The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results

Abstract

Purpose of Review

This is a retrospective review of 90 patients with a posterior fossa meningioma (PFM) treated between 1996 and 2017 in our two tertiary skull base centers. Patients underwent surgical resection via different approaches. We aimed to show how different surgical approaches may help to reach gross total resection (GTR) and low morbidity, especially on facial nerve function.

Recent Findings

PFM is a real surgical challenge with high morbidity and mortality due to the surrounding structures, their common large size at diagnosis, and their potentially invasive behavior. Total resection is the only way to cure people affected. We successfully treated 90 cases of PFM and evaluated different surgical approaches.

Summary

GTR is the aim of the surgery as the extent of resection influences the rate of recurrence, which in turn influences the prognosis. Seventy percent (p < 0.001) of surgical patients achieved a GRT with low morbidity and no mortality.

http://bit.ly/2Bc6yFm

The effect of baclofen combined with a proton pump inhibitor in patients with refractory laryngopharyngeal reflux: a prospective, open‐label study in thirty‐two patients

Abstract

Thirty‐two patients with refractory LPR confirmed by 24‐h MII‐pH were given a 3‐month course of baclofen 10 mg three times a day combined with PPI 15 mg twice a day.

Changes in RSI and reflux‐related quality of life from baseline to after treatment were evaluated.

MII‐pH monitoring of refractory LPR patients showed that the number of non‐acid reflux was much higher than acid reflux in laryngopharyngeal reflux and full‐column reflux.

After 3 months of PPI + baclofen medication, most RSI items and quality of life score showed a significant improvement compared to the baseline score, and the percentage of responders at 3 months was 53.1%.

In our experience, when a PPI therapy is unresponsive to LPR patients, baclofen can be considered as a second treatment option.

This article is protected by copyright. All rights reserved.

http://bit.ly/2Sh6uOc

The Effect of Stimulus Polarity on the Relation Between Pitch Ranking and ECAP Spread of Excitation in Cochlear Implant Users

Abstract

Although modern cochlear implants (CIs) use cathodic-leading symmetrical biphasic pulses to stimulate the auditory nerve, a growing body of evidence suggests that anodic-leading pulses may be more effective. The positive polarity has been shown to produce larger electrically evoked compound action potential (ECAP) amplitudes, steeper slope of the amplitude growth function, and broader spread of excitation (SOE) patterns. Polarity has also been shown to influence pitch perception. It remains unclear how polarity affects the relation between physiological SOE and psychophysical pitch perception. Using a within-subject design, we examined the correlation between performance on a pitch-ranking task and spatial separation between SOE patterns for anodic and cathodic-leading symmetric biphasic pulses for 14 CI ears. Overall, there was no effect of polarity on either ECAP SOE patterns, pitch ranking performance, or the relation between the two. This result is likely due the use of symmetric biphasic pulses, which may have reduced the size of the effect previously observed for pseudomonophasic pulses. Further research is needed to determine if a pseudomonophasic stimulus might further improve the relation between physiology and pitch perception.

http://bit.ly/2TpFoBN

The Effect of Stimulus Polarity on the Relation Between Pitch Ranking and ECAP Spread of Excitation in Cochlear Implant Users

Abstract

Although modern cochlear implants (CIs) use cathodic-leading symmetrical biphasic pulses to stimulate the auditory nerve, a growing body of evidence suggests that anodic-leading pulses may be more effective. The positive polarity has been shown to produce larger electrically evoked compound action potential (ECAP) amplitudes, steeper slope of the amplitude growth function, and broader spread of excitation (SOE) patterns. Polarity has also been shown to influence pitch perception. It remains unclear how polarity affects the relation between physiological SOE and psychophysical pitch perception. Using a within-subject design, we examined the correlation between performance on a pitch-ranking task and spatial separation between SOE patterns for anodic and cathodic-leading symmetric biphasic pulses for 14 CI ears. Overall, there was no effect of polarity on either ECAP SOE patterns, pitch ranking performance, or the relation between the two. This result is likely due the use of symmetric biphasic pulses, which may have reduced the size of the effect previously observed for pseudomonophasic pulses. Further research is needed to determine if a pseudomonophasic stimulus might further improve the relation between physiology and pitch perception.

