Human Papillomavirus-Related Multiphenotypic Sinonasal Carcinoma with Unique HPV type 52 Association: A Case Report with Review of Literature

Abstract

Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC) is a recently described distinctive clinicopathologic entity defined by association to high risk HPV, localization to sinonasal tract and close histologic resemblance to salivary gland tumors. Lack of awareness of its pathologic features and biology among pathologists and oncologists make this entity susceptible to misdiagnosis and erroneous management. Herein, we illustrate a case of HMSC of the nasal cavity associated with heretofore unreported subtype HPV-52 and discuss the challenges associated with diagnosis and management of this rare tumor. A 48-year-old woman with intermittent epistaxis for 6 months presented with a nasal mass and underwent middle turbinectomy. Histology showed a tumor with features typical of adenoid cystic carcinoma (ACC) in the form of basaloid cells and cribriform architecture. However, careful inspection revealed findings uncommon in ACC; such as surface pagetoid tumor spread, areas of solid sheets of myoepithelial cells accompanied by increased mitotic figures which prompted immunohistochemistry. Multidirectional differentiation into ductal (CK7, AE1/AE3) and myoepithelial (p63, p40, S100, calponin) lineage together with strong and diffuse immunopositivity for p16 distinguished this tumor from ACC. HPV genotyping was positive for high risk HPV subtype HPV52, which confirmed the diagnosis of HMSC. HPV-related multiphenotypic sinonasal carcinoma is an under-recognized unique clinicopathologic entity that needs awareness to avoid mistaking it for commoner salivary gland tumors. Making accurate diagnosis of this newly-described tumor is imperative in order to understand its biology and to develop optimal therapeutic strategies.

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Human Papillomavirus-Related Multiphenotypic Sinonasal Carcinoma with Unique HPV type 52 Association: A Case Report with Review of Literature

Abstract

Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC) is a recently described distinctive clinicopathologic entity defined by association to high risk HPV, localization to sinonasal tract and close histologic resemblance to salivary gland tumors. Lack of awareness of its pathologic features and biology among pathologists and oncologists make this entity susceptible to misdiagnosis and erroneous management. Herein, we illustrate a case of HMSC of the nasal cavity associated with heretofore unreported subtype HPV-52 and discuss the challenges associated with diagnosis and management of this rare tumor. A 48-year-old woman with intermittent epistaxis for 6 months presented with a nasal mass and underwent middle turbinectomy. Histology showed a tumor with features typical of adenoid cystic carcinoma (ACC) in the form of basaloid cells and cribriform architecture. However, careful inspection revealed findings uncommon in ACC; such as surface pagetoid tumor spread, areas of solid sheets of myoepithelial cells accompanied by increased mitotic figures which prompted immunohistochemistry. Multidirectional differentiation into ductal (CK7, AE1/AE3) and myoepithelial (p63, p40, S100, calponin) lineage together with strong and diffuse immunopositivity for p16 distinguished this tumor from ACC. HPV genotyping was positive for high risk HPV subtype HPV52, which confirmed the diagnosis of HMSC. HPV-related multiphenotypic sinonasal carcinoma is an under-recognized unique clinicopathologic entity that needs awareness to avoid mistaking it for commoner salivary gland tumors. Making accurate diagnosis of this newly-described tumor is imperative in order to understand its biology and to develop optimal therapeutic strategies.

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Shear wave elastography of parotid glands in pediatric patients with HIV infection

Abstract

Objectives

Parotid gland (PG) involvement is common among the patients with HIV infection. Shear wave elastography (SWE) is a noninvasive method used to measure the tissue stiffness of several organs including PG. The aim of this study was to evaluate the tissue stiffness values of PGs of HIV-infected children via SWE and compare the results with the counterparts of healthy subjects.

Materials and methods

This single-center, prospective study included the PG examinations of 23 pediatric HIV patients and 40 healthy children via grayscale ultrasound and SWE. Independent sample T test and Mann–Whitney U test were used in statistical analysis.

Results

Stiffness of both PGs was significantly higher in patients' group when compared with control subjects. In addition, when the patients were separated into two groups according to the appearance of PG on grayscale ultrasound as homogeneous and heterogeneous, stiffness values were increased in the patients with homogeneous parenchymal appearance. No significant difference was achieved in terms of median CD4 and CD8 counts, HIV RNA levels or median duration of illnesses.

Conclusions

PG examination of HIV-infected children via SWE reveals increased tissue stiffness when compared with healthy subjects. SWE can be used as an ultrasound-assisted noninvasive technique in this manner.

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Shear wave elastography of parotid glands in pediatric patients with HIV infection

Abstract

Objectives

Parotid gland (PG) involvement is common among the patients with HIV infection. Shear wave elastography (SWE) is a noninvasive method used to measure the tissue stiffness of several organs including PG. The aim of this study was to evaluate the tissue stiffness values of PGs of HIV-infected children via SWE and compare the results with the counterparts of healthy subjects.

Materials and methods

This single-center, prospective study included the PG examinations of 23 pediatric HIV patients and 40 healthy children via grayscale ultrasound and SWE. Independent sample T test and Mann–Whitney U test were used in statistical analysis.

Results

Stiffness of both PGs was significantly higher in patients' group when compared with control subjects. In addition, when the patients were separated into two groups according to the appearance of PG on grayscale ultrasound as homogeneous and heterogeneous, stiffness values were increased in the patients with homogeneous parenchymal appearance. No significant difference was achieved in terms of median CD4 and CD8 counts, HIV RNA levels or median duration of illnesses.

Conclusions

PG examination of HIV-infected children via SWE reveals increased tissue stiffness when compared with healthy subjects. SWE can be used as an ultrasound-assisted noninvasive technique in this manner.

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Abatacept for the treatment of psoriatic arthritis.

Authors: Lubrano E, Scriffignano S, Perrotta FM Abstract INTRODUCTION: Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by the presence of psoriasis, arthritis and enthesitis, with the association of other musculoskeletal and extra-articular manifestations. Current treatment of PsA is mainly based on the use of conventional, biological and targeted synthetic DMARDs; however, patients may not respond or have a loss of response to these agents. Recently, a deeper understanding of the pathogenetic mechanisms has made possible the development of new drugs that actively interact with the activation of immune system, inhibiting the co-stimulation between antigen presenting cells and lymphocytes. Areas Covered: The aim of this paper is to review the role of the ac...

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Abatacept for the treatment of psoriatic arthritis.

Authors: Lubrano E, Scriffignano S, Perrotta FM Abstract INTRODUCTION: Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by the presence of psoriasis, arthritis and enthesitis, with the association of other musculoskeletal and extra-articular manifestations. Current treatment of PsA is mainly based on the use of conventional, biological and targeted synthetic DMARDs; however, patients may not respond or have a loss of response to these agents. Recently, a deeper understanding of the pathogenetic mechanisms has made possible the development of new drugs that actively interact with the activation of immune system, inhibiting the co-stimulation between antigen presenting cells and lymphocytes. Areas Covered: The aim of this paper is to review the role of the ac...

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New Contributions to Asarum Powder on Immunology Related Toxicity Effects in Lung.

Conclusion. Our data suggest that expressions of immune related genes in lung were selectively altered by Asarum. Therefore, inflammatory response was active, by regulating Caspase 3, Il1, Il20, Matriptase2, Nfκb, Rag2, Tmprss6, Prkag3, Nptx2, Antxr1, Klk11, Olr77, Cd7, LOC69, C6, LOC68, Cd163, Ampk, Bcl2, and Ccl20. Our study indicated that inflammatory factors take effect in lung toxicity caused by Asarum, which provides a new insight into molecular mechanism of Asarum toxicities in lung. PMID: 30245729 [PubMed] (Source: Evidence-based Complementary and Alternative Medicine)

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New Contributions to Asarum Powder on Immunology Related Toxicity Effects in Lung.

