Sialoendoscopy: Review and Nuances of Technique

Abstract

Introduction

Sialoendoscopy is a nuanced technique of transluminal management of obstructive and nonneoplastic pathology of the major salivary glands. Techniques have been refined in the last two decades due to advances in optical and endoscopic instrumentation. This minimally invasive technique has both diagnostic and therapeutic applications. Obstructive salivary gland disease due to mineralized stones causes the majority of salivary duct-related pathology. Mucus plugs and strictures are the other causes. Submandibular gland sialolithiasis comprises the majority of salivary ductal pathology, with less than ten percent of obstructive symptoms related to parotid gland.

Objective

The aim of this review is to comprehensively understand the scope of practice, the methodology of management, and the techniques for a successful outcome in sialoendoscopy. Anatomy of the salivary glands and the ductal system is reviewed for a successful outcome. Guidance for patient selection, indications, investigations, and preprocedure preparation for sialoendoscopy are discussed. Algorithms and an instrument checklist are provided in table format in the manuscript for clinical utility.

Conclusion

The author simplifies the various systems of sialoendoscopes and the utility of the instruments. The future of transluminal and intraluminal salivary procedures is within the oral and maxillofacial surgical realm with simulators and multidimensional imaging and navigational advances.

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Evaluation of Three-Dimensional Changes in Pharyngeal Airway Following Isolated Lefort One Osteotomy for the Correction of Vertical Maxillary Excess: A Prospective Study

Abstract

Background

Orthognathic surgery involves movement of jaws in all three planes, and this being a part of airway complex, displacement of jaws can influence the dimension of airway at all levels. Lefort one osteotomy surgery with superior repositioning is a common procedure done for patients with vertical maxillary excess

Purpose

The purpose of this study was to evaluate the three-dimensional volumetric changes in airway after lefort one impaction surgery using three-dimensional cone beam computed tomography (3D-CBCT) in patients with vertical maxillary excess (VME).

Methods

A prospective analysis of 15 patients who underwent isolated lefort one impaction surgery was done with pre-operative (T0) and 3-months (T1) post-operative 3D-CBCT scans. Airway was divided into three segments, nasopharyngeal, velopharyngeal and oropharyngeal. Volumetric analysis of all these segments was done before and after surgery. Paired 't test' was used to assess the mean difference in airway volume and area between T0 and T1. One-way ANOVA was used to check the mean percentage difference in airway volume and area among the three segments.

Results

The mean percentage of nasopharyngeal volume difference was − 0.6299 ± 0.9146%, velopharyngeal volume difference was − 0.5205 ± 1.107%, oropharyngeal volume difference was − 1.492 ± 2.745%. Though volume and area of pharyngeal airway were decreased after maxillary impaction surgery in all three segments of airway studied, they were not statistically significant.

Conclusion

Among the three segments of airway studied, oropharyngeal airway volume has shown the highest post-surgical reduction though statistically insignificant. ESS scores were within normal limits. Hence, we are of the opinion that there is lack of evidence to conclude that the patients undergoing lefort one superior repositioning for the treatment of VME might develop significant narrowing of PAS that may predispose the patient to breathing disorders.

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A Woman Oral and Maxillofacial Surgeon of India: Is She Satisfied with Her Career Choice?

Abstract

Just as other surgical fields, maxillofacial surgery also was considered a male-dominated field since long. In the recent past, though, we are witnessing change in this trend. Dentistry in general, and maxillofacial surgery in particular, is seeing a large number of women choosing it as their career option, more so in the last decade and a half. This study was conducted in order to understand issues affecting women maxillofacial surgeons in their career as an academician or a private practitioner. We wanted to analyze the factors leading to career satisfaction and estimate the current work scenario for women maxillofacial surgeons. Since the study is one of its first in the country, the conclusions are not definite. Further studies in the future are needed to understand various factors affecting position of women maxillofacial surgeons in academics, private practice, and residents and role of gender in career advancement and in pursuing leadership positions.

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Efficacy of Neurectomy of Peripheral Branches of the Trigeminal Nerve in Trigeminal Neuralgia: A Critical Review of the Literature

Abstract

Introduction

Of the many chronic painful conditions, trigeminal neuralgia (TN) affecting the orofacial region needs the particular attention of physicians and surgeons, especially those specialising in the maxillofacial region. Treatment protocols for the management of classic TN include pharmacology and surgical intervention. Oral and maxillofacial surgeons have traditionally employed the peripheral neurectomy in the surgical management of TN. This review aims to evaluate the efficacy of peripheral neurectomy in the management of TN with regard to (a) the relief of symptoms in comparison with standard neurosurgical procedures and (b) the duration of pain relief and complications observed compared to standard neurosurgical procedures.

Methods

The review of the literature was done according to PRISMA guidelines and included randomised controlled trials, reviews and prospective clinical studies involving surgical procedures for the management of TN. The primary outcomes evaluated were (a) initial relief of pain, (b) duration of relief of pain, (c) complications observed with ablative procedures and (d) recurrence of symptoms. A total of 43 studies fulfilled the inclusion criteria.

Results

In a total of 7913 patients from the 43 studies, central procedures were found to have best results for both quality and duration of pain relief. Percutaneous and peripheral procedures were associated with increased recurrence rates. The consolidated rates of complication for peripheral, percutaneous and central procedures were 39.46, 65.42 and 10.41%, respectively. The use of peripheral neurectomy alone in the management of classic TN was observed in 10 studies.

Conclusion

Peripheral neurectomy in TN is associated with lesser quality of pain relief in comparison with central neurosurgical procedures. It also provides only short- to medium-term pain relief. Most studies with the use of peripheral neurectomy involved only a small group of patients with short follow-up periods. Oral and maxillofacial surgeons must not consider the peripheral neurectomy as the first surgical option in the management of classic TN. Long-term results can be achieved better with appropriate central neurosurgical procedures and pharmacotherapy.

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A Simple Approach to Intraoperative Handling of Split Thickness Skin Grafts in the Oral Cavity

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The Importance of Panitumumab in Radiotherapy Involving Head and Neck Region

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Reconstruction of Acquired Frontal Bone Defects Using Titanium Mesh Implants: A Retrospective Study

Abstract

Purpose

Frontal bone deformities can be acquired due to trauma or ablative tumor resection surgeries and osteomyelitis. It may also occur due to congenital malformations. Repair of these defects have long been a challenge to oral and maxillofacial surgeons. We report our experience in the reconstruction of acquired frontal bone defects by titanium mesh implant.

Patients and Methods

Titanium mesh was used for reconstruction in 35 patients (18–55 years age-group) (34 males and 01 females) of acquired frontal bone defects secondary to trauma (RTA). All these patients have been referred to author by Department of Neurosurgery of the institute of Affiliation.

Results

All these cases acquired defects as a result of trauma. Follow-up ranged from 12 to 18 months after the reconstruction. Patients were followed up for the progress of healing, stability of implants, infection, wound dehiscence, discharging sinus, exposure of implants, collections, patient satisfaction regarding esthetics and reaction to thermal changes. No postoperative complications were found.

Conclusion

In reconstruction of frontal bone defects, titanium mesh gives satisfactory results.

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Mandibular Torus Harvesting for Sinus Augmentation: Two-Year Follow-Up

Abstract

Maxillary sinus grafting is a commonly used treatment alternative in cases with insufficient bone height to enable insertion of implants in the posterior maxilla. It is commonly carried out with autogenous grafts, biomaterials or both. Autogenous bone grafts are considered gold standard for this procedure; however, due to donor site morbidity, it is not as commonly used as other biomaterials. Mandibular tori are hyperostoses on the lingual side of the mandible in the premolar region. This a case in which mandibular tori were used for a sinus augmentation procedure. The patient was then followed up for 2 years with no complaints, or objective symptoms.

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Efficacy of Sodium Hyaluronate for Temporomandibular Joint Disorder by Single-Puncture Arthrocentesis

Abstract

Background

The term temporomandibular joint internal derangement has characteristic clinical findings such as restricted mouth opening, pain, irregular deviated jaw function and clicking sounds. The technique of TMJ arthrocentesis has gained widespread acceptance as a simple and effective technique for the treatment of acute persistent closed lock of the TMJ. Arthrocentesis is known as the lavage and lysis of upper joint compartment.

Purpose

To evaluate the efficacy of sodium hyaluronate followed by single-puncture arthrocentesis. Sodium hyaluronate is the sodium salt of hyaluronic acid which is a polysaccharide of the glycosaminoglycans family, found in many extracellular tissues, including synovial fluid and cartilage. Exogenous hyaluronate can stimulate the synthesis of endogenous hyaluronic acid.

Methods

In our study, a sample of 10 patients (7 females and 3 males) with TMJ disorder was selected. Arthrocentesis was done followed by sodium hyaluronate injection for all the patients.

Results

On follow-up ranging from 1 to 3 months, pain at rest and pain on mastication had substantially decreased in all patients and mandibular function and mouth opening had significantly improved.

Conclusion

Our study shows that single-puncture Ringer's lactate arthrocentesis followed by sodium hyaluronate injection is effective in the management of the internal derangement of the temporomandibular joint.

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Development of Educational Material for Oral and Maxillofacial Training

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Metastasis of lower gingival squamous cell carcinoma to buccinator lymph node: case report and review of the literature

Metastasis of oral cancer to the buccinator lymph nodes (BN) is uncommon. The antegrade lymphatic flow in patients with normal anatomy and physiology makes metastasis of lower gingival cancer to BN unlikely.

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Metastasis of lower gingival squamous cell carcinoma to buccinator lymph node: case report and review of the literature

Metastasis of oral cancer to the buccinator lymph nodes (BN) is uncommon. The antegrade lymphatic flow in patients with normal anatomy and physiology makes metastasis of lower gingival cancer to BN unlikely.