http://bit.ly/2TpFoBN

Survival and Long-Term Biochemical Cure in Medullary Thyroid Carcinoma in Denmark 1997–2014: A Nationwide Study

Thyroid, Ahead of Print.


http://bit.ly/2DLIeeV

A Career in Global Surgery

This Viewpoint suggests that academic surgical departments are well positioned to lead global surgery efforts given their focus on teaching, innovation, and service.

http://bit.ly/2Bdfs5r

Toward a Broader, More Global Perspective for US Otolaryngology Residents

This essay discusses the benefits of the medical education system offering US otolaryngology residents the opportunity to gain a broader, more global perspective on the practice of otolaryngology.

http://bit.ly/2ToqTy5

Papillary Thyroid Microcarcinoma

A patient who was referred to our clinic for a second opinion on management of a small localized papillary thyroid cancer (PTC) asked, "Why should I have surgery to remove my thyroid if it's such a good cancer?" At the time of diagnosis, her health care practitioner told her she had a good cancer and recommended thyroidectomy. This question directly relates to the work by Davies et al in this issue of JAMA Otolaryngology–Head & Neck Surgery. However, it is important to first clarify some misconceptions about the experiences of patients with thyroid cancer.

http://bit.ly/2BaO5Ja

Patient Experience of Thyroid Cancer Active Surveillance in Japan

This study evaluates the concerns about cancer, treatment decisions, and overall experience of Japanese patients under active surveillance for thyroid cancer.

http://bit.ly/2TokPpr

Phosphaturic Mesenchymal Tumor of the Cerebellopontine Angle

This case report describes an otherwise healthy woman in her 30s who presented with left-ear hearing loss, tinnitus, distorted hearing, and occasional otalgia of a few months' duration.

http://bit.ly/2BdQCSV

Utilization of Nasal Endoscopy in the Medicare Population, 2000-2016

This study analyzes Medicare beneficiary and provider data from 2000 through 2016 to investigate trends in the number of nasal endoscopies performed among the Medicare population, reimbursement, and regional differences.

http://bit.ly/2TsOf5W

Variation in Care Delivery and Diagnostic Modality Among the Medicare Population

In this issue of JAMA Otolaryngology–Head & Neck Surgery, Hur et al suggest that during the past decade, the use of diagnostic nasal endoscopy in the Medicare population has increased substantially and this increase has not been paralleled by a similar increase in surgical ethmoidectomy. The overall increase in the number of endoscopies was also accompanied by marked variability in endoscopy utilization across different states, with some states showing a large increase and others showing smaller increases.

http://bit.ly/2BdJrdz

A Large Tonsillar Mass in a Healthy Teenager

A previously healthy 18-year-old woman presented with a growth in the right oropharynx of 4 months' duration as well as voice changes, recent weight loss, and decreased appetite. What is your diagnosis?

http://bit.ly/2Tnan1q

Doctoring and Hearing Loss

In treating hearing loss, I've found there's a particular tendency–especially in men losing their hearing in late middle age–for patients...

http://bit.ly/2RsViK3

Tonsillectomy: Tonsilliths, Pandas, and other great band names

I can't tell you how many times people at parties find out that I'm an ENT and have me look...

http://bit.ly/2Wut05q

Eustachian Tubes: Pop It Like It’s Hawt

This topic is a bit related to the ear tubes topic, and I think it's worth covering because I get...

http://bit.ly/2G0VQ8I

Correlation between plan quality improvements and reduced acute dysphagia and xerostomia in the definitive treatment of oropharyngeal squamous cell carcinoma

Abstract

Background

To evaluate plan quality using volumetric‐modulated arc therapy (VMAT) and step‐and‐shoot intensity‐modulated radiation therapy (SS‐IMRT) techniques and for patients treated for oropharyngeal squamous cell carcinoma (OPSCC).

Methods

Treatment plans for patients treated definitively for stages I‐IVb, OPSCC between December 2009 and August 2015 were retrospectively reviewed. Dosimetric endpoints of involved organs‐at‐risk (OARs) were retrieved from clinical plans. Common Terminology Criteria for Adverse Events scores of acute toxicities were compared.

