gel" or "PRP" and "dermatology" or "skin" or "hair" or "cutaneous" with thirteen articles meeting the inclusion criteria.

http://bit.ly/2Dr1OMq

Trends in Scholarly Productivity of Dermatology Faculty by Academic Status and Gender

http://bit.ly/2SijGTZ

Guaiacol/β-cyclodextrin for rapid healing of dry socket: antibacterial activity, cytotoxicity, and bone repair—an animal study

Abstract

Purpose

Dry socket (DS) is one the most common and symptomatic post-extraction complications; however, no consensus on its treatment has been reached. This study aimed to develop a novel dressing material for DS containing the phenolic agent guaiacol and evaluate its biological properties.

Methods

An inclusion complex of guaiacol and β-cyclodextrin (Gu/βcd) was prepared by freeze-drying. Its antibacterial activity over six oral bacteria was analyzed using the microdilution method, and its cytotoxicity in osteoblasts was assessed with the MTT assay. The alveolar healing process induced by Gu/βcd was evaluated histologically after the treatment of DS in rats.

Results

βcd complexation potentiated Gu's antibacterial effect and reduced its cytotoxicity in osteoblasts. Bone trabeculae were formed in the alveolar apices of rats treated with Gu/βcd by day 7. On day 14, woven bone occupied the apical and middle thirds of the sockets; on day 21, the entire alveolus was filled by newly formed bone, which was in a more advanced stage of repair than the positive control (Alvogyl™).

Conclusion

The improvement in Gu's biological properties in vitro and the rapid alveolar repair in comparison with Alvogyl™ in vivo demonstrated the benefits of the Gu/βcd complex as a future alternative for the treatment of DS.

http://bit.ly/2E1GkXO

Multidisciplinary oral rehabilitation of an adolescent suffering from juvenile Gorlin-Goltz syndrome – a case report

The Gorlin-Goltz syndrome is an autosomal dominant disorder characterized by keratocystic odontogenic tumors in the jaws, multiple basal cell carcinomas and skeletal abnormities. Frequently, the manifestation ...

http://bit.ly/2TEdrXb

Paraneoplastic opsoclonus–myoclonus syndrome as a rare presentation of breast cancer

Abstract

Opsoclonus–myoclonus paraneoplastic syndrome is a medical condition that includes opsoclonus along with diffuse or focal body myoclonus and truncal titubation with or without ataxia and other cerebellar signs. This rare neurological syndrome is poorly understood and can result in long-term cognitive, behavioral and motor sequelae. We report a case of a 49-year-old woman with anti-Ri antibody opsoclonus–myoclonus syndrome and an invasive ductal carcinoma with axillary nodes involvement. Following the diagnosis of opsoclonus–myoclonus syndrome, a multimodal immunotherapy treatment, with partial remission of the neurological symptoms. The patient underwent lumpectomy and axillary node dissection and the surgical pathology confirmed the diagnosis of breast cancer stage IIA. This was followed by chemotherapy, radiotherapy and hormone therapy with tamoxifen. At the 6 months follow-up there was a partial improvement, anti-Ri antibody was subsequently reported as negative and there was no evidence of disease recurrence.

http://bit.ly/2I9p0o2

Colon adenocarcinoma with metastases to the scaphoid: a case report and review of the literature

Abstract

Metastases to the hand and wrist are extremely rare, with <250 cases described in the literature. We present a case of acrometastasis of colon adenocarcinoma to the scaphoid in an 81-year-old male. Adenocarcinoma of the colon metastasizes to bone in an estimated 10% of cases; however, we are unaware of reports of this tumor metastasizing to the scaphoid or to any of the other carpal bones. We were able to identify only two cases of scaphoid metastases in the literature. This case highlights the potential for metastatic disease and other lesions to develop in the scaphoid and carpus.

http://bit.ly/2I1Dnuf

Postoperative hemiparesis following tonsillectomy

Abstract

We report a rare complication following a routine elective tonsillectomy. A 32-year-old woman woke up from general anaesthesia with left sided hemiparesis. She underwent extensive investigations, which were normal. At follow-up neurology clinic she was given a new diagnosis of hemiplegic migraine and commenced on treatment. This case draws attention to a rare cause of postoperative hemiparesis. Hemiplegic migraine is a differential diagnosis for postoperative motor deficit after exclusion of an acute neurological or metabolic event.

http://bit.ly/2I1DC8D

Laryngeal ulceration in Behçet’s disease: the role of centres of excellence in the UK

Abstract

Introduction

Behçet's disease (BD) is a rare complex multisystem inflammatory condition characterized by the triad of symptoms: aphthous ulcers of the mouth and genitalia and uveitis.

Case report

We present the case of a 31-year-old Caucasian male who had a prolonged journey from first presentation until diagnosis of BD. For 11 years, he presented symptoms affecting the oral cavity and oropharynx, with worsening odynophagia and dysphagia and ultimately, development of stridor. Flexible laryngoscopy showed significant laryngopharyngeal ulceration and scarring. Treatment was with colchicine, corticosteroids and azathioprine and supervised by one of three newly established BD Centres of Excellence in the UK.

Discussion

Although uncommon, ENT manifestations in patients with BD should be taken into consideration to allow for early recognition and treatment of what can become a life-threatening condition. In such situations, early referral to a BD Centre of Excellence is essential to provide confirmation of diagnosis and supervision of treatment.