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IgE Testing Can Predict Food Allergy Status in Patients with Moderate-Severe Atopic Dermatitis

Publication date: Available online 10 January 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Pamela A. Frischmeyer-Guerrerio, Marjohn Rasooly, Wenjuan Gu, Samara Levin, Rekha D. Jhamnani, Joshua D. Milner, Kelly Stone, Anthony L. Guerrerio, Joseph Jones, Magnus P. Borres, Erica Brittain

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Anaphylaxis to amoxicillin-clavulanate, differenitiating the components

Publication date: Available online 10 January 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Matthew Dudgeon, Ismael Carrilo-Martin, Alexei Gonzalez-Estrada

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IgE Testing Can Predict Food Allergy Status in Patients with Moderate-Severe Atopic Dermatitis

Publication date: Available online 10 January 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Pamela A. Frischmeyer-Guerrerio, Marjohn Rasooly, Wenjuan Gu, Samara Levin, Rekha D. Jhamnani, Joshua D. Milner, Kelly Stone, Anthony L. Guerrerio, Joseph Jones, Magnus P. Borres, Erica Brittain

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Anaphylaxis to amoxicillin-clavulanate, differenitiating the components

Publication date: Available online 10 January 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Matthew Dudgeon, Ismael Carrilo-Martin, Alexei Gonzalez-Estrada

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Cutaneous leukocytoclastic vasculitis as the first manifestation of malignant syphilis coinfected with HIV

Malignant syphilis, also known as Lues maligna or ulceronodular syphilis, is a rare form of secondary syphilis mainly characterized by polymorphous, disseminated, and papulonodular cutaneous lesions, typically ulcerated and covered by rupioid crust ¹.

This article is protected by copyright. All rights reserved.

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Cutaneous Ganglioneuroma: A Case Report and Discussion of the Literature

Ganglioneuromas (GN) are benign tumors composed of ganglion cells in a schwannian stroma.¹ They are derived from neural crest cells that give rise to the sympathetic nervous system. Hence, GNs can be found anywhere a sympathetic ganglion is present.² In some cases, GNs are derived from immature ganglioblastomas or neuroganglioblastomas that differentiate.¹

This article is protected by copyright. All rights reserved.

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MULTIPLE FACIAL PLAQUE VARIANT OF TRICHOBLASTOMA

Background

The plaque variant of trichoblastoma has been described as a solitary tumor with diffuse infiltration in the lower dermis and hypodermis with poorly defined borders. Herein, we report a new variant of multiple centrofacial trichoblastoma.

Object

To describe clinical and pathological features of a new multiple kind of plaque variant of centrofacial trichoblastoma.

Methods

Case series of patients with a multiple plaque variant of centrofacial trichoblastoma treated in our department between 2005 and 2017. We identified 8 patients with the centrofacial plaque variant of trichoblastoma treated in our department from 2005 to 2017.

Results

The final study sample comprised 13 trichoblastomas from four patients. All patients also developed at least one basal cell carcinoma. Mohs surgery was the method of treatment in the majority of the cases of trichoblastoma and in all the cases of basal cell carcinoma. We needed between 2 and 6 stages to obtain free margins in our cases of facial plaque trichoblastomas treated by Mohs surgery.

Conclusion

To the best of our knowledge, a multiple plaque variant of trichoblastoma has not been described in the literature. We suggest a genetic origin of this variant of trichoblastoma and describe its remarkable infiltrative nature, with poorly defined surgical margins.

This article is protected by copyright. All rights reserved.

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Tufted angioma‐like lesion associated with VEGF and IL‐6 in TAFRO syndrome: Is it a common histological feature of multicentric Castleman disease/POEMS syndrome?

The histology of skin lesions of TAFRO (thrombocytopenia, anasarca, reticulin fibrosis/renal failure, and organomegaly) syndrome has rarely been reported. We report herein 2 cases of TAFRO syndrome with characteristic vascular skin lesions. The lesions resembled a tufted angioma (TA), although those of case 1 partially resembled a glomeruloid hemangioma, which was known as a specific lesion in POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M‐protein and skin changes), a variant of multicentric Castleman disease (MCD). The high titer of serum Vascular Endothelial Growth Factor (VEGF) and Interleukin‐6 (IL‐6) could explain common characteristic vascular lesions in both TAFRO syndrome and POEMS syndrome/MCD.

This article is protected by copyright. All rights reserved.

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Low‐Grade Fibromyxoid Sarcoma of Acral Sites: Case Report and Literature Review

Low‐grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue sarcoma that usually presents as a deep‐seated tumor in young adults; however, they can occur on superficial sites, mostly documented in pediatric age groups. LGFMS presenting on acral sites is not highly emphasized in the general pathology or dermatopathology literature. The case presented is that of a 30‐year‐old male that had a mass on his foot that was removed fifteen years earlier that subsequently recurred as two masses. The first occurring between the third and fourth toes/metatarsal region and the second over the lateral tarsal region. An excisional biopsy showed a relatively circumscribed, bland spindle cell proliferation with hypocellular and hypercellular zones. The cells showed minimal pleomorphism and lacked mitotic activity. Immunohistochemical analysis showed immunoreactivity with MUC4 and break‐apart Fluorescence in situ hybridization was positive for FUS rearrangement confirming the diagnosis of LGFMS. There are multiple spindle cell tumors that occur on acral sites which usually generates a list of differential diagnoses; however, LGFMS is not usually discussed in that anatomic location. Awareness of the occurrence of LGFMS on acral sites is important to avoid misdiagnosis of this deceptively benign appearing tumor.

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Diagnostic utility of dual 5‐hmC/Melan‐A immunohistochemistry in differentiating nodal nevus from metastatic melanoma: An effective first‐line test for the work‐up of sentinel lymph node specimen

Background

Distinguishing benign nodal nevus from metastatic melanoma can be diagnostically challenging with important clinical consequences. Recently, the loss of epigenetic marker, 5‐Hydroxymethylcytosine (5‐hmC) expression by immunohistochemistry has been found in melanomas and atypical melanocytic neoplasms.

Methods

41 metastatic melanomas and 20 nodal nevi were retrieved. Nuclear 5‐hmC (brown) and cytoplasmic Melan‐A Red (red) double immunohistochemical staining was performed.

Results

Total or partial loss of nuclear expression of 5‐hmC was noted in 40/41 metastatic melanomas; these tumor cells were strongly positive for Melan‐A Red, except in one case of desmoplastic melanoma. All cases of nodal nevus showed uniformly retained nuclear expression of 5‐hmC accompanied by strong Melan‐A Red cytoplasmic staining. In two cases containing both nodal nevus and metastatic melanoma, all tumor cells were positive for Melan‐A Red, but a nuclear expression of 5‐hmC was selectively absent only in the melanoma tumor cells.

Conclusion

Dual 5‐hmC/Melan‐A Red immunohistochemistry is highly specific in distinguishing nodal nevus from metastatic melanoma. Our protocol for brown and red chromogens used in this study provides excellent color contrast and is easy to interpret. Furthermore, this dual staining method allows the preservation of limited tumor tissue, which could be used for potential molecular studies.

This article is protected by copyright. All rights reserved.

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Differential Expression of Phospho‐S6 in Hair Follicle Tumors: Evidence of mTOR pathway activation

Background

The role of the mammalian target of rapamycin (mTOR) in hair follicle tumorigenesis is unclear. mTOR controls cell growth and can be activated through ribosomal S6 kinase. Herein, we sought to evaluate the expression of phospho‐S6 in six different benign and malignant follicular tumor types.

Methods

Seventy‐six cases were selected [17 fibrofolliculomas, 20 trichoepitheliomas, 10 tricholemmomas, 19 pilomatricomas, 1 malignant proliferating tricholemmal tumor, 8 tricholemmal carcinomas and 1 trichoblastic carcinoma] and collected over 16 years. Immunohistochemistry with monoclonal antibody for phospho‐S6 was performed and analyzed semi‐quantitatively; statistical analysis χ² test (p<0.05).

Results

All malignant neoplasms in our series [8/8 (100%) cases of tricholemmal carcinoma, 1/1 (100%) trichoblastic carcinoma and 1/1 (100%) malignant proliferating tricholemmal tumor] demonstrated a strong and diffuse pattern of staining with phospho‐S6 involving 70‐90% of tumor cells. By contrast, a minority of benign tumors were positive for phospho‐S6 and most stained in a patchy pattern including 12/17 (71%) fibrofolliculomas, 9/20 (45%) trichoepitheliomas and 1/10 (10%) tricholemmomas, involving 30‐50%, 5‐20%, and 40‐50% of tumor cells, respectively. Most pilomatricomas [17/19 (89%)] exhibited a stronger, but distinctive staining pattern, staining mostly the basaloid cells with a multifocal distribution, involving 70‐90% of tumor cell.

Conclusions

Phospho‐S6 is differentially expressed among benign and malignant hair follicle tumors (p = 0.0044). While malignant tumors show diffuse expression, only a small subset of benign neoplasms were positive, primarily in a patchy distribution.

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Clinical and histopathologic study of 39 patients with imported tungiasis

Background

Tungiasis is an infestation caused by the penetration in the skin of the flea Tunga penetrans. Histopathologic studies on imported tungiasis are rare and based on a limited number of cases.

Methods

We carried out a review of 39 biopsy specimens collected from 39 patients with imported tungiasis. In all patients, ethnicity, gender, age, location and clinical features of the lesions, Fortaleza classification and countries of infestation were recorded.

Results

Histopathologic study revealed hyper‐ parakeratosis and acanthosis. Fragments of the flea were located in the epidermis and upper dermis and were circumscribed by a pseudo‐cystic cavity. Inside this cavity, we observed: the exoskeleton, made up of a thickened and eosinophilic cuticle; the striated muscle; the tracheal rings and the digestive organs (observed only in some specimens); the ovaries, very rich in eggs, and an inflammatory infiltrate, made up of lymphocytes and neutrophils, with numerous eosinophils. The hypodermic layer was never observed.

Conclusions

Histopathologic examination is helpful for the correct diagnosis of tungiasis in travelers returning from Tropical and Subtropical countries in whom the infestation may be characterized by an atypical clinical presentation.

This article is protected by copyright. All rights reserved.

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Cutaneous leukocytoclastic vasculitis as the first manifestation of malignant syphilis coinfected with HIV

Malignant syphilis, also known as Lues maligna or ulceronodular syphilis, is a rare form of secondary syphilis mainly characterized by polymorphous, disseminated, and papulonodular cutaneous lesions, typically ulcerated and covered by rupioid crust ¹.

This article is protected by copyright. All rights reserved.

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Cutaneous Ganglioneuroma: A Case Report and Discussion of the Literature

Ganglioneuromas (GN) are benign tumors composed of ganglion cells in a schwannian stroma.¹ They are derived from neural crest cells that give rise to the sympathetic nervous system. Hence, GNs can be found anywhere a sympathetic ganglion is present.² In some cases, GNs are derived from immature ganglioblastomas or neuroganglioblastomas that differentiate.¹

This article is protected by copyright. All rights reserved.

