Transconjunctival versus subciliary approach to the infraorbital margin for open reduction of zygomaticomaxillary complex fractures: a randomized feasibility study

Abstract

Introduction

Although some studies addressed the differences between subciliary and transconjunctival approaches, no previous prospective comparative study on displaced zygomaticomaxillary complex (ZMC) fracture that repaired by three-point internal fixation using also upper gingivolabial incision and upper eye lid incision. So, the effect of these incisions on the comparison was not investigated.

Purpose

The purpose of this study was to compare transconjunctival and subciliary approaches for open reduction and internal rigid fixation (OR/IF) of ZMC fractures.

Methods

This prospective study was carried out on 40 patients had displaced ZMC fractures repaired by OR/IF. Patients were randomly assigned into two equal groups (20 patients for each); subciliary group subjected to subciliary approach and transconjunctival group subjected to transconjunctival approach for inferior orbital rim repair. In both groups, frontozygomatic and zygomaticomaxillary buttresses were also approached by lateral eye brow and superior gingivolabial incision, respectively. Primary outcome measures include accessibility (need for lateral canthotomy), the exposure duration, postoperative pain, early postoperative edema, and operative complications. Secondary outcome measures include dental occlusion, average intrinsic vertical mouth opening, post subciliary scar assessment, late postoperative complication, and opthalmological assessment concerning ectropion, entropion, scleral show, and eye globe affection (enophthalmos or diplopia).

Results

The mean duration from incisions to fracture exposure was 13.7 ± 2.17 min in subciliary approach and 14.6 ± 2.31 min in transconjunctival approach with nonsignificant difference (p = 0.1284). Lateral canthotomy was required for proper exposure of the fracture and OR/IF using transconjunctival approach while not needed with subciliary approach. Ectropion and scleral show occurred in 10 and 15% respectively in subciliary group and were not encountered in transconjunctival group. Although postoperative periorbital edema was significantly more sever in transconjunctival group within the first postoperative week (p = 0.028), no persistent periorbital edema was reported. Infection, hematoma, and globe complication were not detected in any patient. All authors characterized all scars of the subciliary group as unnoticeable.

Conclusion

Transconjunctival approach mostly needs lateral canthotomy that was not needed with subciliary approach. Transient postoperative edema is more in transconjunctival approach while postoperative ectropion and sclera show was detected only with subciliary approach. So, building up of experience in transconjunctival approach will be beneficial for maxillofacial surgeons and more measures to avoid ectropion are needed with subciliary approach.

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Transconjunctival versus subciliary approach to the infraorbital margin for open reduction of zygomaticomaxillary complex fractures: a randomized feasibility study

Abstract

Introduction

Although some studies addressed the differences between subciliary and transconjunctival approaches, no previous prospective comparative study on displaced zygomaticomaxillary complex (ZMC) fracture that repaired by three-point internal fixation using also upper gingivolabial incision and upper eye lid incision. So, the effect of these incisions on the comparison was not investigated.

Purpose

The purpose of this study was to compare transconjunctival and subciliary approaches for open reduction and internal rigid fixation (OR/IF) of ZMC fractures.

Methods

This prospective study was carried out on 40 patients had displaced ZMC fractures repaired by OR/IF. Patients were randomly assigned into two equal groups (20 patients for each); subciliary group subjected to subciliary approach and transconjunctival group subjected to transconjunctival approach for inferior orbital rim repair. In both groups, frontozygomatic and zygomaticomaxillary buttresses were also approached by lateral eye brow and superior gingivolabial incision, respectively. Primary outcome measures include accessibility (need for lateral canthotomy), the exposure duration, postoperative pain, early postoperative edema, and operative complications. Secondary outcome measures include dental occlusion, average intrinsic vertical mouth opening, post subciliary scar assessment, late postoperative complication, and opthalmological assessment concerning ectropion, entropion, scleral show, and eye globe affection (enophthalmos or diplopia).

