Aural and nasal foreign bodies in children – Epidemiology and correlation with hyperkinetic disorders, developmental disorders and congenital malformations

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tobias Schuldt, Wilma Großmann, Nora M. Weiss, Atilla Ovari, Robert Mlynski, Sebastian P. Schraven

Abstract

Objectives

Foreign body incorporation in children is often a serious situation. Attention deficit hyperactivity disorder (ADHD) could be a risk factor for self-insertion of foreign bodies. Large cohort analyses are missing.

Methods

This was a retrospective analysis of patients' records from a health insurance company representing 2.19% of the German population and 1.75% of German children and adolescents. According to the International Classification of Diseases, children in the age range between 1 and 18 years have been screened for foreign bodies in ear, nasal sinus and nostrils as well as for hyperkinetic disorders (F90), disorders of psychological development (F80–F89), and congenital malformations, deformations and chromosomal abnormalities (Q00–Q99).

Results

In total, 12887 children (6609 male; 6278 female) have been treated in 16929 cases. The majority (n=10041 (77.9%)) presented with foreign body incorporation on a single occasion. On average, 1.31 cases of foreign body treatment were recorded per child; 14.1% of children with foreign body treatment (FBT) also had a record of hyperkinetic disorder, 52.7% had a disorder of psychological development, and 50.8% a congenital malformation. Mean occurrence of FBT was 174.8 days before the diagnosis of a hyperkinetic disorder but 517.2 days after the diagnosis of a psychological development disorder and 683.1 days after the diagnosis of a congenital malformation, deformation or chromosomal abnormality.

Conclusion

Patients with disorders of psychological development as well as children with congenital malformations are high-risk patients for nasal and aural foreign bodies. The prevalence of a hyperkinetic disorder in patients with FBT is much higher than in the normal population. ADHD is a risk factor for foreign bodies.

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Residual airway foreign bodies in children who underwent rigid bronchoscopy

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Bin Xu, Lei Wu, Ziying Jin, Xiaowei Chen, Cao Chen, Jia Liu, Ai Jiang, Yong Fu, Qiang Shu

Abstract

OBJECTIVE

To analyze the causes of residual airway foreign bodies in children who underwent rigid bronchoscopy in order to improve the success rate of primary surgery.

METHODS

Clinical data from 1130 children with airway foreign bodies, including 736 males and 394 females aged 0.42–14 years, who underwent rigid bronchoscopy in our hospital from January 2015 to May 2018 were retrospectively collected and analyzed by cluster sampling. Clinical characteristics including sex, age, time of onset, location of the foreign body, type of foreign body and experience of surgeon were gathered. All patients were classified into two groups as Group A (with residual airway foreign bodies) and Group B (without residual airway foreign bodies) according to chest CT scans and fiberoptic bronchoscope examinations after rigid bronchoscopy. The values were compared between the two groups.

RESULTS

Thirty-one patients with residual foreign bodies were confirmed by fiberoptic bronchoscopy among 1130 children with airway foreign bodies who underwent rigid bronchoscopy under general anesthesia. The percentage of residual airway foreign body was 2.7%. The mean age was 1.55±0.46 years (range 1–3 years). There were 24 male patients (77.4%), and 7 female patients (22.6%), with a male/female ratio of 3.43:1. The time of onset was 1.0 (interquartile range: 1.0-8.0) day. There were no significant difference in age, sex and time of onset between the two groups. Most residual foreign bodies were food-related: nuts (n=27, 87.1%), beans (n=3, 9.7%), and one case was unclear in nature (3.2%). The residual incidence of fragile foreign bodies was higher than non-friable foreign bodies (P=0.028). The most common residual foreign body locations were left superior lobar bronchi (32.3%), left inferior lobar bronchi (25.8%) and right inferior lobar bronchi (25.8%). The residual rate of foreign bodies for surgeons with more than 5 years of operative experience was 1.92%, and 4.25% for surgeons with less than 5 years of operation experience, showing a significant difference (P=0.022).

CONCLUSION

Friable foods, the complicated structure of the bronchus tree and the surgeon's experience are important causes of residual foreign bodies in the airway. Surgeons with sufficient experience are important for the success of the procedure, which is supported by chest CT and flexible bronchoscopy.

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Ovine model as a surgical simulator for pediatric laryngotracheal reconstruction

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): S. Ranguis, P. Ryan, A.T. Cheng

Abstract

Objectives

There are increasing pressures on the health system and training programs to provide adequate training opportunities for surgical trainees. This is particularly true with respect to complex procedures that are performed less commonly. We sought to develop an ovine model for the simulation of pediatric laryngotracheal reconstruction (LTR) and validate its use for training.

Methods

Knee-high lamb specimens were sourced from an accredited Australian abattoir that included structures of the neck, cervical spine and subcutaneous tissues from the thyroid cartilage to the carina. Specimens were positioned and draped to simulate surgical exposure. Otorhinolaryngology residents and consultants performed two LTRs on separate specimens that were video recorded for assessment of performance.

Results

Sixteen LTRs were performed by eight participants. Performance of experienced (advanced) participants was significantly better than novice participants (p = 0.001). There was a strong linear association between general surgical competence and procedural performance (r = 0.88). The developed assessment scales demonstrated strong reliability and internal consistency (Cronbach's α = 0.83).

Conclusions

The complexity of pediatric airway surgery makes simulation an attractive option for developing skills that are transferrable to the operating setting. The ovine model presented here has similarities in size, structure and tissue characteristics to the pediatric airway that make it an ideal model for simulating pediatric LTR. It is a low-cost, readily available option for otorhinolaryngology residents to develop and refine essential skills throughout their training.

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The Incidence of velopharyngeal insufficiency and oronasal fistula after primary palatal surgery with Sommerlad intravelar veloplasty: a retrospective study in Isfahan Cleft Care Team

Publication date: Available online 8 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Dorsa Mapar, Fatemeh Khanlar, Saba Sadeghi, Hossein Abdali, Mehrdad Memarzadeh, Heydar Ali Davari, Fatemeh Derakhshandeh

Abstract

Objectives

This study was designed to determine the incidence of velopharyngeal insufficiency (VPI), oronasal fistula development and facial grimace in patients seen by Isfahan Cleft Care Team (ICCT) after primary Sommerlad intravelar veloplasty (SIVV). Furthermore the association of gender, cleft type and age at primary surgery with the incidence of hypernasality and fistula is determined.

Methods

A group of 40 patients with history of cleft palate with or without cleft lip were identified from the records of ICCT between 2011 and 2014. The main outcome measures were the incidence of hypernasality and fistula after primary palate repair with SIVV. Speech recordings were analyzed by consensus by two speech therapists according to the Cleft Audit Protocol for Speech- Augmented (CAPS-A), (Kappa =82.4). Deciding whether or not to have a fistula was based on the oral examination videos.

Results

Severe and moderate hypernasality was observed in 42.5% of patients. Normal resonance and mild/borderline hypernasality was observed in 37.5% and 20% of patients, respectively. The frequency of fistulas was 17.5%. There was a significant association between hypernasality with cleft type and the age at primary surgery (p <0.05).

Conclusion

Significant progress has been made in the outcomes of the primary palate surgeries with the SIVV technique compared to the previous study in the ICCT.

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Reducing the Need for General Anesthesia in the Repair of Choanal Atresia with Steroid-Eluting Stents: A Case Series

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Joseph B. Meleca, Samantha Anne, Brandon Hopkins

Abstract

Introduction

Choanal atresia (CA) is a rare pediatric congenital disorder resulting in upper airway obstruction and respiratory distress in the setting of obligate nasal breathing in infants. In 2016, a novel technique was reported in the literature utilizing drug-eluting stents to correct CA. However, 2 out of 3 patients in the study required a second operation under general anesthesia. The repeated visits to the operating room for evaluations and debridement under general anesthesia continues to be a concern for increased morbidity and mortality in infants undergoing repair of CA.

Methods

A case series of three (3) patients who underwent repair of CA. Outcomes were measured by post-operative, in-office flexible nasoendoscopy.

Results

Each patient was implanted with mometasone furoate drug-eluting stents at the conclusion of the operation. Post-operatively, patients were instructed to perform nasal saline rinses 3-4 times daily. Outpatient follow-up between 6-17 months showed patent nasal passages on nasal endoscopy. There were no post-operative complications. Moreover, patients only underwent a single episode of general anesthesia at time of initial repair.

Conclusions

In our study, we report successful outcomes using drugeluting stents for one-stage surgical correction of CA, therefore negating the need for children to undergo multiple subjections to general anesthetics.

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Can standard deviation of overnight pulse oximetry be used to screen childhood obstructive sleep apnea

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Siriporn Warapongmanupong, Aroonwan Preutthipan

Abstract

Objectives

Pulse oximetry (PO) has been frequently used as an alternative test to polysomnography (PSG) in children. We conducted this study to determine which statistical parameters obtained from overnight PO monitoring would be most suitable and to evaluate its diagnostic performance.

Methods

We prospectively recruited children with snoring referred for PSG. Subjects were monitored with PO while performing PSG. Eight statistical parameters of SpO₂ data were analyzed to identify which had the best diagnostic performance as assessed by the area under the receiver-operating characteristic curve (AUC). To validate this parameter (which was found to be the standard deviation, SD) in a larger population, we retrospectively extracted raw data of SpO₂ from our previous PSG records, calculated the SD of each patient, and assessed its AUC.

Results

A total of 166 children were recruited in the first phase. SD of SpO₂ was found to have the largest AUC. In the second phase, raw data of 457 patients were extracted. SD of SpO₂ correlated well with the apnea/hypopnea index (AHI) (r=0.6, P<0.001). For diagnosis of moderate to severe obstructive sleep apnea (OSA) (AHI ≥5 events/h), AUC was 0.74. SD of SpO₂ ≥1.06 representing mean + 2SD of normal to mild OSA (AHI <5) provided 97% specificity and 92% positive predictive value. The positive likelihood ratio was 11.

Conclusion

Calculating the SD of SpO₂, which quantifies the amount of dispersion of SpO₂ values, is a useful initial investigation in childhood OSA. An SD ≥1.06 can predict moderate to severe OSA with confidence. This parameter is simple, practical, and readily accessible.