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MULTIPLE FACIAL PLAQUE VARIANT OF TRICHOBLASTOMA

Background

The plaque variant of trichoblastoma has been described as a solitary tumor with diffuse infiltration in the lower dermis and hypodermis with poorly defined borders. Herein, we report a new variant of multiple centrofacial trichoblastoma.

Object

To describe clinical and pathological features of a new multiple kind of plaque variant of centrofacial trichoblastoma.

Methods

Case series of patients with a multiple plaque variant of centrofacial trichoblastoma treated in our department between 2005 and 2017. We identified 8 patients with the centrofacial plaque variant of trichoblastoma treated in our department from 2005 to 2017.

Results

The final study sample comprised 13 trichoblastomas from four patients. All patients also developed at least one basal cell carcinoma. Mohs surgery was the method of treatment in the majority of the cases of trichoblastoma and in all the cases of basal cell carcinoma. We needed between 2 and 6 stages to obtain free margins in our cases of facial plaque trichoblastomas treated by Mohs surgery.

Conclusion

To the best of our knowledge, a multiple plaque variant of trichoblastoma has not been described in the literature. We suggest a genetic origin of this variant of trichoblastoma and describe its remarkable infiltrative nature, with poorly defined surgical margins.

This article is protected by copyright. All rights reserved.

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Histiocytoid Sweet Syndrome (HSS) Harboring an IDH‐1 Mutation: A Case Report and Retrospective Analysis of 29 Cases of HSS

Histiocytoid Sweet syndrome (HSS) is a rare histopathologic variant of Sweet syndrome that was first described in 2005 by Requena et al. In contrast to the dense infiltrate of mature neutrophils seen in conventional Sweet syndrome, this variant demonstrates dermal and/or subcutaneous infiltrate with a prominent component of immature myeloid cells resembling histiocytes. (1) A number of publications have since reported similar findings, sometimes in association with hematologic neoplasms. In recent years, an ever increasing number of mutations have been discovered in myelodysplastic syndrome (MDS) and acute myelogenous leukemia (AML), including mutations in isocitrate dehydrogenase 1 (IDH‐1) and isocitrate dehydrogenase 2 (IDH‐2).

This article is protected by copyright. All rights reserved.

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Tufted angioma‐like lesion associated with VEGF and IL‐6 in TAFRO syndrome: Is it a common histological feature of multicentric Castleman disease/POEMS syndrome?

The histology of skin lesions of TAFRO (thrombocytopenia, anasarca, reticulin fibrosis/renal failure, and organomegaly) syndrome has rarely been reported. We report herein 2 cases of TAFRO syndrome with characteristic vascular skin lesions. The lesions resembled a tufted angioma (TA), although those of case 1 partially resembled a glomeruloid hemangioma, which was known as a specific lesion in POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M‐protein and skin changes), a variant of multicentric Castleman disease (MCD). The high titer of serum Vascular Endothelial Growth Factor (VEGF) and Interleukin‐6 (IL‐6) could explain common characteristic vascular lesions in both TAFRO syndrome and POEMS syndrome/MCD.

This article is protected by copyright. All rights reserved.

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Diagnostic utility of dual 5‐hmC/Melan‐A immunohistochemistry in differentiating nodal nevus from metastatic melanoma: An effective first‐line test for the work‐up of sentinel lymph node specimen

Background

Distinguishing benign nodal nevus from metastatic melanoma can be diagnostically challenging with important clinical consequences. Recently, the loss of epigenetic marker, 5‐Hydroxymethylcytosine (5‐hmC) expression by immunohistochemistry has been found in melanomas and atypical melanocytic neoplasms.

Methods

41 metastatic melanomas and 20 nodal nevi were retrieved. Nuclear 5‐hmC (brown) and cytoplasmic Melan‐A Red (red) double immunohistochemical staining was performed.

Results

Total or partial loss of nuclear expression of 5‐hmC was noted in 40/41 metastatic melanomas; these tumor cells were strongly positive for Melan‐A Red, except in one case of desmoplastic melanoma. All cases of nodal nevus showed uniformly retained nuclear expression of 5‐hmC accompanied by strong Melan‐A Red cytoplasmic staining. In two cases containing both nodal nevus and metastatic melanoma, all tumor cells were positive for Melan‐A Red, but a nuclear expression of 5‐hmC was selectively absent only in the melanoma tumor cells.

Conclusion

Dual 5‐hmC/Melan‐A Red immunohistochemistry is highly specific in distinguishing nodal nevus from metastatic melanoma. Our protocol for brown and red chromogens used in this study provides excellent color contrast and is easy to interpret. Furthermore, this dual staining method allows the preservation of limited tumor tissue, which could be used for potential molecular studies.

This article is protected by copyright. All rights reserved.

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Differential Expression of Phospho‐S6 in Hair Follicle Tumors: Evidence of mTOR pathway activation

Background

The role of the mammalian target of rapamycin (mTOR) in hair follicle tumorigenesis is unclear. mTOR controls cell growth and can be activated through ribosomal S6 kinase. Herein, we sought to evaluate the expression of phospho‐S6 in six different benign and malignant follicular tumor types.

Methods

Seventy‐six cases were selected [17 fibrofolliculomas, 20 trichoepitheliomas, 10 tricholemmomas, 19 pilomatricomas, 1 malignant proliferating tricholemmal tumor, 8 tricholemmal carcinomas and 1 trichoblastic carcinoma] and collected over 16 years. Immunohistochemistry with monoclonal antibody for phospho‐S6 was performed and analyzed semi‐quantitatively; statistical analysis χ² test (p<0.05).

Results

All malignant neoplasms in our series [8/8 (100%) cases of tricholemmal carcinoma, 1/1 (100%) trichoblastic carcinoma and 1/1 (100%) malignant proliferating tricholemmal tumor] demonstrated a strong and diffuse pattern of staining with phospho‐S6 involving 70‐90% of tumor cells. By contrast, a minority of benign tumors were positive for phospho‐S6 and most stained in a patchy pattern including 12/17 (71%) fibrofolliculomas, 9/20 (45%) trichoepitheliomas and 1/10 (10%) tricholemmomas, involving 30‐50%, 5‐20%, and 40‐50% of tumor cells, respectively. Most pilomatricomas [17/19 (89%)] exhibited a stronger, but distinctive staining pattern, staining mostly the basaloid cells with a multifocal distribution, involving 70‐90% of tumor cell.

Conclusions

Phospho‐S6 is differentially expressed among benign and malignant hair follicle tumors (p = 0.0044). While malignant tumors show diffuse expression, only a small subset of benign neoplasms were positive, primarily in a patchy distribution.

This article is protected by copyright. All rights reserved.

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Clinical and histopathologic study of 39 patients with imported tungiasis

Background

Tungiasis is an infestation caused by the penetration in the skin of the flea Tunga penetrans. Histopathologic studies on imported tungiasis are rare and based on a limited number of cases.

Methods

We carried out a review of 39 biopsy specimens collected from 39 patients with imported tungiasis. In all patients, ethnicity, gender, age, location and clinical features of the lesions, Fortaleza classification and countries of infestation were recorded.

Results

Histopathologic study revealed hyper‐ parakeratosis and acanthosis. Fragments of the flea were located in the epidermis and upper dermis and were circumscribed by a pseudo‐cystic cavity. Inside this cavity, we observed: the exoskeleton, made up of a thickened and eosinophilic cuticle; the striated muscle; the tracheal rings and the digestive organs (observed only in some specimens); the ovaries, very rich in eggs, and an inflammatory infiltrate, made up of lymphocytes and neutrophils, with numerous eosinophils. The hypodermic layer was never observed.

Conclusions

Histopathologic examination is helpful for the correct diagnosis of tungiasis in travelers returning from Tropical and Subtropical countries in whom the infestation may be characterized by an atypical clinical presentation.

This article is protected by copyright. All rights reserved.

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Congenital diaphragmatic hernia sacs: prenatal imaging and associated postnatal outcomes

Abstract

Background

The presence of a hernia sac in congenital diaphragmatic hernia (CDH) has been reported to be associated with higher lung volumes and better postnatal outcomes.

Objective

To compare prenatal imaging (ultrasound and MRI) prognostic measurements and postnatal outcomes of CDH with and without hernia sac.

Materials and methods

We performed database searches from January 2008 to March 2017 for surgically proven cases of CDH with and without hernia sac. All children had a detailed ultrasound (US) examination and most had an MRI examination. We reviewed the medical records of children enrolled in our Pulmonary Hypoplasia Program.

Results

Of 200 cases of unilateral CDH, 46 (23%) had hernia sacs. Cases of CDH with hernia sac had a higher mean lung-to-head ratio (LHR; 1.61 vs. 1.17; P<0.01), a higher mean observed/expected LHR (0.49 vs. 0.37; P<0.01), and on MRI a higher mean observed/expected total lung volume (0.53 vs. 0.41; P<0.01). Based on a smooth interface between lung and herniated contents, hernia sac or eventration was prospectively questioned by US and MRI in 45.7% and 38.6% of cases, respectively. Postnatally, hernia sac is associated with shorter median periods of admission to the neonatal intensive care unit (45.0 days vs. 61.5 days, P=0.03); mechanical ventilation (15.5 days vs. 23.5 days, P=0.04); extracorporeal membrane oxygenation (251 h vs. 434 h, P=0.04); decreased rates of patch repair (39.0% vs. 69.2%, P<0.01); and pulmonary hypertension (56.1% vs. 75.4%, P=0.03).

Conclusion

Hernia sac is associated with statistically higher prenatal prognostic measurements and improved postnatal outcomes. Recognition of a sharp interface between lung and herniated contents may allow for improved prenatal diagnosis; however, delivery and management should still occur at experienced quaternary neonatal centers.

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

Congenital diaphragmatic hernia sacs: prenatal imaging and associated postnatal outcomes

Abstract

Background

The presence of a hernia sac in congenital diaphragmatic hernia (CDH) has been reported to be associated with higher lung volumes and better postnatal outcomes.

Objective

To compare prenatal imaging (ultrasound and MRI) prognostic measurements and postnatal outcomes of CDH with and without hernia sac.

Materials and methods

We performed database searches from January 2008 to March 2017 for surgically proven cases of CDH with and without hernia sac. All children had a detailed ultrasound (US) examination and most had an MRI examination. We reviewed the medical records of children enrolled in our Pulmonary Hypoplasia Program.

