Accessory Auricles: Systematic Review of Definition, Associated Conditions, and Recommendations for Clinical Practice

Abstract Accessory auricles are rare congenital abnormalities embryologically derived from the first branchial arch. Presentation may be variable with locations grouped into anatomical zones based on the frequency of location found in the literature. This study reviewed the papers between 1981 and 2017. Findings included an association with syndromes including Goldenhar, VACTERL, Treacher–Collins, Townes–Brocks, and Wolf–Hirschhorn. Based on histological and embryological evidence, the term "accessory auricle" is best used as an umbrella term to define this difference. Finally, indications are provided for imaging and laboratory investigations to guide the physician treating patients with accessory auricles. Address correspondence and reprint requests to Mark S. Lloyd, MPhil, FRCS(Plast), Department of Plastic Surgery, Autologous Ear Reconstruction Service, Birmingham Children's and Women's Hospital NHS Trust, 4th Floor, Ladywood House, Steelhouse Lane, Birmingham B4 6NH, UK; E-mail: marklloyd1@nhs.net Received 11 July, 2017 Accepted 1 September, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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A Rare Complication After Septoplasty: Visual Loss Due to Right Retinal Artery Spasm

Abstract Septoplasty is a commonly used procedure for correcting septal cartilage deformities. Hemorrhage, abscesses, scaling, adhesions, and scar tissue are often seen after the operation of the septoplasty, but temporary or permanent visual loss due to local anesthetic use has been reported very rarely in the literature. The authors also aimed to present a female patient with retinal artery spasm in the right eye after septoplasty in this article. A 27-year-old female patient was admitted to the authors' clinic with long-standing nasal obstruction and postnasal drip. There was no feature in her history and also no sign other than nasal septal deviation on physical examination. The patient was informed about the operation and the operation was planned. Emergency eye consultation was requested after the patient said that the right eye of the patient had never seen in the postoperative wake-up hall. Examination by an ophthalmologist; mild exotropia and total loss of vision in the right eye (including loss of light reflex) was detected. The light reaction in the affected eye was negative and indirect reaction was positive. After enlargement of the pupil, fundus examination revealed that the right posterior pole region (inside of the macula and vessel arches) was pale and no central retinal artery pulsation was observed. The patient was diagnosed with central retinal artery occlusion and emergency intervention was performed. The right eye massage, paracentesis, and hyperbaric oxygen therapy returned to the patient's visual function. Address correspondence and reprint requests to Dr Celal Günay, MD, Department of Otolaryngology, Head and Neck Surgery, Medipol University Hospital, Istanbul, Turkey; E-mail: gunaycelal@gmail.com Received 28 July, 2017 Accepted 27 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Inferiorly Pedicled Nasolabial Flap for Reconstruction of Anterior Maxilla Defects Class I and II

Objectives: The aim of this study was to present the use of inferiorly pedicled nasolabial flap (IPNF) in the reconstruction of anterior maxilla defects class I and II. Methods: Seven patients, 4 females and 3 males, aging from 38 to 75 (mean = 55.9) years old, from 2014 to 2017 reconstructed anterior part of maxilla with or without oronasal communication were included in this study. Five patients diagnosed with squamous cell carcinoma, 1 patient presented with epithelial-myoepithelial carcinoma, and 1 patient had ameloblastoma. The IPNFs were harvested in 7 patients. Follow-up data were collected for a period ranging from 9 to 26 months. Speech, mastication, and aesthetic outcomes were evaluated with a questionnaire in interview. Results: All patients healed without infection, flap loss, and flap failure. Five patients without prothetic treatment had little pronunciation problem (score: 1 to 3 points), while 2 patients with removable partial denture had excellent speech clarity (score: 1 to 2 points). All patients had no problem with mastication (score: 1 to 2 points). Aesthetic outcomes were acceptable in all patients (score: 1 to 3 points). Conclusion: The IPNF is a good option for reconstruction of anterior maxilla defects class I and II. Address correspondence and reprint requests to Zhongcheng Gong, PhD, DDS, Chairman and Professor of Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, No. 137 South Liyushan Road, Wulumuqi, Xinjiang Uyghur Autonomous Region 830054, China; E-mail: gump0904@aliyun.com Received 12 May, 2017 Accepted 30 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Critical Appraisal in Plastic Surgery: Nullius in Verba

No abstract available

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Primary Closure of Oroantral Communication Using Pedicled Buccal Fat Pad Following Maxillary Cyst Enucleation