Results

Two‐hundred twenty‐two patients were identified with 134 and 88 receiving SS‐IMRT and VMAT with median follow‐up time of 23.0 and 7.9 months, respectively. The dosimetric endpoints of the OARs were significantly improved in VMAT cohort, which translated into significantly lower rates of grade 2 or higher acute dysphagia and xerostomia.

Conclusion

Improvements in stages I‐IVb, oropharyngeal cancer plan quality are associated with reduced grade ≥ 2 acute dysphagia and xerostomia.

http://bit.ly/2Wy7ZXq

Issue Information

http://bit.ly/2RsQAfg

Cover Image

The cover image, by Yifan Meng MD et al., is based on the Original Article Origin site‐based staging system of sinonasal inverted papilloma for application to endoscopic sinus surgery, DOI: 10.1002/hed.25435.

http://bit.ly/2Wy7Rao

Prof. Heinz Stammberger, MD (Hon. FRCS (Ed.), Hon. FRCS (Engl.), Hon. FACS) December 1st 1946–December 9th 2018

http://bit.ly/2DJ2pdq

Unique considerations in pediatric skull base surgery

Publication date: Available online 30 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Irit Duek, Dan M. Fliss

Pediatric skull base and craniofacial surgery presents a unique challenge since the potential benefits of therapy must be balanced against the cumulative impact of multimodality treatment on craniofacial growth, donor-site morbidity, and the potential for serious psychosocial issues. Skull base reconstruction using locoregional flaps or free flaps may be safely performed in pediatrics. Although the general principles of skull base reconstruction are applicable to nearly all patients, the unique demands of skull base surgery in pediatrics merit special attention. Multidisciplinary care in experienced centers is of utmost importance.

http://bit.ly/2sVIqlP

Engineering of scaffold‐free tri‐layered auricular tissues for external ear reconstruction

Objectives

Current strategies for external ear reconstruction can lead to donor site morbidity and/or surgical complications. Tissue‐engineered auricular tissues may provide readily available reconstructive materials that resemble native auricular tissue, which is composed of a cartilaginous region sandwiched between two perichondrial layers. We previously developed scaffold‐free bi‐layered auricular tissues, consisting of a perichondrial layer and a cartilaginous layer, by cultivating chondrocytes and perichondrial cells in a continuous flow bioreactor. Here, we aimed to improve construct properties and develop strategies to engineer tri‐layered auricular constructs that better mimic native auricular tissue.

Study Design

Experimental study.

Methods

Different concentrations of insulin‐like growth factor (IGF)‐1 and insulin were supplemented during bioreactor culture to determine conditions for engineering bi‐layered constructs. We also investigated two methods of engineering tri‐layered constructs. Method 1 used Ficoll separation to isolate perichondrial cells, followed by the seeding of isolated perichondrial cells onto the opposing side of the bi‐layered constructs. Method 2 involved the growth of the bi‐layered constructs in osteogenic culture medium.

Results

The combination of 10 nM IGF‐1 and 100 nM insulin led to increased collagen content in the engineered bi‐layered constructs. For developing tri‐layered constructs, method 2 yielded thicker constructs with better mechanical and biochemical properties compared to method 1. In addition, the presence of the perichondrial layers protected the engineered constructs from tissue calcification.

Conclusion

Auricular tissues with a biomimetic microstructure can be created by growing chondrocytes and perichondrial cells in a continuous flow bioreactor, followed by cultivation in osteogenic medium.

Level of Evidence

NA. Laryngoscope, 2019

http://bit.ly/2MIgKK1

Impact of treating facilities’ type and volume in patients with major salivary gland cancer

Objectives/Hypothesis

Investigate the relationship between facility volume and type on overall survival (OS) in patients with major salivary gland cancer undergoing surgical treatment.

Study Design

Retrospective review of the National Cancer Database (NCDB) 2004–2015.

Methods

The NCDB was queried for patients with surgically treated major salivary gland cancer. The mean number of cases treated at each institution was calculated. High‐volume facilities (HVFs) were defined as the top 10% of centers. Univariate and multivariate propensity score‐matched analyses were performed to evaluate the impact of facility volume and type on OS.