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A rare case of small bowel obstruction secondary to activated charcoal administration

Abstract

Intestinal obstruction is a rare complication of the administration of activated charcoal. We describe a 22-year-old patient who had received multiple-dose activated charcoal for carbamazepine intoxication. The patient presented with sudden-onset abdominal pain after discharge from the emergency room, and abdominal imaging examinations revealed findings consistent with small bowel obstruction. Laparoscopic-assisted exploration of the abdomen was offered, and a hard obstructing charcoal mass was found in the small bowel. Clinicians should be aware of the rare occurrence of gastrointestinal complication or obstruction following the administration of multiple-dose activated charcoal, especially in patients who ingested a drug that is potentially antiperistaltic.

http://bit.ly/2I1DzJZ

When breast cancer gets complicated. A case report of synchronous bilateral breast cancers with discordant tumor markers from the primary to nodes with findings of a sentinel internal mammary subpectoral lymph node

Abstract

This case reviews synchronous bilateral breast cancer with left infiltrating ductal carcinoma ER+/PR−, Her2− and right invasive lobular carcinoma ER+/PR−, Her2−. Independent primary bilateral breast tumors are present in 0.2–3.2% of breast cancer. Biopsy also showed differing ER status on the left breast versus the node which was triple negative. The final sentinel node was a left internal mammary node. Recent studies have found that the ER, PR and HER2 status of the primary tumor do not always correlate to the ER, PR and HER2 status of the metastatic sites. This can have deleterious effects on survival. There are no clear guidelines on course of treatment for these complex cases. A review of the current literature is supportive of treating the highest-risk breast malignancy. Despite the unusual pathology and severity of disease, our patient is doing well with treatment.

http://bit.ly/2Ghfxt2

Primary midgut volvulus in a patient with Marfan syndrome

Abstract

Marfan syndrome is a mutation in the fibrillin-1 gene resulting in a connective tissue disorder primarily affecting musculoskeletal, cardiovascular and ocular systems. However, patients with Marfan's rarely manifest gastrointestinal symptoms. Midgut volvulus is abnormal twisting of small bowel around its mesentery that can result in compromising blood flow to the bowel causing intestinal ischemia and obstruction. Primary midgut volvulus is a term used when there is no underlying cause for the volvulus. This case describes an 80-year-old female with Marfan syndrome presenting with primary midgut volvulus, which preoperatively was suspected based on imaging, and later confirmed upon operative exploration. The small bowel mesentery was long with a narrow base twisted around its mesentery 360°. The long narrow base and floppy mesentery likely contributed to hypermobility leading to volvulus and small bowel obstruction. To our knowledge, this is the first reported case of primary midgut volvulus associated with Marfan's syndrome.

http://bit.ly/2I9p47g

Extra-gastrointestinal stromal tumor with a large cyst

Abstract

Gastrointestinal stromal tumors (GISTs) arising at sites other than the alimentary tract are rare, and they are called extra-GISTs (EGISTs). We report a case of a large EGIST forming a cyst, probably arising in the mesentery of the transverse colon. A 64-year-old Japanese man presented to a hospital with an abdominal tumor forming a large cyst. Intraoperatively, the tumor was neither present in nor in contact with the alimentary tract. It was present in the mesentery of the transverse colon and was attached to the greater omentum and peritoneum, immediately anterior to the body of the pancreas. The tumor was resected with the spleen and a part of the pancreas. Histological examination of the tumor revealed that it belonged to the high-risk category of cystic EGISTs.

http://bit.ly/2Gi8z6N

Knee locked in flexion: incarcerated semitendinosus tendon around a proximal tibial osteochondroma

Abstract

This case reports on a knee locked in flexion due to incarceration of the semitendinosus tendon around an osteochondroma in a patient with a history of multiple hereditary exostoses (MHE). An 18-year-old female with history of MHE presented with acute right medial knee pain and inability to extend her knee. Radiographs confirmed multiple lower extremity osteochondromas, notably a large, 3-cm pedunculated osteochondroma about her right medial proximal tibia. This was assessed as a locked knee secondary to incarcerated hamstring tendons around an osteochondroma. Excision of the osteochondroma restored normal flexion and extension of her knee. At the 3-month follow-up visit, she had returned to all activities with no recurrent medial knee pain or locking. The differential diagnosis for a locked knee joint can be broad, but tendon incarceration should be considered in appropriate patients with significant symptoms. In patients with a history of MHE, osteochondromas may be the cause of tendon entrapment.

http://bit.ly/2GfwGTH

Glioblastoma and prolactinoma: a rare simultaneous occurrence

Abstract

The simultaneous development of two or more primary central nervous system (CNS) tumors of different cell types represents 0.9% of all diagnosed CNS tumors. To the best of our knowledge, the simultaneous occurrence of glioblastoma and pituitary adenomas has been reported four times in the English literature, with only two cases harboring prolactinoma and glioblastoma. We report a case of a 42-year-old male who was diagnosed with a sporadic co-occurrence of glioblastoma and a prolactin-secreting pituitary adenoma (prolactinoma). This case report discusses the clinical presentation, radiological/histopathological features, and outcome as well as reviewing the pertinent medical literature. Glioblastoma and a prolactin-secreting adenoma may be detected within the same patient. Further studies are required to delineate the tumorigenesis of the development and co-occurrence of multiple intracranial tumors.

http://bit.ly/2I9oXsm

Open brachiocephalic artery stent for static obstruction caused by acute type A aortic dissection

Abstract

Brachiocephalic artery dissection complicated by acute type A aortic dissection occasionally causes cerebral malperfusion. Although immediate central aortic repair has been the standard treatment for aortic dissection, dissection in supra-aortic vessels frequently remains after the surgery. The residual brachiocephalic artery dissection is reported to be associated with late neurological events. Therefore, additional intervention for brachiocephalic artery dissection during central aortic repair should be considered in selected cases. In this report, we describe two cases requiring open brachiocephalic artery stenting simultaneous with central aortic repair. There were no neurological or stent induced complications at latest follow-up.