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Aural and nasal foreign bodies in children – Epidemiology and correlation with hyperkinetic disorders, developmental disorders and congenital malformations

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tobias Schuldt, Wilma Großmann, Nora M. Weiss, Atilla Ovari, Robert Mlynski, Sebastian P. Schraven

Abstract

Objectives

Foreign body incorporation in children is often a serious situation. Attention deficit hyperactivity disorder (ADHD) could be a risk factor for self-insertion of foreign bodies. Large cohort analyses are missing.

Methods

This was a retrospective analysis of patients' records from a health insurance company representing 2.19% of the German population and 1.75% of German children and adolescents. According to the International Classification of Diseases, children in the age range between 1 and 18 years have been screened for foreign bodies in ear, nasal sinus and nostrils as well as for hyperkinetic disorders (F90), disorders of psychological development (F80–F89), and congenital malformations, deformations and chromosomal abnormalities (Q00–Q99).

Results

In total, 12887 children (6609 male; 6278 female) have been treated in 16929 cases. The majority (n=10041 (77.9%)) presented with foreign body incorporation on a single occasion. On average, 1.31 cases of foreign body treatment were recorded per child; 14.1% of children with foreign body treatment (FBT) also had a record of hyperkinetic disorder, 52.7% had a disorder of psychological development, and 50.8% a congenital malformation. Mean occurrence of FBT was 174.8 days before the diagnosis of a hyperkinetic disorder but 517.2 days after the diagnosis of a psychological development disorder and 683.1 days after the diagnosis of a congenital malformation, deformation or chromosomal abnormality.

Conclusion

Patients with disorders of psychological development as well as children with congenital malformations are high-risk patients for nasal and aural foreign bodies. The prevalence of a hyperkinetic disorder in patients with FBT is much higher than in the normal population. ADHD is a risk factor for foreign bodies.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TBClWH

Residual airway foreign bodies in children who underwent rigid bronchoscopy

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Bin Xu, Lei Wu, Ziying Jin, Xiaowei Chen, Cao Chen, Jia Liu, Ai Jiang, Yong Fu, Qiang Shu

Abstract

OBJECTIVE

To analyze the causes of residual airway foreign bodies in children who underwent rigid bronchoscopy in order to improve the success rate of primary surgery.

METHODS

Clinical data from 1130 children with airway foreign bodies, including 736 males and 394 females aged 0.42–14 years, who underwent rigid bronchoscopy in our hospital from January 2015 to May 2018 were retrospectively collected and analyzed by cluster sampling. Clinical characteristics including sex, age, time of onset, location of the foreign body, type of foreign body and experience of surgeon were gathered. All patients were classified into two groups as Group A (with residual airway foreign bodies) and Group B (without residual airway foreign bodies) according to chest CT scans and fiberoptic bronchoscope examinations after rigid bronchoscopy. The values were compared between the two groups.

RESULTS

Thirty-one patients with residual foreign bodies were confirmed by fiberoptic bronchoscopy among 1130 children with airway foreign bodies who underwent rigid bronchoscopy under general anesthesia. The percentage of residual airway foreign body was 2.7%. The mean age was 1.55±0.46 years (range 1–3 years). There were 24 male patients (77.4%), and 7 female patients (22.6%), with a male/female ratio of 3.43:1. The time of onset was 1.0 (interquartile range: 1.0-8.0) day. There were no significant difference in age, sex and time of onset between the two groups. Most residual foreign bodies were food-related: nuts (n=27, 87.1%), beans (n=3, 9.7%), and one case was unclear in nature (3.2%). The residual incidence of fragile foreign bodies was higher than non-friable foreign bodies (P=0.028). The most common residual foreign body locations were left superior lobar bronchi (32.3%), left inferior lobar bronchi (25.8%) and right inferior lobar bronchi (25.8%). The residual rate of foreign bodies for surgeons with more than 5 years of operative experience was 1.92%, and 4.25% for surgeons with less than 5 years of operation experience, showing a significant difference (P=0.022).

CONCLUSION

Friable foods, the complicated structure of the bronchus tree and the surgeon's experience are important causes of residual foreign bodies in the airway. Surgeons with sufficient experience are important for the success of the procedure, which is supported by chest CT and flexible bronchoscopy.

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Ovine model as a surgical simulator for pediatric laryngotracheal reconstruction

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): S. Ranguis, P. Ryan, A.T. Cheng

Abstract

Objectives

There are increasing pressures on the health system and training programs to provide adequate training opportunities for surgical trainees. This is particularly true with respect to complex procedures that are performed less commonly. We sought to develop an ovine model for the simulation of pediatric laryngotracheal reconstruction (LTR) and validate its use for training.

Methods

Knee-high lamb specimens were sourced from an accredited Australian abattoir that included structures of the neck, cervical spine and subcutaneous tissues from the thyroid cartilage to the carina. Specimens were positioned and draped to simulate surgical exposure. Otorhinolaryngology residents and consultants performed two LTRs on separate specimens that were video recorded for assessment of performance.

Results

Sixteen LTRs were performed by eight participants. Performance of experienced (advanced) participants was significantly better than novice participants (p = 0.001). There was a strong linear association between general surgical competence and procedural performance (r = 0.88). The developed assessment scales demonstrated strong reliability and internal consistency (Cronbach's α = 0.83).

Conclusions

The complexity of pediatric airway surgery makes simulation an attractive option for developing skills that are transferrable to the operating setting. The ovine model presented here has similarities in size, structure and tissue characteristics to the pediatric airway that make it an ideal model for simulating pediatric LTR. It is a low-cost, readily available option for otorhinolaryngology residents to develop and refine essential skills throughout their training.

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Comparison of radial forearm free flap and gastric pull‐up in pharyngo‐esophageal reconstruction

Abstract

Despite multiple reconstructive approaches proposed over the past several decades, there remains no consensus on the optimal method of reconstructing pharyngo‐esophageal defects. In this paper, we compare our experience with tubed radial forearm free flap (RFF) and gastric pull‐up (GP).

Patients who underwent GP had lower rates of stricture formation, regardless of preoperative radiation status.

Patients who underwent preoperative radiation had higher rates of stricture and fistula formation.

Non‐radiated patients also had higher rates of return to oral diet.

Gastric pull‐up offers lower rates of stricture and fistula formation, as well as high rates of return to oral diet. Patients who underwent preoperative radiation suffered higher rates of stricture and fistula regardless of reconstructive method.

This article is protected by copyright. All rights reserved.

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Dysregulation of ß‐catenin, WISP1 and TCF21 predicts disease‐specific survival and primary response against radio(chemo)therapy in patients with locally advanced squamous cell carcinomas of the head and neck

Abstract

Objective

The objective of this study was to determine the prognostic and predictive impact of β‐catenin, TCF21 and WISP1 expression in patients with squamous cell carcinomas of the head and neck who underwent primary radiotherapy or concomitant chemoradiotherapy.

Study Design

Prospective cohort study.

Setting

University hospital.

Participants

Protein expression profiles of β‐catenin, TCF21, WISP1 and p16 were determined by immunhistochemical analyses in tissue samples of 59 untreated patients. Expression was correlated to different outcome parameters.

Main Outcome Measures

Impact of TNM classification, grading, sex, age, gender, type of therapy, response to therapy and p16 status on disease specific (DSS) and disease free survival (DFS)

Results

Patients with high expression of TCF21 were associated with significantly worse disease specific survival (p=0.005). In a multivariable analysis TCF21 was a significant determinant of disease specific survival. (HR 3.01; p=0.036). Conversely, low expression of β‐catenin (p=0.025) and WISP1 (p=0.037) revealed a better response to radiotherapy.

Conclusion

Since data show that TCF21 is a prognostic factor for disease specific survival and WISP1 and ß‐catenin are predictive factors for clinical outcome after definitive radiotherapy, further studies are warranted to prove these preliminary but very promising findings.

This article is protected by copyright. All rights reserved.

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PEG tube dependency after prophylactic placement in 209 head and neck cancer patients treated with chemoradiotherapy or radiation with cetuximab

Abstract

Incidence of PEG tube dependency in our cohort of patients with prophylactic PEG placement is 47,5% at 6 months and 22,4% at 12 months.

Risk factors identified for tube dependency were oral cavity localization, high T‐stage or N‐stage and disease recurrence.

PEG tube dependency is comparable to previous described cohorts with comparable patients with PEG tube on a reactive approach.

The rate of treatment related complications appears favourable in patients in whom a prophylactic approach was used, compared to previous cohorts with a reactive approach.

A risk stratified program with special emphasis on swallowing exercises, speech/swallowing therapy and adequate analgesia could be helpful to decrease tube feeding dependency.

This article is protected by copyright. All rights reserved.

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An anatomically consistent approach for performing transthyrohyoid injection laryngoplasty

Abstract

Office‐based laryngeal injections are becoming established as a viable, and indeed, in many laryngology units, as the standard of care for delivering a range of therapeutic substances including fillers, corticosteroids, and botulinum toxin to the larynx. Vocal augmentation through injection laryngoplasty can be life‐saving when used to improve airway protection in selected patients with dysphagia and aspiration, and life‐transforming when used to restore voice in palliative patients with vocal palsy.

This article is protected by copyright. All rights reserved.

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Why skin is so important for Baha Attract success: A preliminary analysis of the first twenty implantations

Abstract

We propose a classification for skin and soft tissue evolution with Baha^® Attract.

We share our strategy adapted to treat the different soft tissue problems.

We share recommendations that surgeons and audiologists must provided to the patients.

The education, information, and follow‐up should be given and repeated very carefully during the first year of fitting to avoid any skin and soft tissues issues.

The soft tissue issues are unusual but can be potentially serious.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H33aSk

Comparison of radial forearm free flap and gastric pull‐up in pharyngo‐esophageal reconstruction

Abstract

Despite multiple reconstructive approaches proposed over the past several decades, there remains no consensus on the optimal method of reconstructing pharyngo‐esophageal defects. In this paper, we compare our experience with tubed radial forearm free flap (RFF) and gastric pull‐up (GP).

Patients who underwent GP had lower rates of stricture formation, regardless of preoperative radiation status.

Patients who underwent preoperative radiation had higher rates of stricture and fistula formation.

Non‐radiated patients also had higher rates of return to oral diet.