Conclusion. Our data suggest that expressions of immune related genes in lung were selectively altered by Asarum. Therefore, inflammatory response was active, by regulating Caspase 3, Il1, Il20, Matriptase2, Nfκb, Rag2, Tmprss6, Prkag3, Nptx2, Antxr1, Klk11, Olr77, Cd7, LOC69, C6, LOC68, Cd163, Ampk, Bcl2, and Ccl20. Our study indicated that inflammatory factors take effect in lung toxicity caused by Asarum, which provides a new insight into molecular mechanism of Asarum toxicities in lung. PMID: 30245729 [PubMed] (Source: Evidence-based Complementary and Alternative Medicine)

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Eosinophilic Dermatosis of Myeloproliferative Disease in a Young Adult With Diffuse Large B-Cell Lymphoma

Abstract: Exaggerated insect bite reactions present as exuberant papular and vesiculobullous lesions in patients with hematologic malignant neoplasms. The most commonly reported hematological malignancy with exaggerated insect bite reactions is chronic lymphocytic leukemia. Other reported reactions have been seen in patients with mantle cell lymphoma. Clinical presentation may vary with many patients unaware of a previous insect bite. Therefore, the terms "exaggerated bite-like reaction" and "eosinophilic dermatosis of myeloproliferative disease" have been proposed. The lesions may wax and wane or persist for many years, and they seem to be unrelated to the underlying hematologic disorder course or therapy. In some circumstances, the lesions may actually precede the diagnosis of the hematological malignancy. In this study, we describe a case of "eosinophilic eruption of myeloproliferative disease" associated with diffuse large B-cell lymphoma in a young adult. To the best of our knowledge, this is the first case reported in association with diffuse large B-cell lymphoma. Correspondence: Katrin Kiavash, MD, Department of Pathology, Roger Williams Medical Center, Boston University, 14 Shadow Farm Way, Wakefield, RI 02879 (kiavashkatrin@yahoo.com). K. Kiavash and A. Jencks have equal contribution to this manuscript and both are considered as first authors. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cutaneous Mastocytosis With Predominant Infiltration of Promastocytes

Abstract: Mastocytosis is a heterogeneous group of disorders with a variable clinical course, ranging from indolent disease with normal life expectancy to highly aggressive disease. In the skin, mast cells may show a spindle-shape appearance or appear as round cells with wide, polygonal cytoplasm. In this study, we present a case series of 4 patients with cutaneous childhood-onset mastocytosis in whom skin mast cells showed striking nuclear pleomorphism with bilobed and multilobed nuclei. Such finding does not seem to represent a malignant phenotype of the disease in the skin, although the true biological significance and the potential prognostic impact remain to be determined. Correspondence: Nicole Knöpfel, MD, Department of Dermatology, Hospital Infantil Universitario Niño Jesús, C/Menéndez Pelayo, 65, Madrid 28009, Spain (e-mail: nicole.knopfel@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Eosinophilic Dermatosis of Myeloproliferative Disease in a Young Adult With Diffuse Large B-Cell Lymphoma

Abstract: Exaggerated insect bite reactions present as exuberant papular and vesiculobullous lesions in patients with hematologic malignant neoplasms. The most commonly reported hematological malignancy with exaggerated insect bite reactions is chronic lymphocytic leukemia. Other reported reactions have been seen in patients with mantle cell lymphoma. Clinical presentation may vary with many patients unaware of a previous insect bite. Therefore, the terms "exaggerated bite-like reaction" and "eosinophilic dermatosis of myeloproliferative disease" have been proposed. The lesions may wax and wane or persist for many years, and they seem to be unrelated to the underlying hematologic disorder course or therapy. In some circumstances, the lesions may actually precede the diagnosis of the hematological malignancy. In this study, we describe a case of "eosinophilic eruption of myeloproliferative disease" associated with diffuse large B-cell lymphoma in a young adult. To the best of our knowledge, this is the first case reported in association with diffuse large B-cell lymphoma. Correspondence: Katrin Kiavash, MD, Department of Pathology, Roger Williams Medical Center, Boston University, 14 Shadow Farm Way, Wakefield, RI 02879 (kiavashkatrin@yahoo.com). K. Kiavash and A. Jencks have equal contribution to this manuscript and both are considered as first authors. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Mucinous Metaplasia of the Vulva in Zoon Vulvitis and Lichen Sclerosus et Atrophicus. Description of 3 Additional Cases of a Rarely Reported Histopathologic Finding

Abstract: Mucinous metaplasia of the vulva (MMV) is a histopathologic finding that has been reported previously in only 3 patients and needs to be distinguished from vulvar extramammary Paget disease. We report 3 additional instances of MMV associated to Zoon vulvitis and vulvar lichen sclerosus et atrophicus. Histochemical and immunohistochemical studies were performed on biopsies from erythematous and erosive vulvar lesions of 3 women aged 64, 80 and 84 years, with features of Zoon vulvitis (2 cases) and lichen sclerosus et atrophicus (1 case). Mucin-containing epithelial cells were present on the uppermost layers of the squamous epithelium. On immunohistochemical study the metaplastic cells were positive for cytokeratin 7, epithelial membrane antigen and carcinoembryonic antigen, thus mimicking the phenotype of Paget disease. MMV is most likely related to chronic inflammation. Cytological and architectural features allow for distinction from Paget disease because the mucin-containing cells of mucinous metaplasia of the vulva lack atypia and are predominantly located on the most superficial layers of the surface epithelium. Correspondence: Carlos Santonja, MD, Anatomía Patológica, Hospital Universitario Fundación Jiménez Díaz, Avenida de los Reyes Católicos, 2, 28040 Madrid, Spain (e-mail: csantonja@fjd.es). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cutaneous Mastocytosis With Predominant Infiltration of Promastocytes

Abstract: Mastocytosis is a heterogeneous group of disorders with a variable clinical course, ranging from indolent disease with normal life expectancy to highly aggressive disease. In the skin, mast cells may show a spindle-shape appearance or appear as round cells with wide, polygonal cytoplasm. In this study, we present a case series of 4 patients with cutaneous childhood-onset mastocytosis in whom skin mast cells showed striking nuclear pleomorphism with bilobed and multilobed nuclei. Such finding does not seem to represent a malignant phenotype of the disease in the skin, although the true biological significance and the potential prognostic impact remain to be determined. Correspondence: Nicole Knöpfel, MD, Department of Dermatology, Hospital Infantil Universitario Niño Jesús, C/Menéndez Pelayo, 65, Madrid 28009, Spain (e-mail: nicole.knopfel@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Brooke–Spiegler Syndrome: Two Patients From a Turkish Family With Multiple Familial Trichoepithelioma

No abstract available

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Mucinous Metaplasia of the Vulva in Zoon Vulvitis and Lichen Sclerosus et Atrophicus. Description of 3 Additional Cases of a Rarely Reported Histopathologic Finding

Abstract: Mucinous metaplasia of the vulva (MMV) is a histopathologic finding that has been reported previously in only 3 patients and needs to be distinguished from vulvar extramammary Paget disease. We report 3 additional instances of MMV associated to Zoon vulvitis and vulvar lichen sclerosus et atrophicus. Histochemical and immunohistochemical studies were performed on biopsies from erythematous and erosive vulvar lesions of 3 women aged 64, 80 and 84 years, with features of Zoon vulvitis (2 cases) and lichen sclerosus et atrophicus (1 case). Mucin-containing epithelial cells were present on the uppermost layers of the squamous epithelium. On immunohistochemical study the metaplastic cells were positive for cytokeratin 7, epithelial membrane antigen and carcinoembryonic antigen, thus mimicking the phenotype of Paget disease. MMV is most likely related to chronic inflammation. Cytological and architectural features allow for distinction from Paget disease because the mucin-containing cells of mucinous metaplasia of the vulva lack atypia and are predominantly located on the most superficial layers of the surface epithelium. Correspondence: Carlos Santonja, MD, Anatomía Patológica, Hospital Universitario Fundación Jiménez Díaz, Avenida de los Reyes Católicos, 2, 28040 Madrid, Spain (e-mail: csantonja@fjd.es). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Follicle and Sebaceous Gland Multinucleated Cells in Measles

Abstract: We report the case of a 32-year-old man with measles in which skin biopsy helped to establish a definitive diagnosis. Follicular involvement is a common histopathologic feature of measles. Multinucleated epidermal and follicular cells are distinctive findings. Correspondence: Jorge Magdaleno-Tapial, MD, Department of Dermatology, Hospital General Universitario de Valencia, Avenida Tres Creus, 2, 46014 Valencia, Spain (e-mail: jormagta@gmail.com). J. Magdaleno-Tapial wrote most of the original draft of the paper. C. Valenzuela-Oñate, M. Giacaman-von der Weth, and B. Ferrer-Guillén have participated in writing the paper. M. García-Legaz Martínez and P. Hernández-Bel have followed the patient. V. Alegre-de Miquel and Á. Martínez-Domenech have performed the histological study of the samples. V. Alegre-de Miquel has followed the patient and has reviewed the pertinent raw data on which conclusions of this study are based. All authors have read and approved the final version of the manuscript submitted. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Brooke–Spiegler Syndrome: Two Patients From a Turkish Family With Multiple Familial Trichoepithelioma

No abstract available

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Langerhans Cell Histiocytoma: A Benign Histiocytic Neoplasm of Diverse Lines of Terminal Differentiation

Abstract: Langerhans cell (LC) histiocytoma is a neonatal tumor that often consists of a single, ulcerated nodule. Systemic involvement is rare, and LC histiocytoma is considered to be a variant of congenital, self-healing LC histiocytosis (also referred to as Hashimoto–Pritzker disease). In view of its low prevalence, LC histiocytoma is not always diagnosed in a clinical examination and requires histological confirmation. Furthermore, the histological and molecular features of LC histiocytoma have not been well characterized. Here, we report on 6 cases of this rare disease and review the corresponding literature. LC histiocytoma differs from classical self-healing LC histiocytosis with regard to the pathological features; we found that LC histiocytoma was associated with massive infiltration by histiocytes of various sizes and shapes (although often large) throughout the dermis and the superficial subcutis. Epidermotropism was rare, mitotic figures were not inconspicuous, and necrotic or calcified areas were often present. Immunohistochemical assessment revealed a mixture of different types of histiocytes (with CD1a+ CD207+, CD1a+ CD207−, and CD1a− CD207− CD163+ cells). Genetic testing was performed in 5 cases; it revealed a BRAF mutation (p.V600E and p.485_490delinsF) in 2 cases, a HRAS mutation (p.T58I) in 1 case, a combination of 2 PTEN mutations in another case (p.I224M and p. R234W), and no mutations in the fifth case. All the lesions regressed spontaneously, and none recurred during follow-up. Correspondence: Sylvie Fraitag, MD (e-mail: Sylvie.fraitag@aphp.fr). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Follicle and Sebaceous Gland Multinucleated Cells in Measles

