Sentinel lymph node biopsy staging for cutaneous malignant melanoma of the head and neck.

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Sentinel lymph node biopsy staging for cutaneous malignant melanoma of the head and neck.

Acta Otolaryngol. 2016 Jan 15;:1-7

Authors: Hafström A, Romell A, Ingvar C, Wahlberg P, Greiff L

Abstract
Conclusion Sentinel lymph node biopsies (SLNBs) can be performed safely and with reasonable accuracy in HNM patients. The outcome provides important prognostic information concerning DFS and further treatment. However, one must recognize that SLNB is a multidisciplinary procedure with a learning curve for all. Objectives To evaluate efficacy of performing SLNBs in a series of consecutive patients with cutaneous head and neck melanoma (HNM) ≥ T1b from introduction of the procedure and 10 years onward. Method End-points comprised of SLNB outcome, disease-free survival (DFS), and overall survival (OS). Results SNs were harvested in 128 of 160 patients (median Breslow = 2.0 mm, 29% ulcerated); success rate = 80.0%, or 92.1% if excluding patients where SLNBs were omitted due to non-localization on pre-operative imaging or because of SN-location in the parotid basin. Ten patients (7.8%) had positive SLNBs and were offered early completion neck dissections. Of the 146 patients available for follow-up (median = 27 months), 15.8% had recurrent disease. The risk of a regional nodal recurrence after a negative SLNB was 7.5%. SN-negative patients had improved DFS c.f. SN-positive patients (p < 0.001). A positive SLNB was the most important prognostic predictor of decreased DFS (hazard ratio = 5.70; p < 0.005), but had no significant impact on OS.

PMID: 26767628 [PubMed - as supplied by publisher]

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Skull base osteomyelitis missed in mastoidectomy for cholesteatoma.

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Skull base osteomyelitis missed in mastoidectomy for cholesteatoma.

Acta Otolaryngol. 2016 Jan 15;:1-3

Authors: Lee HS, Yang CJ, Lee JH, Ahn JH

Abstract
Conclusions A high suspicion of skull base involvement should be warranted, even if radiological findings are not atypical, in cases of chronic otitis media (COM) with cholesteatoma. Objective To investigate some clues indicating the development of skull base osteomyelitis (SBO) in patients who received mastoidectomy, through reviewing pre-operative temporal bone computed tomography (TBCT). Method Retrospective review of patients with SBO after mastoidectomy for COM. A total of five patients with SBO after mastoidectomy with available pre-operative TBCTs were enrolled in this study. Results All patients were diagnosed as COM with cholesteatoma and open cavity mastoidectomy was performed. After surgery, SBO were occurred. The recovery in these five patients was complicated by lower cranial nerve palsy, and one patient had a stroke due to lateral thrombophlebitis. Through re-interpretation of pre-operative TBCT, the bony destruction around the skull base missed at the initial diagnosis was observed in all cases.

PMID: 26767507 [PubMed - as supplied by publisher]

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Daily music exposure dose and hearing problems using personal listening devices in adolescents and young adults: A systematic review.

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Daily music exposure dose and hearing problems using personal listening devices in adolescents and young adults: A systematic review.

Int J Audiol. 2016 Jan 15;:1-9

Authors: Jiang W, Zhao F, Guderley N, Manchaiah V

Abstract
OBJECTIVE: This systematic review aimed to explore the evidence on whether the preferred listening levels (PLLs) and durations of music listening through personal listening devices (PLDs) in adolescents and young adults exceed the current recommended 100% daily noise dose; together with the impact on hearing and possible influential factors of such listening behaviours.
DESIGN: A systematic search was conducted using multiple online bibliographic databases.
STUDY SAMPLE: The 26 studies were included on the basis of the inclusion and exclusion criteria.
RESULTS: The results showed that up to 58.2% of participants exceeded the 100% daily noise dose, particularly in the presence of background noise. Significantly positive correlations were found among background noise levels and mean PLLs, as well as the proportion of participants exceeding the 100% daily noise dose. Moreover, significantly worse hearing thresholds were found in PLD users using audiometry, and significantly poor results in otoacoustic emission (OAE), even in the participants with self-reported 'normal hearing'.
CONCLUSION: It is crucial to develop appropriate standards and safe recommendations for daily music exposure dose in future studies. Providing an essential guide and effective education to adolescents and young adults will help raise awareness, increase knowledge, and consequently change attitudes and listening habits.

PMID: 26768911 [PubMed - as supplied by publisher]

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Noise-Induced Neural Degeneration and Therapeutic Effect of Antioxidant Drugs.

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Noise-Induced Neural Degeneration and Therapeutic Effect of Antioxidant Drugs.

J Audiol Otol. 2015 Dec;19(3):111-9

Authors: Choi SH, Choi CH

Abstract
The primary site of lesion induced by noise exposure is the hair cells in the organ of Corti and the primary neural degeneration occurs in synaptic terminals of cochlear nerve fibers and spiral ganglion cells. The cellular basis of noise-induced hearing loss is oxidative stress, which refers to a severe disruption in the balance between the production of free radicals and antioxidant defense system in the cochlea by excessive production of free radicals induced by noise exposure. Oxidative stress has been identified by a variety of biomarkers to label free radical activity which include four-hydroxy-2-nonenal, nitrotyrosine, and malondialdehyde, and inducible nitric oxide synthase, cytochrome-C, and cascade-3, 8, 9. Furthermore, oxidative stress is contributing to the necrotic and apoptotic cell deaths in the cochlea. To counteract the known mechanisms of pathogenesis and oxidative stress induced by noise exposure, a variety of antioxidant drugs including oxygen-based antioxidants such as N-acetyl-L-cystein and acetyl-L-carnitine and nitrone-based antioxidants such as phenyl-N-tert-butylnitrone (PBN), disufenton sodium, 4-hydroxy PBN, and 2, 4-disulfonyl PBN have been used in our laboratory. These antioxidant drugs were effective in preventing or treating noise-induced hearing loss. In combination with other antioxidants, antioxidant drugs showed a strong synergistic effect. Furthermore, successful use of antioxidant drugs depends on the optimal timing of treatment and the duration of treatment, which are highly related to the time window of free radical formation induced by noise exposure.