Gastric pull‐up offers lower rates of stricture and fistula formation, as well as high rates of return to oral diet. Patients who underwent preoperative radiation suffered higher rates of stricture and fistula regardless of reconstructive method.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RwSyzl

Dysregulation of ß‐catenin, WISP1 and TCF21 predicts disease‐specific survival and primary response against radio(chemo)therapy in patients with locally advanced squamous cell carcinomas of the head and neck

Abstract

Objective

The objective of this study was to determine the prognostic and predictive impact of β‐catenin, TCF21 and WISP1 expression in patients with squamous cell carcinomas of the head and neck who underwent primary radiotherapy or concomitant chemoradiotherapy.

Study Design

Prospective cohort study.

Setting

University hospital.

Participants

Protein expression profiles of β‐catenin, TCF21, WISP1 and p16 were determined by immunhistochemical analyses in tissue samples of 59 untreated patients. Expression was correlated to different outcome parameters.

Main Outcome Measures

Impact of TNM classification, grading, sex, age, gender, type of therapy, response to therapy and p16 status on disease specific (DSS) and disease free survival (DFS)

Results

Patients with high expression of TCF21 were associated with significantly worse disease specific survival (p=0.005). In a multivariable analysis TCF21 was a significant determinant of disease specific survival. (HR 3.01; p=0.036). Conversely, low expression of β‐catenin (p=0.025) and WISP1 (p=0.037) revealed a better response to radiotherapy.

Conclusion

Since data show that TCF21 is a prognostic factor for disease specific survival and WISP1 and ß‐catenin are predictive factors for clinical outcome after definitive radiotherapy, further studies are warranted to prove these preliminary but very promising findings.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GYi2RR

PEG tube dependency after prophylactic placement in 209 head and neck cancer patients treated with chemoradiotherapy or radiation with cetuximab

Abstract

Incidence of PEG tube dependency in our cohort of patients with prophylactic PEG placement is 47,5% at 6 months and 22,4% at 12 months.

Risk factors identified for tube dependency were oral cavity localization, high T‐stage or N‐stage and disease recurrence.

PEG tube dependency is comparable to previous described cohorts with comparable patients with PEG tube on a reactive approach.

The rate of treatment related complications appears favourable in patients in whom a prophylactic approach was used, compared to previous cohorts with a reactive approach.

A risk stratified program with special emphasis on swallowing exercises, speech/swallowing therapy and adequate analgesia could be helpful to decrease tube feeding dependency.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RBgSjj

Relationship Between the Results of the Head‐shaking Test and Short‐term Prognosis of Hearing Impairment in Patients with Unilateral Ménière's Disease: A retrospective analysis of 157 cases

Abstract

Fifty‐seven (36%) of 157 patients with unilateral Ménière's Disease (MD) without spontaneous nystagmus showed head‐shaking nystagmus (HSN) on the head‐shaking test (HST), even though 16 (10%) had not experienced vertigo.

If patients show contralateral‐HSN (c‐HSN), short‐term hearing recovery may be poor compared to patients with no HSN.

It is possible that "subclinical" vestibular dysfunction can be detected by the HST and may have some correlation with the prognosis of hearing loss in the short term.

The present study showed that HST may be useful in MD patients to predict the short‐term prognosis of hearing impairment.

This article is protected by copyright. All rights reserved.

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An anatomically consistent approach for performing transthyrohyoid injection laryngoplasty

Abstract

Office‐based laryngeal injections are becoming established as a viable, and indeed, in many laryngology units, as the standard of care for delivering a range of therapeutic substances including fillers, corticosteroids, and botulinum toxin to the larynx. Vocal augmentation through injection laryngoplasty can be life‐saving when used to improve airway protection in selected patients with dysphagia and aspiration, and life‐transforming when used to restore voice in palliative patients with vocal palsy.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RwSjnV

Curcumin, a Turmeric Extract, for Oral Lichen Planus: A Systematic Review

Abstract

Topical corticosteroids are commonly used for Oral Lichen Planus (OLP) but may induce candidiasis and mucosal atrophy (Bombeccari, Gianni, & Spadari., 2017). Oral corticosteroids can cause adverse systemic effects such as immune suppression, sleep disturbances and bone demineralization (Thongprasom, 2018). Turmeric extracts suppress inflammation in vitro and in animals and may be an alternative (Nagpal & Sood, 2013). This systematic review (PROSPERO [CRD42018105227]) assesses the impact of curcumin extract on OLP

This article is protected by copyright. All rights reserved.

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Curcumin, a Turmeric Extract, for Oral Lichen Planus: A Systematic Review

Abstract

Topical corticosteroids are commonly used for Oral Lichen Planus (OLP) but may induce candidiasis and mucosal atrophy (Bombeccari, Gianni, & Spadari., 2017). Oral corticosteroids can cause adverse systemic effects such as immune suppression, sleep disturbances and bone demineralization (Thongprasom, 2018). Turmeric extracts suppress inflammation in vitro and in animals and may be an alternative (Nagpal & Sood, 2013). This systematic review (PROSPERO [CRD42018105227]) assesses the impact of curcumin extract on OLP

This article is protected by copyright. All rights reserved.

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Multibreath Hyperpolarized 3He Imaging Scheme to Measure Alveolar Oxygen Tension and Apparent Diffusion Coefficient

Publication date: Available online 8 January 2019

Source: Academic Radiology

Author(s): Tahmina Achekzai, Hooman Hamedani, Stephen J. Kadlecek, Kai Ruppert, Yi Xin, Ryan J. Baron, Ian F. Duncan, Federico Sertic, Sarmad Siddiqui, Faraz Amzajerdian, Mehrdad Pourfathi, Luis A. Loza, Maurizio Cereda, Rahim R. Rizi

Rationale and Objectives

In this study, we compared a newly developed multibreath simultaneous alveolar oxygen tension and apparent diffusion coefficient (P_AO₂-ADC) imaging sequence to a single-breath acquisition, with the aim of mitigating the compromising effects of intervoxel flow and slow-filling regions on single-breath measurements, especially in chronic obstructive pulmonary disease (COPD) subjects.

Materials and Methods

Both single-breath and multibreath simultaneous P_AO₂-ADC imaging schemes were performed on a total of 10 human subjects (five asymptomatic smokers and five COPD subjects). Estimated P_AO₂ and ADC values derived from the different sequences were compared both globally and regionally. The distribution of voxels with nonphysiological values was also compared between the two schemes.

Results

The multibreath protocol decreased the ventilation defect volumes by an average of 12.9 ± 6.6%. The multibreath sequence generated nonphysiological P_AO₂ values in 11.0 ± 8.5% fewer voxels than the single-breath sequence. Single-breath P_AO₂ maps also showed more regions with gas-flow artifacts and general signal heterogeneity. On average, the standard deviation of the P_AO₂ distribution was 16.5 ± 7.0% lower using multibreath P_AO₂-ADC imaging, suggesting a more homogeneous gas distribution. Both mean and standard deviation of the ADC increased significantly from single- to multibreath imaging (p = 0.048 and p = 0.070, respectively), suggesting more emphysematous regions in the slow-filling lung.

Conclusion

Multibreath P_AO₂-ADC imaging provides superior accuracy and efficiency compared to previous imaging protocols. P_AO₂ and ADC maps generated by multibreath imaging allowed for the qualification of various regions as emphysematous or obstructed, which single-breath P_AO₂ maps can only identify as defects. The simultaneous P_AO₂ and ADC measurements generated by the presented multibreath method were also more physiologically realistic, and allowed for more detailed analysis of the slow-filling regions characteristic of COPD subjects.

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Differences in the strain applied to Achilles tendon fibers when the subtalar joint is overpronated: a simulation study

Abstract

Purpose

The purpose of this study was to investigate the strain applied to each of the tendon fiber bundles of the medial head of the gastrocnemius (MG), the lateral head of the gastrocnemius (LG), and the soleus muscle (Sol) that compose the Achilles tendon (AT) when the subtalar joint is pronated and supinated.

Methods

Three AT twist types (least, moderate, extreme) were investigated. Using the MicroScribe system, the AT and the talocrural and subtalar joints were digitized to reconstruct three-dimensional models. Using this system, subtalar joint rotations in the pronation (20°) and supination (20°) directions were simulated, and the degrees of strain (%) on each tendon were calculated.

Results

For all twist types, when the subtalar joint was pronated, MG, LG, and Sol stretched, and when supinated, MG, LG, and Sol shortened. In particular, the least and severe twist types had large degrees of strain of Sol when the subtalar joint was pronated, and furthermore, each tendon fiber composing Sol had different degrees of strain.

Conclusions

The study results suggest that the degree of strain applied within the AT with subtalar joint pronation is not constant, and that, especially in least and extreme twist types, the risk of developing AT disorders may increase.

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Morphometric evaluation and clinical implications of the greater palatine foramen, greater palatine canal and pterygopalatine fossa on CBCT images and review of literature

Abstract

Introduction

The pterygopalatine fossa (PPF) infiltration is performed to reduce blood flow during endoscopic sinus surgery and septorhinoplasty, as well as to control posterior epistaxis and provide regional anesthesia in dental procedures. PPF infiltration performed with consideration of the morphometrics of greater palatine foramen (GPF), greater palatine canal (GPC) and PPF would increase the success of the procedure and reduce the risk of complications. The aim of this study is to investigate the GPF, GPC, lesser palatine foramen (LPF), lesser palatine canal (LPC) and PPF morphology via the images obtained by CBCT, to provide information for interventional procedures.

Materials and methods

GPF, GPC, LPF, LPC and PPF were morphometrically evaluated retrospectively in CBCT images of 75 female and 75 male cases by Planmeca Romexis program. The 19 parameters were measured on these images.

Results

These parameters were evaluated statistically. The comparison of these parameters by genders revealed significant differences in distances between GPC–PC, PC–IOF, LPC–GPF, GPF–MS in the coronal and transverse planes, the distance between GPF and the occlusal plane of the teeth, GPF–PNS, GPF–IF and TD-GPF, and in the area of GPF. The number of LPF was found ranging from 1 to 5.

Conclusion

Our results may help to insert to needle properly for application of maxillary nerve block with a high success rate and minimal complication. We recommend that the needle should be inserted 14–15 mm lateral to the midsagittal plane, 19–20 mm over the occlusal plane of the teeth and on the same line with the third molar teeth. For PPF infiltration through the GPF, the needle should be pushed forward 28 mm upward at 66° angle on the transverse plane and 14°–15° angle on the vertical plane.