Results

A total of 8,658 patients were analyzed. Distribution among facilities was highly skewed, with a median value of 1.38 cases/year (range, 0.11–23.25). On univariate analysis, treatment at HVFs was not associated with improved OS. However, there were significantly more patients with adverse clinical features treated at HVFs. Treatment at HVFs was associated with increased rates of concomitant neck dissections and lower rates of positive margins. In propensity‐score matched cohorts, OS was not significantly improved in patients treated at HVFs (hazard ratio [HR]: 0.979; 95% confidence interval [CI]: 0.879‐1.091) or academic/research institutions (HR: 0.914; 95% CI: 0.821‐1.018).

Conclusions

Regionalization of care is occurring in patients with major salivary gland malignancies. Patients treated at HVFs had greater rates of adverse clinical features and more commonly underwent neck dissections, although adjuvant radiotherapy rates were similar between facility types. There was no apparent survival benefit to patients treated at HVFs or academic/research institutions, although there were lower rates of positive margins at HVF.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2sXc2PF

The benefit of trans‐attic endoscopic control of ossicular prosthesis after cholesteatoma surgery

Objective

To show the efficiency of using transmastoid atticotomy (TMA) endoscopy on the outcome of ossiculoplasty in patients with cholesteatoma.

TMA is often performed as part of the surgical management of patients with middle ear cholesteatoma extending to the epitympanum. TMA can also be used as an access for endoscopic view to confirm the right alignment and stability of the ossicular prosthesis because the reconstruction of the tympanic membrane will obscure the visualization of the prosthesis.

Methods

A retrospective study was done at a tertiary referral institute, including 133 ears with cholesteatoma that underwent canal wall‐up tympanomastoidectomy (CWU) with ossicular reconstruction using titanium prosthesis between August 2013 and August 2015. Post packing of the ear canal and position, stability, and axis of the prosthesis were checked using endoscope positioned in the attic through TMA. A postoperative pure‐tone average air–bone gap (ABG) of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups.

Results

Of the 133 ears, 88 patients underwent reconstruction with partial ossicular replacement prosthesis (PORP), whereas the rest (45 patients) had total ossicular replacement prosthesis (TORP). A postoperative ABG ≤ 20 dB was obtained in 77.4% of all the patients (79.5% for PORP; 73.3% for TORP).

Conclusion

Endoscopic assessment of the ossicular prosthesis via the attic, after repositioning of the tympanomeatal flap and packing the ear canal, decreases the risk of immediate ossiculoplasty failure and improves the functional outcome after ossicular chain reconstruction in cholesteatoma surgery.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2MHKpDh

Feasibility and tolerability of measuring translaryngeal pressure during exercise

Objectives/Hypothesis

To determine if simultaneous tracheal and supraglottic pressure measurement performed during a continuous laryngoscopy exercise (CLE) test is possible, tolerable, and feasible, and if so, whether measurements can be used to determined airflow resistance over the larynx, thus providing an objective outcome measure for the CLE test, the gold standard for diagnosing exercise‐induced laryngeal obstruction.

Study Design

Explorative descriptive clinical study.

Methods

A CLE test was performed with the addition of two pressure sensors (Mikro‐Cath 825‐0101; Millar, Houston, TX) placed at the epiglottic tip and at the fifth tracheal ring. To place sensors, laryngeal anesthesia and a channel scope were required. Tolerability and feasibility was determined by a Likert score and subjective indication from subjects and operators. Adjustments to the technique were made to increase tolerability. The pressure data were continuously collected and analyzed for artifacts, drifts, frequency response, and used with flow data to calculate translaryngeal resistance.

Results

All subjects (n = 7) completed all procedures. Two main areas of concern were identified regarding tolerability: application of topical anesthesia to the larynx and nasal discomfort due to the added diameter of the laryngoscope. Protocol adjustments improved both. Pressure data were obtained from all procedures in all subjects, were consistent, and followed physiological trends.