PMID: 26771008 [PubMed]

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Auditory nerve synapses persist in ventral cochlear nucleus long after loss of acoustic input in mice with early-onset progressive hearing loss.

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Auditory nerve synapses persist in ventral cochlear nucleus long after loss of acoustic input in mice with early-onset progressive hearing loss.

Brain Res. 2015 Apr 24;1605:22-30

Authors: McGuire B, Fiorillo B, Ryugo DK, Lauer AM

Abstract
Perceptual performance in persons with hearing loss, especially those using devices to restore hearing, is not fully predicted by traditional audiometric measurements designed to evaluate the status of peripheral function. The integrity of auditory brainstem synapses may vary with different forms of hearing loss, and differential effects on the auditory nerve-brain interface may have particularly profound consequences for the transfer of sound from ear to brain. Loss of auditory nerve synapses in ventral cochlear nucleus (VCN) has been reported after acoustic trauma, ablation of the organ of Corti, and administration of ototoxic compounds. The effects of gradually acquired forms deafness on these synapses are less well understood. We investigated VCN gross morphology and auditory nerve synapse integrity in DBA/2J mice with early-onset progressive sensorineural hearing loss. Hearing status was confirmed using auditory brainstem response audiometry and acoustic startle responses. We found no change in VCN volume, number of macroneurons, or number of VGLUT1-positive auditory nerve terminals between young adult and older, deaf DBA/2J. Cell-type specific analysis revealed no difference in the number of VGLUT1 puncta contacting bushy and multipolar cell body profiles, but the terminals were smaller in deaf DBA/2J mice. Transmission electron microscopy confirmed the presence of numerous healthy, vesicle-filled auditory nerve synapses in older, deaf DBA/2J mice. The present results suggest that synapses can be preserved over a relatively long time-course in gradually acquired deafness. Elucidating the mechanisms supporting survival of central auditory nerve synapses in models of acquired deafness may reveal new opportunities for therapeutic intervention.

PMID: 25686750 [PubMed - indexed for MEDLINE]

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[Frequency-specific analysis of the hVOR Prior of Cochlear Implant Operation].

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[Frequency-specific analysis of the hVOR Prior of Cochlear Implant Operation].

Laryngorhinootologie. 2015 Mar;94(3):173-8

Authors: Hülse R, Hülse M, Wenzel A, Hörmann K, Servais JJ

Abstract
Dizziness is one of the most common postoperative complications after a cochlear-implant (CI) surgery. With our prospective, matched-paired controlled study, we could demonstrate that patients with distinctive sensorineural hearing loss--even without any complaints of dizziness--already have a reduced horizontal vestibular-ocular-reflex (hVOR). Compared to controls, CI patients presented with a significantly reduced gain. 9 out of 17 CI patients showed physiological results in rotatory testing and video head thrust testing. One patient presented with pathological results in both tests. Remarkably, there were 2 patients who presented with pathological head impulse testing but normal values in rotatory testing and 5 patients who showed normal gains in video head impulse testing but abnormal rotatory tests. These findings clearly show the importance of a differentiated, frequency-dependent pre-operative vestibular assessment including rotatory testing and video-head impulse testing. Additionally, only an accurate pre-operative vestibular testing allows evaluating possible post-operative dizziness related complications and should be documented precisely, also for forensic reasons. This is the key to differentiate post-operative dizziness from an pre-operatively existing vestibular disorder that possibly might not be clinically apparent by the time of testing.

PMID: 25265227 [PubMed - indexed for MEDLINE]

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[Refractory Hoarseness In Granular Cell Tumor of the Vocal Cord].

[Refractory Hoarseness In Granular Cell Tumor of the Vocal Cord].

Laryngorhinootologie. 2016 Jan 15;

Authors: Reiter R, Ruess J, Brosch S, Pickhard A

PMID: 26771451 [PubMed - as supplied by publisher]

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Cysts of the larynx - Classification.

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Cysts of the larynx - Classification.

Laryngoscope. 2015 Dec;125(12):2629

Authors: DeSanto LW, Devine KD, Weiland LH

PMID: 26768765 [PubMed - in process]

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A novel method of intubation and orogastric tube insertion using a C-MAC-D-blade videolaryngoscope-bougie technique.

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A novel method of intubation and orogastric tube insertion using a C-MAC-D-blade videolaryngoscope-bougie technique.

