A 15-year-old schoolboy, who was attacked and bitten in the face by a neighbour's dog, was today in the Circuit Civil Court awarded a 32,000 damages for personal injuries. http://ift.tt/2iTT5vy A 15-year-old schoolboy, who was attacked and bitten in the face by a neighbour's dog, was today in the Circuit Civil Court awarded a 32,000 damages for personal injuries.
This review of oral health status in people with intellectual disabilities included 39 studies. Higher level of dental plaque, worse gingival status, and fewer decayed and filled permanent teeth were seen than in patients without intellectual disabilities.
The post Children and adolescents with intellectual disabilities: oral health status appeared first on National Elf Service.
Allergy testing is commonly used when symptoms of allergic rhinitis are refractory to symptoms and there is potential for treatment with institution of avoidance measures or immunotherapy. Once the decision for testing has been made, the method of testing by either in vivo skin testing by prick/puncture or intradermal testing or in vitro testing of serum-specific IgE is dictated by factors in the clinical history and an informed decision by the patient. Because there is no perfect testing method, understanding the benefits and limitations of each method is important in selecting the best testing option for each patient.
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Sublingual immunotherapy (SLIT) is effective for the treatment of allergic rhinitis and allergic asthma in adults and children. In a limited number of studies, SLIT efficacy has been demonstrated for the treatment of food allergy. SLIT has a higher safety profile versus subcutaneous immunotherapy, although some systemic reactions have been reported. Appropriate patient selection, meticulous patient education, and routine follow-up are key for the safe and effective administration of SLIT. With organization and attention to detail, adding SLIT to one's practice can provide a highly valued patient service.
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Anaphylaxis is a severe systemic reaction that can be managed appropriately with expedient diagnosis and treatment. Intramuscular epinephrine continues to be the mainstay of treatment of anaphylaxis; however, it is still underused in the community and in the medical setting. Further education and counseling of patients and health care providers is required to prevent and manage anaphylaxis successfully. In-office management of anaphylaxis includes training of staff, preparedness with the necessary supplies and medication, and an effective action plan.
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Elsevier
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The diagnosis and treatment of allergic disease is an integral part of otolaryngology practice, where care for inflammatory disorders of the nose, sinuses, and upper airway is common. This issue of Otolaryngologic Clinics of North America is designed to bring the practicing otolaryngologist up to date by focusing on where developments have occurred.
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The management of allergic disorders is an integral part of the specialty of otolaryngology–head and neck surgery. Its importance in the comprehensive management of the ENT patient has become more and more apparent over time. In 1985, 58% of Otolaryngology residency programs offered no formal training in allergy. That situation had improved by 2006, when 62% of programs had active allergy programs, and the remainder were adding them.1,2
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SUJANA S. CHANDRASEKHAR, MD
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OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA
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Congenital Vascular Lesions of the Head and Neck
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The following four articles are the first part of a special series highlighting important aspects of Head and Neck Reconstruction. These peer-reviewed papers are grouped into four different categories: 1) Quality and Value; 2) Uncommon but versatile microvascular free flaps 3) Subsite reconstruction; and 4) Perioperative considerations.
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The field of head and neck oncology and tumor immunology has lost one of its giants. Paul B. Chretien, MD died peacefully at home in Rockville, Maryland on August 16th, 2017 at age 86 after a prolonged decline in health. He was a true pioneer of head and neck tumor immunology and in the early 1970's, adapted the emerging discoveries of the differing immune functions of T and B lymphocytes to the study of head and neck cancer patients. Working at the National Cancer Institute Surgery Branch as a Senior Investigator (1966-1972), and Chief of the Tumor Immunology Section (1972-1980), he was the first to characterize deficiencies in T lymphocyte numbers and function in patients with head and neck cancer.
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An estimated 13,430 newly diagnosed laryngeal cancer (LC) cases and 3620 deaths were in the U.S in 2016 [1], while the National Central Cancer Registry of China Report showed that about 26,400 new LC cases and 14,500 cancer deaths occurred in China in 2015, with increasing incidence and mortality in recent years [2]. In LC, tumor-infiltrating lymphocytes (TILs) are frequently found [3], and various laryngeal TILs and cytokines integrate with the immune system to either kill or promote tumors and thereby have roles in the elimination, equilibrium, and escape phases of cancer immunoediting and tumor progression [4,5].
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Head and neck squamous cell carcinoma (HNSCC) represents the sixth most common malignant tumor worldwide, with over 600.000 new cases diagnosed per year [1]. In last 15 years, human papilloma virus (HPV) infection has been recognized to account for a distinct epidemiologic trend occurring mainly in western countries, leading to a rising incidence of oropharyngeal cancer (OPC) particularly in male patients in their 5 th decade of life [2,3]. Next to the pathogenesis of HPV-driven OPC [4], the development of HNSCC is still largely the result of a chronic exposure to tobacco and alcohol – induced field cancerization [5] of the upper aerodigestive mucosal tract.
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Dysphagia is present in 5–57% of patients at the time of head and neck cancer [HNC] diagnosis [1,2], more than half of whom have experienced major weight loss, as a consequence not only of tumor-associated catabolism [3], but also due to tumor size and location itself, and functional limitations in chewing and swallowing [2,4–7].
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More than 500,000 cases are diagnosed as head and neck cancer (HNC) annually worldwide [1,2]. In Taiwan, HNC is one of the top five increasing cancers over the past decade and the fifth most common cancer [3]. More than half of the patients with HNC survive more than 5 years [4], but this is accompanied by treatment-related complications and subsequent profound disability [5]. HNC treatments, including surgical dissection, chemotherapy, and radiation therapy, contribute to complications involving shoulder dysfunction, pain in the upper extremities, and physical inactivity [6–9].
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Oral cancer is one of the most common cancers in the world and accounts for nearly 3% of all cancers [1–4]. Because of the high prevalence of betel quid chewing and smoking, the incidence of buccal squamous cell carcinoma (BSCC), together with other cancers of the oral cavity, has been increasing in China and other regions and countries of Asia [5]. Surgery is still the most important treatment modality [5–8]. Due to the anatomic complexity of the oral commissure and cheek, the result of tumour excision in this area is a great challenge to plastic surgeons.
