[NK/T-cell Lymphoma of nasal-type: A rare affection with a poor prognosis].

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[NK/T-cell Lymphoma of nasal-type: A rare affection with a poor prognosis].

Rev Stomatol Chir Maxillofac Chir Orale. 2016 Mar 10;

Authors: Doh K, Tagba E, Thiam I, Sarr A, Woto-Gaye G

Abstract
INTRODUCTION: NK/T cell lymphoma of nasal-type was described in 1933 as a malignant midfacial granuloma. The diagnosis of this rare affection is clinical and immunohistopathological. We report a case of NK/T cell lymphoma diagnosed at an advanced stage.
OBSERVATION: A 60-year-old man with no particular medical history presented since seven months with a left nasal obstruction associated with a purulent and fetid rhinorrhea followed by a centrifugal midfacial necrosis. Blood tests showed an inflammatory syndrome. The CT-scan of the face showed a filling of the nose and sinus by a tissular process and a lysis of the bone walls. Three series of biopsies (le last being performed under general anesthesia) were necessary to get the diagnosis of NK/T cell lymphoma. The standard histology showed a malignant proliferation made of round and spindle-shaped lymphoid-like cells and angiocentric arrangement. The cells were CD 2+, CD 3+, CD 5+ and CD 56+. The spontaneous evolution was fatal one month after diagnosis in a context of septic shock.
CONCLUSION: NK/T cell lymphoma of nasal-type is a rare disease but should be evocated in patient with midfacial necrosis of centrifugal evolution. The diagnosis certainty is made on immunohistopathological analysis. Multiple biopsies, made at distance from necrotic areas and under general anesthesia may be necessary.

PMID: 26972561 [PubMed - as supplied by publisher]

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Long-term efficacy of percutaneous steroid injection for treating benign vocal fold lesions: A prospective study.

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Long-term efficacy of percutaneous steroid injection for treating benign vocal fold lesions: A prospective study.

Laryngoscope. 2016 Mar 12;

Authors: Lee SW, Park KN

Abstract
OBJECTIVES/HYPOTHESIS: This study assessed the long-term efficacy and recurrence rates of percutaneous steroid injections (PSIs) for benign vocal fold lesions.
STUDY DESIGN: Prospective clinical study.
METHODS: A prospective human clinical trial was performed from October 2008 to September 2014 at Soonchunhyang University Hospital, Bucheon, Korea. Percutaneous steroid injection was performed in 84 consecutive patients with small benign vocal fold lesions, such as vocal fold nodules, polyps, and Reinke's edema, who could not be treated with voice therapy or surgery. Patients had acoustic aerodynamic, perceptual, stroboscopic, and voice handicap index evaluations before PSI and also 3, 6, 12, and 24 months after PSI.
RESULTS: Of the 84 patients, 37 (44.0%) showed complete remission; 22 (26.2%) showed partial remission; five (6%) had no response; and 20 (23.8%) developed recurrences after PSI. Most of the objective and subjective parameters that improved statistically (P < 0.05) 3 months after PSI remained stable until 24 months. For the recurrences, the average recurrence time interval after PSI was 8.5 ± 8.2 (range 3-36) months. Recurrence was associated with voice abuse after PSI and professional voice users (P < 0.05). Complications during follow-up included minimal vocal fold hematomas in 2.4% (2 of 84) and mild vocal fold atrophy in 1.2% (1 of 84).
CONCLUSION: Percutaneous steroid injection is a useful alternative modality for treating benign vocal fold lesions without morbidity. However, recurrence rates were higher with voice abuse after PSI and professional voice users.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2016.

PMID: 26971530 [PubMed - as supplied by publisher]

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Bilateral Vestibular Hypofunction: Insights in Etiologies, Clinical Subtypes, and Diagnostics.

Bilateral Vestibular Hypofunction: Insights in Etiologies, Clinical Subtypes, and Diagnostics.

Front Neurol. 2016;7:26

Authors: Lucieer F, Vonk P, Guinand N, Stokroos R, Kingma H, van de Berg R

Abstract
OBJECTIVE: To evaluate the different etiologies and clinical subtypes of bilateral vestibular hypofunction (BVH) and the value of diagnostic tools in the diagnostic process of BVH.
MATERIALS AND METHODS: A retrospective case review was performed on 154 patients diagnosed with BVH in a tertiary referral center, between 2013 and 2015. Inclusion criteria comprised (1) imbalance and/or oscillopsia during locomotion and (2) summated slow phase velocity of nystagmus of less than 20°/s during bithermal caloric tests.
RESULTS: The definite etiology of BVH was determined in 47% of the cases and the probable etiology in 22%. In 31%, the etiology of BVH remained idiopathic. BVH resulted from more than 20 different etiologies. In the idiopathic group, the percentage of migraine was significantly higher compared to the non-idiopathic group (50 versus 11%, p < 0.001). Among all patients, 23.4% were known with autoimmune disorders in their medical history. All four clinical subtypes (recurrent vertigo with BVH, rapidly progressive BVH, slowly progressive BVH, and slowly progressive BVH with ataxia) were found in this population. Slowly progressive BVH with ataxia comprised only 4.5% of the cases. The head impulse test was abnormal in 94% of the cases. The torsion swing test was abnormal in 66%. Bilateral normal hearing to moderate hearing loss was found in 49%. Blood tests did not often contribute to the determination of the etiology of the disease. Abnormal cerebral imaging was found in 21 patients.
CONCLUSION: BVH is a heterogeneous condition with various etiologies and clinical characteristics. Migraine seems to play a significant role in idiopathic BVH and autoimmunity could be a modulating factor in the development of BVH. The distribution of etiologies of BVH probably depends on the clinical setting. In the diagnostic process of BVH, the routine use of some blood tests can be reconsidered and a low-threshold use of audiometry and cerebral imaging is advised. The torsion swing test is not the "gold standard" for diagnosing BVH due to its lack of sensitivity. Future diagnostic criteria of BVH should consist of standardized vestibular tests combined with a history that is congruent with the vestibular findings.

PMID: 26973594 [PubMed]

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Response of a patient with severe thyroid dermopathy to combined multipoint subcutaneous injection of glucocorticoid and local excision.

