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Τετάρτη 28 Σεπτεμβρίου 2022

Reconstruction of the Obliterated Eustachian Tube: A Pilot Case Series

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Reconstruction of the Obliterated Eustachian Tube: A Pilot Case Series

Complete occlusion of the cartilaginous ET can be associated with intractable mucoid effusion; endoscopic examination should be considered in such cases. In this pilot study, ET reconstruction was done and found to be a safe and possibly effective procedure in patients with total obliteration of the ET from various etiologies.


Objective

To investigate the safety and early efficacy of a procedure for reconstruction of the obliterated Eustachian tube (ET).

Study Design

Retrospective case series.

Methods

Patients with total obliteration of the cartilaginous ET, with intractable mucoid effusion causing repeated occlusion of tympanostomy tubes were included. Patients underwent endoscopic transnasal/transoral reconstruction of the obliterated ET using transtympanic illuminated guidewire guidance. A temporary stent (angiocatheter filled with bonewax) was placed to maintain patency while healing. In four cases an additional steroid-eluting propel stent was placed in the ET orifice. Main outcome measures were otomicroscopy results, absence of middle ear effusion, and nasopharyngoscopy showing patency of the ET orifice.

Results

Nine ETs (seven patients), ages 17–68 years (mean 37.9) underwent ET reconstruction. Follow-up ranged from 4 to 56 months (mean 30.9 months). 89% of operated ears had no effusion at last follow-up. Two patients (three Eustachian tubes) underwent successful reoperation. There were no complications directly related to the procedure. Etiologies of obliteration included scarring after sinus surgery, obstruction after maxillo-mandibular advancement surgery (two patients), bullous pemphigus, gunshot trauma, and previous patulous obliteration (two patients).

Conclusions

Complete occlusion of the cartilaginous ET can be associated with intractable mucoid effusion; endoscopic examination should be considered in such cases. In this pilot study, ET reconstruction was found to be a safe and possibly effective procedure in patients with total obliteration of the ET from various etiologies. Larger studies with long term follow up are indicated.

Level of Evidence

4 Laryngoscope, 2022

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Antimicrobial potential of new diclofenac hydrogels for disinfection in regenerative endodontics: An in vitro and ex vivo study

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Abstract

Aim

There is a need to explore new alternatives for root canal disinfection in regenerative endodontics, since the current strategies are far from ideal. Currently, the potential use of diclofenac (DC) is being investigated for controlling root canal infections. The objective was to evaluate the antimicrobial efficacy of novel DC-based hydrogels (DCHs) against polymicrobial biofilms grown in radicular dentine and root canals, and to compare results with triantibiotic (TAH) and diantibiotic (DAH) hydrogels, and calcium hydroxide (Ca(OH)2).

Methodology

The in vitro antimicrobial activity of intracanal medicaments was evaluated against 3-week-old polymicrobial root canal biofilms grown on human radicular dentine. Dentine samples were obtained and randomly divided into the study groups (n = 4/group): 1) 1mg/mL TAH; 2) 1mg/mL DAH; 3) 5% DCH; 4) 2.5% DCH; 5) 1.25% DCH; 6) 1mg/mL DAH +5% DCH; 7) Ca(OH)2 paste; 8) positive control. The microbial viability, in terms of percentage of intact cell membranes, was assessed after 7 days by confocal scanning laser microscopy (CSLM). The ex vivo efficacy of intracanal medications was evaluated in root canals infected with a polymicrobial suspension. Intracanal microbiological samples at baseline (S1) and 7 days post-treatment (S2) were taken; microbial quantification and cell viability were assessed by quantitative polymerase chain reaction (qPCR) and flow cytometry (FC). The mean Log10 of bacterial DNA copies in root canal samples befor e (S1) and the Log10 reduction of DNA copies S1-S2 in qPCR were recorded. The absolute value of total cells stained, and the percentage reduction of intact membranes cells after treatment (S1-S2), were analyzed by FC. Global comparison was done using the Kruskall-Wallis test, while the Mann-Whitney U test was used for pair-by-pair comparison.

Results

CSLM analysis indicated that the greatest effectiveness was obtained with 5% DCH, showing significant differences with respect to the other groups (p< 0.001). In root canals, the highest Log10 DNA reduction S1-S2 was obtained with 5% DCH and TAH, with no differences between them. The results of FC showed that only 5% DCH proved significantly superior to the other treatments.

Conclusions

Sodium diclofenac hydrogels demonstrate antimicrobial efficacy against endodontic biofilms.

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The Effect of Subglottic Steroid injection on Blood Glucose in a Cohort of Patients With Subglottic Stenosis

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The Effect of Subglottic Steroid injection on Blood Glucose in a Cohort of Patients With Subglottic Stenosis

Intralesional subglottic steroid injections are commonly used for patients with subglottic stenosis. This prospective study shows that these injections have a transient effect on blood glucose that peaks at 1 day after the injection and normalizes within 72 h.