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Mucosal melanoma is a rare malignant neoplasm, accounting for only 0.8–3.7% of all melanomas [1,2]. The most common site of mucosal melanoma is the upper aerodigestive tract, which accounts for 55% of all cases [1]. Several studies have reported that MMHN is more common in some parts of African countries and Japan than in Western countries [3,4]. The most common primary sites of MMHN are the sinonasal cavity and oral cavity. Although rare, MMHN is a very aggressive malignancy, with 5-year OS ranges from 20% to 40% [5–8].
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The oral tongue and the floor of the mouth are the most common sites of squamous cell carcinoma (SCC) within the oral cavity, accounting for more than 50% of cases [1,2]. The increasing incidence of oral tongue SCC in young patients (ages 20–44years) who have a lower incidence and duration of tobacco and alcohol exposure suggests that genetic, environmental or viral factors may contribute to the pathogenesis of oral tongue SCC [3–6]. The tongue has a significantly different histologic makeup with a rich lymphatic supply compared to the other areas of the oral cavity.
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The incidence of oropharyngeal squamous cell carcinomas (OPSCCs) is increasing in the Western world [1–3]. The increase is primarily driven by increasing numbers of human papillomavirus positive (HPV+) OPSCCs [1–3]. The subgroup of patients with HPV+ OPSCC has markedly better overall and progression-free survival than HPV-negative (HPV−) patients [4].
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A wide variety of imaging studies are employed for the staging or follow-up of head and neck cancer patients. It is not uncommon to encounter incidental findings outside of the head and neck region. Some of these "incidentalomas" (INs) represent distant metastatic disease, separate malignancies or non-malignant processes that can have significant clinical consequences if left untreated.
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Head and Neck Squamous Cell Carcinoma (HNSCC) is sixth most common malignancy worldwide, accounting for approximately 6% of all cases and is responsible for an estimated 1–2% of all cancer deaths [1]. HNSCC has been historically associated with tobacco and alcohol use; however, in the past decade, infection with high-risk human papillomaviruses (HPV) and especially type 16 has been implicated in the pathogenesis of a subset of HNSCCs, mainly those arising from the oropharynx. HPV-associated oropharyngeal cancer represents a distinct biological and clinical entity with a more favorable prognosis [2,3].
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There were an estimated 61,760 incident cases of head and neck cancer (oral cavity, pharynx, oral cavity, and larynx) in the United States in 2016, accounting for about 3.7% of all new cancer cases [1]. Among oral cavity and pharynx cancer, oral cavity cancer rates are decreasing mostly due to decreases in smoking and alcohol use [2,3]. However, cancers of the base of tongue, tonsil, and oropharynx (oropharyngeal cancer) are increasing because of increases in human papillomavirus (HPV) infection.
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Head-and-neck squamous cell carcinoma carcinoma (HNSCC) is a disease where the prognosis varies substantially between patients. Human papilloma virus (HPV) positive oropharyngeal carcinoma is, in relative terms, a favorable subtype with a 3-year overall survival (OS) of around 80% [1]. It has been suggested that treatment de-intensification would be possible in this group without compromising the treatment effect, and several such studies are ongoing [2]. This begs the question whether we can identify subset of HPV positive patients where de-intensification may be detrimental for long term survival due to a – for the group – unfavorable disease characteristics.
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Squamous cell carcinoma of the head and neck (SCCHN), affecting the lips, oral cavity, pharynx, and larynx, accounts for over 650,000 new cases and 350,000 cancer deaths worldwide each year. While early stage disease is usually amenable to either surgery or radiotherapy, both with curative intents, the majority of patients still present with advanced stages. In the latter category, prognosis remains dismal because recurrences and distant metastases occur frequently, and novel treatment options are urgently needed [1,2].
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Since the term odontogenic keratocyst (OKC) has been re-classified several times between cyst and tumor due to a debate over biological behaviors and oncogenic mutation of OKC [1,2]. Although a number of treatment methods have been developed in addition to simple enucleation, surgical approaches are often limited owing to the high recurrence of OKC as well as its locally destructive behavior [3]. While many targeted therapeutics for oncogenic mutation have become widely available recently, the molecular background of OKC and non-invasive therapeutic approaches based on oncogenic mutation have not been widely studied.
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The presence of extracapsular extension (ECE) in lymph node-positive head and neck squamous cell carcinoma (HNSCC) leads to poor locoregional control (LRC), distant control (DC) and overall survival (OS) [1–8]. Due to its poor prognosis, histologically identified ECE is an indication for more aggressive adjuvant treatment, with both an increased dose of post-operative radiotherapy (RT) and concurrent chemotherapy [9]. Evidence supporting this approach largely stems from two contemporaneous, separately designed and run, phase III randomized trials, EORTC 22931 and RTOG 95–01, and the meta-analysis of their pooled data [10–12].
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Head and neck cancer (HNC) is common and its frequency is increasing, with over 61,000 cases in the United States per year [1–3]. After definitive treatment, approximately 30–40% will progress [4–6]. Platinum-based systemic chemotherapy is the first treatment for patients with incurable recurrent or metastatic disease. Until recently, no agent has demonstrated efficacy following progression after standard platinum-based regimens, with most data suggesting a median survival of 5–6months regardless of regimen [7–9].
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Salivary duct carcinoma (SDC) was originally described by Kleinsasser and colleagues in 1968 as a salivary malignancy that histologically resembles ductal carcinoma of the breast [1]. It occurs more commonly in the parotid gland than in the submandibular or minor salivary glands [2–6]. SDC has a propensity to metastasize early to regional lymph nodes and distant sites, as well as a high rate of recurrence [3–5,7–12]. The mainstay of therapy includes surgery and radiation; use of systemic therapy has been explored in some case series and small clinical trials [9,13,14].
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Genioglossus muscle advancement (GMA) was reported in 1993 as an option for the surgical treatment of obstructive sleep apnoea syndrome (OSAS), in the context of phase I of the Stanford University (Powell–Riley) protocol. The rationale for this technique is the placement of tension on the base of the tongue, thus preventing the tongue from falling back into the posterior airway space. However, in retrognathic patients undergoing phase I of the Stanford University protocol, an additional genioplasty will provide a better aesthetic outcome.