Abstract Odontogenic keratocyst (OKC) is a clinically aggressive developmental odontogenic cyst with a high recurrence rate as 62%. Oroantral communication (OAC) is a gateway through the maxillary sinus and the oral cavity, which, if not treated, will develop into oroantral fistula or chronical sinus diseases. Different methods for closure of OAC were described but only few of them have common usage. In recent years, the use of a pedicled buccal fat pad (BFP) in closure of large oroantral defects has been become popular. In our patient, the OAC resulted from the surgical removal of OKC was closed with BFP. Address correspondence and reprint requests to Yusuf Emes, DDS, PhD, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University 34093 Çapa, Istanbul, Turkey; E-mail: yusufemes@yahoo.com Received 27 July, 2017 Accepted 21 September, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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A Novel Method to Calculate the Volume of Alveolar Cleft Defect Before Surgery

Background: This study aimed to evaluate a novel subtractive method for the precise calculation of alveolar cleft defect volume before surgery using the three-dimensional imaging software Mimics. Methods: Ten patients (3 female, 7 male, age range 8–12 years) with unilateral alveolar cleft were enrolled in the study. Preoperative helical computed tomography scans were performed for all patients. A new subtractive method was introduced to precisely calculate the alveolar cleft defect volume before surgery with the aid of Mimics. The DICOM data of every patient were processed using the subtractive method. Statistical analyses were performed using Pearson's correlation test and t test. Results: The mean volume of the alveolar cleft defect was 1811.97 ± 817.90 mm3. The mean time spent to calculate an alveolar cleft defect volume was 60.60 ± 11.67 minutes. The Pearson correlation test (r = 0.38, P = 0.279) indicated a poor correlation between alveolar cleft defect volume and calculation time. Conclusions: Preoperative knowledge of defect volume is crucial in alveolar cleft repair. Accurate estimation of graft volume in alveolar cleft patients can be performed using this new subtractive method. Compared with previous methods, this new subtractive method is time-saving and suitable for both unilateral and bilateral clefts. Surgeons can use this method to design a surgical plan for each patient before surgery within a short time, and with less cost. Address correspondence and reprint requests to Hai D. Li, MD, Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-da-chu, Beijing 100144, China; E-mail: 15910775061@yeah.net Received 2 June, 2017 Accepted 30 August, 2017 This study was supported by the Capital Clinical Feature Applied Research Fund of China (Z161100000516155). The study was approved by the ethics committee of the Plastic Surgery Hospital affiliated to Peking Union Medical College. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://ift.tt/2iuFjMi). © 2017 by Mutaz B. Habal, MD.

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The Validity of Training Endoscopic Sinus and Skull Base Surgery Techniques on the Experimental Head Model

Objectives: The aim of this study was to better understand the usual learning curve in acquiring endonasal endoscopic sinus and skull base surgery (ESSBS) techniques during the novice training on the lamb's head model. Methods: Ten novices were asked to perform 10 bilateral dissections on the particular lamb's head each. The dissections were uniform, consisted of 10 well-defined steps, beginning from the simple removal of the inferior turbinate, and ending with more complicated procedures like cerebrospinal fluid leak repair, Draf 3 procedure for the frontal sinus and elevation of the nasal septal flap. The dissections have been supervised by experienced surgeons. A set of standard ESSBS instruments and 0° and 45° endoscopes have been used under the navigational system. The time required to complete each step has been measured in minutes. Results: In general and quite expectedly, time rates have been obviously lowering as the number of the dissections performed has been growing in each of the participants. Conclusion: Training of the endonasal ESSBS techniques on the lamb's head proved to be useful for novices in getting basic surgical skills in the field. Because of the high degree of anatomic similarity and high level of the anatomic dimensions congruency between the lamb's head and human head (sheep's head has bigger dimensions!) it proved to be an essential preparation for the human cadaveric dissection. The median values of the time rates having been needed to complete the particular of the 10 steps in the last novices' dissections could be accepted as an orientation, just suggesting that once the time needed to complete 1 of the 10 steps has been and achieved by the particular novice, this could be an approximate sign of the maturity for the exercises on human cadaver head. Address correspondence and reprint requests to Nuray Bayar Muluk, MD, Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 Blok, No 6-3/43, 06610 Çankaya, Ankara, Turkey; E-mail: nuray.bayar@yahoo.com; nurayb@hotmail.com. Received 23 August, 2017 Accepted 20 September, 2017 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://ift.tt/2iuFjMi). © 2017 by Mutaz B. Habal, MD.