Response of a patient with severe thyroid dermopathy to combined multipoint subcutaneous injection of glucocorticoid and local excision.

Thyroid. 2016 Mar 14;

Authors: Huang Y, Wei C, Ma S, Fu Y, Xu W

Abstract
(No Abstract in "Letter to the Editor" type).

PMID: 26971589 [PubMed - as supplied by publisher]

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Inappropriate suppression of thyrotropin concentrations in young patients with thyroid nodules including thyroid cancer: the Fukushima Health Management survey.

Inappropriate suppression of thyrotropin concentrations in young patients with thyroid nodules including thyroid cancer: the Fukushima Health Management survey.

Thyroid. 2016 Mar 14;

Authors: Suzuki S, Nakamura I, Suzuki S, Ohkouchi C, Mizunuma H, Midorikawa S, Fukushima T, Ito Y, Shimura H, Ohira T, Matsuzuka T, Ohtsuru A, Abe M, Yamashita S, Suzuki S

Abstract
BACKGROUND: Serum thyroid hormone concentration is regulated through the hypothalamic-pituitary-thyroid axis. We aimed at clarifying the relationships between thyroid hormone regulation and ultrasonographic findings in subjects with thyroid nodules detected during thyroid ultrasound examination for the Fukushima Health Management Survey.
METHODS: As of October 31, 2014, a total of 296,253 subjects, who had been living in Fukushima Prefecture at the time of the Fukushima nuclear power plant accident and were aged 18 years or younger on March 11, 2011, participated in two concurrent screening programs. In the primary screening, thyroid nodules were detected in a total of 2,241 subjects. A secondary confirmatory thyroid ultrasound examination and blood sampling for thyroid function tests were performed on 2,004 subjects. The subjects were re-assessed and classified into disease-free subjects (Group 1), subjects with cysts only (Group 2), subjects with nodules (Group 3), and subjects with malignancy or suspected malignancy (Group 4). Serum concentrations of FT3, FT4, thyrotropin (TSH), and thyroglobulin, as well as the FT3/FT4 ratio were classified according to the diagnoses.
RESULTS: Inverse relationships between age and log TSH values (Spearman's correlation r = -0.311, P = 0.015), serum FT3 concentration (r = -0,688, P < 0.001), and the FT3/FT4 ratio (r = -0.520, P < 0.001) were observed in Group 1. When ANCOVA with Bonferroni post hoc comparisons was used in the four groups, the log TSH values were significantly lower in either Group 3 or Group 4 compared to either Group 1 or Group 2 after correction for age (ANCOVA P < 0.001, Group 1 vs. Group 3; P = 0.016, Group 1 vs. Group 4; P = 0.022, Group 2 vs. Group 3; P = 0.001, Group 2 vs Group 4; P = 0.008). However, no significant differences were observed between the four groups regarding levels of FT3, FT4, FT3/FT4 ratio, and thyroglobulin (ANCOVA P = 0.304, 0.340, 0.208, and 0.583, respectively).
CONCLUSION: TSH suppression can be present in response to illness, including thyroid nodules, in young subjects. Low TSH levels may be associated with the finding of a papillary thyroid cancer, but also with thyroid nodules, in children and adolescents.

PMID: 26971545 [PubMed - as supplied by publisher]

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Highly concordant key genetic alterations in primary tumors and matched distant metastases in differentiated thyroid cancer.

Highly concordant key genetic alterations in primary tumors and matched distant metastases in differentiated thyroid cancer.

Thyroid. 2016 Mar 14;

Authors: Sohn SY, Park WY, Shin HT, Bae JS, Ki CS, Oh YL, Kim SW, Chung JH

Abstract
BACKGROUND: Distant metastases uncommonly occur in differentiated thyroid carcinoma (DTC), but they are a frequent cause of thyroid cancer-related death. Genomic alterations in metastatic tumors, and the relationship with their corresponding primary tumors in DTC, are poorly understood. The objective of this study was to investigate whether genetic alterations in primary tumors are concordant with distant metastases in DTC patients.
METHODS: Surgical samples from primary and matched distant metastatic tumor pairs from 17 DTC patients, and three additional unpaired metastatic tumors from two patients, were analyzed using targeted next generation sequencing (Ion Torrent Ampliseq cancer panel) with a focus on known recurrent somatic mutations in thyroid cancer. Additionally, TERT promoter mutations were assessed by direct sequencing methods.
RESULTS: BRAF mutations were found in 8 of 10 patients with papillary thyroid carcinoma (PTC). NRAS mutation was detected in one patient with follicular variant PTC. TERT promoter mutations were detected in 8 of 10 patients with PTC and most were coexistent with BRAF mutation (7 of 8 BRAF-positive and one BRAF-negative PTC patients). In follicular thyroid carcinoma (FTC), NRAS was the most frequently observed mutation (4 of 9 patients), followed by HRAS (2 patients) and KRAS (one patient). TERT promoter mutations were found in 6 of 7 RAS positive FTC patients. Key somatic alterations such as BRAF and RAS mutations were highly concordant between primary and matched metastatic tumors without discrepancies. The BRAF or RAS mutant allelic frequency was higher in matched metastatic tumors than in the corresponding primary tumors (35% vs. 25% for BRAF mutation, P=0.04 and 40% vs. 34% for RAS mutation, P=0.002). TERT promoter mutations were also mostly concordant in matched tumors (concordance rate 93%).
CONCLUSIONS: BRAF, RAS and TERT mutations are highly prevalent in metastatic DTC and are concordant between primary and metastatic DTC. This high concordance suggests that primary tumors may reflect the key somatic alterations in matched metastatic DTC. Frequent coexistent TERT promoter and BRAF or RAS mutations in metastatic DTC also suggests its important role in the progression of DTC.

PMID: 26971368 [PubMed - as supplied by publisher]

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Dural diverticulum with a symptomatic cerebrospinal fluid leak.

Dural diverticulum with a symptomatic cerebrospinal fluid leak.