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Intraductal papilloma of the male breast: a case report and review of the literature

Abstract

Intraductal papilloma is a benign neoplasm rarely found in the male breast. In this report, we present the case of a 55-year-old Caucasian man who presented with spontaneous bloody nipple discharge of the right breast. Ultrasonic and mammographic investigations revealed a sub-centimetre solid mass within a dilated duct. He underwent a total duct excision. Histopathologic examination confirmed a benign intraductal papilloma with no evidence of atypia or malignancy. A systematic review of the literature revealed six published cases of intraductal papillomas in men. Clinical presentation is the same as in women with single duct blood stained discharge being the most common presenting symptom. Surgical excision offers both histologic confirmation and definitive treatment. There is one case where the lump was not removed and progressed to malignancy years later. Male intraductal papillomas may be associated to medical treatments with hormonal activity given for other reasons or endocrine abnormalities.

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Collapsed wall: destructive and reconstructive surgery of anterior abdominal wall tumour in a young girl

ABSTRACT

Natural history of abdominal wall soft tissue sarcoma is still poorly understood due to its rarity. In unpublished data of our institution, only seven cases of abdominal wall soft sarcoma with ICD-10 coding of 49.4 were found for past 10 years. We illustrate a case of juvenile fibrosarcoma of anterior abdominal wall. This is a case of young girl with anterior abdominal wall tumour, underwent wide local excision with immediate reconstruction. There are few options of surgical treatment for this case, but which is the best. It is always a challenge in managing young patient with giant abdominal wall defect in view of long term effect namely weakened abdominal wall, pregnancy related issue and risk of herniation and surgical site recurrence as well.

http://bit.ly/2GhLcKW

Laparoscopic deroofing of a ruptured hepatic cyst presenting as an acute abdomen

Abstract

The rupture of a nonparasitic hepatic cyst is a rare complication for which there is no optimal treatment strategy yet. Laparoscopic deroofing is the standard approach for the elective treatment of symptomatic NHCs but it has seldom been described as an option for a ruptured hepatic cyst. The authors report a case of a male patient presenting to the emergency room with an acute abdomen caused by the rupture of a hepatic cyst. The patient was successfully treated by urgent laparoscopic deroofing of the cyst. Laparoscopic surgery can be a valid option for treating urgent cases presenting the same efficacy and less morbidity than open surgery.

http://bit.ly/2I9oRRw

Bariatric surgery and the evaluation of subclinical systemic lymphedema

Abstract

The aim of the study was to report an improvement in clinical lymphedema in a patient who went from morbid obesity to overweight following bariatric surgery. A 52-year-old female patient reported having undergone bariatric surgery with a body mass index (BMI) of 51.2 kg/m², losing 40 kg and arriving at her current BMI of 37.1 kg/m². She would previously awake with bilateral edema that involved her feet and worsened throughout the day, corresponding to clinical stage II lymphedema, and currently no longer had this problem. Eight years after the surgery and weight loss, the patient was submitted to electrical bioimpedance analysis, which revealed an increase in total intracellular and extracellular fluids in the limbs and trunk. Active exercise and further weight loss were recommended. This study paves a path for a new line of investigation in the treatment of obesity and changes in the lymphatic system caused by obesity.

http://bit.ly/2GfSjn5

The tales of two neighbours: when cholecystitis does not preclude pancreatitis

Abstract

An 83-year-old lady with no previous history of gallstones, presented with a sudden-onset severe epigastric pain radiating through to the back associated with nausea and vomiting. On examination, the patient's vital signs were normal. There was severe epigastric tenderness on palpation, as well as moderate right upper quadrant tenderness. Serological investigations showed raised inflammatory markers and serum lipase of 13 000, confirming the diagnosis of acute pancreatitis. Liver function tests were mildly deranged with a normal bilirubin of 12 μmol/L. An abdominal ultrasound demonstrated a distended gallbladder with multiple subcentimeter gallstones and diffuse wall thickening up to 7 mm, consistent with cholecystitis. A follow-up CT abdomen demonstrated evidence of pancreatitis with moderate peripancreatic fat stranding. The diagnosis of concomitant acute cholecystitis and gallstone pancreatitis was made based on the radiological and biochemical findings. The patient underwent an uncomplicated laparoscopic cholecystectomy. The histopathology confirmed cholelithiasis with acute on chronic cholecystitis.

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Upper extremity distal dual bypass enables arteriovenous fistula construction in a critical limb ischemia

Abstract

Background

Arteriovenous fistula (AVF) trouble in a dialysis patient sometimes results in severe forearm ischemia.