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The purpose of this study was to produce reliable estimations of fluctuating facial asymmetry in a normal population. Fifty-four computed tomography (CT) facial models of average-looking and symmetrical Chinese subjects with a class I occlusion were used in this study. Eleven midline landmarks and 12 pairs of bilateral landmarks were digitized. The repeatability of the landmark digitization was first evaluated. A Procrustes analysis was then used to measure the fluctuating asymmetry of each CT model, after all of the models had been scaled to the average face size of the study sample.
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The aim of this study was to evaluate the changes in condylar volume and joint spaces occurring in patients undergoing bimaxillary orthognathic surgery for the treatment of class II deformities, by means of cone beam computed tomography (CBCT). Initial and follow-up (at least 6 months) CBCT examinations of 114 condyles (57 patients) were studied retrospectively. Linear measurements of the joint space and volumetric analysis of changes in condylar volume were performed using Dolphin 3D Imaging in association with ITK-SNAP 3.0.0 segmentation software.
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We aimed to identify the effect of lncRNAs in CD4+ T cells on Allergic rhinitis (AR).
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Risk-adjusted colorectal cancer screening using the FIT and routine screening data: development of a risk prediction model
Risk-adjusted colorectal cancer screening using the FIT and routine screening data: development of a risk prediction model, Published online: 02 November 2017; doi:10.1038/bjc.2017.375
Inhibitor of DNA binding 2 is a novel therapeutic target for stemness of head and neck squamous cell carcinoma
Inhibitor of DNA binding 2 is a novel therapeutic target for stemness of head and neck squamous cell carcinoma, Published online: 02 November 2017; doi:10.1038/bjc.2017.373
Cancer incidence in English children, adolescents and young people: past trends and projections to 2030
Cancer incidence in English children, adolescents and young people: past trends and projections to 2030, Published online: 02 November 2017; doi:10.1038/bjc.2017.341
Hyperbaric oxygen therapy (HBOT) has been used to enhance the microcirculation and thereby the oxygen tension in tissues. The present study aimed to investigate the effect of HBOT on radiation injury in the mandibular area of rats.
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An intraosseous lipoma is a rare histologic variant of lipoma, accounting for only 0.1% of all primary bone tumors. This may not be the actual incidence because most of these lesions are frequently asymptomatic, but imaging modalities such as CT or MRI seem to have increased the detection rate. Lipoma occasionally undergoes osseous metaplasia and becomes an osseous lipoma. Although there are numerous papers discussing intraosseous lipoma and some authors have tried to differentiate lipomas from osseous lipomas, there is still a great deal of confusion regarding radiological characteristic features and the use of terms.
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To characterize methodological conduct, reporting, and quality of five knowledge synthesis (KS) approaches.
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The high prevalence of painful temporomandibular disorders (TMD) in women, suggests that estrogen and its receptors play a fundamental etiologic role in the development of this joint pathology, involving complex action mechanisms.
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The main limitation of surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) is difficulty in defining resection margins. The aim of this study was to compare the efficacy of the surgeon's experience and auto-fluorescence guided bone surgery to delimit resection margins for necrotic bone.
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Our purpose was to investigate the clinical significance of the distance between the resection margin and the tumour cells of the primary sites for oral squamous cell carcinoma patients with particular respect to the local recurrence rate.
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People should be given advice on healthy eating or alcohol consumption during trips to the dentist, a new report suggests. Dentists are "perfectly placed" to deliver health promotion and prevention advice to their patients, according to new report from the Nuffield Trust and the Health Foundation.
New American Food Products, LLC of Methuen, MA is voluntarily recalling various packaged goods because they contain undeclared milk. People who have an allergy or severe sensitivity to milk run the risk of serious or life-threatening allergic reaction if they consume this product.
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The discovery of an exclusive local production of IgE antibodies dates back to the 1970s, but only recently the pathophysiology of such phenomenon was deeply investigated, leading to the concept of local aller...
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Glomangiomyoma is a rare histological variant of glomus tumour. Clinically, it mimicks as a haemangioma and is challenging to diagnose. Its occurrence in the neck of a child has not been previously described.
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Publication date: Available online 2 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Christian Morgenstern, Sabrina Cabric, Carsten Perka, Andrej Trampuz, Nora Renz
IntroductionAnalysis of joint aspirate is the standard preoperative investigation for diagnosis of periprosthetic joint infection (PJI). We compared the diagnostic performance of culture and multiplex polymerase chain reaction (PCR) of synovial fluid for diagnosis of PJI.Patients and methodsPatients in whom aspiration of the prosthetic hip or knee joint was performed before revision arthroplasty were prospectively included. The performance of synovial fluid culture and multiplex PCR was compared by McNemar's chi squared test.ResultsA total of 142 patients were included, 82 with knee and 60 with hip prosthesis. PJI was diagnosed in 77 patients (54%) and aseptic failure in 65 patients (46%). The sensitivity of synovial fluid culture and PCR was 52% and 60%, respectively, showing concordant results in 116 patients (82%). In patients with PJI, PCR missed 6 high-virulent pathogens (S. aureus, streptococci, E. faecalis, E. coli) which grew in synovial fluid culture, whereas synovial fluid culture missed 12 pathogens detected by multiplex PCR, predominantly low-virulent pathogens (Cutibacterium acnes and coagulase-negative staphylococci). In patients with aseptic failure addition, PCR detected 6 low-virulent organisms (predominantly C. acnes).ConclusionWhile the overall performance of synovial fluid PCR was comparable to culture, PCR was superior for detection of low-virulent bacteria such as Cutibacterium spp. and coagulase-negative staphylococci. In addition, synovial fluid culture required several days for growth, whereas multiplex PCR provided results within 5hours in an automated manner.
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B. Crook and H. Senior
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I. Potters et al.
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H. J. Ho et al.
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R. Lühken et al.
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E. A. Undurraga et al.
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But very rarely is a 5-year-old diagnosed with Diffuse Intrinsic Pontine Glioma, known as DIPG - a highly aggressive and difficult-to-treat brain cancer. Too much candy around your house? Tonight a dentist is willing to buy it from you to help a metro girl.