Abstract: We report the case of a 32-year-old man with measles in which skin biopsy helped to establish a definitive diagnosis. Follicular involvement is a common histopathologic feature of measles. Multinucleated epidermal and follicular cells are distinctive findings. Correspondence: Jorge Magdaleno-Tapial, MD, Department of Dermatology, Hospital General Universitario de Valencia, Avenida Tres Creus, 2, 46014 Valencia, Spain (e-mail: jormagta@gmail.com). J. Magdaleno-Tapial wrote most of the original draft of the paper. C. Valenzuela-Oñate, M. Giacaman-von der Weth, and B. Ferrer-Guillén have participated in writing the paper. M. García-Legaz Martínez and P. Hernández-Bel have followed the patient. V. Alegre-de Miquel and Á. Martínez-Domenech have performed the histological study of the samples. V. Alegre-de Miquel has followed the patient and has reviewed the pertinent raw data on which conclusions of this study are based. All authors have read and approved the final version of the manuscript submitted. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Langerhans Cell Histiocytoma: A Benign Histiocytic Neoplasm of Diverse Lines of Terminal Differentiation

Abstract: Langerhans cell (LC) histiocytoma is a neonatal tumor that often consists of a single, ulcerated nodule. Systemic involvement is rare, and LC histiocytoma is considered to be a variant of congenital, self-healing LC histiocytosis (also referred to as Hashimoto–Pritzker disease). In view of its low prevalence, LC histiocytoma is not always diagnosed in a clinical examination and requires histological confirmation. Furthermore, the histological and molecular features of LC histiocytoma have not been well characterized. Here, we report on 6 cases of this rare disease and review the corresponding literature. LC histiocytoma differs from classical self-healing LC histiocytosis with regard to the pathological features; we found that LC histiocytoma was associated with massive infiltration by histiocytes of various sizes and shapes (although often large) throughout the dermis and the superficial subcutis. Epidermotropism was rare, mitotic figures were not inconspicuous, and necrotic or calcified areas were often present. Immunohistochemical assessment revealed a mixture of different types of histiocytes (with CD1a+ CD207+, CD1a+ CD207−, and CD1a− CD207− CD163+ cells). Genetic testing was performed in 5 cases; it revealed a BRAF mutation (p.V600E and p.485_490delinsF) in 2 cases, a HRAS mutation (p.T58I) in 1 case, a combination of 2 PTEN mutations in another case (p.I224M and p. R234W), and no mutations in the fifth case. All the lesions regressed spontaneously, and none recurred during follow-up. Correspondence: Sylvie Fraitag, MD (e-mail: Sylvie.fraitag@aphp.fr). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Children born by C-section face higher risk of having a food allergy

Researchers at Örebro University and the Karolinska Institutet in Stockholm led the study, which tracked more than a million children for around 13 years. (Source: the Mail online | Health)

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Children born by C-section face higher risk of having a food allergy

Researchers at Örebro University and the Karolinska Institutet in Stockholm led the study, which tracked more than a million children for around 13 years. (Source: the Mail online | Health)

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Electric-Acoustic Stimulation Outcomes in Children

Objectives: This study investigates outcomes in children fit with electric-acoustic stimulation (EAS) and addresses three main questions: (1) Are outcomes with EAS superior to outcomes with conventional electric-only stimulation in children? (2) Do children with residual hearing benefit from EAS and conventional electric-only stimulation when compared with the preoperative hearing aid (HA) condition? (3) Can children with residual hearing derive benefit from EAS after several years of listening with conventional electric-only stimulation? Design: Sixteen pediatric cochlear implant (CI) recipients between 4 and 16 years of age with an unaided low-frequency pure tone average of 75 dB HL in the implanted ear were included in two study arms. Arm 1 included new recipients, and Arm 2 included children with at least 1 year of CI experience. Using a within-subject design, participants were evaluated unilaterally with the Consonant-Nucleus-Consonant (CNC) word list in quiet and the Baby Bio at a +5 dB SNR using an EAS program and a conventional full electric (FE) program. Arm 1 participants' scores were also compared with preoperative scores. Results: Speech perception outcomes were statistically higher with the EAS program than the FE program. For new recipients, scores were significantly higher with EAS than preoperative HA scores for both the CNC and Baby Bio in noise; however, after 6 months of device use, results in the FE condition were not significantly better than preoperative scores. Long-term FE users benefited from EAS over their FE programs based on CNC word scores. Conclusions: Whether newly implanted or long-term CI users, children with residual hearing after CI surgery can benefit from EAS. Cochlear implantation with EAS fitting is a viable option for children with HAs who have residual hearing but have insufficient access to high-frequency sounds and poor speech perception. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. ACKNOWLEDGMENTS: The authors wish to thank Dr. Emily Buss for her assistance with statistical analysis. This study was supported by Cochlear Americas. Holly Teagle serves on the audiology advisory board for Cochlear. The authors have no other conflicts of interest to disclose. Portions of this article were presented at The 13th International Conference on Cochlear Implants and Other Implantable Technologies, Toronto, Ontario, Canada, May 12, 2016, and at The 15th International Conference on Cochlear Implants and Other Implantable Technologies, Antwerp, Belgium, June 29, 2018. Received February 10, 2018; accepted August 10, 2018. Address for correspondence: Lisa R. Park, The Children's Cochlear Implant Center at UNC, University of North Carolina at Chapel Hill, 5501 Fortunes Ridge Drive, Suite A, Durham, NC 27713, USA. Phone: 919-419-1449. Fax: 919-419-1399. E-mail: Lisa_Park@med.unc.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Electric-Acoustic Stimulation Outcomes in Children

Objectives: This study investigates outcomes in children fit with electric-acoustic stimulation (EAS) and addresses three main questions: (1) Are outcomes with EAS superior to outcomes with conventional electric-only stimulation in children? (2) Do children with residual hearing benefit from EAS and conventional electric-only stimulation when compared with the preoperative hearing aid (HA) condition? (3) Can children with residual hearing derive benefit from EAS after several years of listening with conventional electric-only stimulation? Design: Sixteen pediatric cochlear implant (CI) recipients between 4 and 16 years of age with an unaided low-frequency pure tone average of 75 dB HL in the implanted ear were included in two study arms. Arm 1 included new recipients, and Arm 2 included children with at least 1 year of CI experience. Using a within-subject design, participants were evaluated unilaterally with the Consonant-Nucleus-Consonant (CNC) word list in quiet and the Baby Bio at a +5 dB SNR using an EAS program and a conventional full electric (FE) program. Arm 1 participants' scores were also compared with preoperative scores. Results: Speech perception outcomes were statistically higher with the EAS program than the FE program. For new recipients, scores were significantly higher with EAS than preoperative HA scores for both the CNC and Baby Bio in noise; however, after 6 months of device use, results in the FE condition were not significantly better than preoperative scores. Long-term FE users benefited from EAS over their FE programs based on CNC word scores. Conclusions: Whether newly implanted or long-term CI users, children with residual hearing after CI surgery can benefit from EAS. Cochlear implantation with EAS fitting is a viable option for children with HAs who have residual hearing but have insufficient access to high-frequency sounds and poor speech perception. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. ACKNOWLEDGMENTS: The authors wish to thank Dr. Emily Buss for her assistance with statistical analysis. This study was supported by Cochlear Americas. Holly Teagle serves on the audiology advisory board for Cochlear. The authors have no other conflicts of interest to disclose. Portions of this article were presented at The 13th International Conference on Cochlear Implants and Other Implantable Technologies, Toronto, Ontario, Canada, May 12, 2016, and at The 15th International Conference on Cochlear Implants and Other Implantable Technologies, Antwerp, Belgium, June 29, 2018. Received February 10, 2018; accepted August 10, 2018. Address for correspondence: Lisa R. Park, The Children's Cochlear Implant Center at UNC, University of North Carolina at Chapel Hill, 5501 Fortunes Ridge Drive, Suite A, Durham, NC 27713, USA. Phone: 919-419-1449. Fax: 919-419-1399. E-mail: Lisa_Park@med.unc.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Children born by C-section face higher risk of having a food allergy

Researchers at Örebro University and the Karolinska Institutet in Stockholm led the study, which tracked more than a million children for around 13 years. (Source: the Mail online | Health)

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Children born by C-section face higher risk of having a food allergy

Researchers at Örebro University and the Karolinska Institutet in Stockholm led the study, which tracked more than a million children for around 13 years. (Source: the Mail online | Health)

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Universal cannabis outcomes from the Climate and Preventure (CAP) study: a cluster randomised controlled trial

The Climate and Preventure (CAP) study was the first trial to assess and demonstrate the effectiveness of a combined universal and selective approach for preventing alcohol use and related harms among adolescents...