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Multibreath Hyperpolarized 3He Imaging Scheme to Measure Alveolar Oxygen Tension and Apparent Diffusion Coefficient

Publication date: Available online 8 January 2019

Source: Academic Radiology

Author(s): Tahmina Achekzai, Hooman Hamedani, Stephen J. Kadlecek, Kai Ruppert, Yi Xin, Ryan J. Baron, Ian F. Duncan, Federico Sertic, Sarmad Siddiqui, Faraz Amzajerdian, Mehrdad Pourfathi, Luis A. Loza, Maurizio Cereda, Rahim R. Rizi

Rationale and Objectives

In this study, we compared a newly developed multibreath simultaneous alveolar oxygen tension and apparent diffusion coefficient (P_AO₂-ADC) imaging sequence to a single-breath acquisition, with the aim of mitigating the compromising effects of intervoxel flow and slow-filling regions on single-breath measurements, especially in chronic obstructive pulmonary disease (COPD) subjects.

Materials and Methods

Both single-breath and multibreath simultaneous P_AO₂-ADC imaging schemes were performed on a total of 10 human subjects (five asymptomatic smokers and five COPD subjects). Estimated P_AO₂ and ADC values derived from the different sequences were compared both globally and regionally. The distribution of voxels with nonphysiological values was also compared between the two schemes.

Results

The multibreath protocol decreased the ventilation defect volumes by an average of 12.9 ± 6.6%. The multibreath sequence generated nonphysiological P_AO₂ values in 11.0 ± 8.5% fewer voxels than the single-breath sequence. Single-breath P_AO₂ maps also showed more regions with gas-flow artifacts and general signal heterogeneity. On average, the standard deviation of the P_AO₂ distribution was 16.5 ± 7.0% lower using multibreath P_AO₂-ADC imaging, suggesting a more homogeneous gas distribution. Both mean and standard deviation of the ADC increased significantly from single- to multibreath imaging (p = 0.048 and p = 0.070, respectively), suggesting more emphysematous regions in the slow-filling lung.

Conclusion

Multibreath P_AO₂-ADC imaging provides superior accuracy and efficiency compared to previous imaging protocols. P_AO₂ and ADC maps generated by multibreath imaging allowed for the qualification of various regions as emphysematous or obstructed, which single-breath P_AO₂ maps can only identify as defects. The simultaneous P_AO₂ and ADC measurements generated by the presented multibreath method were also more physiologically realistic, and allowed for more detailed analysis of the slow-filling regions characteristic of COPD subjects.

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Differences in the strain applied to Achilles tendon fibers when the subtalar joint is overpronated: a simulation study

Abstract

Purpose

The purpose of this study was to investigate the strain applied to each of the tendon fiber bundles of the medial head of the gastrocnemius (MG), the lateral head of the gastrocnemius (LG), and the soleus muscle (Sol) that compose the Achilles tendon (AT) when the subtalar joint is pronated and supinated.

Methods

Three AT twist types (least, moderate, extreme) were investigated. Using the MicroScribe system, the AT and the talocrural and subtalar joints were digitized to reconstruct three-dimensional models. Using this system, subtalar joint rotations in the pronation (20°) and supination (20°) directions were simulated, and the degrees of strain (%) on each tendon were calculated.

Results

For all twist types, when the subtalar joint was pronated, MG, LG, and Sol stretched, and when supinated, MG, LG, and Sol shortened. In particular, the least and severe twist types had large degrees of strain of Sol when the subtalar joint was pronated, and furthermore, each tendon fiber composing Sol had different degrees of strain.

Conclusions

The study results suggest that the degree of strain applied within the AT with subtalar joint pronation is not constant, and that, especially in least and extreme twist types, the risk of developing AT disorders may increase.

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Morphometric evaluation and clinical implications of the greater palatine foramen, greater palatine canal and pterygopalatine fossa on CBCT images and review of literature

Abstract

Introduction

The pterygopalatine fossa (PPF) infiltration is performed to reduce blood flow during endoscopic sinus surgery and septorhinoplasty, as well as to control posterior epistaxis and provide regional anesthesia in dental procedures. PPF infiltration performed with consideration of the morphometrics of greater palatine foramen (GPF), greater palatine canal (GPC) and PPF would increase the success of the procedure and reduce the risk of complications. The aim of this study is to investigate the GPF, GPC, lesser palatine foramen (LPF), lesser palatine canal (LPC) and PPF morphology via the images obtained by CBCT, to provide information for interventional procedures.

Materials and methods

GPF, GPC, LPF, LPC and PPF were morphometrically evaluated retrospectively in CBCT images of 75 female and 75 male cases by Planmeca Romexis program. The 19 parameters were measured on these images.

Results

These parameters were evaluated statistically. The comparison of these parameters by genders revealed significant differences in distances between GPC–PC, PC–IOF, LPC–GPF, GPF–MS in the coronal and transverse planes, the distance between GPF and the occlusal plane of the teeth, GPF–PNS, GPF–IF and TD-GPF, and in the area of GPF. The number of LPF was found ranging from 1 to 5.

Conclusion

Our results may help to insert to needle properly for application of maxillary nerve block with a high success rate and minimal complication. We recommend that the needle should be inserted 14–15 mm lateral to the midsagittal plane, 19–20 mm over the occlusal plane of the teeth and on the same line with the third molar teeth. For PPF infiltration through the GPF, the needle should be pushed forward 28 mm upward at 66° angle on the transverse plane and 14°–15° angle on the vertical plane.

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Localization and characterization of human palatal periosteum stem cells in serum‐free, xeno‐free medium for clinical use

Harvesting, expanding, and re‐implanting osteogenic mesenchymal stem cells (MSCs) avoids the donor‐site morbidity associated with autogenous grafting from bone marrow. Mesenchymal stem cells sourced from the palatal periosteum could be an alternative to isolation of such cells using bone marrow aspiration procedures. For safe use in human therapy, MSCs should be expanded in culture medium that is free from animal or human‐derived serum. In this study we localized, quantified, and characterized MSCs from palatal periosteum cultured in serum‐free, xeno‐free Essential 8 medium. A portion of the palatal periosteum tissues from three patients were dual‐immunostained with MSC‐specific markers (CD105, CD90, and CD73). The remaining portions were expanded in culture, and the isolated MSCs were analyzed using flow cytometry and tri‐lineage differentiation. Palatal periosteum sections were found to contain CD105‐, CD90‐, and CD73‐positive cells. The cultured cells were 73.0 ± 6.7% (mean ± SD) positive for all three MSC‐specific markers and were without hematopoietic stem cell (HSC) markers 0.5 ± 0.3% (mean ± SD). Tri‐lineage differentiation analysis confirmed that palatal periosteum cells could become adipoblasts, chondroblasts, and osteoblasts. The results demonstrate that palatal‐derived MSCs could be detected in situ within small niches, and when expanded in serum‐free, xeno‐free medium represent a viable source of MSCs for clinical use.

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Localization and characterization of human palatal periosteum stem cells in serum‐free, xeno‐free medium for clinical use

Harvesting, expanding, and re‐implanting osteogenic mesenchymal stem cells (MSCs) avoids the donor‐site morbidity associated with autogenous grafting from bone marrow. Mesenchymal stem cells sourced from the palatal periosteum could be an alternative to isolation of such cells using bone marrow aspiration procedures. For safe use in human therapy, MSCs should be expanded in culture medium that is free from animal or human‐derived serum. In this study we localized, quantified, and characterized MSCs from palatal periosteum cultured in serum‐free, xeno‐free Essential 8 medium. A portion of the palatal periosteum tissues from three patients were dual‐immunostained with MSC‐specific markers (CD105, CD90, and CD73). The remaining portions were expanded in culture, and the isolated MSCs were analyzed using flow cytometry and tri‐lineage differentiation. Palatal periosteum sections were found to contain CD105‐, CD90‐, and CD73‐positive cells. The cultured cells were 73.0 ± 6.7% (mean ± SD) positive for all three MSC‐specific markers and were without hematopoietic stem cell (HSC) markers 0.5 ± 0.3% (mean ± SD). Tri‐lineage differentiation analysis confirmed that palatal periosteum cells could become adipoblasts, chondroblasts, and osteoblasts. The results demonstrate that palatal‐derived MSCs could be detected in situ within small niches, and when expanded in serum‐free, xeno‐free medium represent a viable source of MSCs for clinical use.

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Dynamic susceptibility contrast parametric imaging using accelerated dual‐contrast echo planar imaging with keyhole

Background

Echo planar imaging (EPI) is one of the methods of choice in dynamic susceptibility contrast MRI (DSC‐MRI) because it provides a sufficient temporal resolution. However, the relatively long readout duration of EPI often imposes limitations on increased spatial coverage or the use of multiple contrasts.

Purpose

To develop a DSC‐MRI method using EPIK (EPI with keyhole) to provide dual‐contrast (TE₁ and TE₂) information with a higher spatial coverage than EPI. To compare results from the community‐standard EPI method and the proposed EPIK method.

Study Type

Prospective.

Subjects

One healthy subject and 17 brain tumor patients.

Field Strength/Sequence

3 T/accelerated EPI and dual‐contrast EPIK sequences.

Assessment

After an initial evaluation using healthy in vivo images, the use of the proposed method for DSC‐MRI was verified with brain tumor patients. The parametric images (eg, CBF and CBV) and arterial input function (AIF), obtained from both the EPI and EPIK, were compared.

Statistical Tests

The ratio of AIF peak height of the proposed method to that of EPI was computed. The ratio computation was also performed for the time‐to‐peak (TTP) in the AIF curves. From the obtained CBF and CBV maps, the tumor‐to‐brain (TBR) ratio was also calculated for each imaging method and the results were compared.

Results

For the same temporal resolution (1.5 sec), EPIK yielded dual‐contrast (TEs of 13/33 msec) with an increased spatial coverage (24 slices) and less geometric distortions than EPI; EPI provided single contrast (TE of 32 msec) with 20 slices. The obtained parametric values (eg, AIF peak, TTP, and TBR) had similar characteristics between EPI and the proposed method.

Data Conclusion

The dual‐contrast data produced by EPIK in DSC‐MRI allowed T₁‐corrected parametric images without the need of second contrast injection and an enhanced estimation of the AIF.

Level of Evidence: 1

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2019.