MicroRNAs (miRNAs) are single-stranded RNAs that have been implicated in cancer initiation and progression and act as tumour suppressors or oncogenes. In this study, miRNA profiling was conducted on the most frequent malignancy of salivary glands, mucoepidermoid carcinoma (MEC), with comparison to normal tissues.
The TaqMan Human miRNA Cards Array was used for the miRNA profiling of MEC and normal tissues. To validate the differentially expressed miRNAs in MEC, we used real-time PCR (qRT-PCR).
miR-302a was the most significantly increased miRNA in cancer tissues (p < 0.05). Here, we demonstrate that the up-regulation of miR-302a expression in SGT cell lines induced cancer cell invasion in vitro.
These promising results suggest the need for further studies to establish mir-302a as a marker of invasion and aggressiveness in MEC.
This article is protected by copyright. All rights reserved.
Physical inactivity is a leading preventable cause of chronic disease and premature death globally, yet over half of the adult Australian population is inactive. To address this, web-based physical activity in...
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Paraquat is associated with a high rate of fatalities in acute poisoning. This study aimed to examine the association between the national public health policy that banned the use of paraquat and the incidence...
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ConclusionsThis study provides normative data for phonatory aerodynamics in adult connected speech. Significant age and gender effects were observed. Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionsOlder‐aged adolescents, as well as those who are females and those with hearing loss may have a higher risk of tinnitus. Noise exposure in the general pediatric population and smoking in adolescents may represent especially important risk factors in pediatric tinnitus. Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionsPerilymph proteomes were compared across three species. The degree of crossover of proteins of both guinea pig and cat with human indicate that these animals suitable models for the human cochlea, albeit the cat perilymph is a closer match. Level of EvidenceNA Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionsIt was strongly suggested that TJs in the vocal fold epithelium exist at the junctional regions of the first layer of stratified squamous epithelium. TJ‐based paracellular diffusion barrier following vocal fold injury is recovered by 14 days postinjury, and this period corresponds with the time course of structural changes in the regenerating epithelium layer. Level of EvidenceNA Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionsPatients with T0N+M0 HPV‐induced CUP have similar survival outcomes to matched patients with T1‐2N+M0 HPV+ OPX. These patients can reasonably be included in clinical trials investigating the role of treatment deintensification and risk stratified similar to patients with early‐stage known primary OPX cancer. Level of Evidence4. Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionMRSA infection was documented in 30% of patients overall with chronic bacterial laryngitis. Based on the results of the study, a treatment algorithm for management of this unusual patient population is suggested. Level of Evidence4. Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionPatients with a stretched chorda tympani were slightly more symptomatic compared to patients with a sacrificed chorda tympani. Therefore, in cases for which the chorda tympani greatly hinders a proper view of the surgical field, sacrificing the nerve could be considered to maximize surgical performance and have a satisfactory postoperative result. Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionOropharyngeal squamous cell carcinoma incidence rates increased in a nonlinear fashion from 1973 to 2013, whereas mortality rates declined. This, along with variation in trends by demographic and tumor factors, suggest that human papilloma virus is the main driver of the recent rise in incidence. Level of Evidence2b. Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionIntraoperative imaging detects unsatisfactory placement of electrodes during CI surgery at a low, but not negligible, rate. The current literature is not conclusive regarding the utility of routine imaging, but it appears to be most useful with abnormal cochlear anatomy or when the surgeon questions placement. Level of EvidenceNA. Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionsWe demonstrated the ability of a penetrating MEA to selectively stimulate restricted fiber populations within the feline RLN and selectively elicit contractions of discrete LMs in both acute and injury‐model experiments, suggesting a potential role for intraneural MEA implantation in VFP management. Level of EvidenceNA Laryngoscope, 2017 (Source: The Laryngoscope)
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ConclusionOverall, patients had significant improvement following implantation with hypoglossal nerve stimulator. Prior airway surgery had no statistically significant effect on postoperative AHI or NOS. Level of Evidence4. Laryngoscope, 2017 (Source: The Laryngoscope)
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Our goal was to compare the survival advantage of tamoxifen (TAM) and aromatase inhibitor (AI) in female (FBC) and male breast cancer (MBC).
We performed a retrospective study of 2785 FBC and 257 MBC patients treated with hormonal therapy.
The median follow-up was 106 months (range 3–151 months) and 42 months (range 2–115 months) for FBC and MBC, respectively. The patients were divided into two groups according to the hormonal therapy used: TAM-treated and AI-treated. MBC was characterized by older age, advanced tumor stage, and higher rate of lymph node metastases, in comparison with FBC. Matching analysis was performed using six prognostic criteria: patient age, tumor stage, tumor grade, lymph node status, human epidermal growth factor receptor (HER2) status, and administration of chemotherapy. The female and male patients were matched 2:1. In this analysis, 316 women and 158 men treated with TAM, and 60 women and 30 men treated with AI, were included. The overall survival (OS) was estimated by the Kaplan–Meier method and was compared between FBC and MBC. TAM-treated FBC and MBC patients had similar 5-year OS, 85.1 and 89.2%, respectively (p = 0.972). Notably, FBC patients treated with AI had significantly greater 5-year OS (85.0%) in comparison with AI-treated MBC patients (5-year OS of 73.3%; p = 0.028).
The OS of TAM-treated patients with MBC was similar to the OS of TAM-treated FBC patients, whereas AI treatment is associated with poorer survival of MBC patients.
Abstract: The mentalis (MT) and the incisivus labii inferioris (ILI), which are accessory muscles of the orbicularis oris (OO) muscle, form an intertwined and three-dimensionally related complex. The purpose of this study is to clarify the relationship between the MT, ILI, and OO muscles via intraoral dissection. Twenty-two sides from 11 fresh adult Caucasian cadaveric heads were used, and the MT, ILI, and OO dissected under the surgical microscope. Next, measurements of the bony attachment were carried out on another 12 sides. The fibers of the MT were separated into 2 parts: a superior and an inferior part with the former coursing anteromedially and joining the inferior part of the OO. The latter coursed anteroinferiorly to the skin of the chin. The ILI traveled anterolaterally and joined the inferior part of the OO. Inferior labial branches of the mental nerves ran on the OO. There was a significant difference (P = 0.0001) between specimens that were edentulous or had severe periodontitis with regard to the distance from the alveolar ridge to the upper side of the quadrangle when compared with specimens with mild periodontitis. However, there was no significant difference (P > 0.05) between specimens that were edentulous or had severe periodontitis specimens with mild periodontitis with regard to the distance from the inferior border of the mandible to the lower side of the quadrangle. We believe that the observations of this study could help surgeons better understand the anatomy of the chin and minimize complications following surgical and other invasive procedures in this area.