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Universal cannabis outcomes from the Climate and Preventure (CAP) study: a cluster randomised controlled trial

The Climate and Preventure (CAP) study was the first trial to assess and demonstrate the effectiveness of a combined universal and selective approach for preventing alcohol use and related harms among adolescents...

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Insulin allergy can be successfully managed by a systematic approach

Type I insulin allergy can be a challenging condition, and there is no international consensus on how to establish the diagnosis. Measurement of specific IgE and skin testing have been cornerstones in the diag...

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Insulin allergy can be successfully managed by a systematic approach

Type I insulin allergy can be a challenging condition, and there is no international consensus on how to establish the diagnosis. Measurement of specific IgE and skin testing have been cornerstones in the diag...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NDF6Z3

Bronchial Blocker Use in the Difficult Airway Patient Requiring Lung Isolation: Clarification as to What Blockers Are Actually Available

No abstract available

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Intraoperative Considerations for Transgender Patients

No abstract available

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In Response

No abstract available

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In Response

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QYBE9r

Programmed Intermittent Bolus Regimen for Erector Spinae Plane Blocks in Children: A Retrospective Review of a Single-Institution Experience

With few published reports on erector spinae plane block use in children, limited guidance on perioperative local anesthetic dosing exists. We present a series of 22 patients who received erector spinae plane catheters with programmed intermittent bolus for various surgeries. Median loading dose of 0.4 mL/kg (interquartile range [IQR], 0.1 mL/kg) ropivacaine 0.5%, intraoperative bolus of 0.3 mL/kg/h (IQR, 0.1 mL/kg) ropivacaine 0.2%, and a postoperative programmed intermittent bolus regimen of maximum 0.6 mg/kg/h resulted in highest pain scores on postoperative day 1 with a median score of 1.7 of 10 (IQR, 1.8) and highest morphine equivalents consumed on postoperative day 2 with a median score of 0.16 mg/kg up to 120 hours after surgery. Accepted for publication August 22, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Ban C. H. Tsui, MD, FRCPC, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, 300 Pasteur Dr, 3rd Floor, Room H3584, MC 5640, Stanford, CA 94305. Address e-mail to bantsui@stanford.edu. © 2018 International Anesthesia Research Society

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Acute Stroke Management in the First 24 Hours: A Practical Guide for Clinicians

No abstract available

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Obstetric Anesthesiology in the United States: Current and Future Demand for Fellowship-Trained Subspecialists

No abstract available

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Lack of Bias Evaluation and Inadequate Study Selection May Produce Misleading Results

No abstract available

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Should We Always Continue β-Blocking Agents Preoperatively?

No abstract available

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Is Tube Thermosoftening Helpful for Videolaryngoscope-Guided Nasotracheal Intubation?: A Randomized Controlled Trial

BACKGROUND: Thermosoftening of the endotracheal tube (ETT) and telescoping the ETT into a rubber catheter have been suggested as a method for reducing epistaxis during nasotracheal intubation (NTI). However, thermosoftening technique is known to make it difficult to navigate the ETT into trachea without the use of Magill forceps during NTI. The cuff inflation technique has been suggested as an effective alternative to the use of Magill forceps to improve the oropharyngeal navigation of the ETT, irrespective of their stiffness, during direct laryngoscope-guided NTI. We evaluated whether thermosoftening of the ETT telescoped into rubber catheters has an additional benefit in reducing nasal injury. Simultaneously, we also evaluated whether thermosoftening of the ETT worsened orotracheal navigability during cuff inflation-supplemented videolaryngoscope-guided NTI. METHODS: One hundred forty patients were randomly assigned to 1 of the 2 groups depending on whether the ETT was softened by warming or not. The primary outcome was the incidence of epistaxis during NTI. The secondary outcome was nasotracheal navigability of the ETT, assessed by navigation grade and time required for insertion of ETT in each phase (from nose to oropharynx, from oropharynx to glottic inlet aided by cuff inflation if needed, and from glottic inlet to trachea). RESULTS: The ETTs were successfully inserted through the selected nostril of all 140 patients. In the thermosoftening group, the incidence and severity of epistaxis was significantly lower (7% vs 51%; difference of 44.2%; 95% confidence interval, 29.9%–56.2%; P .99 and P = .054, respectively) and from the glottic inlet to the trachea (P > .99 and P = .750, respectively) between the 2 groups. In both groups, all ETTs could be navigated into the trachea without the use of Magill forceps. CONCLUSIONS: Supplemented with cuff inflation during videolaryngoscope-guided NTI, thermosoftening of the ETT telescoped into rubber catheters has a substantial benefit because it significantly reduces the incidence of epistaxis without worsening the oropharyngeal navigability of the ETT. Accepted for publication August 17, 2018. Funding: None. The authors declare no conflicts of interest. This study was approved by the Institutional Ethics Committee (institutional review board [IRB] approval number 2017-03-020, IRB contact information: Institutional Review Board, Hallym University Kangnam Sacred Heart Hospital, B1, 12, Siheung-daero 187-gil, Yeongdeungpo-gu, Seoul 07441, Republic of Korea. E-mail: dandelionc@hallym.or.kr. Reprints will not be available from the authors. Address correspondence to Joo Hyun Jun, MD, PhD, Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea. Address e-mail to ilpleut@naver.com. © 2018 International Anesthesia Research Society

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Multimodal General Anesthesia: Theory and Practice

Balanced general anesthesia, the most common management strategy used in anesthesia care, entails the administration of different drugs together to create the anesthetic state. Anesthesiologists developed this approach to avoid sole reliance on ether for general anesthesia maintenance. Balanced general anesthesia uses less of each drug than if the drug were administered alone, thereby increasing the likelihood of its desired effects and reducing the likelihood of its side effects. To manage nociception intraoperatively and pain postoperatively, the current practice of balanced general anesthesia relies almost exclusively on opioids. While opioids are the most effective antinociceptive agents, they have undesirable side effects. Moreover, overreliance on opioids has contributed to the opioid epidemic in the United States. Spurred by concern of opioid overuse, balanced general anesthesia strategies are now using more agents to create the anesthetic state. Under these approaches, called "multimodal general anesthesia," the additional drugs may include agents with specific central nervous system targets such as dexmedetomidine and ones with less specific targets, such as magnesium. It is postulated that use of more agents at smaller doses further maximizes desired effects while minimizing side effects. Although this approach appears to maximize the benefit-to-side effect ratio, no rational strategy has been provided for choosing the drug combinations. Nociception induced by surgery is the primary reason for placing a patient in a state of general anesthesia. Hence, any rational strategy should focus on nociception control intraoperatively and pain control postoperatively. In this Special Article, we review the anatomy and physiology of the nociceptive and arousal circuits, and the mechanisms through which commonly used anesthetics and anesthetic adjuncts act in these systems. We propose a rational strategy for multimodal general anesthesia predicated on choosing a combination of agents that act at different targets in the nociceptive system to control nociception intraoperatively and pain postoperatively. Because these agents also decrease arousal, the doses of hypnotics and/or inhaled ethers needed to control unconsciousness are reduced. Effective use of this strategy requires simultaneous monitoring of antinociception and level of unconsciousness. We illustrate the application of this strategy by summarizing anesthetic management for 4 representative surgeries. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication June 11, 2018. Funding: This work was supported by the National Institutes of Health (Bethesda, MD): R01 GM104948 (to E.N.B.) and P01GM118269 (to E.N.B.); and by the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA. Conflicts of Interest: See Disclosures at the end of the article. A glossary of terms is available in the Appendix. Reprints will not be available from the authors. Address correspondence to Emery N. Brown, MD, PhD, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Grey-Jackson 444, Boston, MA 02114. Address e-mail to enb@neurostat.mit.edu. © 2018 International Anesthesia Research Society

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Performance of Air Seal of Flexible Reinforced Laryngeal Mask Airway in Thyroid Surgery Compared With Endotracheal Tube: A Randomized Controlled Trial

BACKGROUND: Flexible reinforced laryngeal mask airway (FLMA®) has gained popularity in thyroid surgery, but air leak and displacement are still concerns. METHODS: In this randomized, single-blinded, noninferiority, controlled trial, we randomized patients scheduled for elective radical thyroidectomy to an endotracheal tube (ETT) group or a FLMA group. The primary outcomes were ventilation leak volume, peak airway pressure, and partial pressure of end-tidal carbon dioxide (PetCO2). Data for primary outcomes were collected after insertion of ETT/FLMA, at incision, and at 10-minute intervals during surgery. Ten milliliters, 5 cm H2O, and 10 mm Hg were used as the noninferiority deltas for ventilation leak volume, peak airway pressure, and PetCO2, respectively. We assessed noninferiority of FLMA to ETT on the primary outcomes over time using the results of a linear mixed-effects model. The position of FLMA mask was evaluated before and after surgery, and the airway complications were recorded. RESULTS: A total of 132 patients were included: 65 in ETT group and 67 in FLMA group. Differences (FLMA group minus ETT group) of ventilation leak volume, peak airway pressure, and PetCO2 from the mixed-effects models were 2.09 mL (98.3% confidence interval [CI], –6.46 to 10.64), −0.60 cm H2O (98.3% CI, –2.15 to 0.96), and 1.02 mm Hg (98.3% CI, 0.04–1.99), respectively. Score of fiber-optic position of FLMA was significantly higher after surgery than before. There was no severe shift, loss of the mask seal, regurgitation, or aspiration in the FLMA group. One patient in the FLMA group experienced brief and easily controlled laryngospasm. CONCLUSIONS: In thyroid surgery, FLMA is noninferior to ETT in the peak airway pressure and PetCO2 although mild to moderate mask shift could occur during surgical manipulation. There is no evidence for a higher complication rate when FLMA is used. Accepted for publication July 27, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Clinical Trial Number: ChiCTR-IOR-15006602. LMA Flexible and LMA Classic are registered trademarks of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Jie Yi, MD, Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China. Address e-mail to easyue@163.com. © 2018 International Anesthesia Research Society