Radiol Case Rep. 2016 Mar;11(1):16-20

Authors: Armstrong N, Williamson C, Williamson N, Fortes M, Tjauw I, Vij V, Trojan R

Abstract
A case report of a 63-year-old female patient with a cervical spinal dural diverticulum and intracranial hypotension secondary to a symptomatic CSF leak after minor trauma. The patient responded well after the cervical approach epidural blood patch procedure.

PMID: 26973722 [PubMed]

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Fascia patchwork closure for endoscopic endonasal skull base surgery.

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Fascia patchwork closure for endoscopic endonasal skull base surgery.

Neurosurg Rev. 2015 Jul;38(3):551-6; discussion 556-7

Authors: Ishii Y, Tahara S, Hattori Y, Teramoto A, Morita A, Matsuno A

Abstract
With the development of endoscopic technology and surgery, resection of midline skull base tumors has been achieved using endoscopic endonasal skull base (EESB) approaches. EESB approaches reportedly have a greater risk of postoperative cerebrospinal fluid (CSF) leakage. Recently, the introduction of the nasoseptal flap (NSF) decreased dramatically the incidence of CSF leakage, but the use of an NSF increases the risk of disturbing the function of the nose. Here, we report our new technique called "fascia patchwork closure" for closure after EESB surgery and its outcome. All 48 cases involved midline skull base tumors resected via EESB approaches. Of them, 32 cases were closed by the fascia patchwork technique after tumor resection, and there was no incidence of CSF leakage. Moreover, 6 of the 32 cases were closed without the use of an NSF, indicating that the fascia patchwork closure approach is effective as part of a multilayer closure for the prevention of CSF leakage. The establishment and popularization of this technique might result in the further development of EESB surgery and also an improvement of postoperative nasal function.

PMID: 25675847 [PubMed - indexed for MEDLINE]

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Silicone Granuloma in the Buttocks Incidentally Detected by 18F-FDG PET/CT 30 Years After Free Liquid Silicone Injections.

Silicone Granuloma in the Buttocks Incidentally Detected by 18F-FDG PET/CT 30 Years After Free Liquid Silicone Injections.

Clin Nucl Med. 2016 Mar 11;

Authors: Ohnona J, Durand P, Amegnizin JL, Kerrou K

Abstract
A 59-year-old transexual (male to female) patient presented with a squamous cell carcinoma of the larynx. She underwent an F-FDG PET/CT for initial staging. The examination showed high F-FDG uptake of the primary lesion and a homolateral lymphadenopathy. Incidental heterogeneous uptake of round hyperdense lesions in the gluteal muscles and subcutaneous fat was visualized. The medical history revealed secondly that the patient had had free liquid silicone injections 30 years before the examination. Although the injection of free silicone is not practised since the 1980s, this incidental finding should prompt to check the patient's medical history over several decades.

PMID: 26975013 [PubMed - as supplied by publisher]

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Clinical characteristics of a Japanese family with hearing loss accompanied by compound heterozygous mutations in LOXHD1.

Clinical characteristics of a Japanese family with hearing loss accompanied by compound heterozygous mutations in LOXHD1.

Auris Nasus Larynx. 2016 Mar 10;

Authors: Minami SB, Mutai H, Namba K, Sakamoto H, Matsunaga T

Abstract
OBJECTIVE: To report two novel LOXHD1 mutations, including missense mutations and the clinical features of the patients.
METHODS: We studied a three-generation Japanese family with hearing loss. Targeted next-generation sequencing was used for genetic analysis. Conditional orientation response audiometry and pure tone audiometry were used to assess hearing. SWISS-MODEL was used for molecular modeling of the PLAT domain in LOXHD1 protein.
RESULTS: The two sisters, who had either mild or severe high-frequency hearing loss, were compound heterozygous for two novel mutations (c.5674G>T [p.V1892F] and c.4212+1G>A) in LOXHD1, which is responsible for autosomal-recessive nonsyndromic hearing loss DFNB77. These cases showed less severe hearing impairment than the previously reported cases carrying LOXHD1 mutations, but their hearing loss appeared to be progressive. Molecular modeling predicted that distorted structure of the PLAT domain in the p.V1892F mutant could lead to decreased affinity of the protein to lipid membrane resulting in hair cell dysfunction.
CONCLUSION: We report a Japanese family carrying compound heterozygotes of truncating and nontruncating mutations in LOXHD1 identified by targeted NGS analysis. The fact of lower degree of hearing impairment in our cases than previously reported and the molecular modeling of the missense mutant provide insight to the genotype-phenotype correlation of DFNB77.

PMID: 26973026 [PubMed - as supplied by publisher]

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Effect of vocal fold asymmetries on glottal flow.

Effect of vocal fold asymmetries on glottal flow.

Laryngoscope. 2016 Mar 12;

Authors: Oren L, Khosla S, Gutmark E

Abstract
OBJECTIVES/HYPOTHESIS: Voice disorders, such as unilateral vocal fold paralysis or paresis, and vocal fold scarring feature structural asymmetries of the vocal folds. Studies on how structural asymmetries affect voice has mostly been limited to computational simulations and experiments on mechanical models. The purpose of the current study is to examine the effects of asymmetries in left-right position, height, and length of the vocal folds on the intraglottal flow characteristics, as well as acoustics in the canine larynx model.
STUDY DESIGN: Basic science.
METHODS: Measurements of intraglottal flow velocity fields were taken in excised canine larynges using particle image velocimetry. Asymmetries of the vocal folds are induced by translating the vocal processes in space using a prong apparatus connected to a micrometer.
RESULTS: Asymmetries in length height and abduction produced a reduction in the intraglottal vortices strength and subsequently the glottal efficiency.
CONCLUSION: Current findings can affect future recommendations for surgical interventions that are used to treat unilateral vocal fold paralysis.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2016.

PMID: 26972976 [PubMed - as supplied by publisher]

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Voice features of Parkinson's disease patients with subthalamic nucleus deep brain stimulation.

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Voice features of Parkinson's disease patients with subthalamic nucleus deep brain stimulation.

