Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Πέμπτη 8 Σεπτεμβρίου 2022

Correlation between radiologic and pathologic extranodal extension in HPV‐associated oropharyngeal cancer: Systematic review

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Abstract

Pretreatment determination of extranodal extension (ENE) has significant clinical implications in human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Unfortunately there is no gold-standard imaging modality for radiological assessment of ENE in HPV+ OPSCC, leading to subjective assessments and complex decision making concerning ENE. A systematic review of diagnostic test accuracy was therefore undertaken, with five databases systemically searched to evaluate the diagnostic performance of an imaging modality for detection of ENE in HPV+ OPSCC. A meta-analysis was conducted on four CT studies using a random-effects model. While a narrative synthesis was provided for the studies using PET/CT and "CT and MRI." Out of 1772 hits, six studies were included in the review. Meta-analysis on four CT studies showed CT had an overall sensitivity of 77% and specificity of 60%. PET/CT had a sensitivity of 37.5% and specificity of 97%. "CT and MRI" had a se nsitivity of 62% and specificity of 78%. Further diagnostic studies involving CT, PET/CT and MRI are ultimately required.

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Fully digital versus conventional workflow for horizontal ridge augmentation with intraoral block bone: A randomized controlled clinical trial

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Abstract

Objectives

To compare the outcome and efficiency of the computer-aided intraoral block bone grafting procedure with those of the conventional technique for the augmentation of horizontal ridge defects.

Materials and Methods

A total of 28 patients with single missing tooth in esthetic zone with class IV horizontal alveolar bone defect in need of dental implant restoration were recruited. Computer-aided design of the implant restoration and intraoral block bone grafting was performed for all the participants. The patients were randomly and equally divided into guide and control groups. A fully guided bone harvesting, trimming, and grafting surgery was executed in the guide group. The control group patients underwent surgery without any guide. After 6 months, all the patients underwent implant placement. The primary outcomes were the root mean square estimate (RMSE) values between the outer contours of the actual implanted and planned bone block as well as the RMSE values between the inner surface of the implanted bone block and the original bone surface of the recipient site immediately after surgery. The secondary outcomes were the trimming time of bone block and the surgery-associated complications. The postoperative visual analog scale (VAS) of pain, swelling, and mouth opening difficulty was recorded.

Results

All 28 patients underwent intraoral block bone grafting, followed by the placement of implant after 191.8 ± 19.69 days. The RMSE values between the outer contours of the implanted and planned bone blocks were significantly lower in the guide group (0.37 ± 0.16 mm) as compared to those in the control group (0.72 ± 0.29 mm) (p = 0.0007). The RMSE values between the inner contours of the graft block and original bone at the recipient site were lower in the guide group (0.35 ± 0.15 mm) as compared to those in the control group (0.48 ± 0.17 mm) (p = 0.043). The duration of bone block trimming was shorter in the guide group (401.51 ± 97.60 s) as compared to the control group (602.36 ± 160.57 s) (p = 0.0005). In the control group, two patients received secondary bone grafting, one patient experienced bleeding of donor site and temporary hypoesthesia of the lower lip and chin skin, and one patient developed temporary sensitivity of the adjacent tooth.

Conclusions

As compared to the conventional procedure, the fully digital workflow in the present study seemed to be a more accuracy and effective protocol for horizontal ridge augmentation with intraoral block bone. Trial registration: Chictr.org.cn (ChiCTR2000036390).

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Perioperative Outcomes in Fibula, Osteocutaneous Radial Forearm, and Scapula Free Flaps

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This cohort study assesses whether fibula free flaps, osteocuta neous radial forearm free flaps, and scapula free flaps are associated with differences in perioperative outcomes in patients undergoing osseous head and neck reconstruction.
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A Novel Molecular Test for Determining HPV Integration Status in HPV-Positive Oropharynx Cancers

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This diagnostic study describes the development of an assay fo r human papillomavirus–driven cancers of the oropharynx and the role viral integration could play in the process.
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Strategies for Evaluating Anosmia Therapeutics in the COVID-19 Era

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Two studies in this issue of JAMA Otolaryngology–Head & Neck Surgery evaluate the use of nasal theophylline, a phosphodiesterase inhibitor that may promote neural olfactory signaling and recovery for postviral olfactory dysfunction (OD). The first, a dose-modification Research Letter by Lee et al was conducted in patients with non-COVID-19–related hyposmia or anosmia secondary to viral infection and confirmed by the objective University of Pennsylvania Smell Identification Test. This open-label, dose-escalation trial provides an educ ational description of how to evaluate the appropriate dose for an emerging pharmacologic intervention. Specifically, the authors identified 400 mg of theophylline twice daily as a tolerated dosage. This was calculated as an equivalent oral dose of 20 mg. A phase 2 pilot study by Gupta et al was designed using this valuable information. Patients with suspected COVID-19–related OD completed the University of Pennsylvania Smell Identification Test and were randomized to either theophylline or placebo nasal irrigations for 6 weeks. This study was inconclusive regarding the clinical benefit of theophylline nasal irrigations, although there was suggested improvement by subjective assessments. The authors acknowledge several limitations, including small sample size, the virtual nature of the study design and subsequent inability to conduct endoscopic nasal examinations, lack of information regarding participant COVID-19 vaccination status, lack of polymerase chain reaction–confirmed C OVID-19 infection, and short-term participant follow-up. These acknowledgments are justified, and many can be overcome in subsequent studies with adequate funding and time. However, the heterogeneous nature of COVID-19 and associated research make this area of work particularly challenging. Herein, we propose several approaches to improve the rigor of OD research in the COVID-19 era.
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Muscle Tension Dysphonia

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This Patient Page describes the causes, symptoms, and tre atment options for muscle tension dysphonia.
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Well-Differentiated Hypopharyngeal Liposarcoma–Associated Airway Obstruction

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This case report describes a man in his 70s who presented with a bilobed, cylindrical mucosal mass that had been expelled from his mouth after an episode of nausea and violent vomiting.
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Exophytic Laryngeal Mass

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A 29-year-old woman presented with postnasal drip, pharyn gitis, odynophagia, cervicalgia, cervical lymphadenopathy, and right-sided otalgia that had persisted for more than a week; what is your diagnosis?
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Rising Incidence of Thyroid Cancer and Thyroid Nodule Detection

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This retrospective analysis of patients who underwent thy roid surgery at 16 centers in 4 countries examines modes of nodule detection and differences by geographic area.
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Association of Outpatient Oral Macrolide Use With Sensorineural Hearing Loss in Pediatric Patients

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This case-control study investigates whether increased ris k of sensorineural hearing loss is associated with macrolide use in a national study population of children, adolescents, and young adults.
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Inflammatory and Cardiometabolic Profile After Soft-Tissue Sleep Surgery

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This systematic review and meta-analysis examines 26 studi es to evaluate how sleep surgery affects proinflammatory marker levels in adults with obstructive sleep apnea.
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