Results

Of 200 cases of unilateral CDH, 46 (23%) had hernia sacs. Cases of CDH with hernia sac had a higher mean lung-to-head ratio (LHR; 1.61 vs. 1.17; P<0.01), a higher mean observed/expected LHR (0.49 vs. 0.37; P<0.01), and on MRI a higher mean observed/expected total lung volume (0.53 vs. 0.41; P<0.01). Based on a smooth interface between lung and herniated contents, hernia sac or eventration was prospectively questioned by US and MRI in 45.7% and 38.6% of cases, respectively. Postnatally, hernia sac is associated with shorter median periods of admission to the neonatal intensive care unit (45.0 days vs. 61.5 days, P=0.03); mechanical ventilation (15.5 days vs. 23.5 days, P=0.04); extracorporeal membrane oxygenation (251 h vs. 434 h, P=0.04); decreased rates of patch repair (39.0% vs. 69.2%, P<0.01); and pulmonary hypertension (56.1% vs. 75.4%, P=0.03).

Conclusion

Hernia sac is associated with statistically higher prenatal prognostic measurements and improved postnatal outcomes. Recognition of a sharp interface between lung and herniated contents may allow for improved prenatal diagnosis; however, delivery and management should still occur at experienced quaternary neonatal centers.

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

Bell Palsy and the Risk of Cardio‐Cerebrovascular Disease: A Population‐Based Follow‐Up Study

Objective

To evaluate the risk of cardio‐cerebrovascular disease (CCVD), such as ischemic stroke and acute myocardial infarction (AMI), in patients diagnosed with Bell palsy

Study Design

Population‐based follow‐up study.

Methods

We used the National Sample Cohort 2002 to 2013 data from the Korea National Health Insurance Service. The Bell palsy group comprised all patients diagnosed with Bell palsy (n = 730). The comparison group comprised patients selected randomly using propensity score matching (n = 1,460). The Kaplan‐Meier survival analysis, log‐rank test, and Cox proportional‐hazards regression models were used to calculate the disease‐free survival rate and hazard ratio (HR) of CCVD for each group.

Results

Of the total study population, ischemic stroke developed in 15.7% of patients with Bell palsy and 9% of patients in the comparison group during the 12‐year follow‐up period. After adjusting for other factors, the HR of ischemic stroke during the 12‐year follow‐up period was 1.84 times greater in the Bell palsy group than in the comparison group (95% confidence interval [CI], 1.43–2.36). However, the adjusted HR of developing ischemic stroke for patients with Bell palsy treated concurrently with antiviral agents and steroids was 1.12 (95% CI, 0.62.–2.04). There was no significant relationship between Bell palsy and risk of AMI development (HR, 1.13; 95% CI, 0.71–1.82).

Conclusion

Bell palsy is linked with an increased incidence of ischemic stroke. Our data suggest that Bell palsy may be used as an indicator of increased stroke risk, and concurrent treatment with antiviral agents and steroids may be effective in preventing ischemic stroke.

Level of Evidence

NA. Laryngoscope, 2019

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

Basaloid nasopharyngeal carcinoma: A population‐based analysis of a rare tumor

Objectives

Basaloid nasopharyngeal carcinoma (BNPC) is an extremely rare malignancy with a paucity of cases reported in the literature. This analysis represents the largest cohort of BNPC to date.

Study Design

Retrospective population‐based analysis.

Methods

The Surveillance, Epidemiology, and End Results registry from 2001 to 2015 was utilized to extract a total of 82 cases of BNPC. Data were analyzed for incidence trends, demographic, and tumor characteristics, as well as potential outcome prognosticators.

Results

White male patients between the ages of 40 to 79 years were most commonly affected. The incidence was measured at 0.06 per 100 thousand people. The majority of tumors were considered high grade (grade III/IV; 92.2%). At presentation, patients were most commonly advanced stage (American Joint Committee on Cancer [AJCC] stage IV) at 29.3%, followed by AJCC stages II and III (20.7%, respectively). T2 tumors were most common at 28.8%. Cervical node involvement and distant metastasis were measured at 53.7% and 10.4%, respectively. One‐year, 5‐year, and 10‐year disease‐specific survival was 87.7%, 60.7%, and 29.8%, respectively. No prognostic factors were identified in this study.

Conclusion

Basaloid squamous cell carcinoma represents a histologic subtype of nasopharyngeal carcinoma with excellent short‐term outcomes but poor survival at 10 years when compared to conventional squamous cell carcinomas.

Level of Evidence

NA. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TI7LLg

Outcomes of transmastoid resurfacing for superior canal dehiscence using a cartilage overlay technique

Objective

Superior semicircular canal dehiscence is a well‐described syndrome with potentially debilitating symptoms. We report on the audiologic and long‐term symptom outcomes of 10 patients (12 ears) undergoing a cartilage overlay transmastoid resurfacing technique.

Methods

Retrospective chart review and cross‐sectional outcomes recall survey were used. A mailed questionnaire quantifying the effect of surgery on symptom severity and patient satisfaction were used. Nonlinear regression curves of pre‐/postoperative air and bone pure‐tone audiometric data were used to evaluate postoperative changes in hearing. Surgical failure was defined as requiring revision surgery, and rates were estimated over time using a Kaplan‐Meier analysis.

Results

Most patients reported improved symptoms postoperatively and were satisfied overall with the surgical outcomes. However, four of 12 ears (33%) had a second (revision) surgery before achieving these results. Postoperatively, hearing through air and bone conduction tended to decrease at frequencies greater than 2500 Hz. The chance of avoiding a re‐operation at 36 months (and up to 120 months) was estimated to be 57.1% (95% confidence interval [confidence interval]: 100%, 32.6%). The most common surgical complication was intraoperative cerebrospinal fluid (CSF) leak, encountered exclusively during dural elevation, seen in four of 12 ears (33%).

Conclusion

Although subjectively successful at reducing symptoms, in our small sample this surgical approach did not provide a long‐term stable repair and was frequently associated with intraoperative CSF leak. Offering transmastoid resurfacing to patients should involve a detailed discussion on the potential for revision surgery and risks of diminished hearing and CSF leak.

Level of Evidence

4. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D57FrB

Laryngeal mask versus intubation for adenoidectomies in children: Analysis of 1,500 operations

Objectives/Hypothesis

To evaluate whether endotracheal intubations are superior to the use of laryngeal masks in the airway management for adenoidectomies in pediatric patients in terms of safety and duration of surgery.

Study Design

Retrospective case series.

Methods

A retrospective analysis of 1,500 adenoidectomies in children using laryngeal mask or endotracheal intubation for intraoperative ventilation between 2009 and 2017. Data collected included complications, duration of surgery, and duration of induction and emergence from anesthesia.

Results

The use of laryngeal masks did not accelerate the time needed for induction and emergence of anesthesia although significantly increasing the duration of surgery itself. There also were significantly more complications during and after anesthesia when using a laryngeal mask. In 10% of the children, the laryngeal mask had to be replaced by an endotracheal tube intraoperatively.

Conclusions

There is no reason to recommend the use of a laryngeal mask as the first choice of airway management regarding adenoidectomies in children.

Level of Evidence

3 Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D4yfBb

Tracheo‐innominate fistula in children: A systematic review of literature

Objective

Tracheo‐innominate fistula (TIF) is a rare but fatal complication of tracheotomy. To date, there is a paucity of literature regarding pediatric TIFs. The objectives of this study were to conduct a systematic review of literature on pediatric TIF following tracheotomy and describe three demonstrative cases from our institutional experience.

Methods

We conducted a systematic review using MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL. All studies with pediatric patients (under 18 years of age) who developed TIF following tracheotomy were included.

Results

Fifty‐four publications met inclusion criteria, reporting on 77 cases. The most common indication for tracheotomy was prolonged intubation and the need for ventilatory support (38.6%), with neurological comorbidities being the most common indication (72.7%). The mean time to TIF was 395.7 days (95% confidence interval, 225.9–565.5). Fifty‐four patients (70.1%) presented with massive hemorrhage, whereas 18 patients (23.3%) presented with a sentinel bleeding event. The most common diagnostic interventions were computed tomography scan with or without contrast and bronchoscopy (55.8%). A substantial number of patients did not have any investigations (41.6%). Surgical management occurred in 70.1% of patients. Mortality was 38.6% in reported cases with variable follow‐up periods.

Conclusion

TIF may occur in long‐term tracheostomy‐dependent children, contrary to the conventionally described 3‐week postoperative period. The mortality may not be as high as previously reported with timely intervention. Our results are limited by inherent risks of bias. Further research including well‐designed cohort studies are needed to guide an evidence‐based approach to TIF.

Level of Evidence

NA. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2THX77f

Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications

Objectives/Hypothesis

To describe the evolution of the butterfly graft technique for the treatment of nasal valve compromise, with specific attention to technical developments allowing for expanded indications. To review the impact on patient‐reported outcomes of nasal airway function and nasal aesthetics.

Study Design

Retrospective chart review.

Methods

A review of a single surgeon's patients at a private practice and tertiary care center undergoing surgical correction for nasal valve compromise using the butterfly graft technique between July 2002 and April 2017. Data collected included etiology of nasal valve compromise, additional procedures performed, complications, and functional and aesthetic patient‐reported outcomes.

Results

Over the study period, 512 patients underwent surgery to correct nasal valve compromise utilizing the butterfly graft technique. The overall patient‐reported relief of nasal obstructive symptoms was complete in 87%, improved but not completely relieved in 10%, and not improved in 4%. No patients reported a worsening in their nasal obstructive symptoms. The overall patient‐reported change in nasal appearance was improved 53%, the same 32%, worse in 15%. The patients in the latter half of the study tended to report better aesthetic results.

Conclusions

The results of this study suggest that the surgical technique for the butterfly graft evolved over time and allowed for improved aesthetic outcomes, without reduction in the efficacy in correction of nasal valve compromise. The evolution in technique allowed for expansion of the indications for the butterfly graft while maintaining the favorable patient‐reported aesthetic and functional results.

Level of Evidence

4 Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D4y4G1

Sex‐based outcomes in type I thyroplasty for nonparalytic glottic incompetence

Objective

Clinical outcomes for type I Gore‐Tex thyroplasty (GMT) for nonparalytic glottic incompetence (GI) have been reported in the literature. Given differences in male and female laryngeal anatomy, sex‐based outcomes should also be evaluated. We endeavored to evaluate sex‐specific post‐GMT voice outcomes.