J Neurol. 2015 May;262(5):1173-81

Authors: Tanaka Y, Tsuboi T, Watanabe H, Kajita Y, Fujimoto Y, Ohdake R, Yoneyama N, Masuda M, Hara K, Senda J, Ito M, Atsuta N, Horiguchi S, Yamamoto M, Wakabayashi T, Sobue G

Abstract
Voice and speech disorders are one of the most important issues after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease patients; however, their characteristics remain unclear. We performed a comprehensive voice evaluation including the multi-dimensional voice program for acoustic analysis, the GRBAS scale for perceptual analysis, and the evaluation of the voice handicap index (VHI) for psychosocial analysis. In total, 68 patients who had undergone STN-DBS (37 assessed in the on- and off-stimulation conditions) and 40 who had been treated with medical therapy alone were evaluated. Further, we performed laryngoscopic examinations in 13 STN-DBS and 19 medical-therapy-alone patients. The STN-DBS group, especially females, showed widespread impairment of voice parameters and significantly poorer VHI scores than the medical-therapy-alone group. The degree of voiceless (DUV) and strained voice were the most impaired factors in the STN-DBS group; and DUV significantly improved after stopping stimulation. Furthermore strained voice, breathiness, and asthenia improved after stopping stimulation. Laryngoscopic examination showed that abnormal laryngeal muscle contraction and incomplete glottal closure were more prominent in the STN-DBS group than in the medical-therapy-alone group. We demonstrated that (1) more widespread voice impairment in females, (2) poorer voice-related QOL, (3) worse DUV and strained voice, and (4) abnormal laryngeal muscle contraction were the characteristic voice and laryngeal findings in the STN-DBS group compared with those in the medical-therapy-alone group.

PMID: 25712544 [PubMed - indexed for MEDLINE]

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Effect of saline inhalation on vocal fold epithelial morphology evaluated by optical coherence tomography.

Effect of saline inhalation on vocal fold epithelial morphology evaluated by optical coherence tomography.

Laryngoscope. 2016 Mar 12;

Authors: Jungheim M, Donner S, Bleeker S, Ripken T, Krueger A, Ptok M

Abstract
OBJECTIVES/HYPOTHESIS: Examination of tissue structures by optical coherence tomography (OCT) has been shown to be useful on mucous membranes of the vocal folds, but so far its application to the human larynx has been limited because it is technically cumbersome and usually needs to be performed with sedation. Here a newly developed, noninvasive combined laryngoscopy and OCT procedure is described and its suitability for ambulatory OCT studies evaluated. Because inhalation therapies utilizing saline solutions are commonly used as a treatment option for disorders of the airways, and vocal fold epithelium is most likely to be affected due to its superficial positioning, epithelial thickness was chosen as a relevant test parameter and evaluated before and after saline inhalation.
METHODS: Seven vocally healthy participants performed a 10-minute inhalation of saline solution and underwent a combined laryngoscopy and OCT before and after the inhalation therapy. Endoscopy was performed using a newly developed combined laryngoscopy and OCT device. The OCT images were used to estimate the epithelial thickness of the vocal folds.
RESULTS: Epithelial thickness measured in all participants before treatment was comparable in size reported in previous studies. Statistical differences before and after inhalation were not detected.
CONCLUSION: The newly developed combined laryngoscopy and OCT procedure enables rapid investigation of the vocal fold epithelium. Inhalation of saline solution did not appear to affect the thickness of the epithelium of the vocal folds in vocally healthy subjects, as evaluated by OCT.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2016.

PMID: 26972688 [PubMed - as supplied by publisher]

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Patterns of Recurrence in Electively Irradiated Lymph Node Regions After Definitive Accelerated Intensity Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma.

Patterns of Recurrence in Electively Irradiated Lymph Node Regions After Definitive Accelerated Intensity Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma.

Int J Radiat Oncol Biol Phys. 2016 Mar 15;94(4):766-74

Authors: van den Bosch S, Dijkema T, Verhoef LC, Zwijnenburg EM, Janssens GO, Kaanders JH

Abstract
PURPOSE: To provide a comprehensive risk assessment on the patterns of recurrence in electively irradiated lymph node regions after definitive radiation therapy for head and neck cancer.
METHODS AND MATERIALS: Two hundred sixty-four patients with stage cT2-4N0-2M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx treated with accelerated intensity modulated radiation therapy between 2008 and 2012 were included. On the radiation therapy planning computed tomography (CT) scans from all patients, 1166 lymph nodes (short-axis diameter ≥5 mm) localized in the elective volume were identified and delineated. The exact sites of regional recurrences were reconstructed and projected on the initial radiation therapy planning CT scan by performing coregistration with diagnostic imaging of the recurrence.
RESULTS: The actuarial rate of recurrence in electively irradiated lymph node regions at 2 years was 5.1% (95% confidence interval 2.4%-7.8%). Volumetric analysis showed an increased risk of recurrence with increasing nodal volume. Receiver operating characteristic analysis demonstrated that the summed long- and short-axis diameter is a good alternative for laborious volume calculations, using ≥17 mm as cut-off (hazard ratio 17.8; 95% confidence interval 5.7-55.1; P<.001).
CONCLUSIONS: An important risk factor was identified that can help clinicians in the pretreatment risk assessment of borderline-sized lymph nodes. Not overtly pathologic nodes with a summed diameter ≥17 mm may require a higher than elective radiation therapy dose. For low-risk elective regions (all nodes <17 mm), the safety of dose de-escalation below the traditional 45 to 50 Gy should be investigated.

PMID: 26972649 [PubMed - in process]

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Interactions of subglottal pressure and neuromuscular activation on fundamental frequency and intensity.

Interactions of subglottal pressure and neuromuscular activation on fundamental frequency and intensity.