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Value of MRI in changing of diabetic foot osteomyelitis management

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MRI of synovitis and joint fluid

Synovitis and joint effusion are common manifestations of rheumatic disease and play an important role in the disease pathophysiology. Earlier detection and accurate assessment of synovial pathology, therefore, can facilitate appropriate clinical management and hence improve prognosis. Magnetic resonance imaging (MRI) allows unparalleled assessment of all joint structures and associated pathology. It has emerged as a powerful tool, which enables not only detection of synovitis and effusion, but also allows quantification, detailed characterization, and noninvasive monitoring of synovial processes. The purpose of this article is to summarize the pathophysiology of synovitis and to review the role of qualitative, semiquantitative, and quantitative MRI in the assessment of synovitis and joint fluid. We also discuss the utility of MRI as an outcome measure to assess treatment response, particularly with respect to osteoarthritis and rheumatoid arthritis. Emerging applications such as hybrid positron emission tomography / MRI and molecular imaging are also briefly discussed.

Level of Evidence: 5

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2019.

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Dynamic susceptibility contrast parametric imaging using accelerated dual‐contrast echo planar imaging with keyhole

Background

Echo planar imaging (EPI) is one of the methods of choice in dynamic susceptibility contrast MRI (DSC‐MRI) because it provides a sufficient temporal resolution. However, the relatively long readout duration of EPI often imposes limitations on increased spatial coverage or the use of multiple contrasts.

Purpose

To develop a DSC‐MRI method using EPIK (EPI with keyhole) to provide dual‐contrast (TE₁ and TE₂) information with a higher spatial coverage than EPI. To compare results from the community‐standard EPI method and the proposed EPIK method.

Study Type

Prospective.

Subjects

One healthy subject and 17 brain tumor patients.

Field Strength/Sequence

3 T/accelerated EPI and dual‐contrast EPIK sequences.

Assessment

After an initial evaluation using healthy in vivo images, the use of the proposed method for DSC‐MRI was verified with brain tumor patients. The parametric images (eg, CBF and CBV) and arterial input function (AIF), obtained from both the EPI and EPIK, were compared.

Statistical Tests

The ratio of AIF peak height of the proposed method to that of EPI was computed. The ratio computation was also performed for the time‐to‐peak (TTP) in the AIF curves. From the obtained CBF and CBV maps, the tumor‐to‐brain (TBR) ratio was also calculated for each imaging method and the results were compared.

Results

For the same temporal resolution (1.5 sec), EPIK yielded dual‐contrast (TEs of 13/33 msec) with an increased spatial coverage (24 slices) and less geometric distortions than EPI; EPI provided single contrast (TE of 32 msec) with 20 slices. The obtained parametric values (eg, AIF peak, TTP, and TBR) had similar characteristics between EPI and the proposed method.

Data Conclusion

The dual‐contrast data produced by EPIK in DSC‐MRI allowed T₁‐corrected parametric images without the need of second contrast injection and an enhanced estimation of the AIF.

Level of Evidence: 1

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2019.

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Effect of gravity on portal venous flow: Evaluation using multiposture MRI

Background

Analysis of portal venous flow (PVF) is important when evaluating the severity and prognosis of liver disease. PVF might be altered by postural changes (ie, difference in the effects of gravity).

Purpose

To evaluate the effect of gravity on PVF using a novel MRI system, which can obtain abdominal MRIs in both the supine and the upright positions.

Study Type

Prospective self control.

Subjects

Twelve healthy young male volunteers.

Field Strength/Sequence

Caval velocity‐mapped images were obtained using the electrocardiography‐triggered cine phase‐contrast technique in the supine and upright positions with multiposture MRI (paired 0.4 T permanent magnets).

Assessment

The mean PVF velocity in the region of interest in each cardiac phase was determined. A PVF curve in the cardiac cycle was also obtained from the PVF velocity multiplied by the cross‐sectional area. The mean PVF velocity, maximum PVF velocity, cross‐sectional area of the PV, mean PVF, maximum PVF, and heart rate in the supine and upright positions were assessed.

Statistical Tests

Wilcoxon signed‐rank tests were applied. P < 0.05 was considered statistically significant.

Results

The mean PVF velocity, maximum PVF velocity, cross‐sectional area of the PV, and maximum PVF were all significantly lower in the upright position compared with the supine position (P = 0.002 for all), with differences of 42% ± 15%, 38% ± 12%, 60% ± 17%, 24% ± 11%, and 22% ± 9.3%, respectively. However, heart rate was significantly higher (116% ± 9.2%, P = 0.003) in the upright position compared with the supine position.

Data Conclusion

The effect of gravity during postural change from a supine to an upright position significantly decreases the PVF. Multiposture MRI allows acquisition of more detailed information on liver function.

Level of Evidence: 2

Technical Efficacy Stage: 1

J. Magn. Reson. Imaging 2019.

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Value of MRI in changing of diabetic foot osteomyelitis management

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Mental nerve injury induces novelty seeking behaviour leading to increasing ethanol intake in Wistar rats

Publication date: Available online 7 January 2019

Source: Archives of Oral Biology

Author(s): Isaac O. Pérez-Martínez, Casandra R. Acevedo-Roque, Claudia D. Montes-Angeles, Mariana Martínez, Florencio Miranda

Abstract

Objective

Dental treatment and orofacial surgeries may induce chronic neuropathic orofacial pain (CNOP). This kind of pain affects adaptability to environmental changes in both model animals and humans. Part of the adaptation process depends on the ability to distinguish between familiar and novel stimuli. CNOP induces novelty seeking behaviour as a deficit in environmental adaptation. Alternatively, novelty seeking is a sign for susceptibility to the development of substance abuse. Evidence shows that CNOP leads to alcoholism in animal models. The behavioural relationship between CNOP, novelty seeking behaviour and substance abuse is unknown. In this article, we investigate if CNOP produces an increase in novelty seeking and leads to increasing ethanol intake.

Design

Firstly, we used mental nerve injury as a neuropathic orofacial pain model to evaluate both thermal and mechanical allodynia. We used the novel recognition task to determine novelty seeking behaviour and the drink in darkness protocol to assess ethanol intake.

Results

Our results show that mental nerve constriction increases novelty seeking behaviour (p = 0.01) and correlates with ethanol binge consumption (r² = 0.68, p = 0.0008).

Conclusions

The present study demonstrates, for the first time, that trigeminal nerve injury, which induces CNOP, is enough to provide novelty seeking behaviour and lead to increasing ethanol intake. The increase of novelty seeking behaviour can serve as a predictor of risk of developing substance abuse. The treatment of CNOP involves a high risk of producing addiction. The level of novelty seeking evaluation in patients with neuropathic pain before treatment is critical.

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Biomarkers of inflammatory external root resorption as a result of traumatic dental injury to permanent teeth in children

Publication date: Available online 7 January 2019

Source: Archives of Oral Biology

Author(s): Iwona Gregorczyk-Maga, Marek Kaszuba, Marta Olszewska, Sabina Lichołai, Teresa Iwaniec, Dorota Kościelniak, Wirginia Krzyściak, Anna Jurczak

Abstract

OBJECTIVE

External inflammatory root resorption (EIRR) is a common complication of traumatic dental injury (TDI) that can be detected radiologically. During EIRR, various proteins are released into gingival sulcus fluid (GCF). The aim of the study was to monitor the levels of selected proteins in GCF in children (8-16 years of age) in order to assess their utility in the early diagnosis of EIRR.

DESIGN

Twenty five children who experienced TDI to permanent incisors with ended root development were enrolled. GCF was collected from injured and control teeth with paper strips within seven days after TDI and on three visits during six-month follow-up. Concentrations of IL-1α, IL-1β, IL-6, IL-8, TNFα, RANKL and MMP-9 in GCF were measured using enzyme-linked immunosorbent assays. EIRR was confirmed by radiological imaging techniques.

RESULTS

Of all analyzed proteins, only the levels of IL-1α, Il-1β and TNFα in GCF from the injured teeth with resorption were higher than in GCF from control teeth on the visit during which the EIRR was diagnosed. In univariate logistic regression model, the concentration of IL-1α in GCF was found as the strongest risk factor for the occurrence of EIRR.

CONCLUSIONS

The composition of GCF may be indicative of EIRR after TDI. The monitoring of selected biomarkers in GCF may help to detect EIRR at its early stage and might be useful in reducing radiological exposure in children after TDI. IL-1α can be considered as a potential marker of the EIRR in children after TDI to the permanent teeth.

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Mental nerve injury induces novelty seeking behaviour leading to increasing ethanol intake in Wistar rats

Publication date: Available online 7 January 2019

Source: Archives of Oral Biology

Author(s): Isaac O. Pérez-Martínez, Casandra R. Acevedo-Roque, Claudia D. Montes-Angeles, Mariana Martínez, Florencio Miranda

Abstract

Objective

Dental treatment and orofacial surgeries may induce chronic neuropathic orofacial pain (CNOP). This kind of pain affects adaptability to environmental changes in both model animals and humans. Part of the adaptation process depends on the ability to distinguish between familiar and novel stimuli. CNOP induces novelty seeking behaviour as a deficit in environmental adaptation. Alternatively, novelty seeking is a sign for susceptibility to the development of substance abuse. Evidence shows that CNOP leads to alcoholism in animal models. The behavioural relationship between CNOP, novelty seeking behaviour and substance abuse is unknown. In this article, we investigate if CNOP produces an increase in novelty seeking and leads to increasing ethanol intake.

Design

Firstly, we used mental nerve injury as a neuropathic orofacial pain model to evaluate both thermal and mechanical allodynia. We used the novel recognition task to determine novelty seeking behaviour and the drink in darkness protocol to assess ethanol intake.

Results

Our results show that mental nerve constriction increases novelty seeking behaviour (p = 0.01) and correlates with ethanol binge consumption (r² = 0.68, p = 0.0008).

Conclusions

The present study demonstrates, for the first time, that trigeminal nerve injury, which induces CNOP, is enough to provide novelty seeking behaviour and lead to increasing ethanol intake. The increase of novelty seeking behaviour can serve as a predictor of risk of developing substance abuse. The treatment of CNOP involves a high risk of producing addiction. The level of novelty seeking evaluation in patients with neuropathic pain before treatment is critical.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RdCmnl

Biomarkers of inflammatory external root resorption as a result of traumatic dental injury to permanent teeth in children

Publication date: Available online 7 January 2019

Source: Archives of Oral Biology

Author(s): Iwona Gregorczyk-Maga, Marek Kaszuba, Marta Olszewska, Sabina Lichołai, Teresa Iwaniec, Dorota Kościelniak, Wirginia Krzyściak, Anna Jurczak

Abstract

OBJECTIVE

External inflammatory root resorption (EIRR) is a common complication of traumatic dental injury (TDI) that can be detected radiologically. During EIRR, various proteins are released into gingival sulcus fluid (GCF). The aim of the study was to monitor the levels of selected proteins in GCF in children (8-16 years of age) in order to assess their utility in the early diagnosis of EIRR.