Results

The mean duration from incisions to fracture exposure was 13.7 ± 2.17 min in subciliary approach and 14.6 ± 2.31 min in transconjunctival approach with nonsignificant difference (p = 0.1284). Lateral canthotomy was required for proper exposure of the fracture and OR/IF using transconjunctival approach while not needed with subciliary approach. Ectropion and scleral show occurred in 10 and 15% respectively in subciliary group and were not encountered in transconjunctival group. Although postoperative periorbital edema was significantly more sever in transconjunctival group within the first postoperative week (p = 0.028), no persistent periorbital edema was reported. Infection, hematoma, and globe complication were not detected in any patient. All authors characterized all scars of the subciliary group as unnoticeable.

Conclusion

Transconjunctival approach mostly needs lateral canthotomy that was not needed with subciliary approach. Transient postoperative edema is more in transconjunctival approach while postoperative ectropion and sclera show was detected only with subciliary approach. So, building up of experience in transconjunctival approach will be beneficial for maxillofacial surgeons and more measures to avoid ectropion are needed with subciliary approach.

http://ift.tt/2mUOXJC

Biological predictors of radiosensitivity in head and neck squamous cell carcinoma

Abstract

Objectives

The aim of this study is to investigate the influence of prognostic biomarkers on radiosensitivity and survival of advanced head and neck squamous cell carcinomas treated by primary (chemo)radiation.

Material and methods

The clinicopathological data and immunohistochemical staining of p16, c-Met, survivin, PD-1, and PD-L1 of 82 primarily (chemo)irradiated patients with head and neck squamous cell carcinoma were analyzed. Associations with local and locoregional radiation response, overall survival (OS), disease-free (DFS), and disease-specific survival (DSS) were assessed.

Results

Complete tumor response was associated with increased patient age (p = 0.007), N0-status (p = 0.022), M0-status (p = 0.007), and p16-positivity (p = 0.022). High PD-L1 was associated with M0-status (p = 0.026) and indicated tumor response to irradiation (p = 0.057); survivin expression showed higher rates of response failure (p = 0.073). Low PD-1 was associated with increased T-stage (p = 0.029) and local recurrence (p = 0.014). High PD-1 was strongly correlated with PD-L1-positive tumor infiltrating lymphocytes (p < 0.001). Low PD-L1 showed a significant correlation with high c-Met expression (p = 0.01). Significant predictors for unfavorable univariate survival were incomplete tumor response (DSS, p < 0.001), single radiotherapy (DSS, p = 0.002), M1-status (DSS, p < 0.001), decreased radiation dose (DSS, p = 0.014), high survivin (DSS, p = 0.045), and high c-Met (OS, p < 0.05). Survivin and c-Met also showed prognostic significance in multivariate survival analysis.

Conclusions

P16 and PD-L1 indicate radiosensitivity, whereas survivin and c-Met implicate radioresistance in primarily (chemo)irradiated head and neck squamous cell carcinomas. The role of the PD-1/PD-L1 immune checkpoints in radiation response and survival merits further investigation.

Clinical relevance

The findings may improve patient-specific therapy according to individual tumor characteristics.

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Neuropeptide expression and morphometric differences in crushed alveolar inferior nerve of rats: Effects of photobiomodulation