Laryngoscope. 2016 Mar 12;

Authors: Chhetri DK, Park SJ

Abstract
OBJECTIVES/HYPOTHESIS: Fundamental frequency (F0) and intensity sound pressure level (SPL) of voice are controlled by intrinsic laryngeal muscle (ILM) activation and subglottal pressure (Psub). Their interactions were investigated.
METHODS: In an in vivo canine model, the thyroarytenoid (TA), lateral cricoarytenoid/interarytenoid (LCA/IA), and cricothyroid (CT) muscles were independently activated from threshold to maximal contraction by neuromuscular stimulation in various combinations, whereas airflow was increased to phonation onset pressure and beyond. The resultant acoustic output was analyzed for effects of Psub on vibratory stability, F0, and SPL. Muscle activation plots and vocal range profiles by individual ILM activation states were analyzed.
RESULTS: Cricothyroid activation increased phonation onset F0, but vibration was less stable in high CT conditions and displayed vibratory mode change. In addition, a decrease in F0 with increased Psub was observed in high CT conditions. Intensity increased with Psub in all conditions, but the slope was greater at high CT, low TA/LCA/IA activations. Lateral cricoarytenoid/interarytenoid activation improved vocal efficiency. To maintain same F0 with increasing SPL (messa di voce), TA activation was decreased and LCA/IA activation was increased. The same F0 and SPL could be achieved with a variety of ILM activation combinations.
CONCLUSION: Cricothyroid is primarily required for increasing F0, whereas TA can increase or decrease F0 and SPL. Lateral cricoarytenoid/interarytenoid activation likely maintains vocal fold adduction during increased Psub and improves vocal efficiency. This study also demonstrates laryngeal motor equivalence, the ability of the larynx to achieve the same target F0 and SPL with multiple combinations of ILM activation.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2015.

PMID: 26971707 [PubMed - as supplied by publisher]

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Retrospective study to determine the accuracy of template-guided implant placement using a novel nonradiologic evaluation method.

Retrospective study to determine the accuracy of template-guided implant placement using a novel nonradiologic evaluation method.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Apr;121(4):e72-9

Authors: Schnutenhaus S, Edelmann C, Rudolph H, Luthardt RG

Abstract
OBJECTIVES: With a novel, noninvasive method for determining three-dimensional accuracy, the realized implant position relative to the planned implant position was analyzed retrospectively. Additional postoperative cone beam computed tomography was thus dispensable.
STUDY DESIGN: Twelve cases with distal extension situations (DESs) or single tooth gaps (STGs) were evaluated. The data sets of the planned implant position were superimposed on the actually achieved implant position, retrieved from digitizing the implant impression. The deviations were measured and statistically analyzed.
RESULTS: The mean deviation was 5° in the DES group and 4° in the STG group for the implant axes, 1 mm (DES) and 0.9 mm (STG) at the implant neck, and 1.6 mm (DES) and 1.5 mm (STG) at the implant apex. The mean height discrepancy was 0.5 mm (DES) and 0.5 mm (STG). No significant differences (P > .05) were found between the DES and STG groups.
CONCLUSIONS: The innovative, noninvasive evaluation method is suitable and sufficiently accurate for the assessment of larger cohorts. The results of our study showed a sufficiently high degree of accuracy when using a virtual planning program for which no radiopaque template is needed when performing cone beam computed tomography.

PMID: 26972545 [PubMed - in process]

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Upregulation of proangiogenic factors expression in the synovium of temporomandibular joint condylar hyperplasia.

Upregulation of proangiogenic factors expression in the synovium of temporomandibular joint condylar hyperplasia.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Apr;121(4):e65-71

Authors: Guo H, Fang W, Chen G, Xu J, Li C, Feng Y, Li Y, Long X

Abstract
OBJECTIVE: Condylar hyperplasia (CH) is a complex disorder of the temporomandibular joint. Many studies have focused on cartilage proliferation, but the behavior of the synovium in CH is poorly understood. The aim of the present study was to investigate the expression of angiogenic-associated factors in the synovium and to discuss the possible role of the synovium in CH progression.
STUDY DESIGN: CH condylar tissues were stained by hematoxylin and eosin staining, and proliferative activity was confirmed by single-photon emission computed tomography. Synovial cells isolated from the temporomandibular joint of patients with CH were collected, and flow cytometric analysis was used to examine the expression of CD34 and CD44. The gene expression of FGF-2, MMP1, MMP3, and MMP13 in synovial cells was examined by quantitative real-time polymerase chain reaction. Western blotting was used to detect the protein expression of VEGF, FGF-2, ANG1, DKK1, TSP1, MMP1, MMP3, MMP13, TIMP1, and TIMP3.
RESULTS: The typical hyperplastic area and activity were observed in condylar tissues. The expression of VEGF, FGF-2, ANG1, DKK1, TIMP1, TIMP3, and CD34 was significantly increased in the synovial cells of CH, but TSP1, MMP1, MMP3, and MMP13 expression was decreased.
CONCLUSIONS: This study exhibited a potential role for proangiogenic factors in the pathogenesis of CH.

PMID: 26972544 [PubMed - in process]

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Multiple complex odontoma of the maxilla and mandible-reply.

Multiple complex odontoma of the maxilla and mandible-reply.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Apr;121(4):443-4

Authors: Sun L, Sun Z

PMID: 26972543 [PubMed - in process]

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Meaningful correlation between asymptomatic retinal arteriole emboli and calcified carotid plaque found on panoramic dental imaging of males with diabetes.

Meaningful correlation between asymptomatic retinal arteriole emboli and calcified carotid plaque found on panoramic dental imaging of males with diabetes.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Apr;121(4):434-40

Authors: Friedlander AH, Giaconi JA, Tsui I, Aghazadehsanai N, Chang TI, Garrett NR

Abstract
OBJECTIVE: There is ongoing controversy with regard to the stability of calcified carotid artery plaques (CCAPs) seen in the bifurcation area on panoramic images (PIs). Therefore, we sought to evaluate the possibility of these plaques shedding emboli by observing their relationship with ipsilateral retinal emboli.
STUDY DESIGN: The study group included 50 neurologically and visually asymptomatic males with diabetes, with PIs that incidentally demonstrated CCAPs (CCAP+) and contemporaneous digital retinal images that had been obtained for evaluation of diabetic retinopathy. The control group consisted of 50 males with diabetes who were matched for age and body mass index and had undergone both imaging studies and whose PIs were devoid of carotid plaques (CCAP-). The presence of retinal emboli was determined by two ophthalmologists blinded to the patients' medical histories, and the prevalence rates for the two groups were calculated.
RESULTS: The presence of asymptomatic retinal arteriolar emboli was found in the eye ipsilateral to the radiographically observed carotid atheroma in 10 of 50 (20%) of the patients in the CCAP+ group, compared with 2 of 50 (4%) in the CCAP- group, and this difference was statistically significant (Fisher's exact P < .03).
CONCLUSIONS: Some male patients with diabetes mellitus type II having calcified carotid artery atheromas in the bifurcation area, as visualized on PIs, may have significant sequelae as evidenced by retinal artery emboli.