Acta Anaesthesiol Belg. 2015;66(3):87-90

Authors: Van Zundert AA, Gatt SP

Abstract
INTRODUCTION: Expertise in airway management is a fundamental aspect of anesthesia practice. Fortunately 'can't intubate, can't ventilate' scenarios are extremely rare. In particular, patients with tumors on the right side of the oropharynx and larynx can be very problematic to intubate.
METHODS: We present an alternative intubation technique, whereby a C-MAC D-blade videolaryngoscope is loaded with a Frova catheter in the narrow, curving channel within the blade's infero-posterior aspect on the left side of the blade. This technique can be a successful alternative in patients with difficult airways.
RESULTS: The proposed technique was successfully demonstrated in a case whereby a 47-year old male with premetrics of a difficult airway, presented with a large mass in the right supraglottis and hypopharynx with through-and-through thyroid cartilage infiltration, obstructing completely the view of the glottis with direct laryngoscopy. The referral hospital considered the patient unintubatable and sent the patient to our academic center for treatment. Endotracheal intubation with the new technique was successful at the first attempt.
CONCLUSIONS: The C-MAC D-Blade videolaryngoscope-bougie technique provides an alternative method to intubate patients with difficult airways, even in exceptional situations such as in patients with a large right-sided oropharynx-larynx tumor.

PMID: 26767233 [PubMed - in process]

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[Contact endoscopy of the vocal folds in combination with narrow band imaging (compact endoscopy].

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[Contact endoscopy of the vocal folds in combination with narrow band imaging (compact endoscopy].

Laryngorhinootologie. 2015 Mar;94(3):150-2

Authors: Arens C, Voigt-Zimmermann S

PMID: 25760257 [PubMed - indexed for MEDLINE]

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Gender-related difference in the upper airway dimensions and hyoid bone position in Chinese Han children and adolescents aged 6-18 years using cone beam computed tomography.

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Gender-related difference in the upper airway dimensions and hyoid bone position in Chinese Han children and adolescents aged 6-18 years using cone beam computed tomography.

Acta Odontol Scand. 2015 Jul;73(5):391-400

Authors: Jiang YY, Xu X, Su HL, Liu DX

Abstract
OBJECTIVE: To investigate the gender-related differences in upper airway dimensions and hyoid bone position in Chinese Han children and adolescents (6-18 years) using cone-beam computed tomography (CBCT).
MATERIALS AND METHODS: CBCT-scans of 119 boys and 135 girls were selected and divided into four groups (group 1: 6-9 years; group 2: 10-12 years; group 3: 13-15 years; group 4: 16-18 years). The airway dimensions including the cross-sectional area (CSA), anteroposterior (AP) and lateral (LAT) width, length (L), mean CSA and volume (VOL) of upper airway segmentations and hyoid bone position including 11 linear and three angular measurements were investigated using Materialism's interactive medical image control system (MIMICS) 16.01 software. Gender-related differences were analyzed by two independent sample t-tests.
RESULTS: No gender-related difference was found in values of the facial morphology, airway dimensions and hyoid bone position for group 1 (p > 0.05). The children and adolescents in groups 2, 3 and 4 showed significant gender-related differences in the measurement results of facial morphology, airway dimensions and hyoid bone positions (p < 0.05). What's more, the measurement values of boys were obviously larger than those of girls except some measurements in group 2.
CONCLUSIONS: The measurements of airway dimensions and hyoid bone positions have gender-related differences in children and adolescents aged 10-18 years. These results could be taken into consideration during orthodontic diagnosis and treatment.

PMID: 25630980 [PubMed - indexed for MEDLINE]

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Low inter-arytenoid height: a subclassification of type 1 laryngeal cleft diagnosis and management.

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Low inter-arytenoid height: a subclassification of type 1 laryngeal cleft diagnosis and management.

Int J Pediatr Otorhinolaryngol. 2015 Jan;79(1):31-5

Authors: Jefferson ND, Carmel E, Cheng AT

Abstract
OBJECTIVE: To report our experience of patients with type 1 laryngeal cleft, (including low inter-arytenoid height) who failed conservative management over a five year period. We describe the diagnostic elements of the history, examination at laryngobronchoscopy and provide a management algorithm including the use of inter-arytenoid submucosal injection of gelfoam as a temporary therapeutic as well as diagnostic tool.
METHODS: A retrospective case note review over a five year period was undertaken to review all cases of type 1 laryngeal cleft who failed conservative management. Presenting symptoms, diagnostic procedures, surgical interventions and clinical outcomes were reviewed.
RESULTS: Seventeen patients were identified. Chronic cough was the most consistent feature in the history (100%). All patients underwent a microlaryngoscopy with binocular microlaryngeal assessment. Six patients (35%) underwent gelfoam injection; four of these went on to a formal repair. The remaining 11 all had a repair performed without injection. The success of surgical repair was 80% (12/15) however in the other three, all had improvement in symptoms.
CONCLUSIONS: Type 1 laryngeal cleft anomalies may extend beyond that described by Benjamin and Inglis. An appropriate history as well as binocular inspection at the time of laryngoscopy is essential. Injection augmentation offers a safe tool in the assessment and management, and endoscopic surgical repair remains the standard for definitive therapy in those that fail conservative management.

PMID: 25481333 [PubMed - indexed for MEDLINE]

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Cricoid reduction laryngoplasty for treatment of dysphonia after pediatric laryngotracheal reconstruction.

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Cricoid reduction laryngoplasty for treatment of dysphonia after pediatric laryngotracheal reconstruction.

Int J Pediatr Otorhinolaryngol. 2015 Jan;79(1):80-2

Authors: Bliss M, Houtz D, Smith ME

Abstract
Dysphonia is common after pediatric laryngotracheal reconstruction (LTR). Surgical techniques designed to rehabilitate the voice after LTR have not yet been proposed. Herein we describe a case of a patient with severe glottal insufficiency after LTR who was treated with a cricoid reduction laryngoplasty in order to surgically rehabilitate the voice. Removal of the posterior costal cartilage graft was effective at improving the quality of the voice and left the patient with an adequate airway even during moderate exercise.