Conclusions

Continuous measurement of the translaryngeal pressure gradient during a CLE test is possible, feasible, and tolerable. A CLE test with direct measurement of the translaryngeal pressure gradient might become a valuable tool in the objective assessment of respiratory function, and normal values should be established in health and disease.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2sWEy3P

Neuroprotective factors and incident hearing impairment in the epidemiology of hearing loss study

Objective

Hearing impairment (HI) is common in aging adults. Aldosterone, insulin‐like growth factor (IGF1), and brain‐derived neurotrophic factor (BDNF) have been identified as potentially protective of hearing. The present study aims to investigate these relationships.

Methods

The Epidemiology of Hearing Loss Study is a longitudinal population‐based study of aging in Beaver Dam, Wisconsin, that began in 1993. Baseline for the present investigation is the 1998 to 2000 phase. Follow‐up exams occurred approximately every 5 years, with the most recent occurring from 2013 to 2016. Hearing was measured by pure‐tone audiometry. HI was defined as a pure tone average (PTA) > 25 decibels hearing level in either ear. Change in PTA was the difference between follow‐up examinations and baseline. Baseline serum samples were used to measure biomarkers in 2017. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to assess the effect of biomarker levels in the lowest quintile (Q1) versus the highest (Q5) on incident HI and PTA change.

Results

There were 1,088 participants (69.3% women) at risk of HI included in analyses. The mean baseline age was 63.8 years (standard deviation = 7.0). The 16‐year incidence of HI was 54.9% and was higher in men (61.1%) than women (52.1%). In age‐ and sex‐adjusted models, aldosterone (HR = 1.06, 95% CI = 0.82–1.37), IGF1 (HR = 0.92, 95% CI = 0.71–1.19), and BDNF (HR = 0.86, 95% CI = 0.66–1.12) levels were not associated with risk of HI. PTA change was similarly not affected by biomarker levels.

Conclusion

Aldosterone, IGF1, and BDNF were not associated with decreased risk of age‐related hearing loss in this study.

Level of Evidence

2b. Laryngoscope, 2019

http://bit.ly/2MFQFeA

Clinical applications of three‐dimensional printing in otolaryngology–head and neck surgery: A systematic review

Objectives

Medical three‐dimensional (3D) printing, the fabrication of handheld models from medical images, has the potential to become an integral part of otolaryngology–head and neck surgery (Oto‐HNS) with broad impact across its subspecialties. We review the basic principles of this technology and provide a comprehensive summary of reported clinical applications in the field.

Methods

Standard bibliographic databases (MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and The Cochrane Central Registry for Randomized Trials) were searched from their inception to May 2018 for the terms: "3D printing," "three‐dimensional printing," "rapid prototyping," "additive manufacturing," "computer‐aided design," "bioprinting," and "biofabrication" in various combinations with the terms: "ptolaryngology," "head and neck surgery," and "otology." Additional articles were identified from the references of retrieved articles. Only studies describing clinical applications of 3D printing were included.

Results

Of 5,532 records identified through database searching, 87 articles were included for qualitative synthesis. Widespread implementation of 3D printing in Oto‐HNS is still at its infancy. Nonetheless, it is increasingly being utilized across all subspecialties from preoperative planning to design and fabrication of patient‐specific implants and surgical guides. An emerging application considered highly valuable is its use as a teaching tool for medical education and surgical training.

Conclusions

As technology and training standards evolve and as healthcare moves toward personalized medicine, 3D printing is emerging as a key technology in patient care in Oto‐HNS. Treating physicians and surgeons who wish to stay abreast of these developments will benefit from a fundamental understanding of the principles and applications of this technology. Laryngoscope, 2019

http://bit.ly/2sZQdyZ

Oxidative stress in prelingual sensorineural hearing loss and the effects of cochlear implant application on serum oxidative stress levels

Publication date: Available online 31 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Mustafa Celik, İsmail Koyuncu

Abstract

Objectives

The aim of this study is to investigate oxidative stress conditions in patients with prelingual profound sensorineural hearing loss (SNHL) and the effects of cochlear implant application on oxidative stress. In addition, we also aimed to evaluate the correlation between pre- and post-surgery oxidative stress markers and Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), Meaningful Use of Speech Scale (MUSS) and Free-Field Audiometry (FFA).