Methods

We performed a retrospective review of patients undergoing GMT for nonparalytic GI. Multidimensional voice outcome measures including voice‐related quality of life (VRQOL), Glottal Function Index (GFI), and grade/roughness/breathiness/asthenia/strain (GRBAS) were analyzed at postoperative time frames: 0 to 3 months, 3 to 9 months, and 9 to 18 months.

Results

Eighty‐five subjects (43 females, 42 males) with mean age 53.5 undergoing GMT for nonparalytic GI from 2005 to 2017 met inclusion criteria. Etiologies included vocal fold hypomobility (N = 36, 42%), paresis (N = 18, 21%), vocal fold atrophy (N = 17, 20%), and scarring (N = 14, 17%). Females had significantly greater improvement on VRQOL at 0 to 3 months and 9 to 18 months timeframes compared to males, with mean change in VRQOL: 41.3 versus 22.4 (P = 0.0002) and 42.5 versus 20.8 (P = 0.002), respectively. Similarly, women had significantly greater improvement in GFI at 0 to 3 months follow‐up (mean difference − 10.8 vs. −4.9, respectively, P = 0.0002). There was no statistically significant sex difference in GRBAS at any follow‐up interval.

Conclusion

Following GMT, females had greater improvement in patient‐reported voice outcomes in the early postoperative period. No significant difference between sexes was noted in perceptual measures (GRBAS). Sex‐specific outcomes should be evaluated for clinical interventions to improve specificity of preoperative counseling.

Level of Evidence

4. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TLf7hd

Application of amniotic membrane for covering mastoid cavity in canal wall down mastoidectomy

Objective

Prevention of granulation tissue formation and acceleration of epithelialization of the mastoid cavity in canal wall down (CWD) mastoidectomy by use of amniotic membrane (AM) as a biologic dressing.

Study Design

Prospective and randomized study.

Methods

During CWD mastoidectomy, an inferiorly base musculoperiosteal flap was rotated into the cavity. In order to coverage of this flap, the AM (75 ears) or the temporalis fascia (control group, 73 ears) was used. The times for mastoid cavity epithelialization were compared in both groups.

Results

In the AM group, duration of complete epithelialization of the cavity was 41.4 ± 7.7 days, whereas in the control group it was 59.2 ± 9.1 days. Duration of time for complete epithelialization in the AM group was shorter than in the control group, which was significant (P < 0.0001).

Conclusion

The use of AM in CWD mastoidectomy is beneficial in minimizing postoperative epithelialization time.

Level of Evidence

1b. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D4xW9v

Determining effectiveness of EBM education in otolaryngology residents using modified fresno test

Objective

To determine the effectiveness of education in evidence‐based medicine (EBM) on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir‐Alam and Imam Khomeini Hospitals.

Methods

In a quasi‐experimental (before‐and‐after) study, all ear, nose, and throat residents of TUMS (n = 41) entered the study. The residents underwent the modified Fresno test. Then, two EBM workshops with a similar content were held on 2 separate days in each hospital, with each session lasting 6 hours. The learned material was practiced in weekly journal clubs. Six months after the workshop, the modified Fresno test was applied again, and the results were analyzed.

Results

A significant improvement in the modified Fresno test score was observed. The mean score of the modified Fresno test was 57.43 ± 22.07 before the workshop and 79.26 ± 22.48 after the workshop (P < 0.001).

Conclusion

The results of the study show that EBM education and practice of the learned materials in journal clubs can improve the knowledge and skills of residents.

Further research with larger samples is needed to improve the precision of our findings and to increase confidence in the results.

Level of Evidence

2. Laryngoscope, 2018

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

Bell Palsy and the Risk of Cardio‐Cerebrovascular Disease: A Population‐Based Follow‐Up Study

Objective

To evaluate the risk of cardio‐cerebrovascular disease (CCVD), such as ischemic stroke and acute myocardial infarction (AMI), in patients diagnosed with Bell palsy

Study Design

Population‐based follow‐up study.

Methods

We used the National Sample Cohort 2002 to 2013 data from the Korea National Health Insurance Service. The Bell palsy group comprised all patients diagnosed with Bell palsy (n = 730). The comparison group comprised patients selected randomly using propensity score matching (n = 1,460). The Kaplan‐Meier survival analysis, log‐rank test, and Cox proportional‐hazards regression models were used to calculate the disease‐free survival rate and hazard ratio (HR) of CCVD for each group.

Results

Of the total study population, ischemic stroke developed in 15.7% of patients with Bell palsy and 9% of patients in the comparison group during the 12‐year follow‐up period. After adjusting for other factors, the HR of ischemic stroke during the 12‐year follow‐up period was 1.84 times greater in the Bell palsy group than in the comparison group (95% confidence interval [CI], 1.43–2.36). However, the adjusted HR of developing ischemic stroke for patients with Bell palsy treated concurrently with antiviral agents and steroids was 1.12 (95% CI, 0.62.–2.04). There was no significant relationship between Bell palsy and risk of AMI development (HR, 1.13; 95% CI, 0.71–1.82).

Conclusion

Bell palsy is linked with an increased incidence of ischemic stroke. Our data suggest that Bell palsy may be used as an indicator of increased stroke risk, and concurrent treatment with antiviral agents and steroids may be effective in preventing ischemic stroke.

Level of Evidence

NA. Laryngoscope, 2019

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

Basaloid nasopharyngeal carcinoma: A population‐based analysis of a rare tumor

Objectives

Basaloid nasopharyngeal carcinoma (BNPC) is an extremely rare malignancy with a paucity of cases reported in the literature. This analysis represents the largest cohort of BNPC to date.

Study Design

Retrospective population‐based analysis.

Methods

The Surveillance, Epidemiology, and End Results registry from 2001 to 2015 was utilized to extract a total of 82 cases of BNPC. Data were analyzed for incidence trends, demographic, and tumor characteristics, as well as potential outcome prognosticators.

Results

White male patients between the ages of 40 to 79 years were most commonly affected. The incidence was measured at 0.06 per 100 thousand people. The majority of tumors were considered high grade (grade III/IV; 92.2%). At presentation, patients were most commonly advanced stage (American Joint Committee on Cancer [AJCC] stage IV) at 29.3%, followed by AJCC stages II and III (20.7%, respectively). T2 tumors were most common at 28.8%. Cervical node involvement and distant metastasis were measured at 53.7% and 10.4%, respectively. One‐year, 5‐year, and 10‐year disease‐specific survival was 87.7%, 60.7%, and 29.8%, respectively. No prognostic factors were identified in this study.

Conclusion

Basaloid squamous cell carcinoma represents a histologic subtype of nasopharyngeal carcinoma with excellent short‐term outcomes but poor survival at 10 years when compared to conventional squamous cell carcinomas.

Level of Evidence

NA. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TI7LLg

Outcomes of transmastoid resurfacing for superior canal dehiscence using a cartilage overlay technique

Objective

Superior semicircular canal dehiscence is a well‐described syndrome with potentially debilitating symptoms. We report on the audiologic and long‐term symptom outcomes of 10 patients (12 ears) undergoing a cartilage overlay transmastoid resurfacing technique.

Methods

Retrospective chart review and cross‐sectional outcomes recall survey were used. A mailed questionnaire quantifying the effect of surgery on symptom severity and patient satisfaction were used. Nonlinear regression curves of pre‐/postoperative air and bone pure‐tone audiometric data were used to evaluate postoperative changes in hearing. Surgical failure was defined as requiring revision surgery, and rates were estimated over time using a Kaplan‐Meier analysis.

Results

Most patients reported improved symptoms postoperatively and were satisfied overall with the surgical outcomes. However, four of 12 ears (33%) had a second (revision) surgery before achieving these results. Postoperatively, hearing through air and bone conduction tended to decrease at frequencies greater than 2500 Hz. The chance of avoiding a re‐operation at 36 months (and up to 120 months) was estimated to be 57.1% (95% confidence interval [confidence interval]: 100%, 32.6%). The most common surgical complication was intraoperative cerebrospinal fluid (CSF) leak, encountered exclusively during dural elevation, seen in four of 12 ears (33%).

Conclusion

Although subjectively successful at reducing symptoms, in our small sample this surgical approach did not provide a long‐term stable repair and was frequently associated with intraoperative CSF leak. Offering transmastoid resurfacing to patients should involve a detailed discussion on the potential for revision surgery and risks of diminished hearing and CSF leak.

Level of Evidence

4. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D57FrB

Vestibular atelectasis: Myth or reality?

Objectives/Hypothesis

Because delayed post‐contrast three‐dimensional fluid‐attenuated inversion recovery imaging sequences enable the distinction between the utricle and the saccule, we raised the hypothesis that patients with vestibular atelectasis (VA) could show unilateral collapse of the utricle and the ampullas on imaging.

Study Design

Retrospective case series.

Methods

We retrospectively reviewed 200 patients who underwent 3 T magnetic resonance imaging (MRI) after intravenous administration of gadolinium. MRI scans were assessed for the presence of VA. The endolymphatic space was considered as collapsed when the utricle and at least two ampullas were not visible or were barely visible.

Results

We reported four patients with VA on MRI responsible for atypical clinical presentations of acute vestibular deficit. All patients presented a specific involvement of the pars superior sensory captors (utricle, ampullas), preserving the pars inferior sensory captors (cochlea and saccule). This was confirmed both clinically and on MRI.

Conclusions

Our study is the first to describe in vivo unilateral collapse of the pars superior on delayed postcontrast MRI in patients with a clinical unilateral vestibular loss.

Level of Evidence

4 Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TC3fxM

Tracheo‐innominate fistula in children: A systematic review of literature

Objective

Tracheo‐innominate fistula (TIF) is a rare but fatal complication of tracheotomy. To date, there is a paucity of literature regarding pediatric TIFs. The objectives of this study were to conduct a systematic review of literature on pediatric TIF following tracheotomy and describe three demonstrative cases from our institutional experience.

Methods

We conducted a systematic review using MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL. All studies with pediatric patients (under 18 years of age) who developed TIF following tracheotomy were included.

Results

Fifty‐four publications met inclusion criteria, reporting on 77 cases. The most common indication for tracheotomy was prolonged intubation and the need for ventilatory support (38.6%), with neurological comorbidities being the most common indication (72.7%). The mean time to TIF was 395.7 days (95% confidence interval, 225.9–565.5). Fifty‐four patients (70.1%) presented with massive hemorrhage, whereas 18 patients (23.3%) presented with a sentinel bleeding event. The most common diagnostic interventions were computed tomography scan with or without contrast and bronchoscopy (55.8%). A substantial number of patients did not have any investigations (41.6%). Surgical management occurred in 70.1% of patients. Mortality was 38.6% in reported cases with variable follow‐up periods.

