Head and Neck Medicine by Alexandros G.Sfakianakis

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Maja Marewski, Carola Petto, Matthias Schneider, Winfried Harzer
One third of adult patients with orthognathic surgery of a prognathic or retrognathic mandible show relapse. The sagittal split osteotomy of the mandible leads to a displacement of both parts up to 10 mm without any changes of muscle attachment. Changed mandible length needs adaptation of muscle capacity because of changed force to moment ratio. The aim of this Microarray study was to analyze the general genetic response of masseter muscle in patients with retrognathism or prognathism of the mandible six months after surgery in comparison with healthy untreated controls. We found in tissue samples from masseter muscle a reduction of different entities between patients and controls but less in retrognathic than in prognathic patients (274/429). The different entities to controls in prognathia were reduced from 1862 to 1749 but increased in retrognathia from 1070 to 1563. We have to consider that the total amount of different entities to the controls is higher in patients with prognathic mandible (7364) because of their strong genetic controlled development compared with that in patients with retrognathic mandible (4126), which is more environmentally influenced.It can be concluded that function follows form after surgical change with high inheritance. In retrognathic patients the adaptation could be delayed or the capacity of regeneration potential is not sufficient.

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Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: A randomised prospective study

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Martín Fernández-Ferro, Jacinto Fernández-Sanromán, Andrés Blanco-Carrión, Alberto Costas-López, Annahys López-Betancourt, Jorge Arenaz-Bua, Bogdan Stavaru Marinescu
PurposeThe main objective of our study was to evaluate the effectiveness of the injection of plasma rich in platelet-derived growth factors (PRGF) versus hyaluronic acid (HA) following arthroscopic surgery in patients diagnosed with internal derangement of the temporomandibular joint (TMJ) with osteoarthritis (OA).Materials and MethodsA total of 100 patients were randomised into two study groups. Group A (n = 50) received an injection of PRGF, and Group B (n = 50) received an injection of HA. The mean age was 35.5 years (range 18-77 years), and 88% of the patients were women. The pain intensity (visual analogue scale) and the extent of maximum mouth opening before and after the procedure were statistically analysed.ResultsBetter results were observed in the group treated with PRGF, with a significant reduction in pain at 18 months, compared with HA treatment. Regarding mouth opening, an increase was observed in both groups, with no significant difference.ConclusionsThe injection of PRGF following arthroscopy is more effective than the injection of HA with respect to pain in patients with advanced internal derangement of the TMJ.

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Efficacy of a Rhealba® Oat Extract-based emollient on chronic pruritus in elderly French outpatients

Abstract

Background

Chronic pruritus, defined as itch persisting more than 6 weeks, is a debilitating problem that affects one in four elderly adults. Emollients are recommended for the management of pruritus, but evidence of efficacy is scarce.

Objective

Assess the efficacy of a Rhealba^® Oat Extract-based emollient in the management of chronic pruritus in elderly outpatients.

Methods

This was a randomized, mono-centric, open-label, cross-over study in adults ≥60 years of age with xerosis associated with chronic pruritus. Subjects were randomized 1:1 to start with a 2-week non-treatment phase or a 2-week treatment phase in which they applied the emollient once or twice daily. The primary outcome was subject-assessed pruritus using an established visual analogue scale. Subjects also assessed pruritus using the 5-D itch scale. Investigators assessed xerosis using the Overall Dry Skin Score and measured hydration index by Corneometer^®, desquamation by D-Squame and transepidermal water loss by Aquaflux^®.

Results

Thirty subjects were included. Pruritus intensity on the visual analogue scale improved significantly more during the treatment phase than during the non-treatment phase (P < 0.0001). This was also observed immediately after the first product application (P < 0.0001). According to the 5-D itch scale, pruritus decreased during the treatment phase but remained stable during the non-treatment phase (P = 0.0042). At the end of the treatment phase, more than half of the subjects reported an improvement in pruritus, and 30% reported complete disappearance, whereas pruritus remained stable during the non-treatment phase (P < 0.0001). Xerosis improved significantly more during the treatment phase than during the non-treatment phase as measured by D-Squame, clinical assessment and hydration index (P < 0.0001). Transepidermal water loss did not significantly change.