Case presentation

We present the case of 27-year-old man with severe steal syndrome complained of AVF malfunction. There was a condition where an upstream artery of AVF is occluded and AVF is maintained by regurgitation from the palmar arch with ischemic digits. The patient underwent distal dual bypass: proximal to peripheral artery arterioarterial and arteriovenous bypasses and brachial arterioplasty. His skin perfusion pressure improved from 17 to 90 mmHg with enough quantity of blood: 250 ml/min for hemodialysis.

Conclusions

In severe steal syndrome cases, it is often observed that proximal artery is occluded and AVF inflow was supplied from palmar circulation and collateral vessels. Distal dual bypass is effective to re-establish digital circulation and repair AVF malfunction simultaneously in PAD patients.

http://bit.ly/2GhPtO7

Transverse colon perforation secondary to fish bone ingestion

Abstract

Accidental ingestion of foreign bodies can be a common occurrence in clinical practice and subsequent perforation is quite rare. The rate of fish bone ingestion is predicted to be higher in some cultures given culinary differences. We report a case of 62-year-old gentleman in rural Australia who had severe left sided abdominal pain and fevers, with a presumptive diagnosis of diverticulitis. Computated tomography revealed intraabdominal abscess. Surgical intervention via laparotomy and right hemicolectomy was performed for an extensive abdominal abscess with a transverse colon perforation and fish bone foreign body in situ (Grunter fish).

http://bit.ly/2GhL91I

Portal venous gas and pneumatosis intestinalis: ominous findings with an idiopathic aetiology

Abstract

Pneumatosis Intestinalis and hepato-portal venous gas are rare but ominous radiological findings that are synonymous with mesenteric ischaemia and bowel infarction in the majority of cases. Very uncommonly benign pathology have been implicated, including respiratory and inflammatory bowel disease. We provide a case of a 69-year-old gentleman with extensive peripheral vascular disease, who presented with generalized abdominal pain and findings of both pneumatosis intestinalis and hepato-portal venous gas. Laboratory investigations were unequivocal, with only mild lactatemia. Emergency laparotomy was performed, which revealed no obvious cause and only some turbid pelvic free fluid. The patient had an uncomplicated recovery. This case illustrates the importance of guiding decisions based on the patient's clinical state, and of keeping an open mind to benign pathology. It also highlights the importance of early surgical intervention in cases of high clinical suspicion.

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Oral cancer of Sigmund Freud

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Bleeding assessment in oral surgery: a cohort study comparing individuals on anticoagulant therapy and a non-anticoagulated group

Publication date: Available online 7 February 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Amanda Leal Rocha, Sicilia Rezende de Oliveira, Alessandra Figueiredo Souza, Denise Vieira Travassos, Lucas Guimarães Abreu, Daniel Dias Ribeiro, Tarcília Aparecida Silva

Abstract

Some prospective studies have been designed specifically to investigate perioperative bleeding in dental surgery. The quantitative assessment of intraoperative blood loss can be useful for indicating the real risk of bleeding complications, especially in medically compromised individuals. The aim of this study was to evaluate the pattern of bleeding in individuals under vitamin K antagonist (VKA) therapy and non-anticoagulated individuals submitted to dental extractions. Perioperative bleeding was evaluated by using a total collected bleeding corrected by absorbance reading (dental bleeding score). 138 procedures were performed. When the perioperative dental bleeding score was correlated with the number of extracted teeth, the quantity of bleeding was found to be directly proportional to the procedure. Extractions of two or more teeth presented higher scores than single extractions (p = 0.003). In a comparative analysis between the VKA and non-anticoagulated groups, no significant difference in the scores was found. The previous history of complications in dental procedures (p = 0.001) and the use of additional hemostatic measures were higher in the VKA group (p = 0.017). VKA therapy did not impact significantly the volume of blood lost during dental extractions. Perioperative bleeding assessment might be a useful parameter for evaluating patients under antithrombotic treatment.

http://bit.ly/2BpYn8s

Immune checkpoints and the regulation of tolerogenicity in dendritic cells: Implications for autoimmunity and immunotherapy

Publication date: Available online 8 February 2019

Source: Autoimmunity Reviews

Author(s): Samanta C. Funes, Amaranta Manrique de Lara, María J. Altamirano-Lagos, Juan P. Mackern-Oberti, Jorge Escobar-Vera, Alexis M. Kalergis

Abstract

The immune system is responsible for defending the host from a large variety of potential pathogens, while simultaneously avoiding immune reactivity towards self-components. Self-tolerance has to be tightly maintained throughout several central and peripheral processes; immune checkpoints are imperative for regulating the immunity/tolerance balance. Dendritic cells (DCs) are specialized cells that capture antigens, and either activate or inhibit antigen-specific T cells. Therefore, they play a key role at inducing and maintaining immune tolerance. DCs that suppress the immune response have been called tolerogenic dendritic cells (tolDCs). Given their potential as a therapy to prevent transplant rejection and autoimmune damage, several strategies are under development to generate tolDCs, in order to avoid activation and expansion of self-reactive T cells. In this article, we summarize the current knowledge relative to the main features of tolDCs, their mechanisms of action and their therapeutic use for autoimmune diseases. Based on the literature reviewed, autologous antigen-specific tolDCs might constitute a promising strategy to suppress autoreactive T cells and reduce detrimental inflammatory processes.