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Bronchial Blocker Use in the Difficult Airway Patient Requiring Lung Isolation: Clarification as to What Blockers Are Actually Available

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DuByE4

Intraoperative Considerations for Transgender Patients

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QXTfOL

In Response

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Dt9VeD

In Response

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QYBE9r

Programmed Intermittent Bolus Regimen for Erector Spinae Plane Blocks in Children: A Retrospective Review of a Single-Institution Experience

With few published reports on erector spinae plane block use in children, limited guidance on perioperative local anesthetic dosing exists. We present a series of 22 patients who received erector spinae plane catheters with programmed intermittent bolus for various surgeries. Median loading dose of 0.4 mL/kg (interquartile range [IQR], 0.1 mL/kg) ropivacaine 0.5%, intraoperative bolus of 0.3 mL/kg/h (IQR, 0.1 mL/kg) ropivacaine 0.2%, and a postoperative programmed intermittent bolus regimen of maximum 0.6 mg/kg/h resulted in highest pain scores on postoperative day 1 with a median score of 1.7 of 10 (IQR, 1.8) and highest morphine equivalents consumed on postoperative day 2 with a median score of 0.16 mg/kg up to 120 hours after surgery. Accepted for publication August 22, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Ban C. H. Tsui, MD, FRCPC, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, 300 Pasteur Dr, 3rd Floor, Room H3584, MC 5640, Stanford, CA 94305. Address e-mail to bantsui@stanford.edu. © 2018 International Anesthesia Research Society

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Acute Stroke Management in the First 24 Hours: A Practical Guide for Clinicians

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QYBvmp

Obstetric Anesthesiology in the United States: Current and Future Demand for Fellowship-Trained Subspecialists

No abstract available

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Lack of Bias Evaluation and Inadequate Study Selection May Produce Misleading Results

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QYBgrv

Should We Always Continue β-Blocking Agents Preoperatively?

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DGm1RN

Is Tube Thermosoftening Helpful for Videolaryngoscope-Guided Nasotracheal Intubation?: A Randomized Controlled Trial

BACKGROUND: Thermosoftening of the endotracheal tube (ETT) and telescoping the ETT into a rubber catheter have been suggested as a method for reducing epistaxis during nasotracheal intubation (NTI). However, thermosoftening technique is known to make it difficult to navigate the ETT into trachea without the use of Magill forceps during NTI. The cuff inflation technique has been suggested as an effective alternative to the use of Magill forceps to improve the oropharyngeal navigation of the ETT, irrespective of their stiffness, during direct laryngoscope-guided NTI. We evaluated whether thermosoftening of the ETT telescoped into rubber catheters has an additional benefit in reducing nasal injury. Simultaneously, we also evaluated whether thermosoftening of the ETT worsened orotracheal navigability during cuff inflation-supplemented videolaryngoscope-guided NTI. METHODS: One hundred forty patients were randomly assigned to 1 of the 2 groups depending on whether the ETT was softened by warming or not. The primary outcome was the incidence of epistaxis during NTI. The secondary outcome was nasotracheal navigability of the ETT, assessed by navigation grade and time required for insertion of ETT in each phase (from nose to oropharynx, from oropharynx to glottic inlet aided by cuff inflation if needed, and from glottic inlet to trachea). RESULTS: The ETTs were successfully inserted through the selected nostril of all 140 patients. In the thermosoftening group, the incidence and severity of epistaxis was significantly lower (7% vs 51%; difference of 44.2%; 95% confidence interval, 29.9%–56.2%; P .99 and P = .054, respectively) and from the glottic inlet to the trachea (P > .99 and P = .750, respectively) between the 2 groups. In both groups, all ETTs could be navigated into the trachea without the use of Magill forceps. CONCLUSIONS: Supplemented with cuff inflation during videolaryngoscope-guided NTI, thermosoftening of the ETT telescoped into rubber catheters has a substantial benefit because it significantly reduces the incidence of epistaxis without worsening the oropharyngeal navigability of the ETT. Accepted for publication August 17, 2018. Funding: None. The authors declare no conflicts of interest. This study was approved by the Institutional Ethics Committee (institutional review board [IRB] approval number 2017-03-020, IRB contact information: Institutional Review Board, Hallym University Kangnam Sacred Heart Hospital, B1, 12, Siheung-daero 187-gil, Yeongdeungpo-gu, Seoul 07441, Republic of Korea. E-mail: dandelionc@hallym.or.kr. Reprints will not be available from the authors. Address correspondence to Joo Hyun Jun, MD, PhD, Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea. Address e-mail to ilpleut@naver.com. © 2018 International Anesthesia Research Society

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Multimodal General Anesthesia: Theory and Practice

Balanced general anesthesia, the most common management strategy used in anesthesia care, entails the administration of different drugs together to create the anesthetic state. Anesthesiologists developed this approach to avoid sole reliance on ether for general anesthesia maintenance. Balanced general anesthesia uses less of each drug than if the drug were administered alone, thereby increasing the likelihood of its desired effects and reducing the likelihood of its side effects. To manage nociception intraoperatively and pain postoperatively, the current practice of balanced general anesthesia relies almost exclusively on opioids. While opioids are the most effective antinociceptive agents, they have undesirable side effects. Moreover, overreliance on opioids has contributed to the opioid epidemic in the United States. Spurred by concern of opioid overuse, balanced general anesthesia strategies are now using more agents to create the anesthetic state. Under these approaches, called "multimodal general anesthesia," the additional drugs may include agents with specific central nervous system targets such as dexmedetomidine and ones with less specific targets, such as magnesium. It is postulated that use of more agents at smaller doses further maximizes desired effects while minimizing side effects. Although this approach appears to maximize the benefit-to-side effect ratio, no rational strategy has been provided for choosing the drug combinations. Nociception induced by surgery is the primary reason for placing a patient in a state of general anesthesia. Hence, any rational strategy should focus on nociception control intraoperatively and pain control postoperatively. In this Special Article, we review the anatomy and physiology of the nociceptive and arousal circuits, and the mechanisms through which commonly used anesthetics and anesthetic adjuncts act in these systems. We propose a rational strategy for multimodal general anesthesia predicated on choosing a combination of agents that act at different targets in the nociceptive system to control nociception intraoperatively and pain postoperatively. Because these agents also decrease arousal, the doses of hypnotics and/or inhaled ethers needed to control unconsciousness are reduced. Effective use of this strategy requires simultaneous monitoring of antinociception and level of unconsciousness. We illustrate the application of this strategy by summarizing anesthetic management for 4 representative surgeries. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication June 11, 2018. Funding: This work was supported by the National Institutes of Health (Bethesda, MD): R01 GM104948 (to E.N.B.) and P01GM118269 (to E.N.B.); and by the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA. Conflicts of Interest: See Disclosures at the end of the article. A glossary of terms is available in the Appendix. Reprints will not be available from the authors. Address correspondence to Emery N. Brown, MD, PhD, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Grey-Jackson 444, Boston, MA 02114. Address e-mail to enb@neurostat.mit.edu. © 2018 International Anesthesia Research Society

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Performance of Air Seal of Flexible Reinforced Laryngeal Mask Airway in Thyroid Surgery Compared With Endotracheal Tube: A Randomized Controlled Trial

BACKGROUND: Flexible reinforced laryngeal mask airway (FLMA®) has gained popularity in thyroid surgery, but air leak and displacement are still concerns. METHODS: In this randomized, single-blinded, noninferiority, controlled trial, we randomized patients scheduled for elective radical thyroidectomy to an endotracheal tube (ETT) group or a FLMA group. The primary outcomes were ventilation leak volume, peak airway pressure, and partial pressure of end-tidal carbon dioxide (PetCO2). Data for primary outcomes were collected after insertion of ETT/FLMA, at incision, and at 10-minute intervals during surgery. Ten milliliters, 5 cm H2O, and 10 mm Hg were used as the noninferiority deltas for ventilation leak volume, peak airway pressure, and PetCO2, respectively. We assessed noninferiority of FLMA to ETT on the primary outcomes over time using the results of a linear mixed-effects model. The position of FLMA mask was evaluated before and after surgery, and the airway complications were recorded. RESULTS: A total of 132 patients were included: 65 in ETT group and 67 in FLMA group. Differences (FLMA group minus ETT group) of ventilation leak volume, peak airway pressure, and PetCO2 from the mixed-effects models were 2.09 mL (98.3% confidence interval [CI], –6.46 to 10.64), −0.60 cm H2O (98.3% CI, –2.15 to 0.96), and 1.02 mm Hg (98.3% CI, 0.04–1.99), respectively. Score of fiber-optic position of FLMA was significantly higher after surgery than before. There was no severe shift, loss of the mask seal, regurgitation, or aspiration in the FLMA group. One patient in the FLMA group experienced brief and easily controlled laryngospasm. CONCLUSIONS: In thyroid surgery, FLMA is noninferior to ETT in the peak airway pressure and PetCO2 although mild to moderate mask shift could occur during surgical manipulation. There is no evidence for a higher complication rate when FLMA is used. Accepted for publication July 27, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Clinical Trial Number: ChiCTR-IOR-15006602. LMA Flexible and LMA Classic are registered trademarks of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Jie Yi, MD, Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China. Address e-mail to easyue@163.com. © 2018 International Anesthesia Research Society

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Vitamin D for the management of multiple sclerosis.