DESIGN

Twenty five children who experienced TDI to permanent incisors with ended root development were enrolled. GCF was collected from injured and control teeth with paper strips within seven days after TDI and on three visits during six-month follow-up. Concentrations of IL-1α, IL-1β, IL-6, IL-8, TNFα, RANKL and MMP-9 in GCF were measured using enzyme-linked immunosorbent assays. EIRR was confirmed by radiological imaging techniques.

RESULTS

Of all analyzed proteins, only the levels of IL-1α, Il-1β and TNFα in GCF from the injured teeth with resorption were higher than in GCF from control teeth on the visit during which the EIRR was diagnosed. In univariate logistic regression model, the concentration of IL-1α in GCF was found as the strongest risk factor for the occurrence of EIRR.

CONCLUSIONS

The composition of GCF may be indicative of EIRR after TDI. The monitoring of selected biomarkers in GCF may help to detect EIRR at its early stage and might be useful in reducing radiological exposure in children after TDI. IL-1α can be considered as a potential marker of the EIRR in children after TDI to the permanent teeth.

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Antifibrotic effect of mitomycin‐C on human vocal cord fibroblasts

Objective

Acquired laryngotracheal stenosis is a potentially life‐threatening situation and a very difficult and challenging problem in laryngology. Therefore, new trends and innovative approaches based on antifibrotic drugs and minimally invasive regimens are being developed to attenuate laryngotracheal fibrosis and scarring. The purpose of this study was to examine the efficacy of mitomycin‐C (MMC) to reverse the transforming growth factor (TGF)‐β‐induced differentiation of MRC‐5 fibroblast and human primary vocal cord fibroblasts to reveal the possible applicability of MMC to laryngotracheal fibrotic conditions.

Methods

Human primary fibroblast cells were isolated from vocal cord specimens of patients undergoing total laryngectomy. The established primary vocal cord fibroblast cell cultures as well as the MRC‐5 human fibroblast cells were treated with 5 ng/mL TGF‐β alone and then with 0.5 µg/mL MMC for 24 hours. Differentiation of fibroblasts was characterized by α‐smooth muscle actin (α‐SMA) immunhistochemistry, Western blot analysis, and real‐time polymerase chain reaction. Cell motility was assessed by wound‐healing assay.

Results

Elevated α‐SMA mRNA and protein expression as well as increased cell motility were observed upon TGF‐β exposures. However, after MMC treatments the TGF‐β‐induced fibroblasts exhibited a significant decrease in α‐SMA expression and wound‐healing activity. Therefore, TGF‐β‐stimulated fibroblast‐myofibroblast transformation was reversed at least in part by MMC treatment. Histopathological examinations of tissue specimens of a laryngotracheal stenosis patient supported these findings.

Conclusion

Antifibrotic effects of MMC were demonstrated on the human MRC‐5 cell line and on primary vocal cord fibroblast cultures. These results verify that MMC can be used with success to reverse upper airway stenosis by reverting the myofibroblast phenotype.

Level of Evidence

NA Laryngoscope, 2019

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Digital Pathology: Review of Current Opportunities and Challenges for Oral Pathologists

Abstract

Whole slide imaging (WSI) has impacted the practice of pathology in the arenas of education, clinical practice, and research. With digital slides, pathologists can circumvent the limitations of traditional glass. Presently, digital pathology is primarily utilized for second opinion consults, clinical conferences, and education at select academic medical centers, with its mainstream adoption on the rise. However, challenges of adoption for oral pathologists are unique given the highly specialized nature of their work. The hurdles include the high cost instrumentation and regular maintenance, need for additional training, changes to traditional workflow, and integration with present software. Given these barriers, it remains unclear the extent to which slide scanning and virtual pathology should be adopted by oral pathologists at this conjuncture. This review seeks to shed light on the current state of WSI and analyzes the opportunities and challenges for oral pathology in the rapidly evolving field of digital pathology.

This article is protected by copyright. All rights reserved.

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Biological and molecular effects of bromodomain and extra‐terminal (BET) inhibitors JQ1, IBET‐151 and IBET‐762 in OSCC cells

Abstract

Background

Despite improvements in oral squamous cell carcinoma (OSCC) management, survival rates remain relatively low and novel anti‐neoplastic agents are needed. Bromodomain and extra‐terminal (BET) inhibitors proved to be promising agents for cancer treatment. We investigated the effects of three BET inhibitors (JQ1, IBET‐151, IBET‐762) on SCC‐25 cell line and primary oral cancer cell culture.

Methods

Cell viability was evaluated by MTT. Protein levels of MCM5 and cleaved‐PARP were estimated by Western blot. Clonogenic and migratory abilities were determined by colony forming and scratch assays. BET inhibitors effects on mRNA levels of E‐Cadherin, Vimentin, SNAI1, SNAI2, CLU, serpini1, MCM5, c‐Myc, E2F, IL7R, and PPARg were analyzed by qPCR.

Results

BET inhibitors significantly reduced oral cancer cell viability. JQ1 showed the greatest effect reducing cell viability to 10%, both in SCC‐25 and primary OSCC cultures (p<0.001), compared to control cells. Cells treated with BET inhibitors displayed a reduction to 50% in colony forming capacity compared to control cells (p<0.0001) and the colonies were smaller; they also had a 50‐60% reduction in migratory capacity (p<0.05) compared to untreated cells. BET inhibitors had a significant impact on genes related to epithelial to mesenchymal transition and other cancer cell markers, notably on MCM5, a gene related to cell cycle control.

Conclusions

BET inhibitors induce both OSCC cell death and reduction of tumor aggressiveness. Molecular mechanisms of BET inhibition involve among others, MCM5 downregulation. Importantly, this study demonstrates for the first time the anti‐tumoral effect of IBET‐151 and IBET‐762 in oral cancer.

This article is protected by copyright. All rights reserved.

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Antifibrotic effect of mitomycin‐C on human vocal cord fibroblasts

Objective

Acquired laryngotracheal stenosis is a potentially life‐threatening situation and a very difficult and challenging problem in laryngology. Therefore, new trends and innovative approaches based on antifibrotic drugs and minimally invasive regimens are being developed to attenuate laryngotracheal fibrosis and scarring. The purpose of this study was to examine the efficacy of mitomycin‐C (MMC) to reverse the transforming growth factor (TGF)‐β‐induced differentiation of MRC‐5 fibroblast and human primary vocal cord fibroblasts to reveal the possible applicability of MMC to laryngotracheal fibrotic conditions.

Methods

Human primary fibroblast cells were isolated from vocal cord specimens of patients undergoing total laryngectomy. The established primary vocal cord fibroblast cell cultures as well as the MRC‐5 human fibroblast cells were treated with 5 ng/mL TGF‐β alone and then with 0.5 µg/mL MMC for 24 hours. Differentiation of fibroblasts was characterized by α‐smooth muscle actin (α‐SMA) immunhistochemistry, Western blot analysis, and real‐time polymerase chain reaction. Cell motility was assessed by wound‐healing assay.

Results

Elevated α‐SMA mRNA and protein expression as well as increased cell motility were observed upon TGF‐β exposures. However, after MMC treatments the TGF‐β‐induced fibroblasts exhibited a significant decrease in α‐SMA expression and wound‐healing activity. Therefore, TGF‐β‐stimulated fibroblast‐myofibroblast transformation was reversed at least in part by MMC treatment. Histopathological examinations of tissue specimens of a laryngotracheal stenosis patient supported these findings.

Conclusion

Antifibrotic effects of MMC were demonstrated on the human MRC‐5 cell line and on primary vocal cord fibroblast cultures. These results verify that MMC can be used with success to reverse upper airway stenosis by reverting the myofibroblast phenotype.

Level of Evidence

NA Laryngoscope, 2019

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Digital Pathology: Review of Current Opportunities and Challenges for Oral Pathologists

Abstract

Whole slide imaging (WSI) has impacted the practice of pathology in the arenas of education, clinical practice, and research. With digital slides, pathologists can circumvent the limitations of traditional glass. Presently, digital pathology is primarily utilized for second opinion consults, clinical conferences, and education at select academic medical centers, with its mainstream adoption on the rise. However, challenges of adoption for oral pathologists are unique given the highly specialized nature of their work. The hurdles include the high cost instrumentation and regular maintenance, need for additional training, changes to traditional workflow, and integration with present software. Given these barriers, it remains unclear the extent to which slide scanning and virtual pathology should be adopted by oral pathologists at this conjuncture. This review seeks to shed light on the current state of WSI and analyzes the opportunities and challenges for oral pathology in the rapidly evolving field of digital pathology.

This article is protected by copyright. All rights reserved.

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Biological and molecular effects of bromodomain and extra‐terminal (BET) inhibitors JQ1, IBET‐151 and IBET‐762 in OSCC cells

Abstract

Background

Despite improvements in oral squamous cell carcinoma (OSCC) management, survival rates remain relatively low and novel anti‐neoplastic agents are needed. Bromodomain and extra‐terminal (BET) inhibitors proved to be promising agents for cancer treatment. We investigated the effects of three BET inhibitors (JQ1, IBET‐151, IBET‐762) on SCC‐25 cell line and primary oral cancer cell culture.

Methods

Cell viability was evaluated by MTT. Protein levels of MCM5 and cleaved‐PARP were estimated by Western blot. Clonogenic and migratory abilities were determined by colony forming and scratch assays. BET inhibitors effects on mRNA levels of E‐Cadherin, Vimentin, SNAI1, SNAI2, CLU, serpini1, MCM5, c‐Myc, E2F, IL7R, and PPARg were analyzed by qPCR.