PMID: 26972542 [PubMed - in process]

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Patient movement and motion artefacts in cone beam computed tomography of the dentomaxillofacial region: a systematic literature review.

Patient movement and motion artefacts in cone beam computed tomography of the dentomaxillofacial region: a systematic literature review.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Apr;121(4):425-33

Authors: Spin-Neto R, Wenzel A

Abstract
OBJECTIVES: To undertake a systematic review on the current knowledge regarding patient movement detection and patient motion artefacts related to cone beam computed tomography (CBCT) imaging of the dentomaxillofacial region.
METHODS: The MEDLINE (PubMed) bibliographic database was searched for a period up to June 2015 for studies evaluating patient movement and/or motion artefacts in CBCT. The search strategy was restricted to English language publications using the following combined terms: (movement OR motion) AND (CBCT OR cone beam CT).
RESULTS: The search strategy yielded eight publications, which qualitatively or quantitatively evaluated patient movement and/or patient motion artefacts in CBCT.
CONCLUSIONS: The literature suggests that patient movement usually presents itself in CBCT images as stripe-like and ring-like patterns, double bone contours, and overall lack of sharpness. Studies monitoring patients during CBCT examination reported a prevalence of movement in approximately 20% of the cases, and studies based on image artefact recognition to define patient movement reported prevalence as high as 41.5%. There seems to be a consensus on the fact that young patients (children and adolescents) often move during the examination.

PMID: 26972541 [PubMed - in process]

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Human papillomavirus in tonsillar squamous cell carcinomas from Guatemala and Brazil.

Human papillomavirus in tonsillar squamous cell carcinomas from Guatemala and Brazil.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Apr;121(4):412-8

Authors: Piña AR, Jimenez LS, Mariano FV, de Andrade BA, Carlos R, Altemani A, de Almeida OP

Abstract
OBJECTIVES: A subgroup of tonsillar squamous cell carcinoma (SCC) is associated with human papillomavirus (HPV). Nevertheless, the prevalence of HPV seems to be variable in different regions and ethnic groups. There are no reports of HPV in tonsillar carcinomas in Guatemala, and data from Brazil are scarce. The aim of this study is to analyze and compare HPV presence in samples of tonsillar SCC from these countries.
STUDY DESIGN: This study describes the histologic features, expression of p16 by immunohistochemistry (IHC), and HPV by in situ hybridization (ISH) in 13 Guatemalan and 13 Brazilian patients.
RESULTS: All cases of tonsillar SCC from Guatemala were positive for p16, 92% expressed HPV by ISH, and 75% corresponded to the high-risk genotype 16/18. From the Brazilian patients, only four expressed p16, and all were negative for HPV.
CONCLUSIONS: Cases from Guatemala, which were mostly nonkeratinizing SCC and originated from the crypt/reticular epithelium of the tonsil, had high-risk integrated HPV, whereas in Brazilian cases, which were mostly keratinizing SCC that originated from the surface epithelium, there was no association with HPV.

PMID: 26972540 [PubMed - in process]

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Immunohistochemical expression of K6, K8, K16, K17, K19, maspin, syndecan-1 (CD138), α-SMA, and Ki-67 in ameloblastoma and ameloblastic carcinoma: diagnostic and prognostic correlations.

Immunohistochemical expression of K6, K8, K16, K17, K19, maspin, syndecan-1 (CD138), α-SMA, and Ki-67 in ameloblastoma and ameloblastic carcinoma: diagnostic and prognostic correlations.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Apr;121(4):402-11

Authors: Safadi RA, Quda BF, Hammad HM

Abstract
OBJECTIVE: To identify cutoff values of markers that correlate with the histopathologic diagnosis of ameloblastic carcinoma (AC) and/or the increased recurrence potential of ameloblastoma (AB).
STUDY DESIGN: Immunohistochemical expression (IHCE) of 9 selected markers were investigated in 18 non-recurrent ameloblastomas (NRABs), 6 recurrent ameloblastomas (RABs), and 5 ACs.
RESULTS: No significant difference in IHCE of K6, K8, K16, K17, K18, K19, maspin, or syndecan-1 was observed among study groups. α Smooth muscle actin (α-SMA)-positive area in central epithelial cells significantly differentiated between AB and AC (P = .017; t -test). Ki-67 score significantly differentiated between AB and AC (P < .005; t -test) and between AC and RAB (P = .015; ANOVA/post hoc).
CONCLUSIONS: Ki-67 score of 75 cells/HPF (ROC curve) is a potential indicator of AC. Clinical recurrence of AB may be predicted by α-SMA expression pattern. Syndecan-1 and α-SMA may indicate a higher aggressive potential of AB when expressed in the stroma.

PMID: 26972539 [PubMed - in process]

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Coffee consumption associated with reduced risk of oral cancer: a meta-analysis.

Coffee consumption associated with reduced risk of oral cancer: a meta-analysis.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Apr;121(4):381-389.e1

Authors: Li YM, Peng J, Li LZ

Abstract
OBJECTIVE: Currently, there is no consensus on the effect of coffee consumption on the risk of oral cancer. We performed a meta-analysis based on published studies to uncover the association.
STUDY DESIGN: We searched PubMed (1946-2015), Embase (1976-2015), and the bibliographies of all retrieved articles for relevant citations. We performed random-effects meta-analyses of observational studies on coffee consumption and oral cancer.
RESULTS: A total of 11 case-control studies and 4 cohort studies comprising 2,832,706 controls and 5021 cases of oral cancer were included in our analysis. The results indicated that the summary odds ratio for the highest versus the lowest or no category consumption of coffee was 0.63 (95% confidence interval [CI]: 0.52-0.75). The odds ratios were 0.60 (95% CI: 0.49-0.74) for case-control studies and 0.66 (95% CI: 0.45-0.98) for cohort studies.
CONCLUSION: Overall, our results suggested that coffee consumption appears to have a protective benefit in oral cancer.