CONCLUSIONS: To date, very low-quality evidence suggests no benefit of vitamin D for patient-important outcomes among people with MS. Vitamin D appears to have no effect on recurrence of relapse, worsening of disability measured by the Expanded Disability Status Scale (EDSS), and MRI lesions. Effects on health-related quality of life and fatigue are unclear. Vitamin D₃ at the doses and treatment durations used in the included trials appears to be safe, although available data are limited. Seven ongoing studies will likely provide further evidence that can be included in a future update of this review. PMID: 30246874 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)

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Vitamin D for the management of multiple sclerosis.

CONCLUSIONS: To date, very low-quality evidence suggests no benefit of vitamin D for patient-important outcomes among people with MS. Vitamin D appears to have no effect on recurrence of relapse, worsening of disability measured by the Expanded Disability Status Scale (EDSS), and MRI lesions. Effects on health-related quality of life and fatigue are unclear. Vitamin D₃ at the doses and treatment durations used in the included trials appears to be safe, although available data are limited. Seven ongoing studies will likely provide further evidence that can be included in a future update of this review. PMID: 30246874 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)

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Children born by C-section face a 21% higher risk of having a food allergy

Researchers at Örebro University and the Karolinska Institutet in Stockholm led the study, which tracked more than a million children for around 13 years. (Source: the Mail online | Health)

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Children born by C-section face a 21% higher risk of having a food allergy

Researchers at Örebro University and the Karolinska Institutet in Stockholm led the study, which tracked more than a million children for around 13 years. (Source: the Mail online | Health)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Children born by C-section face a 21% higher risk of having a food allergy

Researchers at Örebro University and the Karolinska Institutet in Stockholm led the study, which tracked more than a million children for around 13 years. (Source: the Mail online | Health)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Children born by C-section face a 21% higher risk of having a food allergy

Researchers at Örebro University and the Karolinska Institutet in Stockholm led the study, which tracked more than a million children for around 13 years. (Source: the Mail online | Health)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Newborn hearing screening protocols and their outcomes: A systematic review

Publication date: Available online 25 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Amisha Kanji, Katijah Khoza-Shangase, Nomfundo Moroe

Abstract

Objective

To conduct a review of the most current research in objective measures used within newborn hearing screening protocols with the aim of exploring the actual protocols in terms of the types of measures used and their frequency of use within a protocol, as well as their outcomes in terms of sensitivity, specificity, false positives, and false negatives in different countries worldwide.

Methods

A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Electronic databases such as PubMed, Google Scholar and Science Direct were used for the literature search. A total of 422 articles were identified, of which only 15 formed part of the current study. The 15 articles that met the study's criteria were reviewed. Pertinent data and findings from the review were tabulated and qualitatively analysed under the following headings: country; objective screening and/or diagnostic measures; details of screening protocol; results (including false positive and negative findings, sensitivity and/or specificity), conclusion and/or recommendations. These tabulated findings were then discussed with conclusions and recommendations offered.

Results

Findings reported in this paper are based on a qualitative rather than a quantitative analysis of the reviewed data. Generally, findings in this review revealed firstly, that there is a lack of uniformity in protocols adopted within newborn hearing screening. Secondly, many of the screening protocols reviewed consist of two or more tiers or stages, with transient evoked otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR) being most commonly used. Thirdly, DPOAEs appear to be less commonly used when compared to TEOAEs. Lastly, a question around routine inclusion of AABR as part of the NHS protocol remains inconclusively answered.

Conclusions

There is sufficient evidence to suggest that the inclusion of AABR within a NHS programme is effective in achieving better hearing screening outcomes. The use of AABR in combination with OAEs within a test-battery approach or cross-check principle to screening is appropriate, but the inclusion of AABR to facilitate appropriate referral for diagnostic assessment needs to be systematically studied.

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Immunohistochemical Expression of RUNX2 in Condylar Hyperplasia

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10, Supplement

Author(s): L.E. Almeida, S. Butcher, A. Sorenson, F.D.A. Camejo, A. Doetzer

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Computed Tomographic Angiography Perforator Localization for Virtual Surgical Planning of Osteocutaneous Fibular Free Flaps in Head and Neck Reconstruction

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Kyle S. Ettinger, Amy E. Alexander, Kevin Arce

Virtual surgical planning (VSP), computer-aided design and computer-aided modeling, and 3-dimensional printing are 3 distinct technologies that have become increasingly employed in head and neck oncology and microvascular reconstruction. Although each of these technologies have long been utilized for treatment planning in other surgical disciplines such as craniofacial surgery, trauma surgery, temporomandibular joint surgery, and orthognathic surgery, its widespread use in head and neck reconstructive surgery remains a much more recent advent. In response to the growing trend of VSP being used for the planning of fibular free flaps in head and neck reconstruction, some surgeons have questioned the technology's implementation based upon its perceived inadequacy in addressing other reconstructive considerations beyond hard tissue anatomy. Detractors of VSP for head and neck reconstruction highlight its lack of capability in accounting for multiple reconstructive factors, such as recipient vessel selection, vascular pedicle reach, need for dead space obliteration, and skin paddle perforator location. It is with this premise in mind that we report a simple technique for anatomically localizing peroneal artery perforators during VSP for osteocutaneous fibular free flaps in which both bone and a soft tissue skin paddle are required for ablative reconstruction. The technique allows for anatomic perforator localization during the VSP session based solely upon data existent within the preoperative computed tomographic angiography (CTA) and it does not require any modifications to preoperative clinical workflows. It is the authors' presumption that many surgeons in the field are unaware of this planning capability within the context of modern VSP for head and neck reconstruction. The primary purpose of this manuscript is to introduce and further familiarize surgeons with the technique of CTA perforator localization as a method of improving intraoperative fidelity for VSP of osteocutaneous fibular free flaps.

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Novel Patient-Specific 3-Dimensional Printed Fixation Tray for Mandibular Reconstruction With Fibular Free Flaps

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Kevin Arce, Samir Waris, Amy E. Alexander, Kyle S. Ettinger

Segmental mandibular defects secondary to infectious, traumatic, and pathologic conditions can be debilitating because of their impact on function and facial esthetics. Several reconstructive techniques are available, with vascularized flaps commonly used for the reconstruction of large bony or composite segmental defects. The free fibular flap for mandibular reconstruction is well documented and remains a commonly used flap because of its bone length, versatility, distant location from the head and neck region that allows for a 2-team approach, and ability to simultaneously place endosseous implants. Virtual surgical planning (VSP) and guided resection and reconstruction of maxillofacial defects have facilitated complex 3-dimensional (3D) reconstruction. The accuracy and fidelity of VSP are dependent on the intraoperative execution of the VSP, with computer-aided design and computer-aided modeling of patient-specific cutting guides and hardware providing a template for its execution. The goal of this report is to describe the authors' experience with the use of a novel 3D printed fixation tray designed from the VSP data. It provides dual functionality by aiding in alignment and stabilization of the fibular segments and concomitantly providing patient-specific anatomic references for indexing of bony and soft tissue components. This tray enables rapid ex vivo configuration of the fibula segment(s) with the reconstruction bar relative to the native mandibular segments and allows the compiled construct to be transferred to the head and neck for insetting as a precisely configured single unit.

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Quantifying Soft Tissue Changes in Cleft Lip and Palate Using Nonionizing Three-Dimensional Imaging: A Systematic Review

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Laurent A.M. Thierens, Noëmi M.C. De Roo, Guy A.M. De Pauw, Nele Brusselaers

Purpose

The use of nonionizing 3-dimensional (3D) imaging in cleft lip and palate (CLP) research is well-established; however, general guidelines concerning the assessment of these images are lacking. The aim of the present study was to review the methods for quantification of soft tissue changes on 3D surface images acquired before and after an orthopedic or surgical intervention in CLP patients.

Materials and Methods

A systematic literature search was performed using the databases MEDLINE (through PubMed), CENTRAL, Web of Science, and EMBASE. The literature search and eligibility assessment were performed by 2 independent reviewers in a nonblinded standardized manner. Only longitudinal studies reporting the assessment of pre- and postoperative 3D surface images and at least 10 CLP patients were considered eligible.