Results

BET inhibitors significantly reduced oral cancer cell viability. JQ1 showed the greatest effect reducing cell viability to 10%, both in SCC‐25 and primary OSCC cultures (p<0.001), compared to control cells. Cells treated with BET inhibitors displayed a reduction to 50% in colony forming capacity compared to control cells (p<0.0001) and the colonies were smaller; they also had a 50‐60% reduction in migratory capacity (p<0.05) compared to untreated cells. BET inhibitors had a significant impact on genes related to epithelial to mesenchymal transition and other cancer cell markers, notably on MCM5, a gene related to cell cycle control.

Conclusions

BET inhibitors induce both OSCC cell death and reduction of tumor aggressiveness. Molecular mechanisms of BET inhibition involve among others, MCM5 downregulation. Importantly, this study demonstrates for the first time the anti‐tumoral effect of IBET‐151 and IBET‐762 in oral cancer.

This article is protected by copyright. All rights reserved.

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Histologic analyses of flapless ridge preservation in sockets with buccal dehiscence defects using two alloplastic bone graft substitutes

Abstract

Objectives

To investigate whether one of two synthetic bone substitute materials used for ridge preservation in the extraction sockets with buccal dehiscence defects was superior regarding new bone formation and ridge preservation and to compare it to sites left for spontaneous healing.

Materials and methods

In sixteen dogs, P3 and P4 were hemi-sectioned and the respective distal roots were extracted. Following the preparation of a mucoperiosteal flap without vertical releasing incisions, 50% of the buccal bone was carefully removed. The extraction sites were randomly assigned either to a ridge preservation procedure (alloplastic bone substitute material (two test groups)) or to spontaneous healing (control group). Descriptive histology and histomorphometric analyses were performed at healing times of 4, 8, and 16 weeks. In case of homogeneous variances, the results were analyzed by one-way ANOVA, followed by Tukey's post-hoc test. If inhomogeneous, the data was analyzed using Welch-type ANOVA, followed by the Games–Howell post-hoc test.

Results

The use of bone substitute material led to significantly greater horizontal dimensions amounting to 3.3 mm (SD = 0.67; test 1) and 3.5 mm (SD = 0.72; test 2) compared to spontaneous healing (1.7 mm, SD = 0.23) at 16 weeks of healing (p < 0.0001). A significant difference was observed between spontaneous healing and the test groups in terms of newly formed bone tissue at 4, 8, and 16 weeks (p = 0.001), with values reaching 7.9, 21.8, and 36.8% (test 1), 5.0, 10.4, and 29% (test 2), and 26.2, 43.5, and 56.4% (control), but there were no significant differences between the test groups (p > 0.05). The final ridge profile was more favorable after ridge preservation (p < 0.001) as demonstrated by a loss of 28.8% (spontaneous healing) and an increase in both test groups at 16 weeks (test 1 = 60.5% and test 2 = 31.2%).

Conclusions

The use of alloplastic materials rendered greater horizontal dimensions and a more favorable maintenance of the ridge profile.

Clinical relevance

Alloplastic bone substitute materials can successfully be used for ridge preservation procedures.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ABn8y2

Histologic analyses of flapless ridge preservation in sockets with buccal dehiscence defects using two alloplastic bone graft substitutes

Abstract

Objectives

To investigate whether one of two synthetic bone substitute materials used for ridge preservation in the extraction sockets with buccal dehiscence defects was superior regarding new bone formation and ridge preservation and to compare it to sites left for spontaneous healing.

Materials and methods

In sixteen dogs, P3 and P4 were hemi-sectioned and the respective distal roots were extracted. Following the preparation of a mucoperiosteal flap without vertical releasing incisions, 50% of the buccal bone was carefully removed. The extraction sites were randomly assigned either to a ridge preservation procedure (alloplastic bone substitute material (two test groups)) or to spontaneous healing (control group). Descriptive histology and histomorphometric analyses were performed at healing times of 4, 8, and 16 weeks. In case of homogeneous variances, the results were analyzed by one-way ANOVA, followed by Tukey's post-hoc test. If inhomogeneous, the data was analyzed using Welch-type ANOVA, followed by the Games–Howell post-hoc test.

Results

The use of bone substitute material led to significantly greater horizontal dimensions amounting to 3.3 mm (SD = 0.67; test 1) and 3.5 mm (SD = 0.72; test 2) compared to spontaneous healing (1.7 mm, SD = 0.23) at 16 weeks of healing (p < 0.0001). A significant difference was observed between spontaneous healing and the test groups in terms of newly formed bone tissue at 4, 8, and 16 weeks (p = 0.001), with values reaching 7.9, 21.8, and 36.8% (test 1), 5.0, 10.4, and 29% (test 2), and 26.2, 43.5, and 56.4% (control), but there were no significant differences between the test groups (p > 0.05). The final ridge profile was more favorable after ridge preservation (p < 0.001) as demonstrated by a loss of 28.8% (spontaneous healing) and an increase in both test groups at 16 weeks (test 1 = 60.5% and test 2 = 31.2%).

Conclusions

The use of alloplastic materials rendered greater horizontal dimensions and a more favorable maintenance of the ridge profile.

Clinical relevance

Alloplastic bone substitute materials can successfully be used for ridge preservation procedures.

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Awake and behaving mouse fMRI during Go/No-Go task

Publication date: March 2019

Source: NeuroImage, Volume 188

Author(s): Zhe Han, Wenjing Chen, Xifan Chen, Kaiwei Zhang, Chuanjun Tong, Xiaoxing Zhang, Chengyu T. Li, Zhifeng Liang

Abstract

Functional magnetic imaging (fMRI) has been widely used to examine the functional neural networks in both the evoked and resting states. However, most fMRI studies in rodents are performed under anesthesia, which greatly limits the scope of their application, and behavioral relevance. Efforts have been made to image rodents in the awake condition, either in the resting state or in response to sensory or optogenetic stimulation. However, fMRI in awake behaving rodents has not yet been achieved. In the current study, a novel fMRI paradigm for awake and behaving mice was developed, allowing functional imaging of the mouse brain in an olfaction-based go/no-go task. High resolution functional imaging with limited motion and image distortion were achieved at 9.4T with a cryogenic coil in awake and behaving mice. Distributed whole-brain spatiotemporal patterns were revealed, with drastically different activity profiles for go versus no-go trials. Therefore, we have demonstrated the feasibility of functional imaging of an olfactory behavior in awake mice. This fMRI paradigm in awake behaving mice could lead to novel insights into neural mechanisms underlying behaviors at a whole-brain level.

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Alpha and alpha-beta phase synchronization mediate the recruitment of the visuospatial attention network through the Superior Longitudinal Fasciculus

Publication date: March 2019

Source: NeuroImage, Volume 188

Author(s): Antea D'Andrea, Federico Chella, Tom R. Marshall, Vittorio Pizzella, Gian Luca Romani, Ole Jensen, Laura Marzetti

Abstract

It is well known that attentional selection of relevant information relies on local synchronization of alpha band neuronal oscillations in visual cortices for inhibition of distracting inputs. Additionally, evidence for long-range coupling of neuronal oscillations between visual cortices and regions engaged in the anticipation of upcoming stimuli has been more recently provided. Nevertheless, on the one hand the relation between long-range functional coupling and anatomical connections is still to be assessed, and, on the other hand, the specific role of the alpha and beta frequency bands in the different processes underlying visuo-spatial attention still needs further clarification.

We address these questions using measures of linear (frequency-specific) and nonlinear (cross-frequency) phase-synchronization in a cohort of 28 healthy subjects using magnetoencephalography. We show that alpha band phase-synchronization is modulated by the orienting of attention according to a parieto-occipital top-down mechanism reflecting behavior, and its hemispheric asymmetry is predicted by volume's asymmetry of specific tracts of the Superior-Longitudinal-Fasciculus. We also show that a network comprising parietal regions and the right putative Frontal-Eye-Field, but not the left, is recruited in the deployment of spatial attention through an alpha-beta cross-frequency coupling. Overall, we demonstrate that the visuospatial attention network features subsystems indexed by characteristic spectral fingerprints, playing different functional roles in the anticipation of upcoming stimuli and with diverse relation to fiber tracts.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LZ4Jzq

Awake and behaving mouse fMRI during Go/No-Go task

Publication date: March 2019

Source: NeuroImage, Volume 188

Author(s): Zhe Han, Wenjing Chen, Xifan Chen, Kaiwei Zhang, Chuanjun Tong, Xiaoxing Zhang, Chengyu T. Li, Zhifeng Liang

Abstract

Functional magnetic imaging (fMRI) has been widely used to examine the functional neural networks in both the evoked and resting states. However, most fMRI studies in rodents are performed under anesthesia, which greatly limits the scope of their application, and behavioral relevance. Efforts have been made to image rodents in the awake condition, either in the resting state or in response to sensory or optogenetic stimulation. However, fMRI in awake behaving rodents has not yet been achieved. In the current study, a novel fMRI paradigm for awake and behaving mice was developed, allowing functional imaging of the mouse brain in an olfaction-based go/no-go task. High resolution functional imaging with limited motion and image distortion were achieved at 9.4T with a cryogenic coil in awake and behaving mice. Distributed whole-brain spatiotemporal patterns were revealed, with drastically different activity profiles for go versus no-go trials. Therefore, we have demonstrated the feasibility of functional imaging of an olfactory behavior in awake mice. This fMRI paradigm in awake behaving mice could lead to novel insights into neural mechanisms underlying behaviors at a whole-brain level.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sfJf8v

Alpha and alpha-beta phase synchronization mediate the recruitment of the visuospatial attention network through the Superior Longitudinal Fasciculus

Publication date: March 2019

Source: NeuroImage, Volume 188

Author(s): Antea D'Andrea, Federico Chella, Tom R. Marshall, Vittorio Pizzella, Gian Luca Romani, Ole Jensen, Laura Marzetti

Abstract

It is well known that attentional selection of relevant information relies on local synchronization of alpha band neuronal oscillations in visual cortices for inhibition of distracting inputs. Additionally, evidence for long-range coupling of neuronal oscillations between visual cortices and regions engaged in the anticipation of upcoming stimuli has been more recently provided. Nevertheless, on the one hand the relation between long-range functional coupling and anatomical connections is still to be assessed, and, on the other hand, the specific role of the alpha and beta frequency bands in the different processes underlying visuo-spatial attention still needs further clarification.