http://bit.ly/2E0UJU9

Pemphigus and mucous membrane pemphigoid: An update from diagnosis to therapy

Publication date: Available online 7 February 2019

Source: Autoimmunity Reviews

Author(s): Alessio Buonavoglia, Patrizia Leone, Rosanna Dammacco, Giuseppe Di Lernia, Massimo Petruzzi, Domenico Bonamonte, Angelo Vacca, Vito Racanelli, Franco Dammacco

Abstract

Pemphigus diseases (PDs) and mucous membrane pemphigoid (MMP) are a group of immune-mediated mucocutaneous disorders clinically characterized by the formation of blisters, erosions and ulcers. The skin and mucous membranes are predominantly affected, with the oropharyngeal mucosa as the initially involved site. Ocular involvement is also a frequent feature of these diseases. Because of the considerable overlap in their clinical presentations, the diagnosis of PDs vs. MMP can be challenging. A recognition of their specific immunological and histopathologic features is crucial in the differential diagnosis. Treatment modalities include systemically administered corticosteroids, steroid-sparing immunosuppressive agents, and biologic therapies (rituximab, intravenous immunoglobulins, and anti-tumor necrosis factor agents). Topical, oral, conjunctival, or intralesional corticosteroids as well as anti-inflammatory drugs and antibiotics are prescribed as needed.

http://bit.ly/2GwEn7x

Microvascular heart involvement in systemic autoimmune diseases: The purinergic pathway and therapeutic insights from the biology of the diseases

Publication date: Available online 7 February 2019

Source: Autoimmunity Reviews

Author(s): De Lorenzis Enrico, Gremese Elisa, Bosello Silvia, Nurmohamed Michael Tuahier, Sinagra Gianfranco, Ferraccioli Gianfranco

Abstract

Heart involvement – often asymptomatic – is largely underestimated in patients with systemic autoimmune diseases (SADs). Cardiovascular events are more frequent in patients with SADs compared to the general population, owing to the consequences of inflammation and autoimmunity and to the high prevalence of traditional risk factors. Coronary microvascular disease (CMD) is a form of cardiac involvement that is increasingly recognised yet still largely neglected. CMD, the incapacity of the coronary microvascular tree to dilate when myocardial oxygen demand increases or when there is a microvascular spasm (or subclinical myocarditis), is increasingly reported because of the widespread use of new cardiac imaging tools, even in a subclinical phase. The assessment of myocardial coronary flow reserve (CFR) emerged as the most effective clinical tool to detect microvascular damage. The potential causes of microvascular damage, molecular and cellular inflammation along with a pathological CD39-CD73 axis, need always to be considered because data show that they play a role in the occurrence of acute coronary syndromes, heart failure and arrhythmias, even in the early asymptomatic stage. Data suggest that controlling disease activity by means of methotrexate, biologic drugs, antimalarial medications, statins and aspirin, according to indication, might reduce the cardiovascular risk related to macrovascular and microvascular damage in most patients with SADs, provided that they are used early and timely to control diseases. The need of new biomarkers and a careful assessment of myocardial CFR emerged as the most effective clinical tool to detect microvascular damage.

http://bit.ly/2GuuVS0

Real-time PCR HPV genotyping in fine needle aspirations of metastatic head and neck squamous cell carcinoma: Exposing the limitations of conventional p16 immunostaining

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): F. El-Salem, M. Mansour, M. Gitman, B.A. Miles, M.R. Posner, R.L. Bakst, E.M. Genden, W.H. Westra

Abstract

Background

Given the propensity for HPV-positive head and neck squamous cell carcinoma (HPV-HNSCC) to metastasize to cervical lymph nodes, fine needle aspiration (FNA) plays an important diagnostic role in their initial detection. Indeed, there is now an unwavering commitment to HPV testing of FNAs even in the absence of clear methodologic guidelines and threshold criteria. A particular difficulty pertains to the interpretation of p16 staining.

Design

Data was collected for 210 patients with suspected regionally metastatic HNSCC that had undergone FNA as part of standard clinical care. Initial HPV screening was performed on cell blocks with real-time PCR using primers targeting L1 of high-risk HPV types. Additional genotyping was performed on HPV-positive cases. The results were compared to p16 staining and subsequent excisions when available.

Results

Of the 207 samples with sufficient DNA, 175 (85%) were HPV positive. HPV-16 was the most commonly detected genotype (90%). Of the HPV-positive cases, the primary site was the oropharynx (n = 154, 88.0%), supraglottic larynx (n = 2, 1.1%), nasal cavity (n = 1, 0.6%), hypopharynx (n = 1, 0.6%) or unknown (n = 17, 9.7%). On comparison with 31 paired surgical excisions, HPV status was concordant in all cases (100% correlation). Of 142 HPV-positive cases with matching p16 stains, p16 staining was reported as positive (n = 85, 60%), focal (n = 27, 19%), negative (n = 24, 17%) or non-contributory (n = 6, 4%); and only 33% reached the standard threshold limit (i.e. 70%) for HPV positivity.