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Anti-Neutrophil Cytoplasmic Antibody-Negative Central Nervous System Granulomatosis With Polyangiitis and Its Clinical Characteristics

Abstract Granulomatosis with polyangiitis (GPA) is a necrotizing granulomatous vasculitis occasionally affecting central nervous system (CNS), and GPA patients with initial CNS symptoms are even rarer, whose diagnosis is further confused by an absence of positive antineutrophil cytoplasmic antibody. The authors described the characteristics of antineutrophil cytoplasmic antibody -negative GPA with CNS onset in a patient and discussed on its management, which may contribute to future diagnosis and treatment of patients with similar conditions. Address correspondence and reprint requests to Dr Yongming Qiu, MD, PhD, Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai 200127, China; E-mail: qiuzhoub@126.com; Dr Longtian Chen, MD, Department of Rheumatology, Longyan First Hospital Affiliated to Fujian Medical University, Fujian Province, China; E-mail: LT_chen@163.com Received 20 July, 2017 Accepted 24 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Sequencing of bimaxillary surgery in the correction of vertical maxillary excess: retrospective study

The aim of this study was to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced with mandibular surgery first or maxillary surgery first. Thirty-two patients, divided into two groups, were included in this retrospective study. Group 1 comprised patients who received bimaxillary surgery following the classical sequence with repositioning of the maxilla first. Patients in group 2 received bimaxillary surgery, but the mandible was operated on first. (Source: International Journal of Oral and Maxillofacial Surgery)

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Comparative study of volumetric changes and trabecular microarchitecture in human maxillary sinus bone augmentation with bioactive glass and autogenous bone graft: a prospective and randomized assessment

The aim of this study was to compare the volumetric changes and the new bone microarchitecture in human maxillary sinuses augmented with bioactive glass (Biogran) alone, bioactive glass combined with autogenous bone graft (1:1), or autogenous bone graft alone. Twelve maxillary sinuses were grafted with bioactive glass (group 1), nine with bioactive glass mixed with autogenous bone graft 1:1 (group 2), and 12 with autogenous bone graft (group 3). Patients underwent cone beam computed tomography 15days after the procedure to determine the initial volume of the graft (T1) and again 6 months later (T2). (Source: International Journal of Oral and Maxillofacial Surgery)

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Signs of electrocochleography on endolymphatic sac decompression for patients with Ménière's Disease: our experience in 12 patients

Abstract

Endolymphatic hydrops (ELH) is a well-established histological marker of Ménière's Disease (MD). The diagnosis of MD still depends on clinical symptoms complemented with inner ear function tests. Thus far, definitive diagnosis remains difficult. It is necessary for clinicians to explore an objective examination to diagnose MD and to monitor patients' ELH.

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Superoxide dismutase from Helicobacter pylori suppresses the production of pro-inflammatory cytokines during in vivo infection

Abstract

Background

Helicobacter pylori has undergone considerable adaptation to allow chronic persistence within the gastric environment. While H. pylori-associated diseases are driven by an excessive inflammation, severe gastritis is detrimental to colonization by this pathogen. Hence, H. pylori has developed strategies to minimize the severity of gastritis it triggers in its host. Superoxide dismutase (SOD) is well known for its role in protecting against oxidative attack; less recognized is its ability to inhibit immunity, shown for SOD from mammalian sources and those of some bacterial species. This study examined whether H. pylori SOD (HpSOD) has the ability to inhibit the host immune response to these bacteria.

Materials and Methods

The ability of recombinant HpSOD to modify the response to LPS was measured using mouse macrophages. A monoclonal antibody against HpSOD was generated and injected into H. pylori-infected mice.

Results

Addition of HpSOD to cultures of mouse macrophages significantly inhibited the pro-inflammatory cytokine response to LPS stimulation. A monoclonal antibody was generated that was specific for SOD from H. pylori. When injected into mice infected with H. pylori for 3 months, this antibody was readily detected in both sera and gastric tissues 5 days later. While treatment with anti-HpSOD had no effect on H. pylori colonization at this time point, it significantly increased the levels of a range of pro-inflammatory cytokines in the gastric tissues. This did not occur with antibodies against other antioxidant enzymes.

Conclusions

SOD from H. pylori can inhibit the production of pro-inflammatory cytokine during in vivo infection.

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