Objective

The objective of this work was to assess the effect of a single intralesional subglottic steroid injection on fasting blood glucose over 7 days in a cohort of patients with subglottic stenosis.

Methods

A prospective cohort study of patients undergoing intralesional steroid injections at a tertiary academic center. Patients had baseline bloodwork performed, including fasting blood glucose (FBG), and hemoglobin A1C levels. Demographic data and risk factors were collected. Fasting capillary glucose (FCG) was measured using a capillary glucometer and performed by patients daily from days 0 to 7 after a single injection of Triamcinolone into the subglottic airway. Data were analyzed using descriptive and comparative statistics.

Results

Eleven patients were enrolled, and 10 completed data collection over 7 days. All were female, with a mean age of 52.6 years (SD 17.5). Two patients were diabetic (non-insulin dependent). There was a statistically significant increase in FCG on day 1 post-injection (mean = 122.4 mg/dl compared to 100.7 mg/dl) that normalized for all patients within 24–72 h. The mean increase in FCG was 21.5% (SD 22.5%) of the initial value for the cohort. The diabetic group had statistically significant higher glucose values on day 1 compared to the non-diabetic group (146.5 mg/dl compared to 117.0 mg/dl).

Conclusion

A single subglottic steroid injection appears to cause a transient increase in FCG 1 day post injection, which resolves after 24–72 h and can be more pronounced in diabetic patients.

Level of Evidence

4 Laryngoscope, 2022

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Bone characteristics in condylar hyperplasia of the temporomandibular joint: a microcomputed tomography, histology, and Raman microspectrometry study

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Unilateral condylar hyperplasia (UCH) of the temporomandibular joint is a progressive deformation of the mandibular condyle of unknown origin. UCH is characterized by excessive growth of the condylar head and neck, leading to an increase in size and volume. The aim of this study was to investigate the characteristics of the bone in patients with UCH using microcomputed tomography (micro-CT), histology, and Raman microspectroscopy. The mandibular condyles of six patients with UCH were analysed using micro-CT, histology, and Raman microspectrometry and imaging, and the results were compared with those obtained for a normal control subject. (Source: International Journal of Oral and Maxillofacial Surgery)
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A complete digital approach for facially generated full arch diagnostic wax up, guided surgery, and implant‐supported interim prosthesis by integrating 3D facial scanning, intraoral scan, and CBCT

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Abstract

Continuous innovation in digital dental technology offers new prospects for creating a complete virtual environment. This technique described adds a facial approach to the conventional digital workflow by incorporating 3D face scans to cone beam computed tomography and intraoral scans. Thus, obtaining a complete virtual patient for facially generated diagnostic wax up and planning to implement a predictable implant placement and interim prosthesis. It provides a full digital workflow by restoratively driven computer-aided implant planning, guided surgery, and 3D printing of an interim complete-arch fixed implant-supported prosthesis.

This article is protected by copyright. All rights reserved

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Pterygoid muscle activity in speech: a preliminary investigation

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Abstract

Background

Speaking depends on refined control of jaw opening and closing movements. The medial pterygoid muscle (MPT), involved in jaw closing, and the lateral pterygoid muscle (LPT), involved in jaw opening, are two key mandibular muscles in mastication and are likely to be recruited for controlled movements in speech.

Objectives

Three hypotheses were investigated, that during speech the MPT and LPT: (1) are both active, (2) but exhibit different patterns of activity, (3) which fluctuate with the vowels and consonants in speech.

Methods

Intramuscular EMG recordings were made from the right inferior head of the LPT and/or the right MPT in five participants during production of 40 target nonsense words (NWs) consisting of three syllables in the form /V1 C 1 V 2 C2ə/ (V = vowel; C = consonant; ə = unstressed, reduced vowel), spoken by each participant 10 times per NW; analysis focussed on the target syllable, C 1 V 2 .

Results

Both MPT and LPT exhibited robust increases in EMG activity during utterance of most NWs, relative to rest. Peak LPT activation was time-locked to the final part of the target consonant (C1) interval when the jaw begins opening for the target vowel (V2), whereas peak MPT activation occurred around the temporal midpoint of V2, when the jaw begins closing for C2. EMG amplitude peaks differed in magnitude between "high" vowels, i.e., for which the tongue/jaw are high (e.g., in S EE K), and "low" vowels, i.e., for which the tongue/jaw are low (e.g., in S O CK).

Conclusion

These novel findings suggest a key role for the LPT and MPT in the fine control of speech production. They imply that speech may impose major synergistic demands on the activities of the MPT and the LPT, and thereby provide insights into the possible interactions between speech activities and orofacial activities (e.g. mastication) and conditions (e.g. Temporomandibular Disorders) that involve the masticatory muscles.