Conclusion

For patients with metastatic HNSCC, real-time PCR of FNAs reliably reflects HPV status, and is superior to conventional p16 immunostaining.

http://bit.ly/2BoK4RC

Guidelines for the use of cerebral oximetry by near-infrared spectroscopy in cardiovascular anesthesia: a report by the cerebrospinal Division of the Academic Committee of the Japanese Society of Cardiovascular Anesthesiologists (JSCVA)

Abstract

Cerebral Oximetry by Near-infrared Spectroscopy (NIRS) has been used in cardiovascular anesthesia, but there was no guideline of regional cerebral oxygen saturation measured by cerebral oximetry by NIRS. This guideline provides recommendations applicable to patients at a risk of developing cerebral ischemia in cardiovascular surgery. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances, and should not replace clinical judgment. The Japanese Society of Cardiovascular Anesthesiologists (JSCVA) Task Force on Guidelines make an effort to ensure that the guideline writing committee contains broad views in using cerebral oximetry. Adherence to recommendations could be enhanced by shared decision making between healthcare providers and patients. This guideline was focused on cerebral oximetry of pediatric and adult cardiovascular disease. We hope this guideline would play an important role in using cerebral oximetry by measured NIRS.

http://bit.ly/2BqJkLv

Oesophagectomy and Chest Wall and Respiratory Function

Conditions:   Esophageal Cancer;   Esophagectomy;   Respiratory Function Loss
Interventions:   Other: 3D motion capture system;   Other: Incentive spirometry;   Other: Questionnaires
Sponsor:   Imperial College London
Not yet recruiting

http://bit.ly/2MWSXpV

The Bacterial Composition of the Stomach in Reflux Disease

Conditions:   GORD;   Oesophageal Cancer;   Oesophageal Reflux;   Gastric Cancer;   Gastro Esophageal Reflux;   Oesophageal Carcinoma;   Barrett Esophagus;   Esophagitis
Intervention:   Diagnostic Test: No intervention but patients are undergoing an upper GI endoscopy and biopsies for clinical purposes
Sponsor:   Imperial College London
Recruiting

http://bit.ly/2SCb5KR

Endocytosis of CF in marginal cells of stria vascularis regulated by ROCK and MLCK signaling cascade, but not G-proteins

Publication date: Available online 8 February 2019

Source: Auris Nasus Larynx

Author(s): Akinobu Kakigi, Teruhiko Okada, Taizo Takeda, Natsumi Uehara, Ken-ichi Nibu

Abstract

Objective The endocytosis of cationized feritin (CF) via a clathrin-mediated pathway is regulated by a signaling network. Marginal cells showed the active endocytosis of CF via a clathrin-mediated pathway. The internalization of receptors through this clathrin-mediated pathway is an important regulatory event in signal transduction. Numerous kinases are involved in endocytosis, and each endocytic route is subjected to high-order regulation by cellular signaling mechanisms. In this study, we investigated whether ROCK and MLCK signaling cascades and G-proteins regulate the endocytosis of CF in marginal cells of the stria vascularis.

Methods CF was infused into the cochlear duct with pertussis toxin (PTX),Clostridium botulinum C3 toxin (BTX), guanosine(g-thio)-triphosphate (GTP-γS), ML-7, Y-27632. Endocytic activity was measured at 30 min after the start of infusion under an electron microscope.

Results In marginal cells, CF was internalized via a clathrin-mediated pathway that depends on F-actin and microtubules (MT). Its processes were controlled by myosin light chain kinase (MLCK) and Rho-associated kinase (ROCK), but not affected by G-protein-coupled receptor (GPCR) or the RhoA signaling cascade.

Conclusion Our previous study showed that the main endocytotic pathway of microperoxidase (MPO) did not depend on the Rho/ROCK molecular switch or actin/myosin motor system, but was mainly regulated by the RhoA signaling cascade. The present study results indicate that these signaling cascades regulating CF internalization completely differ from the cascades for MPO internalization.

http://bit.ly/2GfRiva

Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy

Publication date: Available online 8 February 2019

Source: Auris Nasus Larynx

Author(s): Seiichiro Makihara, Shin Kariya, Mai Noujima-Harada, Nobuya Ohara, Tomoyuki Naito, Junya Matsumoto, Yohei Noda, Mitsuhiro Okano, Tadashi Yoshino, Kazunori Nishizaki

Abstract

As has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy. After withdrawal of MTX, the multiple bilateral pulmonary nodules and bilateral cervical lymphadenopathy disappeared without chemotherapy in both cases. From these results, patients with pulmonary nodules and cervical lymphadenopathy should be examined for head and neck malignant tumors. Also, physicians should carefully check the administration of MTX. In patients with an MTX-associated LPD, we need to make an early diagnosis and consider discontinuing the administration of MTX as soon as possible.

http://bit.ly/2HYRC39

Prescription of Potentially Inappropriate Medications in Geriatric Patients: Data from a Single Dental Institution

Publication date: Available online 8 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Arwa Farag, Jessaca York, Matthew Finkelman, Bhavik Desai

ABSTRACT

Objectives

The Beers Criteria and the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions(STOPP) are consensus-driven lists of potentially inappropriate medications(PIMs) in geriatric patients. The Primary objective was to determine the frequency of PIMs prescribed to geriatrics at Tufts University School of Dental Medicine(TUSDM). The secondary aim was to determine the American Society of Anesthesiologists (ASA) status of these patients and suggest that Beers/STOPP guidelines should be implied with consideration to the patient's ASA status.

Methods

Beers/STOPP criteria were studied and PIMs thus identified. A retrospective electronic chart review of patients at TUSDM aged 65+ was performed for calendar years 2013,2014 and 2015. Search queries were generated for ASA status, along with PIM's prescribed.

Results

Out of 15569 geriatrics, over half of patients between 65-74 years were classified as ASA-I. Over a 3-year-period, 895(5.75%) and 840(5.4%) received new prescriptions for opioids or NSAIDs, respectively. New prescriptions for muscle relaxants, benzodiazepines and tricyclic antidepressants were given to 65(0.42%),44(0.28%) and 38(0.24%) patients, respectively.