Methods

This is a prospective controlled study of the Ear-Nose-Throat Department of the Harran University Faculty of Medicine between April 2017 and January 2018. The study included 25 patients with prelingual profound SNHL diagnosis and cochlear implant surgery and 25 healthy control groups. Total thiol, native thiol, disulphide levels and LOOH levels were studied in serum samples taken from the patient group 2 weeks before and 6 months after the cochlear implant surgery and the healthy control group. In addition, IT-MAIS, MUSS and FFA tests, which were used to evaluate the personal development of patients with cochlear implants, were performed at preoperative and postoperative 6th month.

Results

In our study, we found that the levels of native thiol (p<0.01) and total thiol (p <0.01) were significantly lower and LOOH (p<0.04) values were significantly higher in preoperative SNHL patients than control group. We found that native thiol, total thiol values increased and LOOH values decreased in the postoperative with respect to preoperative values. However, the difference between preoperative and post operative values was not statistically significant. The correlation between pre- and post-surgery biochemical data and IT-MAIS, MUSS and FFA tests were found not to be significant.

Conclusions

Our study suggests that patients with prelingual profound SNHL are under oxidative stress and post-CI surgery data show that there is no significant relief in patients. This study can shed light on the biologic mechanisms between prelingual profound SNHL and oxidative stress.

http://bit.ly/2SlLYMe

Stridor as initial presentation of Rolandic Epilepsy

Publication date: Available online 30 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): José Ferreira Penêda, Sandra Alves, Francisco Monteiro, Inês Sousa Ribeiro, Nuno Barros Lima, Artur Condé

Abstract

The authors present the case of a 5-year-old girl referred to our institution due to several episodes of nocturnal stridor with ocular retroversion and parental notion of apnea. She has been previously submitted to adenotonsillectomy. Due to symptoms worsening she was referred to our hospital. Here, a nasal fiberoptic endoscopy evaluation was conducted and a diagnosis of laryngomalacia was done. The was submitted to CO2 laser ariepiglotoplasty with symptom improvement after surgery. During a follow-up appointment, parents reported self-limited clonic facial movements at sleep onset. The electroencephalogram (EEG) was compatible with benign childhood epileptiform discharges.

http://bit.ly/2HGnB7X

Pediatric Acute Unilateral Suppurative Lymphadenitis: The Role of Antibiotic Susceptibilities at a Large Tertiary Pediatric Care Center

Publication date: Available online 30 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Nathan R. Lindquist, Ankita Patro, Sarah A. Gitomer, Karina T. Cañadas

http://bit.ly/2SiQtav

Thanks to reviewers

Publication date: February 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 1

Author(s):

http://bit.ly/2sVIkdE

Contents

Publication date: February 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 1

Author(s):

http://bit.ly/2MFMu2F

Serum-based metabolomics characterization of patients with reticular oral lichen planus

Publication date: Available online 30 January 2019

Source: Archives of Oral Biology

Author(s): Xu-zhao Li, Shuai-nan Zhang, Xu-yan Yang

Abstract

Objective

Oral lichen planus (OLP) is a chronic inflammatory mucosal lesion and systemic disease. In OLP, reticular type is the most common presentation of the disease. However, little is known about it. The aim of this study was to analyze the pathogenesis of reticular OLP and its possible associations with the pathological changes in other organ systems through serum-based metabolomics.

Methods

Blood samples were obtained from 16 reticular OLP patients and 24 control subjects. Liquid chromatography (LC)-mass spectrometry (MS) system was used to identify differentially expressed metabolites. The pathways analysis was performed by MetaboAnalyst. Pathological network was constructed by Cytoscape software.

Results

Totally, 31 modulated metabolites were identified, whose dysregulations affected 25 metabolic pathways and 7 pathological processes in the disease. Through an impact-value screen (impact-value＞0.1), 6 pathways were selected as the significantly dysregulated pathways. Pathological network showed that these metabolites participated in 7 pathological processes, that is, apoptosis process, DNA damage and repair disorder, oxidative stress injury, carbohydrate metabolism disorder, mood dysfunction, inflammatory lesion, and other pathological process.