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Paediatric mandibular distraction: optimizing outcomes

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imagePurpose of review The purpose of this review is to summarize current evidence surrounding the use of mandibular distraction osteogenesis in children and to highlight recent advances in our knowledge of this subject. Recent findings Distraction osteogenesis of the mandible has gained in popularity since its initial description about 30 years ago. Its efficacy and safety have been well described. More recently, proper patient selection, technique modifications and long-term outcomes have been the subject of much discussion around this revolutionary technique. Summary Distraction osteogenesis of the mandible is a powerful tool for surgeons. Technological advances and high-quality research have allowed for optimization of this technique within the field of craniomaxillofacial surgery.
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Evaluation and management of paediatric vertigo

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imagePurpose of review This review summarizes the most current information on cause, evaluation and treatment of dizziness in children. Recent findings There has been an increased understanding of the multifactorial cause of dizziness in the paediatric population. Quantitative vestibular testing is increasingly used and valuable as a diagnostic adjunct. Vestibular rehabilitation, migraine hygiene, psychological therapies, pharmaceuticals and/or surgery can be used as well tolerated and effective treatments for vertigo in children and adolescents when tailored to cause. Summary Paediatric vertigo can be effectively evaluated through careful history taking and physical examination along with adjunctive tests, such as vestibular testing and audiometry, when appropriate. Options for treatment of vestibular disorders in children and adolescents have greatly expanded in recent years allowing for the effective management of nearly all cases of paediatric vertigo, though a multimodal and/or multidisciplinary approach is often needed.
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Τρίτη 27 Σεπτεμβρίου 2022

A novel animal model of primary blast lung injury and its pathological changes in mice

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imageBACKGROUND Primary blast lung injury (PBLI) is a major cause of death in military conflict and terrorist attacks on civilian populations. However, the mechanisms of PBLI are not well understood, and a standardized animal model is urgently needed. This study aimed to establish an animal model of PBLI for laboratory study. METHODS The animal model of PBLI was established using a self-made mini shock tube simulation device. In brief, mice were randomly divided into two groups: the control group and the model group, the model group were suffered 0.5 bar shock pressures. Mice were sacrificed at 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours after injury. Lung tissue gross observation, hematoxylin and eosin staining and lung pathology scoring were performed to evaluated lung tissue damage. Evans blue dye leakage and bronchoalveolar lavage fluid examination were performed to evaluated pulmonary edema. The relative expression levels of inflammation factors were measured by real-time quantitative polymerase chain reaction and Western blotting analysis. The release of neutrophil extracellular traps was observed by immunofluorescence stain. RESULTS In the model group, the gross observation and hematoxylin and eosin staining assay showed the inflammatory cell infiltration, intra-alveolar hemorrhage, and damaged lung tissue structure. The Evans blue dye and bronchoalveolar lavage fluid examination revealed that the lung tissue permeability and edema was significantly increased after injury. Real-time quantitative polymerase chain reaction and Western blotting assays showed that IL-1β, IL-6, TNF-α were upregulated in the model group. Immunofluorescence assay showed that the level of neutrophil extracellular traps in the lung tissue increased significantly in the model group. CONCLUSION The self-made mini shock tube simulation device can be used to establish the animal model of PBLI successfully. Pathological changes of PBLI mice were characterized by mechanical damage and inflammatory response in lung tissue.
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Ventilator-associated pneumonia and intubation location in adults with traumatic injuries: Systematic review and meta-analysis

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imageBACKGROUND Ventilator-associated pneumonia (VAP) is an important cause of morbidity and mortality among critically ill patients, particularly those who present with traumatic injuries. This review aims to determine whether patients with traumatic injuries who are intubated in the prehospital setting are at higher risk of developing VAP compared with those intubated in the hospital. METHODS A systematic review of Medline, Scopus, and Cochrane electronic databases was conducted from inception to January 2021. Inclusion criteria were patients with traumatic injuries who were intubated in the prehospital or hospital settings with VAP as an outcome. Using a random-effects model, the risk of VAP across study arms was compared by calculating a summary relative risk with 95% confidence intervals. The results of individual studies were also summarized qualitatively. RESULTS The search identified 754 articles of which 6 studies (N = 2,990) met the inclusion criteria. All studies were good quality based on assessment with the Newcastle Ottawa scale. Prehospital intubation demonstrated an increased risk of VAP development in two of the six studies. Among the six studies, the overall quality weighted risk ratio was 1.09 (95% confidence interval, 0.90–1.31). CONCLUSION Traumatically injured patients who are intubated in the prehospital setting have a similar risk of developing VAP compared with those that are intubated in the hospital setting. LEVEL OF EVIDENCE Systematic review and meta-analysis; Level IV.
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