Conclusion

PIMs are prescribed at low percentages to geriatric patients. However, prescription of opioids, benzodiazepines and NSAIDs across undergraduate/postgraduate clinics is not uncommon. The majority of TUSDM geriatric patients fall within the category of ASAI-II. ASA classification must be taken into consideration when PIMs are prescribed to geriatrics rather than relying solely on chronological age.

http://bit.ly/2TEwEb8

A bibliometric analysis of the most cited articles about squamous cell carcinoma of the mouth, lips and oropharynx

Publication date: Available online 8 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Y. Hassona, T. Qutachi

Abstract

Objectives

to identify the top cited articles about squamous cell carcinoma of the mouth, lips, and oropharynx.

Method

Web of Science database was searched for the 100 most-cited articles using the algorithm "Oral cancer" OR "Mouth cancer" OR "Oral squamous cell carcinoma" OR "oropharyngeal carcinoma" OR "oropharynx squamous cell carcinoma" OR "lip cancer" OR "lip squamous cell carcinoma". The search was conducted independently by two researchers, and the characteristics of the most cited articles were analyzed.

Results

the most-cited articles received a combined total of 38215 citations. Citation rates ranged from 191 to 2062. The earliest article was published in 1984 and the latest in 2013, but most articles (n=69) were published in the period between 2000 to2010. Articles were published in 46 different journals, and were cited on average 33.2 times/year. Articles were originated from 19 different countries, but there was a predominance of articles from USA. Narrative reviews and experimental studies were the most common types among the 100 most-cited articles.

Conclusion

Etiology and risk factors were the most commonly represented topic in the list of the 100 most cited articles. Narrative reviews and experimental studies are the most common types of studies among the top cited articles.

http://bit.ly/2Br6DVs

Association of geographic tongue and fissured tongue with ABO blood group among adult psoriasis patients – A novel study from a tertiary care hospital in Saudi Arabia

Publication date: Available online 7 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Nabeeh A. Al Qahtani, Angeline Deepthi, Nada Mohammed Alhussain, BashayerAyesh Mohammed Al Shahrani, Hamza Alshehri, Amal Alhefzi, Betsy Joseph

Abstract

Objective

We aimed to determine if there was any association between geographic tongue and fissured tongue with ABO blood group among adult psoriasis patients in Saudi Arabia.

Materials and method

This hospital-based cross-sectional study included 100 consecutive new adult patients diagnosed with psoriasis and 100 case-matched participants in the control group (non-psoriatic). Socio-demographic and dermatologic parameters, intraoral lesions (geographic tongue (GT) and fissured tongue (FT)) along with ABO blood grouping and immunoglobulins (Ig)) were recorded which was evaluated using the Chi-square test or Fisher's exact test.

Results

74% of patients had an early age of onset, and 48% of them reported this disease in their parents.76% in generalized psoriasis had plaque type while 78% in the localized type had pustular type lesions. 70% of psoriatic patients had O positive blood group. 63% of tongue lesions seen in these patients were GT, and it was most prominent in O positive (64.28%) and O negative (62.50%) blood groups. GT was prevalent among in females (75.6%).

Conclusion

This study demonstrates a positive association of both GT and FT in this population of adult patients with psoriasis compared to a case-matched control population without psoriasis.

http://bit.ly/2TyOegF

CLINICO-RADIOLOGICAL FOLLOW UP OF CHERUBISM WITH AGGRESSIVE CHARACTERISTICS: A SERIES OF 3 CASES

Publication date: Available online 7 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Dr. Sunita Gupta, Dr. Khushboo Singh, Dr. Anju Garg, Dr. P.S. Bhandari, Dr. Shyam Kishor Sah, Dr. Ernst Reichenberger, Dr. Seema Kapoor, Dr. Shyama Jain, Dr. Nirupama Trehanpati

ABSTRACT

Background

Cherubism is a rare autosomal dominant disorder characterized by degradation of bone that is replaced by fibrous tissue containing multinucleated giant cells. It clinically manifests as bilateral mandibular and maxillary enlargement. The recent World Health Organization (WHO) classification of 2017 now lists cherubism as one of the giant cell lesions of the jaws, distinct from fibro-osseous disorders.

Materials and Methods

We discuss three cases of familial cherubism having aggressive characteristics with clinico-radiologic evaluation of the lesions for 12 years, 18 years, and 1.5 years, respectively. Follow-up was observational without active intervention. Clinical analysis of the lesions for increase or decrease in size and association with functional impairments was correlated with periodic conventional and advanced imaging. All three cases are currently on a follow-up examination schedule.

Conclusion

The outcome in two cases with long term follow-up has been excellent without intervention, although one case had extensive involvement of the jaws as well as unusual involvement of the mandibular condyle and orbit. Another unique finding was the development of a secondary giant cell lesion involving the palate in the affected mother of patient 3, who had had cherubic lesions in childhood.

http://bit.ly/2BpIe2Q

Plasmacytoid cells in salivary pleomorphic adenoma. An alternative interpretation of their immunohistochemical characteristics highlights function and capability for epithelial-mesenchymal transition

Publication date: Available online 7 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Ioannis G. Koutlas, Michelle Dolan, Mark W. Lingen, Prokopios P. Argyris

Abstract

Objectives

Plasmacytoid cells (PLCs) in salivary pleomorphic adenoma (SPA) are regarded as modified neoplastic myoepithelia and define plasmacytoid myoepithelioma (pMYO). However, histochemically, immunohistochemically and ultrastructurally, PLCs fail to demonstrate frank myogenous properties. Epithelial-mesenchymal transition (EMT) may explain the phenotypes in SPA. Our aim was to evaluate 1) PLCs with accepted or purported myoepithelial and EMT-related markers; and 2) pMYOs for PLAG1 aberrations by FISH.