PMID: 25465446 [PubMed - indexed for MEDLINE]

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Pretreatment screening for distant metastases in the Dutch head and neck centers: 10 years later.

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Pretreatment screening for distant metastases in the Dutch head and neck centers: 10 years later.

Eur Arch Otorhinolaryngol. 2016 Jan 14;

Authors: Senft A, Hoekstra OS, Castelijns JA, Leemans CR, de Bree R

Abstract
To evaluate the current practice and change in practice concerning screening for distant metastases in head and neck squamous cell carcinoma patients, we performed a survey with the same questionnaire as 10 years ago among the eight centers of the Dutch Head and Neck Society treating head and neck cancer in The Netherlands. Factors related to extensive lymph node metastases are the most frequent indication for screening for distant metastases. The combinations of whole body PET-CT and contrast-enhanced chest CT are nowadays the diagnostic techniques for routinely screening for distant metastases. Screening for distant metastases is performed more frequently than 10 years ago. Although the sensitivity of the diagnostic pathway needs to be improved, most centers are satisfied with the current diagnostic pathway. A reduction of variation in indications and diagnostic techniques used for screening for distant metastases is observed during the last 10 years. In future guidelines patients' selection and diagnostic tests need to be specified in more detail.

PMID: 26769038 [PubMed - as supplied by publisher]

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Comparison of CO2 laser and conventional laryngomicrosurgery treatments of polyp and leukoplakia of the vocal fold.

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Comparison of CO2 laser and conventional laryngomicrosurgery treatments of polyp and leukoplakia of the vocal fold.

Int J Clin Exp Med. 2015;8(10):18265-74

Authors: Zhang Y, Liang G, Sun N, Guan L, Meng Y, Zhao X, Liu L, Sun G

Abstract
The efficacies of CO2 laser and conventional laryngeal microsurgery for vocal cord benign (vocal cord polyp) and precancerous (vocal cord leukoplakia) lesions were compared. Patients with bilateral vocal cord polyps (n = 60) and leukoplakia (n = 30) were divided randomly into two groups. One group was treated with throat microsurgical instruments and underwent routine lesion resection (conventional group) and the other with CO2 laser (laser group). For the subjective assessment, the tools GRABS and VHI were used. The objective assessment, A multi-dimensional voice program module for voice spectrum analysis was used. The laser group was slightly worse than the conventional group 1 week post-surgery by stroboscopic findings. The subjective and objective data of the two groups pre-and post-surgery showed that the voice recovery of the laser group was significantly better than that of the conventional group (P < 0.05). CO2 laser laryngeal microsurgery for vocal cord polyp and leukoplakia can improve significantly the vocal cord morphology and pronunciation quality. The procedure is especially more effective than conventional surgery in patients with vocal cord leukoplakia.

PMID: 26770428 [PubMed]

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Bedside diagnosis of dysphagia: a systematic review.

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Bedside diagnosis of dysphagia: a systematic review.

J Hosp Med. 2015 Apr;10(4):256-65

Authors: O'Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N

Abstract
Dysphagia is associated with aspiration, pneumonia, and malnutrition, but remains challenging to identify at the bedside. A variety of exam protocols and maneuvers are commonly used, but the efficacy of these maneuvers is highly variable. We conducted a comprehensive search of 7 databases, including MEDLINE, Embase, and Scopus, from each database's earliest inception through June 9, 2014. Studies reporting diagnostic performance of a bedside examination maneuver compared to a reference gold standard (videofluoroscopic swallow study or flexible endoscopic evaluation of swallowing with sensory testing) were included for analysis. From each study, data were abstracted based on the type of diagnostic method and reference standard study population and inclusion/exclusion characteristics, design, and prediction of aspiration. The search strategy identified 38 articles meeting inclusion criteria. Overall, most bedside examinations lacked sufficient sensitivity to be used for screening purposes across all patient populations examined. Individual studies found dysphonia assessments, abnormal pharyngeal sensation assessments, dual axis accelerometry, and 1 description of water swallow testing to be sensitive tools, but none were reported as consistently sensitive. A preponderance of identified studies was in poststroke adults, limiting the generalizability of results. No bedside screening protocol has been shown to provide adequate predictive value for presence of aspiration. Several individual exam maneuvers demonstrated reasonable sensitivity, but reproducibility and consistency of these protocols was not established. More research is needed to design an optimal protocol for dysphagia detection.

PMID: 25581840 [PubMed - indexed for MEDLINE]

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Re: "Five-year alveolar bone level changes in women of varying skeletal bone mineral density and bone trabeculation-a commentary".

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Re: "Five-year alveolar bone level changes in women of varying skeletal bone mineral density and bone trabeculation-a commentary".

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Nov 14;

Authors: Kumar S, Patil V, Pai KM, Vineetha R

PMID: 26768078 [PubMed - as supplied by publisher]

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Maxillary reconstruction assisted by preoperative planning and accurate surgical templates.

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Maxillary reconstruction assisted by preoperative planning and accurate surgical templates.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Oct 23;

Authors: Zheng GS, Wang L, Su YX, Liao GQ, Zhang SE, Lao XM

Abstract
OBJECTIVE: Surgical reconstruction of maxilla is technically challenging and time consuming. The study reports a new method of maxillary reconstruction assisted by preoperative surgical simulation and accurate transferring templates.
STUDY DESIGN: Six patients requiring maxillary reconstruction were enrolled in our study. Templates of maxillary resection, fibula cutting, and positioning were designed based on computed tomography (CT) data and fabricated via rapid prototyping technique. Resection, fibula cutting, and positioning were performed according to the templates. Accuracy was evaluated by measuring deviation, performed by superimposing preoperative planning and postoperative maxilla.
RESULTS: The surgery was performed faithfully to the preoperative planning. The facial contour was satisfied. Postoperative CT scans showed high accuracy of the surgical implementation. The average central point deviation, maximum deviation, and rotation were 0.58 mm, 1.53 mm, and 6.0°, respectively.
CONCLUSION: With preoperative surgical simulation and templates, maxillary reconstruction can be performed accurately.