Abstract: Inflammatory myofibroblastic tumor, also known as inflammatory pseudotumor and plasma cell granuloma, is a tumor that occurs most often in the lungs, abdomen, skin, soft tissue, genital system, and mediastinal. Before surgery, the diagnosis is difficult to establish because of its diverse manifestations. In the head and neck, manifestation is rare and may occur in the upper respiratory tract, soft tissues, orbits, and skull base. This article aims to report a rare manifestation of the disease in the face, highlighting the importance of a correct diagnosis to determine the most appropriate form of treatment, in male patient, leucoderma, 22 years old, with complain of a painless unilateral growth in the left cheek, beginning 2 months before and with progressive growth.
No abstract available
No abstract available
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Abstract: Early management of premalignant lesions like oral submucous fibrosis cannot be underestimated in context of prevention and control of oral malignancies. Soft tissue reconstruction of the oral cavity and face is a complex undertaking. Several flaps local and distant as well as microvascular are available, each with their pros and cons. Microvascular free flaps lay a considerable burden on resources, expertise, increased operating time, and logistics. Simple and technically reproducible alternatives are needed to tackle these issues, more so in developing countries like ours. Submental flap is based on a large branch of the facial artery and was initially described in 1993 by Martin et al as an excellent option in head and neck reconstruction. We describe innovative modification of the submental flap based on concept of bilateral presence of facial and submental vasculature and thus can be used for bilateral cheek reconstruction. We use pedicled bilateral submental flap (BSF) by dividing the oval skin paddle obliquely, maintaining needed length. The best use of the BSF is in reconstruction of cheek defect, after surgical release of grade IV oral submucous fibrosis, a debilitating affliction commonly affecting young productive adults and seen in Indian subcontinent. The technique was used successfully in 20cases with minor complications.
Background: Osseointegrated implants have been used for craniofacial prosthetic reconstruction since 1979. The authors sought to review long-term outcomes of osseointegrated orbital reconstruction at the Institute for Reconstructive Sciences in Medicine (iRSM). Methods: Twenty-six patients have undergone osseointegrated orbital prosthetic (OOP) reconstruction at iRSM since 1991. A retrospective chart review was performed and patient satisfaction assessed through a questionnaire used in previous osseointegration studies. Multivariate binary logistic regression analysis was performed to assess the relationship between smoking, age, sex, and previous radiation treatment with the occurrence of skin reactions and implant failures. A χ2 test was used to assess the relationship between implant position within the orbit and development of a skin reaction or implant failure. Results: Patients received an average of 5.8 implants during the course of treatment. Follow-up ranged from 6 months to 24 years (mean = 10.6 years). A statistically significant correlation was found between skin reaction and age (P = 0.022), with younger patients more likely to develop a reaction. No variables in our model were significant for predicting implant failure. Overall, there were 39 failures of 155 osseointegrated implants, for a success rate of 74.8%. There was no relationship between skin reaction and implant failure compared to implant position within the orbit. Survey responses were received from 11 of 19 patients (58% response rate). Ninety-one percent of patients were overall satisfied with their prosthesis. Conclusions: There are minimal contraindications for consideration of OOP reconstruction. Patients find their prosthesis comfortable, report increased self-confidence, and are happy to have undergone reconstruction.
Abstract: Problems concerning vascular blood flow are the most frequently encountered ones after flap applications. The flap tissue starts to develop ischemia in patients with a vascular blood flow insufficiency. And reperfusion starts in those patients in whom the ischemia is temporary, triggering an ischemia-reperfusion injury depending on the duration of the ischemia. The aim of this study was to evaluate the effect of propofol, which is an anesthetic agent known to have an antioxidant effect and a free radical scavenging feature on the ischemia-reperfusion injury created on an experimental epigastric island flap. Thirty Sprague–Dawley rats were used in the study. The rats were divided into 3 groups of 10 rats each. Inferior epigastric artery-based abdominal flaps were prepared in all the groups. In group 1 (sham), the flap was elevated but no ischemia was applied. In groups 2 (control) and 3 (propofol), the flap was exposed to ischemia for 2 hours after it was elevated. All the rats were sacrificed and biochemical and histopathological assessments were made on the tissue samples taken on the 14th day. As a result of a comparison between the groups, the flap viability rates and the superoxide dismutase, total antioxidant capacity, and catalase values were found to be significantly higher (P 
Purpose: Autologous fat grafting is a useful adjunctive procedure to orthognathic surgery and may also confer anti-inflammatory properties. The purpose of this study is to answer the clinical question: among patients undergoing orthognathic operations, what are the effects of fat grafting on facial edema (magnitude, duration, and rate of decrease)? Methods: A retrospective cohort study was performed. Three-dimensional photos (Canfield, Fairfield, NJ) from preoperative and a series of postprocedure time-points were analyzed. The data set was divided into a fat-grafted cohort and a non-fat-grafted cohort and later analyzed using paired and unpaired t tests and linear regressions to determine significant correlations. Results: One hundred sixteen pre- and postoperative three-dimensional photo data sets were included. The sample included 29 subjects. The facial volume was analyzed both overall and comparing each subgroup (orthognathic vs. orthognathic + fat grafting group). Postoperative facial volume increase averaged 23.7% for the entire cohort (FG and nFG). By week 12, the swelling decreased about 62% from baseline. In all patients, there was a statistically significant decrease in facial volume with time. In the fat-grafted group, despite adding volume, the facial volume was equal to the non-fat-grafted group at week 1, yet the rate of decrease was faster through week 12. Conclusion: The majority of postoperative facial edema decreases by 12 weeks following orthognathic surgery. In this cohort of patients, despite the addition of volume, concurrent fat grafting lessened postoperative edema, and led to a greater magnitude and speed of resolution.