Results

Fifteen unique studies (reported from 1996 to 2017) were identified after an eligibility assessment. The assessment of the 3D images was performed with landmark-dependent analyses, mostly supported by superimposition of the pre- and postoperative images. A wide spectrum of superimposition techniques has been reported. The reliability of these assessment methods was often not reported or was insufficiently reported.

Conclusions

Soft tissue changes subsequent to a surgical or an orthopedic intervention can be quantified on 3D surface images using assessment methods that are primarily based on landmark identification, whether or not followed by superimposition. Operator bias is inherently enclosed in landmark-dependent analyses. The reliability of these methods has been insufficiently reported.

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Dental and Maxillofacial Signs in Aarskog Syndrome: A Review of 3 Siblings and the Literature

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Arnaud Depeyre, Matthias Schlund, Rémi Gryseleyn, Joël Ferri

Purpose

Dagfinn Aarksog first described faciodigitogenital syndrome in 1970. Its inheritance is X linked and autosomally recessive. Currently, the diagnosis of Aarskog-Scott syndrome (ASS) is based on clinical dysmorphologic findings and can be supported by genetic examination.

Report of Cases

This report describes 3 brothers already diagnosed with ASS who were referred for examination of oral and maxillofacial malformations associated with ASS. They presented classic features of ASS, such as digital and genital (shawl scrotum) anomalies. More specifically, in terms of orbitopalpebral malformations, they showed marked ptosis with hypertelorism and antimongoloid palpebral fissure that gave them the characteristic facies. Concerning their oral and maxillofacial malformations, they had dental and skeletal major discrepancies and some dental agenesia.

Discussion and Conclusion

ASS is a rare X-linked syndrome composed of numerous morphologic facial, digital, and genital anomalies. The diagnosis is established genetically with the FGD1 mutation but there is no phenotypic and genotypic correlation with FGD1 mutations. Concerning maxillofacial malformations, maxillary and mandibular hypoplasia with jaw discrepancies can be found, as can teeth anomalies. It seems that these anomalies are widely underestimated.

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Assessing the Quality of Life in Patients With Dentofacial Deformities Before and After Orthognathic Surgery

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Hong Sun, Hong-tao Shang, Li-sheng He, Ming-chao Ding, Zhong-ping Su, Yu-lin Shi

Purpose

This study aimed to assess the effect of health-related quality of life (QoL) among patients with dentofacial deformities who underwent orthognathic surgery compared with a control group without dentofacial deformities by use of generic oral health and condition-specific approaches.

Patients and Methods

In this prospective study, 2 questionnaires were administered to 85 patients (31 male and 54 female patients) who were evaluated before undergoing orthognathic surgery. The Short Form Oral Health Impact Profile Questionnaire (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ) were administered before and 5 to 7 months after orthognathic surgery. The control group comprised 96 young university student volunteers without dentofacial deformities.

Results

The questionnaires were collected 5 to 7 months after surgery. The preoperative scores of the patients and the control group were contrasted separately. The respondents' postoperative OHIP-14 and OQLQ scores were significantly lower (P < .001 for total scores). The preoperative OQLQ scores for all domains were significantly higher among the patients than among the controls (P < .001 for total scores), whereas the total scores and 3 subscale scores of the OHIP-14 in the functional and psychological domains were significantly higher among the patients than among the controls (P < .05 for total scores). The preoperative and postoperative OQLQ total scores were remarkably different between male and female patients (P < .05). The postoperative OQLQ total scores were considerably higher in older patients than in younger patients (P < .05). All patients in the Class III group who underwent double-jaw surgery showed remarkable changes after surgery (P < .001 for total scores).

Conclusions

Patients with dentofacial deformities had a poorer QoL compared with the healthy population, especially in functional and psychological aspects. Orthognathic surgery had a significant positive impact on QoL. Patients with Class III malocclusion who underwent double-jaw surgery seemingly benefitted the most after surgery.

Graphical abstract

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The Microsurgical Approach in Primary Cleft Rhinoplasty—An Anthropometric Analysis

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Frizzi Bschorer, Daniel Schneider, Gerhard Schön, Max Heiland, Reinhard Bschorer

Purpose

Oral and maxillofacial surgeons use different approaches to repair the nasal deformity of patients with a cleft lip deformity, differing in technique and timing. The aim of this longitudinal study was to analyze a new surgical technique to treat the cleft nasal deformity at 4 to 6 weeks of life using a microscope.

Materials and Methods

Twenty-seven newborn patients with a cleft lip deformity were treated by primary repair of the nasal deformity using a microscope at 4 to 6 weeks of life. The procedure includes a columellar incision, alar cartilage plication sutures according to Daniel (Plast Reconstr Surg 103:1491, 1999), and trans-columellar sutures. All patients were photographed at specific time points up to 1 year after surgery. Established angles and distances were analyzed and compared with normal values of age-matched children by Farkas (Anthropometry of the Head and Face [ed 2]. New York: Lippincott Williams and Wilkins, 1994).

Results

All parameters improved through surgery and showed stable values at follow-up assessments. Almost ideal values concerning symmetry, as indicated by columellar deviation and nostril comparison, were obtained. Measurements of nasal morphology were similar to established norm values.

Conclusion

The authors recommend the early treatment of cleft nasal deformity using microscopic surgery because it shows stable and symmetrical results at least up to 1 year after surgery. Clinical observations up to adolescence suggest no growth disturbance or deterioration of nasal shape.

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Impact of Bone Volume Upon Condylar Activity in Patients With Unilateral Condylar Hyperplasia

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Luc H.E. Karssemakers, Jitske W. Nolte, D. Bram Tuinzing, Geerling E.J. Langenbach, Alfred G. Becking, Pieter G. Raijmakers

Purpose

Unilateral condylar hyperplasia or hyperactivity (UCH) is a bone overgrowth disorder affecting the mandible. The purpose of this study was to determine the relations among age, condylar bone structure, condylar bone volume, and condylar bone activity on single-photon emission computed tomographic (SPECT) scans in patients with UCH.

Materials and Methods

This study included 20 patients with a clinical presentation of progressive mandibular asymmetry and a positive bone SPECT scan. A bone SPECT-derived standardized uptake value (bSUV) for the condylar region was determined. All patients underwent condylectomy to arrest further progression of the disease. The resected condyles were scanned with a micro-computed tomographic scanner (18-μm resolution). Bone architectural parameters were calculated with routine morphometric software.

Results

The mean bSUV of the condyle on the affected side was 15.32 (standard deviation [SD], 8.98) compared with 9.85 (SD, 4.40) on the nonaffected side (P = .0007). For trabecular bone structure, there was a nonsignificant correlation between the SUV of the affected condyle and the measured bone volume fraction (r = 0.13; P = .58) and trabecular thickness (r = 0.03; P = .90).

Conclusion

No meaningful relation was found between condylar bone volume fraction and condylar activity on bone scan; therefore, the impact of bone volume fraction on the results of bone scans is limited. The measured condylar activity on SPECT scan seems to be primarily a reflection of the remodeling rate of bone.

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Evaluation of Andrews' Analysis as a Predictor of Ideal Sagittal Maxillary Positioning in Orthognathic Surgery

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Cory M. Resnick, Somi Kim, Rachel R. Yorlets, Carly E. Calabrese, Zachary S. Peacock, Leonard B. Kaban

Purpose

There is no universally accepted method for determining the ideal sagittal position of the maxilla in orthognathic surgery. In "Element II" of "The Six Elements of Orofacial Harmony," Andrews used the forehead to define the goal maxillary position. The purpose of this study was to compare how well this analysis correlated with postoperative findings in patients who underwent bimaxillary orthognathic surgery planned using other guidelines. The authors hypothesized that the Andrews analysis would more consistently reflect clinical outcomes than standard angular and linear measurements.

Materials and Methods

This is a retrospective cohort study of patients who had bimaxillary orthognathic surgery and achieved an acceptable esthetic outcome. Patients with no maxillary sagittal movement, obstructive sleep apnea, cleft or craniofacial diagnoses, or who were non-Caucasian were excluded. Treatment plans were developed using photographs, radiographs, and standard cephalometric measurements. The Andrews analysis, measuring the distance from the maxillary incisor to the goal anterior limit line, and standard measurements were applied to end-treatment records. The Andrews analysis was statistically compared with standard methods.

Results

There were 493 patients who had orthognathic surgery from 2007 through 2014, and 60 (62% women; mean age, 22.1 ± 6.8 yr) met the criteria for inclusion in this study. The mean Andrews distances were −4.8 ± 2.9 mm for women and −8.6 ± 4.6 mm for men preoperatively and −0.6 ± 2.1 mm for women and −1.9 ± 3.4 mm for men postoperatively. For women, the Andrews analysis was closer to the goal value (0 mm) postoperatively than any standard measurement (P < .001). For men, the linear distance from the A point to a vertical line tangent to the nasion from the McNamara analysis performed best (P < .001), followed by the Andrews analysis.

Conclusion

The Andrews analysis correlated well with the final esthetic sagittal maxillary position in the present sample, particularly for women, and could be a useful tool for orthognathic surgical planning.