PMID: 26768077 [PubMed - as supplied by publisher]

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Prognostic value of 2-[(18) F]fluoro-2-deoxy-D-glucose positron emission tomography for patients with oral squamous cell carcinoma treated with retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy.

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Prognostic value of 2-[(18) F]fluoro-2-deoxy-D-glucose positron emission tomography for patients with oral squamous cell carcinoma treated with retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Oct 24;

Authors: Shimizu M, Mitsudo K, Koike I, Taguri M, Iwai T, Koizumi T, Oguri S, Kioi M, Hirota M, Inoue T, Tohnai I

Abstract
OBJECTIVE: To investigate whether 2-[(18) F]fluoro-2-deoxy-D-glucose (FDG) uptake of primary tumor in oral squamous cell carcinoma (OSCC) could predict prognosis.
STUDY DESIGN: Sixty-nine patients with OSCC who underwent retrograde superselective intra-arterial chemoradiotherapy were recruited and underwent dual-time-point FDG positron emission tomography twice, before treatment and 4 weeks after treatment. FDG uptake was defined as the standardized uptake value (SUVmax). The retention index (RI) and the percent change in SUV (% change SUV), derived from the dual-time-point scan, were calculated.
RESULTS: On univariate analysis, patients with high pre-SUV, RI, and percent change SUV values had significantly worse overall survival and disease-free survival compared with patients with low values. On multivariate analysis, high pre-RI (≥20.6%) and high percent change SUV (≥60.0%) (delayed-image) were associated with significantly worse overall survival. High pre-SUV (≥9.6) (delayed-image) and high pre-RI (≥20.6%) were associated with significantly shorter disease-free survival.
CONCLUSIONS: Dual-time-point FDG positron emission tomography in OSCC provided prognostic information and predicted patient outcome.

PMID: 26768076 [PubMed - as supplied by publisher]

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Ameloblastic carcinoma (secondary type) with extensive squamous differentiation areas and dedifferentiated regions.

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Ameloblastic carcinoma (secondary type) with extensive squamous differentiation areas and dedifferentiated regions.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Oct 13;

Authors: Fonseca FP, de Almeida OP, Vargas PA, Gonçalves F, Corrêa Pontes FS, Rebelo Pontes HA

Abstract
Ameloblastic carcinoma is rare, accounting for 1.5%-2.0% of all odontogenic tumors. Few small series are available, but data on its clinicopathologic characteristics derive mainly from single case reports; therefore, descriptions of new cases may help to better understand the biological characteristics of this rare odontogenic malignancy. In the current report we describe an ameloblastic carcinoma affecting a 27-year-old female patient who had a previous diagnosis of ameloblastoma 7 years before. The carcinoma featured extensive areas of squamous differentiation resembling a primary intraosseous squamous cell carcinoma, as well as areas of dedifferentiation, a poorly documented histologic characteristic of ameloblastic carcinoma. This case provides new insights on the microscopic spectrum of ameloblastic carcinoma, permitting a critical discussion of the current World Health Organization classification of this odontogenic tumor.

PMID: 26768075 [PubMed - as supplied by publisher]

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Approaches of robot-assisted neck dissection for head and neck cancer: a review.

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Approaches of robot-assisted neck dissection for head and neck cancer: a review.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Nov 14;

Authors: Zhou S, Zhang C, Li D

Abstract
Robot-assisted surgery is being increasingly used by surgeons because of its enhancement of visualization, precision, and articulation compared with conventional minimally invasive techniques. In recent years, robot-assisted neck dissection (RAND) has begun to be used as an alternative method of neck dissection, one of the classic surgical procedures in the area of head and neck surgery. Currently, there are four kinds of approaches for RAND: (1) modified facelift or retroauricular incision, (2) combined transaxillary and retroauricular incision, (3) transaxillary incision, and (4) transoral incision. RAND may help perform minimally invasive surgery and achieve excellent cosmetic results as well as the desired oncologic outcomes, and this requires selecting an appropriate approach based on the different needs of neck dissections. Although experienced surgeons wishing to avoid large cervical incisions in patients can safely perform RAND, there are still quite a few limitations; in particular, surgical morbidity and oncologic outcomes should be verified by further prospective clinical trials with longer follow-up periods. Also, RAND needs to be standardized and its use disseminated. In this review, we introduce the applications of different approaches for RAND and their indications and determine whether RAND can be more beneficial compared with conventional surgeries.

PMID: 26768074 [PubMed - as supplied by publisher]

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Ophthalmologic complications after administration of local anesthesia in dentistry: a systematic review.

