Intratympanal gentamicin in Meniere’s disease: Effects on individual semicircular canals

In this retrospective study the aim of the authors was to examine the effect of gentamicin on the individual semicircular canals after low dose, single injection intratympanal gentamicin therapy in Meniere's disease.

http://ift.tt/2mgjPD9

Rare Gingival Metastasis by Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) uncommonly metastasizes to the gingiva, which always means a poor outcome. We reported a rare HCC case with multiple metastases to gingiva, lungs, and brain. A 60-year-old man was initially diagnosed as HCC with metastases to double lungs. He was subjected to a transarterial chemoembolization (TACE) (5-fluorouracil, 750 mg) and two cycles of intravenous chemotherapy (gemcitabine 1.8 g at days 1 and 8, oxaliplatin 200 mg at day 2, every 4 weeks). However, the volume of liver tumor still increased. A bean-size gingival nodule growing with occasional bleeding was also found. TACE (5-fluorouracil 750 mg, perarubicin 40 mg, cisplatin 20 mg) was performed again and an oral sorafenib therapy (400 mg, twice per day) was adopted. The disease maintained relatively stable for about 6 months until a second obvious progress. The gingival nodule was then palliatively excised and identified as a poorly differentiated metastatic HCC by histopathological examination. Best supportive treatments were made since the performance score was too bad. Finally, cerebral metastases occurred and the patient died of systemic failure. Upon review of previous reports, we discussed risk factors, clinical and pathological characteristics, treatments, and prognosis of gingival metastasis by HCC.

http://ift.tt/2myqOID

The effect of paravertebral block on maxillofacial free flap survival

Publication date: Available online 11 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A.M.A. Habib, O.M. Zanaty, H.F. Anwer, D. Abo Alia
The purpose of this study was to investigate whether continuous paravertebral block at levels T1 and T2 with bupivacaine infusion can improve the survival of free flaps in maxillofacial reconstruction. The study was designed as a randomized controlled trial and included 36 adult patients scheduled for maxillofacial free flap reconstruction under general anesthesia. Patients were randomly divided into two groups: patients in group A received continuous paravertebral block at levels T1 and T2, while patients in group B served as controls. Postoperatively, a skin thermometer was used to assess the skin temperature. Perfusion of the flaps was evaluated by analysis of skin color, turgor, and capillary refill. Survival of the free flap was recorded. The surface temperature of the reconstructive flap, skin color score, and capillary refill score were significantly higher in group A patients than in group B patients during follow-up. The total perfusion score was significantly higher in group A than in group B at 16h and 20h postoperative (P=0.041 and P=0.039, respectively). Re-operation was recorded in three cases in group B (16.7%) (P=0.031). Continuous paravertebral block at levels T1 and T2 can increase the skin temperature and improve skin color and capillary refilling, which are indices of adequate tissue perfusion and indicate maxillofacial free flap survival.



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Perception of oral and maxillofacial surgery by Brazilian healthcare professionals: what has changed in ten years?

Publication date: Available online 12 March 2017
Source:International Journal of Oral and Maxillofacial Surgery





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Quality assessment of systematic reviews of the significance of keratinized mucosa on implant health

Publication date: Available online 11 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): V. Moraschini, D. Luz, G. Velloso, E.dS.P. Barboza
The aim of this overview was to assess the methods, quality, and outcomes of systematic reviews conducted to evaluate the importance of keratinized mucosa (KM) for the maintenance of peri-implant tissue health in humans. An electronic search was conducted without date or language restriction using the MEDLINE/PubMed, Cochrane Library, Web of Science, and Embase databases up to December 2015. The eligibility criteria included systematic reviews with/without meta-analysis and with a focus on the influence of KM on peri-implant health around implants. Two independent authors performed the quality analysis of the reviews with the AMSTAR guidelines and another checklist proposed in 2003. After screening, four systematic reviews were selected. The present study demonstrated the existence of structural and methodological variability among the systematic reviews with/without meta-analysis. None of the systematic reviews that were included in the study obtained the maximum score in the two quality analyses performed. All systematic reviews included reported a positive association between an adequate KM width (≥2mm) and peri-implant health. There is still insufficient data on the long-term survival and success rates of dental implants. Prospective studies evaluating the importance of KM for the long-term maintenance of dental implants are needed.



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Evaluation of an imaging protocol using ultrasound as the primary diagnostic modality in pediatric patients with superficial soft tissue infections of the face and neck

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Rishabh Sethia, Justin B. Mahida, Rahul A. Subbarayan, Katherine J. Deans, Peter C. Minneci, Charles A. Elmaraghy, Garth F. Essig
ObjectiveTo determine the clinical impact of an initiative to use ultrasound (US) as the primary diagnostic modality for children with superficial face and neck infections versus use of computed tomography (CT).MethodsChildren with a diagnosis of lymphadenitis, face or neck abscess, or face and neck cellulitis were retrospectively evaluated by the otolaryngology service. Patients were separated into two groups based on implementation of a departmental initiative to use US as the primary diagnostic modality. The pre-implementation cohort consisted of patients treated prior to the initiative (2006–2009) and the current protocol cohort consisted of patients treated after the initiative was started (2010–2013). Demographics, use of US or CT, necessity of surgical intervention, and failure of medical management were compared.ResultsThree hundred seventy three children were evaluated; 114 patients were included in the pre-implementation cohort and 259 patients were included in the current protocol cohort for comparison. Patients presenting during the current protocol period were more likely to undergo US (pre-implementation vs. current protocol, p-value) (12% vs. 49%, p < 0.0001) and less likely to undergo CT (66% vs. 41%, p < 0.0001) for their initial evaluation. There were no differences in the percentage of children who underwent prompt surgical drainage, prompt discharge without surgery, or trial inpatient observation. There were also no differences in the rate of treatment failure for patients undergoing prompt surgery or prompt discharge on antibiotics. For those patients who underwent repeat evaluation following trial medical management, US was used more frequently in the current protocol period (4% vs. 20%, p = 0.002) with no difference in CT use, selected treatment strategy, or treatment failure rates.ConclusionIncreased use of US on initial evaluation of children with superficial face and neck infections resulted in decreased CT utilization, without negatively impacting outcome. Decreasing pediatric radiation exposure and potential long-term effects is of primary importance.



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Pneumothorax, Pneumomediastinum, and Pneumorrhachis: A Rare Presentation in a Neurological Patient

No abstract available

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