Conclusion

TIF may occur in long‐term tracheostomy‐dependent children, contrary to the conventionally described 3‐week postoperative period. The mortality may not be as high as previously reported with timely intervention. Our results are limited by inherent risks of bias. Further research including well‐designed cohort studies are needed to guide an evidence‐based approach to TIF.

Level of Evidence

NA. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2THX77f

Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications

Objectives/Hypothesis

To describe the evolution of the butterfly graft technique for the treatment of nasal valve compromise, with specific attention to technical developments allowing for expanded indications. To review the impact on patient‐reported outcomes of nasal airway function and nasal aesthetics.

Study Design

Retrospective chart review.

Methods

A review of a single surgeon's patients at a private practice and tertiary care center undergoing surgical correction for nasal valve compromise using the butterfly graft technique between July 2002 and April 2017. Data collected included etiology of nasal valve compromise, additional procedures performed, complications, and functional and aesthetic patient‐reported outcomes.

Results

Over the study period, 512 patients underwent surgery to correct nasal valve compromise utilizing the butterfly graft technique. The overall patient‐reported relief of nasal obstructive symptoms was complete in 87%, improved but not completely relieved in 10%, and not improved in 4%. No patients reported a worsening in their nasal obstructive symptoms. The overall patient‐reported change in nasal appearance was improved 53%, the same 32%, worse in 15%. The patients in the latter half of the study tended to report better aesthetic results.

Conclusions

The results of this study suggest that the surgical technique for the butterfly graft evolved over time and allowed for improved aesthetic outcomes, without reduction in the efficacy in correction of nasal valve compromise. The evolution in technique allowed for expansion of the indications for the butterfly graft while maintaining the favorable patient‐reported aesthetic and functional results.

Level of Evidence

4 Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D4y4G1

Sex‐based outcomes in type I thyroplasty for nonparalytic glottic incompetence

Objective

Clinical outcomes for type I Gore‐Tex thyroplasty (GMT) for nonparalytic glottic incompetence (GI) have been reported in the literature. Given differences in male and female laryngeal anatomy, sex‐based outcomes should also be evaluated. We endeavored to evaluate sex‐specific post‐GMT voice outcomes.

Methods

We performed a retrospective review of patients undergoing GMT for nonparalytic GI. Multidimensional voice outcome measures including voice‐related quality of life (VRQOL), Glottal Function Index (GFI), and grade/roughness/breathiness/asthenia/strain (GRBAS) were analyzed at postoperative time frames: 0 to 3 months, 3 to 9 months, and 9 to 18 months.

Results

Eighty‐five subjects (43 females, 42 males) with mean age 53.5 undergoing GMT for nonparalytic GI from 2005 to 2017 met inclusion criteria. Etiologies included vocal fold hypomobility (N = 36, 42%), paresis (N = 18, 21%), vocal fold atrophy (N = 17, 20%), and scarring (N = 14, 17%). Females had significantly greater improvement on VRQOL at 0 to 3 months and 9 to 18 months timeframes compared to males, with mean change in VRQOL: 41.3 versus 22.4 (P = 0.0002) and 42.5 versus 20.8 (P = 0.002), respectively. Similarly, women had significantly greater improvement in GFI at 0 to 3 months follow‐up (mean difference − 10.8 vs. −4.9, respectively, P = 0.0002). There was no statistically significant sex difference in GRBAS at any follow‐up interval.

Conclusion

Following GMT, females had greater improvement in patient‐reported voice outcomes in the early postoperative period. No significant difference between sexes was noted in perceptual measures (GRBAS). Sex‐specific outcomes should be evaluated for clinical interventions to improve specificity of preoperative counseling.

Level of Evidence

4. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TLf7hd

Application of amniotic membrane for covering mastoid cavity in canal wall down mastoidectomy

Objective

Prevention of granulation tissue formation and acceleration of epithelialization of the mastoid cavity in canal wall down (CWD) mastoidectomy by use of amniotic membrane (AM) as a biologic dressing.

Study Design

Prospective and randomized study.

Methods

During CWD mastoidectomy, an inferiorly base musculoperiosteal flap was rotated into the cavity. In order to coverage of this flap, the AM (75 ears) or the temporalis fascia (control group, 73 ears) was used. The times for mastoid cavity epithelialization were compared in both groups.

Results

In the AM group, duration of complete epithelialization of the cavity was 41.4 ± 7.7 days, whereas in the control group it was 59.2 ± 9.1 days. Duration of time for complete epithelialization in the AM group was shorter than in the control group, which was significant (P < 0.0001).

Conclusion

The use of AM in CWD mastoidectomy is beneficial in minimizing postoperative epithelialization time.

Level of Evidence

1b. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D4xW9v

Determining effectiveness of EBM education in otolaryngology residents using modified fresno test

Objective

To determine the effectiveness of education in evidence‐based medicine (EBM) on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir‐Alam and Imam Khomeini Hospitals.

Methods

In a quasi‐experimental (before‐and‐after) study, all ear, nose, and throat residents of TUMS (n = 41) entered the study. The residents underwent the modified Fresno test. Then, two EBM workshops with a similar content were held on 2 separate days in each hospital, with each session lasting 6 hours. The learned material was practiced in weekly journal clubs. Six months after the workshop, the modified Fresno test was applied again, and the results were analyzed.

Results

A significant improvement in the modified Fresno test score was observed. The mean score of the modified Fresno test was 57.43 ± 22.07 before the workshop and 79.26 ± 22.48 after the workshop (P < 0.001).

Conclusion

The results of the study show that EBM education and practice of the learned materials in journal clubs can improve the knowledge and skills of residents.

Further research with larger samples is needed to improve the precision of our findings and to increase confidence in the results.

Level of Evidence

2. Laryngoscope, 2018

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

Allergic contact dermatitis from topical ophthalmic medications: keep an eye on it!

Background

Allergic contact dermatitis (ACD) from topical ophthalmic medications is often overlooked.

Objectives

To study the demographic characteristics, lesion locations, and associated medical conditions of the patients with ACD from ophthalmic drugs, and to identify the most common allergenic culprits, as well as trends in frequencies over the years.

Methods

From January 1990 until December 2016, 16 065 patients were investigated in our clinic; all patients with a positive patch‐test reaction to eye medication or its ingredient(s) having caused ACD were studied. For each allergen identified, the number of positive test results compared with the total number of those in the total population, as well as trends across three periods, namely 1990‐1998, 1999‐2007, and 2008‐2016 were studied.

Results

118 patients (0.7%) presented with positive patch‐test results to ingredients of, and/or topical ophthalmic medications. Aminoglycoside antibiotics, followed by corticosteroids, as pharmacologically active ingredients, as well as wool alcohols, thiomersal and benzalkonium chloride, as excipients were the most frequent culprits. Particularly chloramphenicol showed a decreasing trend in positive reactions over time, whereas reactions tobramycin were increasing.

Conclusion

ACD from eye medication is mainly due to active principles, but other excipient ingredients, beside the products "as is", should be tested as well.

This article is protected by copyright. All rights reserved.

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Allergic contact dermatitis from topical ophthalmic medications: keep an eye on it!

Background

Allergic contact dermatitis (ACD) from topical ophthalmic medications is often overlooked.

Objectives

To study the demographic characteristics, lesion locations, and associated medical conditions of the patients with ACD from ophthalmic drugs, and to identify the most common allergenic culprits, as well as trends in frequencies over the years.

Methods

From January 1990 until December 2016, 16 065 patients were investigated in our clinic; all patients with a positive patch‐test reaction to eye medication or its ingredient(s) having caused ACD were studied. For each allergen identified, the number of positive test results compared with the total number of those in the total population, as well as trends across three periods, namely 1990‐1998, 1999‐2007, and 2008‐2016 were studied.

Results

118 patients (0.7%) presented with positive patch‐test results to ingredients of, and/or topical ophthalmic medications. Aminoglycoside antibiotics, followed by corticosteroids, as pharmacologically active ingredients, as well as wool alcohols, thiomersal and benzalkonium chloride, as excipients were the most frequent culprits. Particularly chloramphenicol showed a decreasing trend in positive reactions over time, whereas reactions tobramycin were increasing.

Conclusion

ACD from eye medication is mainly due to active principles, but other excipient ingredients, beside the products "as is", should be tested as well.

This article is protected by copyright. All rights reserved.

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Measuring the value of MRI: Comparative effectiveness & outcomes research

Magnetic resonance imaging (MRI) now provides diagnostic assessment for numerous clinical indications, including lesion detection, characterization, functional assessment, and response to treatment. To maximize the potential to improve health through the use of MRI, it is critical to investigate the impact of MRI on outcomes, and to compare the effectiveness of MRI with existing standard diagnostic approaches. Outcomes of MRI can include survival but also intermediate steps such as potential reduction in unnecessary therapy, shorter time to the appropriate therapy, or shorter periods of hospital admission. To understand the effectiveness of an imaging test's sensitivity and specificity, the results' consequences are weighed, reflecting the disease type, severity, and treatment effects. In some instances, other modalities may be faster, more readily available, or less costly than MRI but additional disease‐related information or better accuracy may translate to greater population level benefit. For health policy decisions and clinical guidelines, studies of comparative outcomes can lend depth to the strength of the evidence, the specific benefits vs. harms of using one test over another, and the most effective use of the test in terms of target population. Cost effectiveness then allows for a direct comparison of approaches in terms of the cost for the projected gain in life expectancy and/or quality adjusted life expectancy. Expanding the literature on improved efficiency, accessibility, clinical effectiveness, and cost effectiveness will support the directive for better quality and value in healthcare.

Level of Evidence 5

Technical Efficacy Stage 5

J. Magn. Reson. Imaging 2019.

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Population net benefit of prostate MRI with high spatiotemporal resolution contrast‐enhanced imaging: A decision curve analysis

Background

The value of dynamic contrast‐enhanced (DCE) sequences in prostate MRI compared with noncontrast MRI is controversial.

Purpose

To evaluate the population net benefit of risk stratification using DCE‐MRI for detection of high‐grade prostate cancer (HGPCA), with or without high spatiotemporal resolution DCE imaging.

Study Type

Decision curve analysis.

Population

Previously published patient studies on MRI for HGPCA detection, one using DCE with golden‐angle radial sparse parallel (GRASP) images and the other using standard DCE‐MRI.