PMID: 26972538 [PubMed - in process]

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ICRP 129 and cone beam computed tomography.

ICRP 129 and cone beam computed tomography.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Apr;121(4):345-7

Authors: Geist JR

PMID: 26972537 [PubMed - in process]

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In reply: "WhatsApp: a telemedicine platform for facilitating remote oral medicine consultation and improving clinical examinations-a commentary".

In reply: "WhatsApp: a telemedicine platform for facilitating remote oral medicine consultation and improving clinical examinations-a commentary".

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Feb 16;

Authors: Petruzzi M, De Benedittis M

PMID: 26972424 [PubMed - as supplied by publisher]

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Lateral tarsotomy: a practical alternative to lateral canthotomy to increase orbital access.

Lateral tarsotomy: a practical alternative to lateral canthotomy to increase orbital access.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Feb 16;

Authors: Emam HA, Stevens MR, Larsen PE, Jatana CA

Abstract
OBJECTIVE: Transconjunctival approach to the lower one-third of the orbit is commonly used to avoid transcutaneous incisions when surgical access is needed. A lateral canthotomy is used in conjunction with this approach if increased lateral exposure is required. A major disadvantage to lateral canthotomy is difficulty in resuspension of the lateral canthal tendon, which can lead to unaesthetic outcomes. The present report describes two cases of lateral tarsal incision or, as we decided to call it, the "lateral tarsotomy" technique. This simple approach is used to increase lateral access to the orbit without the need for lateral canthotomy.
STUDY DESIGN: Two patients presented with internal orbital wall trauma that required repair; access was achieved with a transconjunctival approach in conjunction with lateral tarsotomy. The patients were followed up at 1 week, 1 month, and 3 months to document the development of possible unaesthetic and poor functional outcomes.
RESULTS: Excellent cosmetic results were observed, with no noticeable deformity at the tarsotomy site. There was no evidence of ectropion, entropion, scleral show, and visible scars.
CONCLUSIONS: The above results suggest that the lateral tarsotomy approach is a practical alternative to lateral canthotomy when increased lateral exposure is required.

PMID: 26972423 [PubMed - as supplied by publisher]

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Association between maxillary sinus fungus ball and sinus bone grafting with deproteinized bovine bone substitutes: a case-control study.

Association between maxillary sinus fungus ball and sinus bone grafting with deproteinized bovine bone substitutes: a case-control study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Feb 13;

Authors: Scolozzi P, Perez A, Verdeja R, Courvoisier DS, Lombardi T

Abstract
OBJECTIVE: To evaluate the association between sinus bone graft and the development of fungus ball (FB) of the maxillary sinus.
STUDY DESIGN: The charts of all patients seen for surgical treatment of maxillary sinus FB following sinus bone grafting between 2006 and 2014 were reviewed. The charts of 49 participants were selected from our internal registry for comparison as controls. The association between FB and age, gender, smoking habits, associated co-morbidities, and bone grafting material was evaluated. FB of the maxillary sinus was estimated by using an odds ratio with a Yates' correction. P values were computed using Fisher's exact test, and the statistical significance was set at a P value < .05.
RESULTS: All 13 cases (100%) with FB of the maxillary sinus had received anorganic bovine bone as the bone substitute (P = .0001). There were significantly more women in the case group than in the control group (84.6% in the cases vs 40.8% in the controls; P = .01).
CONCLUSIONS: This study demonstrated a significant association between a specific deproteinized bovine bone substitute use as sinus bone graft material and subsequent development of FB of the maxillary sinus.

PMID: 26972422 [PubMed - as supplied by publisher]

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Practice variations in voice treatment selection following vocal fold mucosal resection.

Practice variations in voice treatment selection following vocal fold mucosal resection.

Laryngoscope. 2016 Mar 12;

Authors: Moore JE, Rathouz PJ, Havlena JA, Zhao Q, Dailey SH, Smith MA, Greenberg CC, Welham NV

Abstract
OBJECTIVES/HYPOTHESIS: To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population.
STUDY DESIGN: Retrospective analysis of a large, nationally representative Medicare claims database.
METHODS: Patients with > 12 months of continuous Medicare coverage who underwent a leukoplakia- or cancer-related vocal fold mucosal resection (index) procedure during calendar years 2004 to 2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each postindex treatment type, treating the other treatment types as competing risks, and further evaluated postindex treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex, and Medicaid eligibility were used as predictors.
RESULTS: A total of 2,041 patients underwent 2,427 index procedures during the study period. In 14% of cases, an initial voice treatment event was identified. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65 to 75 years, the likelihood of undergoing surgical treatment increased significantly with each 5-year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy.
CONCLUSION: The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age, and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care.
LEVEL OF EVIDENCE: 2c. Laryngoscope, 2016.

PMID: 26972900 [PubMed - as supplied by publisher]

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Prevalence of vestibular dysfunction in patients with vestibular schwannoma using video head-impulses and vestibular-evoked potentials.

Related Articles

Prevalence of vestibular dysfunction in patients with vestibular schwannoma using video head-impulses and vestibular-evoked potentials.