Abstract: The aim of the authors was to report a clinical case about immediate implant placement after the removal of complex odontoma. A 35-year-old female patient presented to private service complaining about absence of lower right first premolar. The computed tomographic showed radiopaque attenuation, surrounded by a narrow radiolucency in the area of dental absence, suggesting a mineralized lesion. The surgical removal of lesion was performed by intraoral access with general anesthesia and the implant of 3.75 × 10 mm (Neodent) was placed with the aid of a surgical guide, following the drill sequence established by the manufacturer. No complications were observed after 1 year with the prosthetic rehabilitation.
Abstract: The purpose of this study was to investigate ways to improve rater reliability and satisfaction in nasolabial esthetic evaluations of patients with complete unilateral cleft lip and palate (UCLP), by modifying the Asher-McDade method with use of Q-sort methodology. Blinded ratings of cropped photographs of one hundred forty-nine 5- to 7-year-old consecutively treated patients with complete UCLP from 4 different centers were used in a rating of frontal and profile nasolabial esthetic outcomes by 6 judges involved in the Americleft Project's intercenter outcome comparisons. Four judges rated in previous studies using the original Asher-McDade approach. For the Q-sort modification, rather than projection of images, each judge had cards with frontal and profile photographs of each patient and rated them on a scale of 1 to 5 for vermillion border, nasolabial frontal, and profile, using the Q-sort method with placement of cards into categories 1 to 5. Inter- and intrarater reliabilities were calculated using the Weighted Kappa (95% confidence interval). For 4 raters, the reliabilities were compared with those in previous studies. There was no significant improvement in inter-rater reliabilities using the new method. Intrarater reliability consistently improved. All raters preferred the Q-sort method with rating cards rather than a PowerPoint of photos, which improved internal consistency in rating compared to previous studies using the original Asher-McDade method. All raters preferred this method because of the ability to continuously compare photos and adjust relative ratings between patients.
Abstract: The authors present a case with a 22-year-old man suffering from a 2 pseudoaneurysms at the temporal region following trauma. The second pseudoaneurysm was diagnosed through an astute use of digital subtraction angiography along with ultrasound to the right external carotid artery which was preferred due to the presence of a vascular pathology at the region of the trauma. During surgery, the distal and proximal ends of both aneurysms were ligated and resected. The concomitant pseudoaneurysms and the use of digital subtraction angiography should be kept in mind in such trauma patients to prevent additional surgical interventions.
Introduction: Cleft lip and palate is the most frequent congenital craniofacial deformity. In this article, the authors describe their experience with cleft lip and palate repair. Methods: Data regarding patients presenting with primary diagnosis of cleft lip and/or palate, between 2009 and 2015, were reviewed. Details including demographics, type of cleft, presence of known risk factors, surgical details, and follow-up visits were collected. Documented complications were reported. Caregivers' satisfaction was assessed with a survey. The survey used to assess satisfaction with cleft-related features was based on the cleft evaluation profile (CEP). In addition, 4 assessors used visual analog scale (VAS) to assess the aesthetic satisfaction. Results: Seven hundred fifty-two patients with primary diagnosis of cleft lip and/or palate underwent surgical correction at "S. Chiara" Hospital, 432 (57.45%) male and 320 (42.55%) female. The most common cleft types in our study were incomplete cleft palate (152 patients) and left unilateral complete cleft lip and palate (152 patients). Associated syndromes were found in 46 patients (6.12%). Cleft lip was repaired using a modified Tennison–Randall technique when the defect was unilateral, whereas a modified Mulliken technique was used for bilateral cleft lip. Cleft palate was repaired using the Bardach technique or Von Langenbeck technique at 5 to 6 months of age. Cleft lip and palate was repaired in several surgical steps. In total, complications were reported in 81 of 752 patients (14.16%). Average fathers' satisfaction score assessed using CEP was 4.5 (lip), 4.8 (nose), 4.7 (teeth), 4.8 (bite), 4.2 (breathing), 4.6 (profile). Average mothers' satisfaction score assessed using CEP was 4.3 (lip), 4.6 (nose), 4.4 (teeth), 4.5 (bite), 4.1 (breathing), 4.4 (profile). Average level of aesthetic satisfaction, assessed using VAS, was 8.7 (fathers), 8.1 (mothers), 7.9 (lay person), and 8.0 (senior cleft surgeon). Conclusion: The multidisciplinary management of children with oral cleft determinated good results, in terms of satisfaction and aesthetic appearance. From our experience, periosteoplasty and lip-adhesion are key surgical techniques.
No abstract available
Background: Negative orbit vector is defined as the most anterior globe portion protrudes past the malar eminence. The aim of the study was to evaluate the relationship between negative orbit vector and blow-out fracture location analyzing the distance between the anterior corneal surface and orbital bone with facial soft tissue in medial and orbital floor blow out fractures using orbital computed tomography (CT). Methods: Seventy-seven patients diagnosed with blow-out fractures involving the medial or orbital floor were included. Distances from the anterior cornea to lower lid fat, inferior orbital wall, inferior orbital rim, and anterior cheek mass were measured using orbital CT scans. The proportion of negative orbit vector and measured distanced were compared between medial wall fracture and orbital floor fracture. Medical records including age, sex, concomitant ophthalmic diagnosis, and nature of injury were retrospectively reviewed. Results: Forty-three eyes from 43 patients diagnosed with medial wall fracture and 34 eyes from 34 patients diagnosed with orbital floor fracture were included. There was no significant difference in the distance from the anterior cornea to lower lid fat (P = 0.574), inferior orbital wall (P = 0.494), or orbital rim (P = 0.685). The distance from anterior cornea to anterior cheek mass was significantly different in medial wall fracture (−0.19 ± 3.49 mm) compared with orbital floor fracture (−1.69 ± 3.70 mm), P = 0.05. Negative orbit vector was significantly higher in orbital floor fracture patients (24 among 34 patients, 70.6%) compared with those with medial wall fractures (19 among 43 patients, 44.2%) (P = 0.04). Conclusions: Patients presenting with a negative orbit vector relationship when the most anterior portion of globe protruded past the anterior cheek mass and malar eminence were more likely to develop orbital floor fracture than medial wall fracture.