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Ophthalmologic complications after administration of local anesthesia in dentistry: a systematic review.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Nov 10;

Authors: Alamanos C, Raab P, Gamulescu A, Behr M

Abstract
OBJECTIVE: The aim of this review was to investigate the association between the occurrence of ocular adverse events and dental local anesthesia, the most plausible anatomic mechanisms, and the measures that offer patients a restitutio ad integrum.
STUDY DESIGN: This systematic review adopted a structured protocol to access available publications and followed the PRISMA statement.
RESULTS: Eighty-nine cases of patients experiencing ocular adverse events after administration of dental local anesthesia have been reported in the literature. Most of the complications manifested as double vision. Only 8% of the complications caused permanent functional damage, either as vision deficit or anisocoria. Complete permanent blindness was not reported.
CONCLUSIONS: Ocular complications as a result of dental local anesthesia may be seen as rare occurrences with usually low intensity. However, visual function may become permanently impaired and serious medical conditions may obscure ocular dysfunction.

PMID: 26768073 [PubMed - as supplied by publisher]

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Direct effects of Facio-Oral Tract Therapy(®) on swallowing frequency of non-tracheotomised patients with acute neurogenic dysphagia.

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Direct effects of Facio-Oral Tract Therapy(®) on swallowing frequency of non-tracheotomised patients with acute neurogenic dysphagia.

SAGE Open Med. 2015;3:2050312115578958

Authors: Konradi J, Lerch A, Cataldo M, Kerz T

Abstract
OBJECTIVES: The aim of this study was to investigate the direct effect of Facio-Oral Tract Therapy(®) on swallowing frequency of non-tracheotomised patients with acute neurogenic dysphagia.
METHODS: Within a pre-, post-/during and follow-up study design, 19 non-tracheotomised dysphagic patients were included consecutively and treated according to three specific preselected Facio-Oral Tract Therapy stimulation techniques.
RESULTS: The primary outcome was the direct effect of the three different Facio-Oral Tract Therapy stimulation techniques on the number of swallows. We found a significant effect of Facio-Oral Tract Therapy on swallowing frequency as compared to baseline with an increase by 65.63% and medium effect size of D = 0.62. No significant difference could be demonstrated when comparing baseline to follow-up.
CONCLUSION: For the first time, this positive therapy effect could be demonstrated on a population of non-tracheotomised patients. Facio-Oral Tract Therapy seems to be an appropriate means for improving effectiveness and safety of swallowing. Since improvement was not long lasting, it appears to be reasonable to apply therapy frequently during the day with the plausible result of minimising the amount of aspirated saliva and thereby reducing the risk of aspiration pneumonia. Further studies may consider choosing a randomised controlled trial design to demonstrate that change in swallow frequency is related to the target intervention only.

PMID: 26770778 [PubMed]

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Feasibility and Safety of Transcutaneous Vagus Nerve Stimulation Paired with Notched Music Therapy for the Treatment of Chronic Tinnitus.

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Feasibility and Safety of Transcutaneous Vagus Nerve Stimulation Paired with Notched Music Therapy for the Treatment of Chronic Tinnitus.

J Audiol Otol. 2015 Dec;19(3):159-67

Authors: Shim HJ, Kwak MY, An YH, Kim DH, Kim YJ, Kim HJ

Abstract
BACKGROUND AND OBJECTIVES: A recent study demonstrated that tinnitus could be eliminated by vagus nerve stimulation (VNS) paired with notched sounds in a rat tinnitus model. The aims of this clinical study were to investigate the effects and safety of transcutaneous VNS (tVNS) by patch-type electrode paired with notched music for treating chronic tinnitus.
SUBJECTS AND METHODS: Thirty patients with refractory chronic tinnitus for >12 months were included in this study. A patch-type electrode was attached to the auricular concha of the patient's left ear and tVNS was performed for 30 min (pulse rate 25 Hz, pulse width 200 µs, and amplitude 1-10 mA) using a transcutaneous electric nerve stimulation eco2. During tVNS, the patients listened to notched music cleared of the frequency spectrum corresponding to the tinnitus with a 0.5 octave notch width.
RESULTS: After 10 treatment sessions, 15/30 patients (50%) reported symptom relief in terms of a global improvement questionnaire. The mean tinnitus loudness (10-point scale) and the mean tinnitus awareness score (%) improved significantly from 6.32±2.06 to 5.16±1.52 and from 82.40±24.37% to 65.60±28.15%, respectively (both p<0.05). None of the patients had any specific side effects, such as changes in heart rate or blood pressure.
CONCLUSIONS: This study has demonstrated the feasibility and safety of tVNS paired with notched music therapy in patients with chronic tinnitus, with the use of a pad-type electrode attached to the auricular concha.

PMID: 26771015 [PubMed]

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Tinnitus in patients with temporo-mandibular joint disorder: proposal for a new treatment protocol.

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Tinnitus in patients with temporo-mandibular joint disorder: proposal for a new treatment protocol.

Br Dent J. 2016 Jan 15;220(1):15

Authors:

Abstract
Only if otologic disorders and neurological diseases have been excluded, could treatment of a patient suffering from tinnitus be focussed on managing TMD.

PMID: 26768460 [PubMed - in process]

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Detection of the Epstein-Barr virus, Human Bocavirus and novel KI and KU polyomaviruses in adenotonsillar tissues.

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Detection of the Epstein-Barr virus, Human Bocavirus and novel KI and KU polyomaviruses in adenotonsillar tissues.