Study Design

Eight SPAs with or without PLC-predominance and 3 pMYOs were immunohistochemically studied.

Results

PLCs in SPA and pMYO exhibited strong, scattered to diffuse positivity for K7, rare K14 positivity and were mostly negative for α-SMA, h-caldesmon, and p63/p40. S100 staining was strong and diffuse, while calponin was variable. DOG1 was negative. PLCs in pMYO and PLC-rich-SPA exhibited selective or diffuse, WT-1 and D2-40 immunoreactivity. EMT markers SNAIL/SLUG exhibited strong and variable immunoreactivity in PLCs, in contrast to weak or absent e-cadherin expression. SOX10 was diffusely and strongly positive. PLAG1 rearrangement was present in 1 pMYO.

Conclusions

1) PLCs mostly fail to express myoepithelial markers; 2) PLCs are neoplastic cells adapting to micro-environmental changes and capable of EMT; 3) Tumors composed solely of PLCs are apparently SPAs depleted of a ductal component.

http://bit.ly/2TENgiO

Discrepancies in Interpretation of the Minor Salivary Gland Biopsy in the Diagnosis of Sjögren syndrome

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Sarah Wicheta, Troy Van der Groen, William C. Faquin, Meredith August

Purpose

Although the minor salivary gland biopsy(MSGB) is a major criterion for diagnosis of Sjögren syndrome(SS), multiple studies have outlined difficulties in standardization.1, 2 The purpose of this study was to answer the following question: In all patients referred for MSGB, did strict application of focus scoring criteria alter the sensitivity of and predictive value of the MSGB in the diagnosis of SS when compared to the initial interpretation?

Materials and Methods

We designed a cross-sectional study of patients referred to the Massachusetts General Hospital Department of OMS over a 5-year period for MSGB. The primary predictor variable was the MSGB focus score. The primary outcome variable was the SS diagnosis. The newly established SS diagnosis status results were then compared to the initial SS diagnoses. Sensitivity, specificity and positive and negative predictive values were calculated. Other relevant variables of interest, such as size of glandular tissue harvested and associated signs and symptoms, were also described.

The primary predictor variable was the MSGB focus score the primary outcome variable was the SS diagnosis (positive or negative).

Results

Seventy-three patients met inclusion criteria. The mean age was 48.5 years (range, 19-71yrs) and 64 were female (87.6%). Our previous study utilizing initial pathology reports yielded 80.0% sensitivity, 87.5% specificity, PPV=57.1% and NPV= 95.5%. The current review of the MSGB using strict focus scoring guidelines yielded: 95.4% sensitivity, 76.4% specificity, PPV=63.6% and NPV=97.5%.

Conclusion

The MSGB is an important major criterion in establishing a diagnosis of SS. Application of strict focus scoring guidelines when reviewing the MSGB yielded a sensitivity far greater than initially reported in this group. Difficulties with interpretation are discussed. Future studies will focus on improvement of interpretation and immunohistochemical aids in diagnosis.

http://bit.ly/2tcxz7d

A simple technique to repair a residual oronasal fistula in bilateral cleft lip and palate patients

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Bruce R. Nicol, Noel Ye Naung, Joseph E. Van Sickels

Purpose

An anterior palatal oronasal fistula in a bilateral cleft lip and palate is a challenging clinical dilemma. The purpose of this paper is to present a two-stage technique to repair the fistula in consistent fashion. The technique was developed to avoid more complicated procedures that had greater morbidity to be used on larger oronasal defects that could not be treated in a single procedure.

Methods

This is a retrospective study performed over fifteen years using this technique in a private practice setting. From 2002 to 2017, fifteen 7 to 12-years-old patients (11 male and 4 female) were treated. When they were seen in a multispecialty clinic with an anterior residual fistulae impression were obtained. They were then scheduled for a first stage closing of the fistulae. Data was retrospective analyzed. The two-stage procedure started with closing the central portion of the fistulae as the first stage. During a second stage 6 months later, the residual nasoalveolar cleft would be closed and grafted in a standard fashion. The first stage involves posteriorly reflecting a full thickness mucoperiosteal flap and inserting into the palatal soft tissue and stabilizing the segment with a splint for three weeks. The premaxillary segment was left denuded.

Results

Fourteen out of fifteen patients (93%) had the central portion of the oronasal fistulae successfully closed. One patient had a partial breakdown when the splint was prematurely removed in 2 weeks. The patient underwent successful closure by the same procedure at a later date. All patient had a successful second stage grafting of their nasoalveolar clefts.

Conclusion

An alternative technique was presented to treat the clinically challenging oronasal fistulae. This two-stage closure of a palatal fistula is simple, allows consistent closure of the soft tissue defects, and avoids complex alternative procedures with significant surgical morbidities.

http://bit.ly/2UNV8Pb