Abstract: Bisphosphonates that constrain bone resorption have a direct effect on osteoclast function. In this experimental study, the effects of low-dose local alendronate injections on the distraction gap (DG) in rabbit mandible at 2 different rates were evaluated. The experimental study was conducted on 20 male, New Zealand white rabbits. The animals were divided into 3 experimental groups and 1 control group. Group 1 consisted of animals with distraction at the rate of 1 mm/day, receiving postoperative local low-dose alendronate local injections into the DG. Group 2 consisted of animals with distraction at the rate of 2 mm/day, receiving postoperative 0.75 μg/kg of alendronate local injections into the DG. Group 3 consisted of animals with distraction at the rate of 2 mm/day, receiving postoperative 0.2 mL local saline injections into the DG. Group 4 consisted of animals with distraction at the rate of 1 mm/day, receiving postoperative 0.2 mL local saline injections into the DG. All the injections were performed immediately postoperatively and for all groups at 1, 2, 3, and 4 weeks following surgery. The distraction zones were evaluated using dual-energy X-ray absorptiometry and histological analysis. Histologically, bone healing was found to be significantly accelerated in Groups 1 and 4 compared with Groups 2 and 3 (P 
Objective: To evaluate the impact of nasal septum deviation (NSD) and septoplasty on eustachian tube (ET) functions. Material and Methods: The study was designed as a prospective controlled study and conducted in a tertiary referral center. A study group of 25 patients who were scheduled for septoplasty for NSD; and a control group of 25 healthy individuals having no ear or nose symptoms were formed. Tympanometric analysis of ET function, subjective and objective analysis of nasal functions with acoustic rhinometry and rhinomanometry were performed. Patients in study group underwent nasal surgery and tests were repeated at postoperative 1st and 3rd months. Results: Eustachian tube functions of study group were significantly worse than the control group (P = 0.032). ET functions were found to be poorer as the nasal airway resistances increase which was found to be close to significance (P = 0.056). One and 3 months after corrective surgery, both nasal airway functions and ET functions improved significantly reaching to the level of control group. Conclusions: Nasal septum deviation was associated with higher rates of ET dysfunction, which could be improved by the nasal surgery. However, in some patients, nasal surgery itself caused ET dysfunction in the early postoperative period.
Abstract: The aim of this study is to evaluate the frequency of oral behaviors in patients with temporomandibular disorders (TMD) and a control group without TMD. In this baseline case–control study, 260 controls and 260 subjects with TMD completed the oral behaviors checklist defined as a "self-report scale for identifying and quantifying the frequency of jaw overuse behavior" and underwent clinical examinations using the DC/TMJ international examination form (version May 12, 2013). Relationships of oral parafunctions' frequencies between groups were examined. The statistical analysis was performed with IBM SPSS Statistics 23 software. Age and gender distribution in the study groups did not reveal statistical differences (P > 0.05). Multivariate logistic regression analysis was conducted to establish system of independent oral behaviors for prognosis TMD. The stepwise regression analysis demonstrated that very frequent expression of holding, tightening, or tense muscles is associated with 10.83 times (P 
Abstract: Le Fort II distraction with zygomatic repositioning introduced the ability to restore central midfacial height and convexity independent of changes in orbital morphology. This study analyzes midfacial and orbital morphology before and after Le Fort II distraction with zygomatic repositioning. All patients who underwent Le Fort II Distraction with zygomatic repositioning between 2013 and 2015 were included. Two- and 3-dimensional measurements were made using 3dMD Vultus software to assess canthal tilt, nasolabial angle, ratio of midfacial to lower facial height, and absolute change in nasal length. Presence of an open bite and Angle classification were assessed before and after surgery. Four patients underwent segmental midface advancement using Le Fort II distraction with zygomatic repositioning. Associated diagnoses included Apert syndrome, Goldenhar syndrome, and achondroplasia. Changes in facial dimensions included: 3.19° improvement in canthal tilt (range −4.7° to 8.4°), 9° change in nasolabial angle (range −1.0° to 19°), and 0.69 cm increase in absolute nasal length (range 0.2–0.94 cm). Mean ratio of midfacial to lower facial height was 0.79 preoperatively and 0.89 postoperatively. Preoperatively, all patients demonstrated Angle class III with 3 of 4 patients demonstrating anterior open bite. All achieved closure of open bite and demonstrated class I or II occlusion. No complications were observed. Le Fort II distraction with zygomatic repositioning resulted in normalization of midfacial soft tissue landmarks. This form of advancement demonstrates the ability to selectively improve midfacial height and canthal tilt while restoring normal occlusion.D. Ming et al.
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P. Crook et al.
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If your child can spare a pound or two, they can trade in their candy for a few bucks at two Fresno dental offices Wednesday through Friday. The dentists are among many nationwide who buy candy from children and donate it to nonprofit organizations that then send the sweets to first responders and U. S. soldiers overseas.
Biological components of perilymph affect the electrical performance of cochlear implants. Understanding the perilymph composition of common animal models will improve the understanding of this impact and improve the interpretation of results from animal studies and how it relates to humans.
Analysis and comparison of the proteomes of human, guinea pig, and cat perilymph.
Multiple perilymph samples from both guinea pigs and cats were analysed via liquid chromatography with tandem mass spectrometry. Proteins were identified using the Mascot database. Human data were obtained from a published dataset. Proteins identified were refined to form a proteome for each species.
Over 200 different proteins were found per species. There were 81, 39, and 64 proteins in the final human, guinea pig, and cat proteomes, respectively. Twenty-one proteins were common to all three species. Fifty-two percent of the cat proteome was found in the human proteome, and 31% of the guinea pig was common to human. The cat proteome had similar complexity to the human proteome in three protein classes, whereas the guinea pig had a similar complexity in two. The presence of albumin was significantly higher in human perilymph than in the other two species. Immunoglobulins were more abundant in the human than in the cat proteome.