Int J Pediatr Otorhinolaryngol. 2015 Mar;79(3):423-7

Authors: Günel C, Kırdar S, Ömürlü İK, Ağdaş F

Abstract
OBJECTIVES: We aimed to investigate the seasonal disturbations and the rates of detection of Epstein-Barr virus (EBV), Human Bocavirus (HBoV), and polyomaviruses KI and WU (KIPyV and WUPyV) in adenoid and tonsil tissues during the absence of acute infection symptoms.
STUDY DESIGN: Cross-sectional prospective study.
SETTING: Tertiary hospital.
METHODS: DNA expressions of EBV, HBoV, polyomaviruses KIPyV and WUPyV were investigated in children with chronic tonsillar and adenoidal diseases using real-time polymerase chain reaction. The patients were grouped as follows: adenoid, recurrent tonsillitis and hypertrophic tonsillitis group. The relationships of the expressions of these viruses with age, gender, recurrent infection and airway obstruction were also analyzed. Seasonal variations in rates of detection of these viruses in adenoid and tonsil tissues were also investigated.
RESULTS: Considering adenoid specimens, HBoV was found to be the most frequent virus with the rate of 43.1%. In specimens of recurrent tonsillitis and hypertrophic tonsils, EBV was the most frequently encountered virus (53.8%, and 32.0%, respectively). In children with hypertrophic adenoids, while HBoV was detected to be positive throughout the year, EBV was present throughout the year in children with recurrent tonsillitis.
CONCLUSIONS: The detection of HBoV and EBV throughout the year in samples of children with asymptomatic chronic adenotonsillar diseases may indicate that these viruses may remain persistently in lymphoepithelial tissues of upper respiratory tract. Virus persistence may have a pathogenetic potential for development of lymphoid hypertrophy and a chronic stimulatory effect for inflammation.

PMID: 25631935 [PubMed - indexed for MEDLINE]

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Clinical characteristics of 15 cases of chronic subdural hematomas due to spontaneous intracranial hypotension with spinal cerebrospinal fluid leak.

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Clinical characteristics of 15 cases of chronic subdural hematomas due to spontaneous intracranial hypotension with spinal cerebrospinal fluid leak.

Acta Neurol Belg. 2016 Jan 14;

Authors: Wan Y, Xie J, Xie D, Xue Z, Wang Y, Yang S

Abstract
The etiology of chronic subdural hematoma (CSDH) in patients is diverse. The primary objective of this article was to discuss one of the causes, spontaneous intracranial hypotension with spinal cerebrospinal fluid (CSF) leak, which is usually neglected by the neurosurgeon. All the consecutive 15 patients who underwent operation for CSDHs between June 2012 and June 2014 at Sir Run Run Shaw Hospital of Zhejiang University were included in this retrospective cohort study. The clinical and imaging data of these patients with CSDHs due to spinal CSF leak were retrospectively studied. Fifteen patients, with a mean age of 53.8 ± 8.3 years, underwent operations for CSDH. Hematomas were unilateral in 4 patients and bilateral in 11 patients. Among these patients, eight patients had recurrence of hematomas after operation due to neglect of spinal CSF leak. All patients had fully recovery. Spinal CSF leak is a cause of cSDH, which is overlooked by the doctor.

PMID: 26769700 [PubMed - as supplied by publisher]

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Microsurgical management of vestibular schwannoma after failed previous surgery.

Microsurgical management of vestibular schwannoma after failed previous surgery.

J Neurosurg. 2016 Jan 15;:1-6

Authors: Samii M, Metwali H, Gerganov V

Abstract
OBJECTIVE Microsurgical treatment of recurrent vestibular schwannoma (VS) is difficult and poses specific challenges. The authors report their experience with 53 cases of surgically treated recurrent VS. Outcome of these tumors was compared to that of primarily operated on VS. Special attention was given to the facial nerve functional outcome. METHODS A retrospective analysis was performed of the patients who underwent surgery for recurrent VS at one institution from 2000 to 2013. The preoperative data, intraoperative findings, and outcome in terms of facial nerve function and improvement of the preoperative symptoms were analyzed and compared with those in a control group of 30 randomly selected patients with primarily operated on VS. A multivariate regression analysis was performed to test the factors that could affect the facial nerve outcome in each group. RESULTS Fifty-three consecutive patients underwent surgery for recurrent VS. Seventeen patients were previously operated on and received postoperative radiosurgery (Group A). Thirty-six patients were previously operated on but did not receive postoperative radiosurgery (Group B). The overall postoperative facial nerve function was significantly worse in Groups A and B in comparison with the control group (Group C). Interestingly, there was no significant difference in the facial nerve outcome among the 3 groups in patients who had good preoperative facial nerve function. The tumor size and the preoperative facial nerve function are variables that significantly affect the facial nerve outcome. Most of the patients showed improvement of the preoperative symptoms, such as trigeminal hypesthesia, gait disturbance, and headache. CONCLUSIONS Complete microsurgical tumor removal is the optimal management for patients with recurrent or regrowing VS. The procedure is safe, associated with favorable facial nerve outcome, and may also improve existing neurological symptoms.

PMID: 26771854 [PubMed - as supplied by publisher]

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Comprehensive review on endonasal endoscopic sinus surgery.

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Comprehensive review on endonasal endoscopic sinus surgery.

GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:Doc08

Authors: Weber RK, Hosemann W

Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.

PMID: 26770282 [PubMed]

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Trauma of the midface.

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Trauma of the midface.

GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:Doc06

Authors: Kühnel TS, Reichert TE

Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.

PMID: 26770280 [PubMed]

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Comprehensive review on rhino-neurosurgery.

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Comprehensive review on rhino-neurosurgery.

GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:Doc01

Authors: Hosemann W, Schroeder HW

Abstract
In the past 2 decades, an innovative and active field of surgical collaboration has been evolved and established combining the expertise of neurosurgery and rhinosurgery in the endonasal treatment of different lesions affecting the anterior skull base together with the adjacent intranasal and intradural areas. Important prerequisites for this development were improvements of technical devices, definitions of transnasal surgical corridors, and approvements in endonasal reconstructions, e.g. by use of pedicled nasal mucosal flaps. Due to these improvements, the rate of perioperative infectious complications remained acceptable. Interdisciplinary surgical teams (4-hands-2-minds) have been established constituting specialized centers of "rhino-neurosurgery". With growing expertise of these groups, it could be shown that oncological results and perioperative complications were comparable to traditional surgery while at the same time the patients' morbidity could be reduced. The present review encompasses the recent literature focusing on the development, technical details, results, and complications of "rhino-neurosurgery".

PMID: 26770276 [PubMed]

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Skull base osteomyelitis missed in mastoidectomy for cholesteatoma.

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Skull base osteomyelitis missed in mastoidectomy for cholesteatoma.

Acta Otolaryngol. 2016 Jan 15;:1-3

Authors: Lee HS, Yang CJ, Lee JH, Ahn JH

Abstract
Conclusions A high suspicion of skull base involvement should be warranted, even if radiological findings are not atypical, in cases of chronic otitis media (COM) with cholesteatoma. Objective To investigate some clues indicating the development of skull base osteomyelitis (SBO) in patients who received mastoidectomy, through reviewing pre-operative temporal bone computed tomography (TBCT). Method Retrospective review of patients with SBO after mastoidectomy for COM. A total of five patients with SBO after mastoidectomy with available pre-operative TBCTs were enrolled in this study. Results All patients were diagnosed as COM with cholesteatoma and open cavity mastoidectomy was performed. After surgery, SBO were occurred. The recovery in these five patients was complicated by lower cranial nerve palsy, and one patient had a stroke due to lateral thrombophlebitis. Through re-interpretation of pre-operative TBCT, the bony destruction around the skull base missed at the initial diagnosis was observed in all cases.

PMID: 26767507 [PubMed - as supplied by publisher]

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National trends, complications, and hospital charges in pediatric patients with Chiari malformation type I treated with posterior fossa decompression with and without duraplasty.

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National trends, complications, and hospital charges in pediatric patients with Chiari malformation type I treated with posterior fossa decompression with and without duraplasty.

Pediatr Neurosurg. 2015;50(1):31-7

Authors: Shweikeh F, Sunjaya D, Nuno M, Drazin D, Adamo MA

Abstract
BACKGROUND: The treatment of type 1 Chiari malformation (CM-1) with posterior fossa decompression without (PFD) or with duraplasty (PFDD) is controversial. The authors analyze both options in a national sample of pediatric patients.
METHODS: Utilizing the Kids' Inpatient Database, CM-1 patients undergoing PFD or PFDD from 2000 through 2009 were analyzed.
RESULTS: 1,593 patients with PFD and 1,056 with PFDD were evaluated. The average age was 10.3 years, slightly younger in PFD (9.8 vs. 10.9 years, p = 0.001). PFDD patients were more likely White (81.2 vs 75.6%, p = 0.04) and less likely admitted emergently (8.4 vs. 13.8%, p = 0.007). They also underwent more reoperations (2.1 vs. 0.7%, p = 0.01), had more procedure-related complications (2.3 vs. 0.8%, p = 0.003), a longer length of stay (4.4 vs. 3.8 days, p = 0.001) and higher charges (USD 35,321 vs. 31,483, p = 0.01).
CONCLUSIONS: This large national study indicates that PFDD is performed more often in Caucasians, less so emergently, and associated with significantly more complications and immediate reoperations, while PFD is more frequent in those with syringomyelia and more economical, requiring fewer hospital resources. Overall, PFD is more favorable for CM-1, though it would be prudent to conduct a prospective trial, as this analysis is limited by data on preoperative presentations and long-term outcomes.

PMID: 25721939 [PubMed - indexed for MEDLINE]

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Craniofacial and pharyngeal airway morphology in patients with acromegaly.

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Craniofacial and pharyngeal airway morphology in patients with acromegaly.

Acta Odontol Scand. 2015 Aug;73(6):433-40

Authors: Balos Tuncer B, Canigur Bavbek N, Ozkan C, Tuncer C, Eroglu Altinova A, Gungor K, Akturk M, Balos Toruner F

Abstract
OBJECTIVE: The aim of this study was to assess differences in craniofacial characteristics, upper spine and pharyngeal airway morphology in patients with acromegaly compared with healthy individuals.
MATERIALS AND METHODS: Twenty-one patients with acromegaly were compared with 22 controls by linear and angular measurements on cephalograms. The differences between the mean values of cephalometric parameters were analyzed with Mann-Whitney U-test.
RESULTS: With respect to controls, anterior (p<0.05), middle (p<0.01) and posterior (p<0.05) cranial base lengths were increased, sella turcica was enlarged (p<0.001) and upper spine morphology demonstrated differences in the height of atlas (p<0.01) and axis (p<0.05) in patients with acromegaly. Craniofacial changes were predominantly found in the frontal bone (p<0.01) and the mandible (p<0.05). As for the airway, patients with acromegaly exhibited diminished dimensions at nasal (p<0.001), uvular (p<0.01), mandibular (p<0.01) pharyngeal levels and at the narrowest point of the pharyngeal airway space (p<0.001) compared to healthy controls. Soft palate width was significantly higher (p<0.001) and the hyoid bone was more vertically positioned (p<0.01) in patients with acromegaly.
CONCLUSIONS: Current results point to the importance of the reduced airway dimensions and that dentists and/or orthodontists should be aware of the cranial or dental abnormalities in patients with acromegaly.

PMID: 25543455 [PubMed - indexed for MEDLINE]

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