Abstract

Inferior alveolar nerve (IAN) injuries may occur during various dental routine procedures, especially in the removal of impacted lower third molars, and nerve recovery in these cases is a great challenge in dentistry. Here, the IAN crush injury model was used to assess the efficacy of photobiomodulation (PBM) in the recovery of the IAN in rats following crushing injury (a partial lesion). Rats were divided into four experimental groups: without any procedure, IAN crush injury, and IAN crush injury with PBM and sham group with PBM. Treatment was started 2 days after surgery, above the site of injury, and was performed every other day, totaling 10 sessions. Rats were irradiated with GaAs Laser (Gallium Arsenide, Laserpulse, Ibramed Brazil) emitting a wavelength of 904 nm, an output power of 70 mWpk, beam spot size at target ∼0.1 cm², a frequency of 9500 Hz, a pulse time 60 ns, and an energy density of 6 J/cm². Nerve recovery was investigated by measuring the morphometric data of the IAN using TEM and by the expression of laminin, neurofilaments (NFs), and myelin protein zero (MPZ) using Western blot analysis. We found that IAN-injured rats which received PBM had a significant improvement of IAN morphometry when compared to IAN-injured rats without PBM. In parallel, all MPZ, laminin, and NFs exhibited a decrease after PBM. The results of this study indicate that the correlation between the peripheral nerve ultrastructure and the associated protein expression shows the beneficial effects of PBM.

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Voice outcomes post total laryngectomy.

Purpose of review: A consensus and body of robust evidence has developed regarding optimal laryngeal voice outcome measures. This contrasts with a lack of clarity for equivalent assessments in alaryngeal voice. Addressing this situation would enable clinicians to select the best tools currently available to facilitate research, audit and clinical practice. This is important because of the limited knowledge regarding the optimal surgical or reconstruction techniques and rehabilitation regimes for the laryngectomy population. Recent findings: There is currently no evidence to support the use of acoustic instrumental measures in terms of validity. Preliminary data support the validity of a new tracheoesophageal voice auditory-perceptual tool the SToPS, for professional and naive raters. Few specific self-rating tools exist with the Self Evaluation of Communication Experiences after Laryngectomy having the most evidence regarding validity, reliability and clinical utility. Laryngeal self-report questionnaires have been utilized, but concerns have been expressed regarding content validity. Patient self-report outcomes do not concur with professional or naive judgements, which reflect findings in the laryngeal voice literature. Summary: Further research is needed to establish the optimal tools for research and clinical practice. Investigations should also incorporate assessments of real-life communication in daily living rather than solely focussing on recordings in laboratory conditions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Behaviour change technique taxonomy: a method of describing head and neck cancer dysphagia intervention delivery.

Purpose of review: The purpose of the review is to examine the current state of the art of dysphagia intervention delivery description and to propose use of a new tool to facilitate this: the behaviour change technique taxonomy version 1 (BCTTv1). Recent findings: Describing intervention delivery is difficult, and published research in the field of speech and language therapy (SLT) does not include detail on this key aspect of research protocols. Interventions themselves are often poorly delineated, and a way is needed of classifying how these interventions are delivered in practice. Summary: Use of the BCTTv1 would facilitate clarity and transparency in intervention delivery description and have positive implications for research, clinical practice and undergraduate teaching if employed by the SLT profession. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Tympanometry and isolated fracture of the stapes

Publication date: Available online 18 March 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Aussedat, C. Bobiller, K. Gaillot, E. Lescanne, D. Bakhos
IntroductionTemporal bone fractures are frequently associated with ossicular dislocations or fractures, most commonly involving the incus. To our knowledge, isolated fracture of the posterior crus of the stapes has not been previously reported.Case reportA 20-year-old man consulted for persistent left hypoacusis several months after a head injury. Initial computed tomography of the temporal bone showed a simple temporal bone fracture with no other associated abnormalities. The diagnosis of stapes fracture was suggested by increased compliance on tympanometry, leading to a second thin-section temporal bone computed tomography, which suggested a fracture of the posterior crus of the stapes. Endaural surgical exploration confirmed the diagnosis and allowed placement of ionomer cement in the posterior crus.DiscussionThe possibility of ossicular dislocation or fracture must be considered in patients with persistent conductive hearing loss associated with increased compliance on tympanometry, even when computed tomography of the temporal bone does not show dislocation of the ossicular chain or ossicular fracture. Hearing rehabilitation can be performed by hearing aid or surgical reconstruction of the ossicles.



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