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Orbital Reconstruction by Patient-Specific Implant Printed in Porous Titanium: A Retrospective Case Series of 12 Patients

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Jean-Thomas Bachelet, Guillaume Cordier, Matthieu Porcheray, Jerome Bourlet, Arnaud Gleizal, Jean-Marc Foletti

Purpose

The purpose of this study was to evaluate the orbital patient-specific implant (PSI) directly printed in porous titanium for the reconstruction of complex orbital bone defects in a series of 12 patients.

Patients and Methods

The authors designed and implemented a case series. The sample consisted of patients with unilateral complex orbital bone loss. All patients received a porous titanium PSI designed from the healthy contralateral side (mirroring). The criteria analyzed were the functional results: correction of enophthalmos, correction of ocular motility, operative time, complications, and operative revisions. The study was performed from 2015 through 2017.

Results

The sample was composed of 12 patients (mean age, 47 yr; age range, 13 to 70 yr). Patients were followed for a mean of 36 weeks postoperatively (range, 4 to 100 weeks). Twelve of the 12 patients presented preoperative enophthalmia, and 8 of the 12 patients presented preoperative diplopia. The mean operating time was 71 minutes (range, 60 to 200 minutes). For 8 patients, the follow-up was simple. In contrast, 2 patients required surgical revision with repositioning of the implant because of intraoperative implant malpositioning with esthetic or functional disturbance and malpositioning was confirmed on the postoperative computed tomogram, 1 patient required explantation of his implant 7 months after the surgery because of spheno-orbital meningioma recurrence (the implant was well positioned), and 1 patient operated on by a subciliary approach presented a postoperative ectropion. In this series of porous titanium orbital PSIs without positioning guides, 17% had malpositioning (2 patients who required a new intervention for repositioning).

Conclusion

The results of this study suggest that porous titanium PSI could be a surgical option for patients with complex orbital bone defects. In this series 17% of the sample needed a second operation. There are several ways to improve these results, such as intraoperative navigation or integrated positioning guides.

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A Treatment Protocol for Fractures of the Edentulous Mandible

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Enkh-Orchlon Batbayar, Ruud R.M. Bos, Baucke van Minnen

Purpose

The incidence of fractures of edentulous mandibles is relatively low. Knowledge about the management of these fractured edentulous mandibles relies heavily on case reports and observational studies. On the basis of the current literature, we compiled a treatment protocol for fractures of the edentulous mandible and hypothesized that this protocol would result in fewer complications.

Patients and Methods

We conducted a retrospective cohort study of edentulous patients with mandibular fractures. The predictor variable was the fulfillment of the treatment protocol (yes or no). The outcome variables were postoperative complications and reoperations. Patient demographic characteristics were collected from patient records. The χ² test was used for statistical analysis between predictor and outcome variables.

Results

Of 61 edentulous mandibular fractures (36 patients), 53 were treated according to the protocol and 8 were not. We observed 4 complications in the first group (complication rate, 7.5% [4 of 53]) and 4 in the second group (complication rate, 50% [4 of 8]). The fracture treatments that followed the protocol had a significantly lower postoperative complication rate (P = .001; odds ratio, 0.082) and needed fewer reoperations (P = .0001; odds ratio, 0.019) compared with the treatments that did not follow the protocol.

Conclusions

The results of this study show that following the compiled treatment protocol for fractures of edentulous mandibles significantly reduces postoperative complications and reoperations.

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Fracture Healing and Bone Remodeling With Human Standard-Sized Magnesium Versus Polylactide–Co-Glycolide Plate and Screw Systems Using a Mini-Swine Craniomaxillofacial Osteotomy Fixation Model

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Benoît Schaller, John Patrik Matthias Burkhard, Madeleine Chagnon, Stefan Beck, Thomas Imwinkelried, Michel Assad

Purpose

This study compared the degradation profile, safety, and efficacy of bioresorbable magnesium alloy and polylactide–co-glycolide (PLGA) polymer osteosynthesis systems for the treatment of fractures in a load-sharing maxillofacial environment using a new mini-swine fracture fixation model.

Materials and Methods

Two types of clinically relevant situations were evaluated in 5 Yucatan miniature pigs. Defined porcine midface osteotomies of the supraorbital rim and zygoma were created and fixed with either a coated magnesium (test animals) or PLGA plate and screw osteosynthesis system (control animals). After surgery, the mini-pigs were able to recover for either 1 or 9 months with continuous in vivo post-implantation monitoring. Standardized computed tomography (CT) imaging was taken immediately postoperatively and at termination for all animals. The 9-month cohort also underwent CT at 2, 4, and 6 months after surgery. At necropsy, osteotomy sites and bone-implant units were harvested, and healing was evaluated by micro-CT, histopathology, and histomorphometry.

Results

After clinical and radiologic follow-up examination, all fracture sites healed well for both the magnesium and polymer groups regardless of time point. Complete bone union and gradually disappearing osteotomy lines were observed across all implantation sites, with no major consistency change in periprosthetic soft tissue or in soft tissue calcification. Macroscopic and microscopic examination showed no negative influence of gas formation observed with magnesium during the healing process. Histopathologic analysis showed similar fracture healing outcomes for both plating systems with good biocompatibility as evidenced by a minimal or mild tissue reaction.

Conclusions

This study confirms that WE43 magnesium alloy exhibited excellent fracture healing properties before its full degradation without causing any substantial inflammatory reactions in a long-term porcine model. Compared with PLGA implants, magnesium represents a promising new biomaterial with reduced implant sizes and improved mechanical properties to support fracture healing in a load-sharing environment.

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Adenosquamous Carcinoma in the Midline Dorsum of the Tongue: A Rare Case Report

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Shogo Kikuta, Keita Todoroki, Naoko Seki, Jingo Kusukawa

Adenosquamous carcinoma (ASC) is a rare malignant tumor of the oral and maxillofacial region that displays histologic features of both adenocarcinoma and squamous cell carcinoma. ASC in the midline dorsum of the tongue is exceedingly rare. We report the case of a 48-year-old man who presented with a painless mass in the midline dorsum of the tongue. Although the case was diagnosed as adenocarcinoma by biopsy, a final diagnosis of ASC was established after surgery. Ten months after the patient's initial visit, no recurrence or metastasis has been noted. ASC in the middle dorsum of the tongue is exceedingly rare, and no examples have been reported hitherto.

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Actinomycotic Osteomyelitis of the Mandible Diagnosed Using Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry: A Case Report

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Shinsuke Yamamoto, Hiroshi Takegawa, Naoki Taniike, Toshihiko Takenobu

Actinomycosis is a rare, chronic, slowly progressive granulomatous disease caused by filamentous gram-positive anaerobic bacteria from the Actinomycetaceae family (genus Actinomyces). It has become a rare condition because of the widespread use of antibiotics. When clinical symptoms are not typical, diagnosis of this condition becomes difficult. This report describes a case involving an 82-year-old woman who was diagnosed with actinomycotic osteomyelitis of the mandible using matrix assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI-TOF MS). The patient was referred to the authors' department with chief complaints of swelling, multiple fistulae in the left preauricular region, and trismus. The authors performed fine-needle aspiration microbiology (FNAM) and identified Actinomyces oris using MALDI-TOF MS. A diagnosis of actinomycotic osteomyelitis of the mandible was made and the patient was treated with minocycline and extraction of the culprit tooth. The findings from this case have 2 important implications. First, for patients with clinically suspected actinomycosis, bacteriologic examinations should include not only surface swab tests but also FNAM; moreover, communication with the laboratory medical technologist is important to improve detection of the causative organisms. Second, MALDI-TOF MS could be an effective tool for improving the diagnosis and treatment outcomes of actinomycosis.

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Three-Dimensional Printed Plate-Guided 125I Brachytherapy for Malignant Parotid Tumors

Publication date: October 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 10

Author(s): Jinyuan Liu, Tianfu Wu, Qiwen Man, Nyimi Bushabu Fidèle, Yueyu Zheng, Bing Liu

Purpose

The treatment of malignant parotid tumors with ¹²⁵I brachytherapy is rarely reported. This study evaluated the efficacy and dose and response of ¹²⁵I brachytherapy in patients with malignant tumors.

Materials and Methods

From July 2014 through August 2017, 39 patients with malignant parotid tumors were treated with ¹²⁵I brachytherapy. Thirty-five patients were treated with conservative surgical resection before brachytherapy. Four patients were treated with brachytherapy alone. Clinical outcomes and side effects were evaluated. Clinical factors were investigated to determine correlations with local control (LC) and side effects.

Results

Mean follow-up was 25 months (range, 7 to 47 months). The LC rate was 87.2% and the overall survival rate was 97.4%. High tumor grade and large tumor showed a propensity for local recurrence. Acute skin toxicity occurred in 87.2% of patients and grade 3 and 4 radioepidermitis was found in 20.5% of patients. In total, 89.7% of patients with facial nerve dysfunction recovered within 12 months.

Conclusions

¹²⁵I brachytherapy was a feasible treatment option for patients with malignant parotid tumors. Although side effects were minimal, strict follow-up was necessary for patients treated with a high dose.

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