We address these questions using measures of linear (frequency-specific) and nonlinear (cross-frequency) phase-synchronization in a cohort of 28 healthy subjects using magnetoencephalography. We show that alpha band phase-synchronization is modulated by the orienting of attention according to a parieto-occipital top-down mechanism reflecting behavior, and its hemispheric asymmetry is predicted by volume's asymmetry of specific tracts of the Superior-Longitudinal-Fasciculus. We also show that a network comprising parietal regions and the right putative Frontal-Eye-Field, but not the left, is recruited in the deployment of spatial attention through an alpha-beta cross-frequency coupling. Overall, we demonstrate that the visuospatial attention network features subsystems indexed by characteristic spectral fingerprints, playing different functional roles in the anticipation of upcoming stimuli and with diverse relation to fiber tracts.

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Changes in the Excitability of Corticobulbar Projections Due to Intraoral Cooling with Ice

Abstract

The aim of this study was to assess the effects of ice applied to the oral cavity on the excitability of corticobulbar projections to the swallowing muscles. The subjects were 8 healthy adult volunteers (mean age 29.0 ± 4.9 years). Motor-evoked potentials (MEPs) were recorded from the suprahyoid muscle complex using surface electrodes. Two blocks of 20 MEPs with a test stimulus intensity of 120% of the resting motor threshold were recorded at rest (baseline). Subjects then underwent 5-min thermal stimulation by either of 3 different types: (1) "ice-stick inside mouth," (2) "ice-stick on neck," and (3) "room temperature inside mouth." Blocks of 20 MEPs were then recorded immediately and at 5-min intervals for the following 15 min. There was a significant difference in the effects of the 3 interventions on the amplitude of the MEPs following stimulation (two-way ANOVA: INTERVENTION × TIME; F_8,84 = 3.76, p < 0.01). One-way ANOVA was used to evaluate the changes over time for each intervention type. Only "ice-stick inside mouth" caused an increase in the MEPs (one-way ANOVA main effect of TIME: F_4,28 = 4.04, p = 0.010) with significant differences between baseline and P10 (mean difference 0.050; confidence interval (CI) 95% 0.019–0.079; p = 0.004). There were no significant effects of either "ice-stick on neck" or "room temperature inside mouth" (F_4,28 = 1.13, p = 0.36; F_4,28 = 1.36, p = 0.27, respectively). Ice stimulation within the oral cavity increases the excitability of the cortical swallowing motor pathway.

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Changes in the Excitability of Corticobulbar Projections Due to Intraoral Cooling with Ice

Abstract

The aim of this study was to assess the effects of ice applied to the oral cavity on the excitability of corticobulbar projections to the swallowing muscles. The subjects were 8 healthy adult volunteers (mean age 29.0 ± 4.9 years). Motor-evoked potentials (MEPs) were recorded from the suprahyoid muscle complex using surface electrodes. Two blocks of 20 MEPs with a test stimulus intensity of 120% of the resting motor threshold were recorded at rest (baseline). Subjects then underwent 5-min thermal stimulation by either of 3 different types: (1) "ice-stick inside mouth," (2) "ice-stick on neck," and (3) "room temperature inside mouth." Blocks of 20 MEPs were then recorded immediately and at 5-min intervals for the following 15 min. There was a significant difference in the effects of the 3 interventions on the amplitude of the MEPs following stimulation (two-way ANOVA: INTERVENTION × TIME; F_8,84 = 3.76, p < 0.01). One-way ANOVA was used to evaluate the changes over time for each intervention type. Only "ice-stick inside mouth" caused an increase in the MEPs (one-way ANOVA main effect of TIME: F_4,28 = 4.04, p = 0.010) with significant differences between baseline and P10 (mean difference 0.050; confidence interval (CI) 95% 0.019–0.079; p = 0.004). There were no significant effects of either "ice-stick on neck" or "room temperature inside mouth" (F_4,28 = 1.13, p = 0.36; F_4,28 = 1.36, p = 0.27, respectively). Ice stimulation within the oral cavity increases the excitability of the cortical swallowing motor pathway.

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About 11 Percent of U.S. Adults Have Food Allergy

MONDAY, Jan. 7, 2019 -- Nearly 11 percent of U.S. adults are estimated to be food-allergic, but 19 percent believe they have a food allergy, according to a study published online Jan. 4 in JAMA Network Open. Ruchi S. Gupta, M.D., M.P.H., from the... (Source: Drugs.com - Pharma News)

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About 11 Percent of U.S. Adults Have Food Allergy

MONDAY, Jan. 7, 2019 -- Nearly 11 percent of U.S. adults are estimated to be food-allergic, but 19 percent believe they have a food allergy, according to a study published online Jan. 4 in JAMA Network Open. Ruchi S. Gupta, M.D., M.P.H., from the... (Source: Drugs.com - Pharma News)

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Clinical outcomes after shared decision‐making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy

Objectives

To determine if shared decision‐making tools (SDMTs) improve clinical outcomes for these children.

Shared decision making (SDM) is a collaborative process in which patients and clinicians jointly establish treatment plans that integrate clinical evidence and patient values/preferences. We previously reported less decisional conflict using a SDMT for families of children with obstructive sleep apnea (OSA) without tonsillar hypertrophyl; however, the clinical impact of this finding is unknown.

Methods

Prospective single‐blind randomized controlled trial for consecutive patients referred to a multidisciplinary upper airway center. The study group used a SDMT, whereas the control group did not; all were followed until their next appointment and polysomnogram.

Results

We assessed 50 families (24 study, 26 controls); mean age of patients was 8.8 (95% confidence interval 6.9–10.6) years, and 44% were female. After their initial visit, there was agreement between families and providers on the best treatment option for 22 of 24 (91.7%) study patients and 12 of 26 (46.2%) controls (P < 0.001). Before the first follow‐up, four control families (15.4%) modified their treatment plan, whereas none of the study families did so (P =  0.04). Continuous positive airway pressure (CPAP) compliance was 27% (3 of 11) for controls and 57% (5 of 8) for study patients (P =  0.11). The median obstructive apnea‐hypopnea index significantly improved in study patients from 13.4 (range, 20.0–57.2) to 3.5 (range 0.4–45.5, P =  0.01] events per hour, but not in controls, with 9.4 (range, 0.9–76.2) to 4.9 (range, 0–116, P =  0.10) events per hour.

Conclusion

Families of children with OSA without tonsillar hypertrophy who were counseled regarding treatment options using SMDTs were more likely to undergo agreed upon treatment and had higher CPAP compliance.

Level of Evidence

1b. Laryngoscope, 2019

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Regarding pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

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Incidental thyroid papillary microcarcinoma: survival and follow‐up

Objectives/Hypothesis

The aim was to study the survival of incidental thyroid papillary microcarcinoma patients treated with surgery for benign thyroid disease to validate absence of oncological follow‐up and reduce unnecessary health expenses.

Study Design

Retrospective cohort study.

Methods

We analyzed patient's files and interviewed 252 patients by telephone whose cases were submitted to the multidisciplinary meeting of thyroid pathology in Strasbourg, France, for incidental thyroid papillary microcarcinoma without clinical lymph node involvement, between January 1996 and December 2012.

Results

Thirteen patients (5.8%) died while the data were being collected; however, none of the deaths were due to the thyroid pathology, and no patients showed signs of relapse of the thyroidectomy or cervical lymph node level.

Conclusions

Our retrospective study shows that patients with incidental localized thyroid papillary microcarcinoma who underwent surgery without radioactive iodine treatment have an identical survival compared to the general population at the same age to validate absence of oncological follow‐up and reduce unnecessary health expenses.

Level of Evidence

3 Laryngoscope, 2019

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In response to letter to the editor regarding: pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ffep7Q

Clinical outcomes after shared decision‐making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy

Objectives

To determine if shared decision‐making tools (SDMTs) improve clinical outcomes for these children.

Shared decision making (SDM) is a collaborative process in which patients and clinicians jointly establish treatment plans that integrate clinical evidence and patient values/preferences. We previously reported less decisional conflict using a SDMT for families of children with obstructive sleep apnea (OSA) without tonsillar hypertrophyl; however, the clinical impact of this finding is unknown.

Methods

Prospective single‐blind randomized controlled trial for consecutive patients referred to a multidisciplinary upper airway center. The study group used a SDMT, whereas the control group did not; all were followed until their next appointment and polysomnogram.

Results

We assessed 50 families (24 study, 26 controls); mean age of patients was 8.8 (95% confidence interval 6.9–10.6) years, and 44% were female. After their initial visit, there was agreement between families and providers on the best treatment option for 22 of 24 (91.7%) study patients and 12 of 26 (46.2%) controls (P < 0.001). Before the first follow‐up, four control families (15.4%) modified their treatment plan, whereas none of the study families did so (P =  0.04). Continuous positive airway pressure (CPAP) compliance was 27% (3 of 11) for controls and 57% (5 of 8) for study patients (P =  0.11). The median obstructive apnea‐hypopnea index significantly improved in study patients from 13.4 (range, 20.0–57.2) to 3.5 (range 0.4–45.5, P =  0.01] events per hour, but not in controls, with 9.4 (range, 0.9–76.2) to 4.9 (range, 0–116, P =  0.10) events per hour.

Conclusion

Families of children with OSA without tonsillar hypertrophy who were counseled regarding treatment options using SMDTs were more likely to undergo agreed upon treatment and had higher CPAP compliance.

Level of Evidence

1b. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Fdugo7

Regarding pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Fled6O

Incidental thyroid papillary microcarcinoma: survival and follow‐up

Objectives/Hypothesis

The aim was to study the survival of incidental thyroid papillary microcarcinoma patients treated with surgery for benign thyroid disease to validate absence of oncological follow‐up and reduce unnecessary health expenses.

Study Design

Retrospective cohort study.

Methods

We analyzed patient's files and interviewed 252 patients by telephone whose cases were submitted to the multidisciplinary meeting of thyroid pathology in Strasbourg, France, for incidental thyroid papillary microcarcinoma without clinical lymph node involvement, between January 1996 and December 2012.

Results

Thirteen patients (5.8%) died while the data were being collected; however, none of the deaths were due to the thyroid pathology, and no patients showed signs of relapse of the thyroidectomy or cervical lymph node level.

Conclusions

Our retrospective study shows that patients with incidental localized thyroid papillary microcarcinoma who underwent surgery without radioactive iodine treatment have an identical survival compared to the general population at the same age to validate absence of oncological follow‐up and reduce unnecessary health expenses.

Level of Evidence

3 Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FetzuP

In response to letter to the editor regarding: pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ffep7Q