Field Strength/Sequence

GRASP or standard DCE‐MRI at 3 T.

Assessment

Each study reported the proportion of lesions with HGPCA in each Prostate Imaging Reporting and Data System version 2 (PI‐RADS v2) category (1–5), before and after reclassification of peripheral zone lesions from PI‐RADS 3–4 based on contrast‐enhanced images. This additional risk stratifying information was translated to population net benefit, when biopsy was hypothetically performed for: all lesions, no lesions, PI‐RADS ≥3 (using NC‐MRI), and PI‐RADS ≥4 on DCE.

Statistical Tests

Decision curve analysis was performed for both GRASP and standard DCE‐MRI data, translating the avoidance of unnecessary biopsies and detection of HGPCA to population net benefit. We standardized net benefit values for HGPCA prevalence and graphically summarized the comparative net benefit of biopsy strategies.

Results

For a clinically relevant range of risk thresholds for HGPCA (>11%), GRASP DCE‐MRI with biopsy of PI‐RADS ≥4 lesions provided the highest net benefit, while biopsy of PI‐RADS ≥3 lesions provided highest net benefit at low personal risk thresholds (2–11%). In the same range of risk thresholds using standard DCE‐MRI, the optimal strategy was biopsy for all lesions (0–15% risk threshold) or PI‐RADS ≥3 on NC‐MRI (16–33% risk threshold).

Data Conclusion

GRASP DCE‐MRI may potentially enable biopsy of PI‐RADS ≥4 lesions, providing relatively preserved detection of HGPCA and avoidance of unnecessary biopsies compared with biopsy of all PI‐RADS ≥3 lesions.

J. Magn. Reson. Imaging 2019.

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Diurnal variability of cerebral metabolites in healthy human brain with 2D localized correlation spectroscopy (2D L‐COSY)

Background

Two‐dimensional localized correlation spectroscopy (2D L‐COSY) is a research tool that has been applied to evaluate in vivo metabolic activity in many neurological and oncological disorders. Circadian mediators such as brain temperature, hydration, and osmotic regulation have been claimed to change metabolic profiles.

Purpose

To evaluate the diurnal variability of neuro‐metabolites with 2D L‐COSY in healthy subjects using a 3 T scanner.

Study Type

Crossover.

Population/Phantom

Ten healthy subjects and magnetic resonance spectroscopy‐high definition (MRS‐HD) sphere or "Braino." Field Strength/Sequence: 3 T/2D L‐COSY MRS.

Assessment

In vivo 2D L‐COSY measurements were performed on ten healthy subjects (5 M/5F, mean age 36.1 ± 7.7 years) repeatedly at three timepoints (0700, 1200, and 1700) on the same day. in vitro evaluations were performed in a similar fashion as in vivo on Braino containing selected brain metabolites at physiological concentrations and pH. 2D L‐COSY was acquired from a 27 cm³ voxel located in the posterior cingulate cortex. A total of 75 resonances were included in the analysis and spectral peak volumes were normalized to creatine.

Statistical Test

One‐way repeated measured analysis of variance with Bonferroni post‐hoc adjustment using SPSS software.

Results

In vitro data showed no statistically significant differences between different scans (P > 0.12). in vivo results showed statistically significant diurnal variations (P ≤ 0.05, F > 3.88) for 22 resonances. Bonferroni post‐hoc testing showed there was statistically significant increases in metabolite ratios between 0700 and 1700 and these include different moieties of N‐acetylaspartate, creatine, choline, myo‐inositol, lipids, fucose, glutathione, and homocarnosine.

Data Conclusion

2D L‐COSY can detect diurnal physiological variability in neuro‐metabolite levels. Thus, time of the day should be considered when planning MRS studies to avoid confounding results.

Level of Evidence: 1

Technical Efficacy Stage: 1

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TI0T0i

Population net benefit of prostate MRI with high spatiotemporal resolution contrast‐enhanced imaging: A decision curve analysis

Background

The value of dynamic contrast‐enhanced (DCE) sequences in prostate MRI compared with noncontrast MRI is controversial.

Purpose

To evaluate the population net benefit of risk stratification using DCE‐MRI for detection of high‐grade prostate cancer (HGPCA), with or without high spatiotemporal resolution DCE imaging.

Study Type

Decision curve analysis.

Population

Previously published patient studies on MRI for HGPCA detection, one using DCE with golden‐angle radial sparse parallel (GRASP) images and the other using standard DCE‐MRI.

Field Strength/Sequence

GRASP or standard DCE‐MRI at 3 T.

Assessment

Each study reported the proportion of lesions with HGPCA in each Prostate Imaging Reporting and Data System version 2 (PI‐RADS v2) category (1–5), before and after reclassification of peripheral zone lesions from PI‐RADS 3–4 based on contrast‐enhanced images. This additional risk stratifying information was translated to population net benefit, when biopsy was hypothetically performed for: all lesions, no lesions, PI‐RADS ≥3 (using NC‐MRI), and PI‐RADS ≥4 on DCE.

Statistical Tests

Decision curve analysis was performed for both GRASP and standard DCE‐MRI data, translating the avoidance of unnecessary biopsies and detection of HGPCA to population net benefit. We standardized net benefit values for HGPCA prevalence and graphically summarized the comparative net benefit of biopsy strategies.

Results

For a clinically relevant range of risk thresholds for HGPCA (>11%), GRASP DCE‐MRI with biopsy of PI‐RADS ≥4 lesions provided the highest net benefit, while biopsy of PI‐RADS ≥3 lesions provided highest net benefit at low personal risk thresholds (2–11%). In the same range of risk thresholds using standard DCE‐MRI, the optimal strategy was biopsy for all lesions (0–15% risk threshold) or PI‐RADS ≥3 on NC‐MRI (16–33% risk threshold).

Data Conclusion

GRASP DCE‐MRI may potentially enable biopsy of PI‐RADS ≥4 lesions, providing relatively preserved detection of HGPCA and avoidance of unnecessary biopsies compared with biopsy of all PI‐RADS ≥3 lesions.

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D34654

Diurnal variability of cerebral metabolites in healthy human brain with 2D localized correlation spectroscopy (2D L‐COSY)

Background

Two‐dimensional localized correlation spectroscopy (2D L‐COSY) is a research tool that has been applied to evaluate in vivo metabolic activity in many neurological and oncological disorders. Circadian mediators such as brain temperature, hydration, and osmotic regulation have been claimed to change metabolic profiles.

Purpose

To evaluate the diurnal variability of neuro‐metabolites with 2D L‐COSY in healthy subjects using a 3 T scanner.

Study Type

Crossover.

Population/Phantom

Ten healthy subjects and magnetic resonance spectroscopy‐high definition (MRS‐HD) sphere or "Braino." Field Strength/Sequence: 3 T/2D L‐COSY MRS.

Assessment

In vivo 2D L‐COSY measurements were performed on ten healthy subjects (5 M/5F, mean age 36.1 ± 7.7 years) repeatedly at three timepoints (0700, 1200, and 1700) on the same day. in vitro evaluations were performed in a similar fashion as in vivo on Braino containing selected brain metabolites at physiological concentrations and pH. 2D L‐COSY was acquired from a 27 cm³ voxel located in the posterior cingulate cortex. A total of 75 resonances were included in the analysis and spectral peak volumes were normalized to creatine.

Statistical Test

One‐way repeated measured analysis of variance with Bonferroni post‐hoc adjustment using SPSS software.

Results

In vitro data showed no statistically significant differences between different scans (P > 0.12). in vivo results showed statistically significant diurnal variations (P ≤ 0.05, F > 3.88) for 22 resonances. Bonferroni post‐hoc testing showed there was statistically significant increases in metabolite ratios between 0700 and 1700 and these include different moieties of N‐acetylaspartate, creatine, choline, myo‐inositol, lipids, fucose, glutathione, and homocarnosine.

Data Conclusion

2D L‐COSY can detect diurnal physiological variability in neuro‐metabolite levels. Thus, time of the day should be considered when planning MRS studies to avoid confounding results.

Level of Evidence: 1

Technical Efficacy Stage: 1

J. Magn. Reson. Imaging 2019.

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Three dimensional maxillary growth modeling in newborns

Abstract

Objectives

The aim of this study was to develop an accurate and intuitive semi-automatic segmentation technique to calculate an average maxillary arch and palatal growth profile for healthy newborns in their first year of life.

Materials and methods

Seventy babies born between 1985 and 1988 were included in this study. Each child had five impressions made in the first year after birth that were digitalized. A semi-automatic segmentation tool was developed and used to assess the maxillary dimensions. Finally, random effect models were built to describe the growth and build a simulation population of 10,000 newborns. The segmentation was tested for inter- and intra-observer variability.

Results

The Pearson correlation coefficient for each of the variables was between 0.94 and 1.00, indicating high inter-observer agreement. The paired sample t test showed that, except for the tuberosity distance, there were small, but significant differences in the landmark placements between observers. Intra-observer repeatability was high, with Pearson correlation coefficients ranging from 0.87 to 1.00 for all measurements, and the mean differences were not significant. A third or second degree growth curve could be successfully made for each parameter.

Conclusions

These findings indicated this method could be used for objective clinical evaluation of maxillary growth.

Clinical relevance

The resulting growth models can be used for growth studies in healthy newborns and for growth and treatment outcome studies in children with cleft lip and palate or other craniofacial anomalies.

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Correction to: Influence of foraminal enlargement on the healing of periapical lesions in rat molars

Figures 2 and 3 in the published version of this article contained a mistake. CCP and DCP should have been FEG and NFEG. Correct figures are presented here.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AGf5jv

Three dimensional maxillary growth modeling in newborns

Abstract

Objectives

The aim of this study was to develop an accurate and intuitive semi-automatic segmentation technique to calculate an average maxillary arch and palatal growth profile for healthy newborns in their first year of life.

Materials and methods

Seventy babies born between 1985 and 1988 were included in this study. Each child had five impressions made in the first year after birth that were digitalized. A semi-automatic segmentation tool was developed and used to assess the maxillary dimensions. Finally, random effect models were built to describe the growth and build a simulation population of 10,000 newborns. The segmentation was tested for inter- and intra-observer variability.