Perilymph proteomes were compared across three species. The degree of crossover of proteins of both guinea pig and cat with human indicate that these animals suitable models for the human cochlea, albeit the cat perilymph is a closer match.
NA Laryngoscope, 2017
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The cover image, by Stefan P. Bienz et al., is based on the Original Research Volumetric changes and peri-implant health at implant sites with or without soft tissue grafting in the esthetic zone, a retrospective case–control study with a 5-year follow-up , DOI: 10.1111/clr.13013.
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Practical management of adverse events associated with cabozantinib treatment in patients with renal-cell carcinoma.
Onco Targets Ther. 2017;10:5053-5064
Authors: Gerendash BS, Creel PA
Abstract
Cabozantinib is an oral tyrosine-kinase inhibitor whose targets include VEGFR, MET, and AXL. Cabozantinib is approved for the treatment of patients with advanced clear-cell renal-cell carcinoma (RCC) who have received prior antiangiogenic therapy. In the pivotal Phase III trial of second-line RCC, cabozantinib was associated with a significant improvement in overall survival, progression-free survival, and antitumor response compared with everolimus. Adverse events (AEs) were common for patients receiving cabozantinib, but were effectively managed with supportive care and dose modifications, as discontinuations of cabozantinib due to an AE were infrequent. This article reviews the management of the more common AEs associated with cabozantinib based on findings from the pivotal study, clinical practice guidelines, and the authors' real-world clinical experience, with support from published literature. We focus on hypertension, palmar-plantar erythrodysesthesia, diarrhea, nausea, vomiting, decreased appetite, fatigue, and stomatitis. Effective management of these AEs involves a multimodal strategy that includes patient education, prophylactic and supportive care, and dose modifications. Effective AE management can allow patients to maintain antitumor activity with cabozantinib while mitigating the impact on quality of life.
PMID: 29089775 [PubMed]
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Patterns of childhood body mass index (BMI), overweight and obesity in South Asian and black participants in the English National child measurement programme: Effect of applying BMI adjustments standardizing for ethnic differences in BMI-body fatness associations
Patterns of childhood body mass index (BMI), overweight and obesity in South Asian and black participants in the English National child measurement programme: Effect of applying BMI adjustments standardizing for ethnic differences in BMI-body fatness associations, Published online: 02 November 2017; doi:10.1038/ijo.2017.272
 |  | Rutter's Child and Adolescent Psychiatry is the leading textbook in its field. Both interdisciplinary and international, it provides a coherent appraisal of the current state of the field to help researchers, trainees and practicing clinicians in their daily work. Integrating science and clinical practice, it is a comprehensive reference for all aspects of child and adolescent psychiatry. New to this full color edition are expanded coverage on classification Read More... |
 | | The leading reference on this topic of increasing medical relevance is unique in offering unparalleled coverage. The editors are among the most respected researchers in inflammation worldwide and here have put together a prestigious team of contributors. Starting with the molecular basis of inflammation, from cytokines via the innate immune system to the different kinds of inflammatory cells, they continue with the function of inflammation in infectious Read More... |
 | | Liver disease is an increasingly common cause of mortality, and its management is often complex and challenging. Endoscopy has in recent times undergone a period of rapid progress, with numerous novel and specialized endoscopic modalities that are of increasing value in the investigation and management of the patient with liver disease. As the technology in endoscopy expands, both as a diagnostic and interventional procedure, so does the role of the Read More... |
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A San Antonio man has been arrested, charged with practicing dentistry without a license. His arrest came after a woman accused him of doing an 8-hour surgery on her that ended with what is being considered "extreme damage" to her mouth.
Severe dermatophytosis is described in immunocompromised patients with defective cellular immunity. We report here a large series and a literature review of severe dermatophytosis in solid organ transplant (SOT) recipients.
The data main source was a national French retrospective study of severe dermatophytosis in SOT recipients between 2010 and 2016. Inclusion criteria were the presence of dermatophytes in skin culture and one severity criteria: dermal invasion by dermatophytes (invasive dermatophytosis) or involvement of at least two body sites or >10% of body surface area (extensive dermatophytosis)
Twelve patients were included (8 men, median age of 56 years [range: 33-71]). Ten were kidney transplant. The median time from transplantation to severe dermatophytosis diagnosis was 16 months [range: 2-94]. Clinical signs of superficial dermatophytosis were present in 8/12 patients before the emergence of severe dermatophytosis. Nine patients had invasive forms and three extensive ones and nodules of the lower extremities were found in eight. Trichophyton rubrum was isolated in 11 cases. First line treatment was terbinafine (7/12), posaconazole (3/12) or topical treatment alone (2/12). Immunosuppressive therapy was reduced in three patients because of associated infections. Complete response was obtained for 3/3 and 5/9 patients with extensive or invasive forms, respectively after a median treatment's duration of 2.5 [range: 1.5-5] months and 7.5 months [range: 4-12]. Unrelated deaths (n = 2) and graft function impairment (n = 3) occurred.
Severe dermatophytosis is a late complication in SOT recipients presenting with lower limb nodules, which might be prevented by prompt treatment of superficial dermatophytosis.
This article is protected by copyright. All rights reserved.
Publication date: Available online 5 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Daichi Murakami, Gen Sugita, Mehmet Gunduz, Tomohiro Suenaga, Takashi Takeuchi, Hiroyuki Suzuki, Muneki Hotomi
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Over many decades, researchers have been designing studies to investigate the relationship between genotypes and phenotypes to gain an understanding about the effect of genetics on disease. Recently, a high-throughput approach called phenome-wide associations studies (PheWAS) have been extensively used to identify associations between genetic variants and many diseases and traits simultaneously. In this review, we describe the value of PheWAS along with methodological issues and challenges in interpretation for current applications of PheWAS.
PheWAS have uncovered a paradigm to identify new associations for genetic loci across many diseases. The application of PheWAS has been effective with phenotype data from electronic health records, epidemiological studies, and clinical trials data.
The key strength of PheWAS is to identify the association of one or more genetic variants with multiple phenotypes, which can showcase interconnections among the phenotypes due to shared genetic associations. While the PheWAS approach appears promising, there are a number of challenges that need to be addressed to provide additional robustness to PheWAS findings.