Conclusion

The study demonstrated that reticular OLP could cause the dysregulations of the metabolites in serum, which might be also further linked to other organ and systemic diseases through the blood system, such as diabetes, sleep disorders, and depression, etc.

http://bit.ly/2sSVVCK

Influence of low-level laser therapy on orthodontically-induced inflammatory root resorption. A systematic review

Publication date: Available online 30 January 2019

Source: Archives of Oral Biology

Author(s): Dimitrios Michelogiannakis, Deema Al-Shammery, Zohaib Akram, P. Emile Rossouw, Fawad Javed, Georgios E. Romanos

Abstract

Objective

The aim was to assess the influence of low-level laser therapy (LLLT) on orthodontically-induced inflammatory root resorption (OIIRR).

Methods

A systematic search was conducted in indexed databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The eligibility criteria were as follows: (a) original clinical and animal/experimental studies; (b) prospective studies; (c) intervention: effect of LLLT on OIIRR; (d) control group (OIIRR without LLLT); (e) statistical analysis; and (f) tomographic or histologic assessment of OIIRR. Quality assessment of the experimental and clinical studies was performed following the Animal Research Reporting In-vivo Experiments (ARRIVE) and Consolidated Standards of Reporting Trials (CONSORT) guidelines, respectively. The risk of bias of the included studies was also determined.

Results

Nine (7 experimental and 2 clinical) of the initially identified 39 studies were included. One clinical and 2 experimental studies showed that LLLT during orthodontic tooth movement (OTM) significantly reduces OIIRR. One experimental study reported that LLLT during OTM in sockets treated with alloplastic materials significantly reduces OIIRR. One experimental study found that LLLT after OTM significantly repairs OIIRR, whereas one clinical study did not report a significant reparative affect. Three experimental studies showed that LLLT increases OIIRR during OTM, corticotomized-OTM, and OTM into grafted defects, respectively. The minimum, median and highest ARRIVE scores (out of 20) of the included experimental studies were 15, 17 and 19, respectively. The mean CONSORT score of the included clinical studies was 23 (out of 25).

Conclusions

In conclusion, the influence of LLLT on OIIRR remains debatable.

http://bit.ly/2MFNXFW

HDR interventional radiotherapy (brachytherapy) in the treatment of primary and recurrent head and neck malignancies

Abstract

Background

Interventional radiotherapy (brachytherapy; IRT) reemerged in the last decades as a potentially useful tool in head and neck oncology after a set of clear technical improvements were developed.

Methods

Sixty‐one high dose ratio (HDR) IRT treatments were recommended and performed on 58 patients. We classified the cases into four relatively homogeneous groups based on the clinical needs that led to the recommended IRT. Also, we separately evaluated primary and recurrent cases.

Results

Disease‐specific survival was significantly different among the four treatment groups. The group with the best prognosis was the cohort treated locally by exclusive interstitial IRT for resectable midface malignancies (2‐year relapse‐free survival = 82%, disease‐specific survival = 89%).

Conclusion

HDR IRT is a valuable tool in well‐defined clinical situations and, in particular, in recurrences. In midface malignancies, it could become the preferred primary treatment.

http://bit.ly/2WxFFo4

Assessing functional outcomes in head and neck surgical oncology

Abstract

Background

A reliable method of measuring functional outcomes is essential to inform treatment decisions in head and neck cancer.

Methods

Members of the American Head and Neck Society were surveyed regarding their use of functional outcome assessment tools. Qualitative statistical analysis was performed to identify major tools used and to clarify obstacles to functional outcome assessment. A comprehensive literature review was performed to identify available tools.

Results

A total of 142 surgeons were surveyed. 44.12% of respondents use at least 1 tool to assess functional outcomes. The most frequently used tools were modified barium swallow, MD Anderson Dysphagia Inventory, and functional endoscopic evaluation of swallow (FEES). 72.65% of respondents reported barriers to assessment, most frequently a lack of support to administer the tests or to collect, apply or analyze the results. Review of the literature revealed 173 available tools.

Conclusions

Although a wide variety of validated tools are available in the literature to assess functional outcomes after head and neck surgery, major obstacles to their use persist. The lack of a standard measure that is practical and transferable continues to impair research progression in this field.

http://bit.ly/2RtuIAf