Conclusion

Daily use of a Rhealba Oat Extract-based emollient can provide relief to elderly adults who suffer from xerosis associated with chronic pruritus.

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Nevoid Basal Cell Carcinoma Syndrome and Hairy Skin Patches

Abstract

We report a case of an increasing number of discrete patches of darkly pigmented terminal hair in a patient with nevoid basal cell carcinoma syndrome. This case adds to a small case series of three patients which have previously reported this observation. We report this case to highlight hairy patches as an important clinical feature associated with nevoid basal cell carcinoma syndrome.

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Elderly with remaining teeth report less frailty and better quality of life than edentulous elderly: a cross-sectional study

Abstract

Objective

To assess oral status and self-reported oral health in community-living elderly and to determine differences between relevant subgroups of oral status (remaining teeth, edentulous, implant-retained overdentures) and case complexity (robust, frail, complex care needs).

Subjects and methods

In this cross-sectional descriptive study, 1325 Dutch community-living elderly (≥75 years of age) were asked to complete validated questionnaires on frailty, ADL, complexity of care needs and QoL. Data on oral status, self-reported oral health, dental care, general health and medication use were assessed. Differences between relevant subgroups were determined.

Results

Data of 1026 (77%) elderly (median 80 years, IQR 77-84) were analyzed: 39% had remaining teeth, 51% were edentulous and 10% had implant-supported overdentures. Elderly with complex care needs (n=225, 22%) and frail elderly (n=217, 21%) were more often edentulous and reported more oral problems than robust elderly (n=584, 57%). Elderly persons with remaining teeth were less frail, had better QoL and ADL and used fewer medicines than edentulous elderly. Elderly with implant-supported overdentures performed better on frailty and QoL than edentulous elderly with conventional dentures.

Conclusion

Community-living elderly commonly suffer from oral health problems, in particular elderly with complex care needs. QoL, ADL and general health are higher among community-living elderly with remaining teeth and implant-supported overdentures than in edentulous elderly.

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Hearing sensitivity in adults with a unilateral cleft lip and palate after two-stage palatoplasty

Publication date: March 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 94
Author(s): I.F.P.M. Kappen, J.B.S. Schreinemakers, K.P.Q. Oomen, D. Bittermann, M. Kon, C.C. Breugem, A.B. Mink van der Molen
ObjectiveTo evaluate long-term hearing and middle ear status in patients treated for a unilateral complete cleft lip and palate (UCLP) by two-stage palatoplasty.MethodsForty-nine UCLP patients aged 17 years and older were included in this retrospective study. Patients were invited for a multidisciplinary long-term follow-up of their treatment at a tertiary center for craniofacial surgery in the Netherlands. ENT assessment included tympanometry and pure-tone audiometry. Medical files were searched for medical and surgical history.ResultsIn total, 19.4% of the patients had significant long-term hearing loss (PTA > 20 dB), comprising conductive hearing loss in 21.5% of the patients. In the majority (70%), this hearing loss was more pronounced at higher frequencies. In 25% the high fletcher index showed hearing thresholds above 20 dB. Ventilation tubes were placed at least once in 78.7% of the patients. The frequency of tube insertion was positively correlated with the incidence of reduced tympanic compliance (tympanogram type B) and the need for a pharyngoplasty.ConclusionThe present study reports long-term hearing outcomes in UCLP patients with hard palate closure at 3 years of age. Persistent hearing loss was observed in 19.4% of our patients (PTA > 20 dB), mainly at the higher frequencies. Ventilation tube placement was associated with reduced tympanic compliance and higher risk on hearing loss (PTA air conduction). Our high incidence of velopharyngeal incompetence during early childhood, which is likely associated with Eustachian tube dysfunction, might have contributed to these results.

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