Results

The Pearson correlation coefficient for each of the variables was between 0.94 and 1.00, indicating high inter-observer agreement. The paired sample t test showed that, except for the tuberosity distance, there were small, but significant differences in the landmark placements between observers. Intra-observer repeatability was high, with Pearson correlation coefficients ranging from 0.87 to 1.00 for all measurements, and the mean differences were not significant. A third or second degree growth curve could be successfully made for each parameter.

Conclusions

These findings indicated this method could be used for objective clinical evaluation of maxillary growth.

Clinical relevance

The resulting growth models can be used for growth studies in healthy newborns and for growth and treatment outcome studies in children with cleft lip and palate or other craniofacial anomalies.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SIT0YE

Correction to: Influence of foraminal enlargement on the healing of periapical lesions in rat molars

Figures 2 and 3 in the published version of this article contained a mistake. CCP and DCP should have been FEG and NFEG. Correct figures are presented here.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AGf5jv

Clinical management and outcomes of lacrimal sac squamous cell carcinoma

Abstract

Background

To investigate the management and outcomes of patients with lacrimal sac squamous cell carcinoma (SCC).

Methods

This retrospective study examined 69 lacrimal sac SCC cases treated at our hospital between 1992 and 2017. The potential risk factors for prognosis, a new staging method, treatment outcomes, and complications were investigated.

Results

The 5‐year overall survival (OS) and progression‐free survival (PFS) were 87.6 ± 4.8% and 76.3 ± 6.4%, respectively. Positive lymph node was associated with worse OS and PFS. We divided lacrimal sac SCC into four clinical stages, with significant differences in OS (P = .026) and PFS (P = .042) among each stage. Definitive radiotherapy was equivalent to surgery plus radiotherapy in 26.1% (18/69) of cases, and the incidence of complications was not higher.

Conclusions

Lymph node status was a key factor in determining outcomes. Our staging method could effectively classify tumor stage and predict prognosis, which can contribute to optimizing treatment regimes. Radiotherapy played an important role in treatment.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FpuSX0

The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program

Abstract

Background

Swallowing dysfunction after radiotherapy (RT) for head and neck cancer can be devastating. A randomized control trial compared swallow exercises versus exercise plus neuromuscular electrical stimulation therapy and found no overall difference in outcomes.

Methods

Quality of life (QOL), diet, and swallowing variables collected at discrete intervals on 117 patients were reanalyzed to test the hypothesis that shorter time between the completion of radiotherapy and beginning of the swallowing therapy program yielded improved outcomes.

Results

At baseline, subjects < 1 year post radiation had significantly better function than subjects >2 years post RT in several measures. Over the therapy program, the early group showed significant improvement in diet and QOL. Swallowing physiologic variables showed no difference between groups.

Conclusion

Beginning a swallowing therapy program within 1 year of completion of radiotherapy demonstrates more consistent improvement in QOL and diet performance compared to later periods.

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

Patterns of recurrence and retreatment outcomes among clinical stage I and II head and neck melanoma patients

Abstract

Background

The objective of this study was to determine survival outcomes in patients who underwent retreatment of recurrent cases of cutaneous melanoma of the head and neck (CMHN).

Methods

Retrospective review of all patients who were treated for primary clinical stage I or II CMHN between January 1, 2000 and December 31, 2015.

Results

Twenty percent (33/168) of the patients developed a recurrence. Sixty‐six percent (4/6) of patients who developed local recurrence first and 50% (3/6) of patients who developed regional recurrence first were alive without evidence (NED) of disease at last follow‐up, while 0% (0/21) of patients who developed distant or simultaneous recurrences first were NED at last follow‐up. Among the 7 patients who were NED, the mean time from recurrence to last follow‐up was 735 days.

Conclusions

Of patients with isolated local or regional recurrences, 58% (7/12) obtained durable curative treatment for recurrent melanoma.

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Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

Abstract

Background

The effect of treatment modality on long‐term opioid dependence in patients with oropharyngeal cancer has not been reported.

Methods

A retrospective cohort of 122 patients with T1/T2 oropharyngeal cancer undergoing treatment was generated. Risk factors associated with chronic opioid use were investigated by univariate and multivariate analyses.

Results

The prevalence of chronic opioid use was 45.9%. On multivariate analysis, primary nonsurgical treatment (odds ratio [OR] 4.5, 95% confidence interval [CI]: 1.7‐11.4), pretreatment opioid use (OR 14.9, 95% CI: 3.5‐62.5), psychiatric disorder (OR 4.3, 95% CI: 1.03‐18.5), alcohol use (OR 2.6, 95% CI: 1.03‐6.5), and younger age (OR 1.1, 95% CI: 1.02‐1.11) were significantly associated with chronic opioid use.

Conclusion

Primary nonsurgical treatment, younger age, pretreatment opioid use, alcohol use, and psychiatric disorder were independently associated with an increased risk of chronic opioid use. Preventative strategies should be especially focused toward these patients to reduce their risk of long‐term opioid use.

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Exploring Disease Immunogenicity and the Immunological Effects of Hypomethylating Agents in Acute Myeloid Leukemia

Condition:   Acute Myeloid Leukemia Intervention:   Genetic: Immunogenic profile Sponsor:   Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori Not yet recruiting (Source: ClinicalTrials.gov)

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

Clinical management and outcomes of lacrimal sac squamous cell carcinoma

Abstract

Background

To investigate the management and outcomes of patients with lacrimal sac squamous cell carcinoma (SCC).

Methods

This retrospective study examined 69 lacrimal sac SCC cases treated at our hospital between 1992 and 2017. The potential risk factors for prognosis, a new staging method, treatment outcomes, and complications were investigated.

Results

The 5‐year overall survival (OS) and progression‐free survival (PFS) were 87.6 ± 4.8% and 76.3 ± 6.4%, respectively. Positive lymph node was associated with worse OS and PFS. We divided lacrimal sac SCC into four clinical stages, with significant differences in OS (P = .026) and PFS (P = .042) among each stage. Definitive radiotherapy was equivalent to surgery plus radiotherapy in 26.1% (18/69) of cases, and the incidence of complications was not higher.

Conclusions

Lymph node status was a key factor in determining outcomes. Our staging method could effectively classify tumor stage and predict prognosis, which can contribute to optimizing treatment regimes. Radiotherapy played an important role in treatment.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FpuSX0

The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program

Abstract

Background

Swallowing dysfunction after radiotherapy (RT) for head and neck cancer can be devastating. A randomized control trial compared swallow exercises versus exercise plus neuromuscular electrical stimulation therapy and found no overall difference in outcomes.

Methods

Quality of life (QOL), diet, and swallowing variables collected at discrete intervals on 117 patients were reanalyzed to test the hypothesis that shorter time between the completion of radiotherapy and beginning of the swallowing therapy program yielded improved outcomes.

Results

At baseline, subjects < 1 year post radiation had significantly better function than subjects >2 years post RT in several measures. Over the therapy program, the early group showed significant improvement in diet and QOL. Swallowing physiologic variables showed no difference between groups.

Conclusion

Beginning a swallowing therapy program within 1 year of completion of radiotherapy demonstrates more consistent improvement in QOL and diet performance compared to later periods.

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

Patterns of recurrence and retreatment outcomes among clinical stage I and II head and neck melanoma patients

Abstract

Background

The objective of this study was to determine survival outcomes in patients who underwent retreatment of recurrent cases of cutaneous melanoma of the head and neck (CMHN).

Methods

Retrospective review of all patients who were treated for primary clinical stage I or II CMHN between January 1, 2000 and December 31, 2015.

Results

Twenty percent (33/168) of the patients developed a recurrence. Sixty‐six percent (4/6) of patients who developed local recurrence first and 50% (3/6) of patients who developed regional recurrence first were alive without evidence (NED) of disease at last follow‐up, while 0% (0/21) of patients who developed distant or simultaneous recurrences first were NED at last follow‐up. Among the 7 patients who were NED, the mean time from recurrence to last follow‐up was 735 days.

Conclusions

Of patients with isolated local or regional recurrences, 58% (7/12) obtained durable curative treatment for recurrent melanoma.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FpBe8M

Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

Abstract

Background

The effect of treatment modality on long‐term opioid dependence in patients with oropharyngeal cancer has not been reported.

Methods

A retrospective cohort of 122 patients with T1/T2 oropharyngeal cancer undergoing treatment was generated. Risk factors associated with chronic opioid use were investigated by univariate and multivariate analyses.

Results

The prevalence of chronic opioid use was 45.9%. On multivariate analysis, primary nonsurgical treatment (odds ratio [OR] 4.5, 95% confidence interval [CI]: 1.7‐11.4), pretreatment opioid use (OR 14.9, 95% CI: 3.5‐62.5), psychiatric disorder (OR 4.3, 95% CI: 1.03‐18.5), alcohol use (OR 2.6, 95% CI: 1.03‐6.5), and younger age (OR 1.1, 95% CI: 1.02‐1.11) were significantly associated with chronic opioid use.

Conclusion

Primary nonsurgical treatment, younger age, pretreatment opioid use, alcohol use, and psychiatric disorder were independently associated with an increased risk of chronic opioid use. Preventative strategies should be especially focused toward these patients to reduce their risk of long‐term opioid use.

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

Exploring Disease Immunogenicity and the Immunological Effects of Hypomethylating Agents in Acute Myeloid Leukemia

Condition:   Acute Myeloid Leukemia Intervention:   Genetic: Immunogenic profile Sponsor:   Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori Not yet recruiting (Source: ClinicalTrials.gov)

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

ACAAI: School District'Risks Children's Lives' by Not Stocking Epinephrine

(MedPage Today) -- Weatherford, Texas, board votes to use OTC Benadryl instead (Source: MedPage Today Allergy)

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ACAAI: School District'Risks Children's Lives' by Not Stocking Epinephrine

(MedPage Today) -- Weatherford, Texas, board votes to use OTC Benadryl instead (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2M3ZY81

The Significant Correlation Between the Density of the Cochlea Otic Capsule and Spine in Hearing Loss Patients

This study aimed to analyzes the correlation between the density of the cochlea otic capsule and the ear bone towards the femur and spine density in patients with reduction in bone density. This was a cross-sectional observational type analytic retrospective study analyzing 30 samples of patients with a reduction in bone density that have HRCT Mastoid examination results during 2017 at RSSA Malang 's osteoporosis polyclinic. From 30 samples, most were female with an age range of 51–60 years old. The average femur, spine, ear bone and cochlea otic capsule of the osteoporosis group was lower than the osteopenia group. The spine density was significantly correlated with the otic capsule den sity. There was a positive significant correlation between the spine density towards the otic caps...

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