J Neurol. 2015 May;262(5):1228-37

Authors: Taylor RL, Kong J, Flanagan S, Pogson J, Croxson G, Pohl D, Welgampola MS

Abstract
We sought to investigate the utility of new non-invasive tests of semicircular-canal and otolith function that are usable in the neuro-otology office practice in patients with vestibular schwannoma. Fifty patients with vestibular schwannoma were assessed using a 5-item battery consisting of air-conducted cervical- and bone conducted ocular-vestibular-evoked myogenic potentials (AC cVEMPs and BC oVEMPs) and video head impulse testing (vHIT) in all three canal planes. VEMP asymmetry ratios, latencies, and vHIT gains were used to determine the test sensitivity, relationship with tumour size and the pattern of vestibular nerve involvement. The percentage of abnormalities for each of the five tests for the entire sample ranged between 36.2-61.7%. In 58.3 % of patients, test abnormalities were referable to both superior and inferior vestibular nerve divisions. Selective inferior nerve dysfunction was identified in 10.4% and superior nerve dysfunction in 12.5%. The remaining 18.8% of patients demonstrated a normal test profile. The sensitivity of the 5-item battery increased with tumour size and all patients with medium to large (>14 mm) schwannoma had at least two abnormal vestibular test result. Our results indicate that dysfunction of the superior and inferior vestibular nerve evolves in parallel for most patients with schwannoma. Unexplained vHIT and VEMP asymmetry should alert otologists and neurologists to undertake imaging in patients presenting with non-specific disequilibrium or vertigo.

PMID: 25794859 [PubMed - indexed for MEDLINE]

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Ascending vestibular drive is asymmetrically distributed to the inferior oblique motoneuron pools in a subset of hemispheric stroke survivors.

Ascending vestibular drive is asymmetrically distributed to the inferior oblique motoneuron pools in a subset of hemispheric stroke survivors.

Clin Neurophysiol. 2016 Apr;127(4):2022-30

Authors: Miller DM, Baker JF, Rymer WZ

Abstract
OBJECTIVE: Aberrant vestibular nuclear function is proposed to be a principle driver of limb muscle spasticity after stroke. Although spasticity does not manifest in ocular muscles, we sought to determine whether altered cortical modulation of ascending vestibuloocular pathways post-stroke could impact the excitability of ocular motoneurons.
METHODS: Nineteen chronic stroke survivors, aged 49-68 yrs. were enrolled. Vestibular evoked myogenic potentials (VEMPs) were recorded from the inferior oblique muscles of the eye using surface EMG electrodes. We assessed the impact of ascending otolith pathways on eye muscle activity and evaluated the relationship between otolith-ocular function and the severity of spasticity.
RESULTS: VEMP responses were recorded bilaterally in 14/19 subjects. Response magnitude on the affected side was significantly larger than on the spared side. In a subset of subjects, there was a strong relationship between affected response amplitude and the severity of limb spasticity, as estimated using a standard clinical scale.
CONCLUSIONS: This study suggests that alterations in ascending vestibular drive to ocular motoneurons contribute to post-stroke spasticity in a subset of spastic stroke subjects. We speculate this imbalance is a consequence of the unilateral disruption of inhibitory corticobulbar projections to the vestibular nuclei.
SIGNIFICANCE: This study potentially sheds light on the underlying mechanisms of post-stroke spasticity.

PMID: 26971485 [PubMed - in process]

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Stirnhöhlen-Mediandrainage.

Stirnhöhlen-Mediandrainage.

Laryngorhinootologie. 2016 Mar;95(3):226-228

Authors:

PMID: 26974203 [PubMed - as supplied by publisher]

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Fragen für die Facharztprüfung.

Fragen für die Facharztprüfung.

Laryngorhinootologie. 2016 Mar;95(3):225

Authors:

PMID: 26974202 [PubMed - as supplied by publisher]

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Exazerbierte oropharyngeale Schmerzen mit rezidivierenden synkopalen Episoden.

Exazerbierte oropharyngeale Schmerzen mit rezidivierenden synkopalen Episoden.

Laryngorhinootologie. 2016 Mar;95(3):200-201

Authors: Kramer B, Schultz JD, Hülse R, Hörmann K, Cazan D

PMID: 26974201 [PubMed - as supplied by publisher]

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Therapieresistente Otitis nach Thermenaufenthalt.

Therapieresistente Otitis nach Thermenaufenthalt.

Laryngorhinootologie. 2016 Mar;95(3):197-199

Authors: Scheibner C, Walch C

PMID: 26974200 [PubMed - as supplied by publisher]

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[Middle Ear Drainage and Ventilation: Indications, Complications and their Treatment].

[Middle Ear Drainage and Ventilation: Indications, Complications and their Treatment].

Laryngorhinootologie. 2016 Mar;95(3):171-177

Authors: Ciuman RR

Abstract
Tympanostomy is the most frequently performed surgery procedure in Germany. It enables middle ear ventilation and discharge of secretion from the middle ear with immediate hearing improvement and avoidance of complications and long-term pathologies of the tympanic membrane and the tympanum. The economical importance is emphasized by the fact that about 300 000 myringotomies are performed yearly. The best type of middle ear drainage and ventilation should be chosen on a case-by-case basis. In this context, the various techniques like conventional myringotomy, laser-myringotomy, short-term and long-term tympanostomy tubes and indications, complications and their treatments are described.

PMID: 26974199 [PubMed - as supplied by publisher]

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[Clinical status in Otolaryngology].

[Clinical status in Otolaryngology].

Laryngorhinootologie. 2016 Mar;95(3):168-169

Authors: Roesch S, Janda P, Rasp G

PMID: 26974198 [PubMed - as supplied by publisher]

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Zum 90. Geburtstag von Prof. Dr. med. Dr. med. h.c. Harald Feldmann.

Zum 90. Geburtstag von Prof. Dr. med. Dr. med. h.c. Harald Feldmann.

Laryngorhinootologie. 2016 Mar;95(3):162-163

Authors: Hüttenbrink KB

PMID: 26974197 [PubMed - as supplied by publisher]

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Kommentar der Schriftleitung.

Kommentar der Schriftleitung.

Laryngorhinootologie. 2016 Mar;95(3):161

Authors: Rasp G

PMID: 26974196 [PubMed - as supplied by publisher]

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Decompressive craniectomy following traumatic brain injury: developing the evidence base.

Decompressive craniectomy following traumatic brain injury: developing the evidence base.

Br J Neurosurg. 2016 Mar 14;:1-5

Authors: Kolias AG, Adams H, Timofeev I, Czosnyka M, Corteen EA, Pickard JD, Turner C, Gregson BA, Kirkpatrick PJ, Murray GD, Menon DK, Hutchinson PJ

Abstract
In the context of traumatic brain injury (TBI), decompressive craniectomy (DC) is used as part of tiered therapeutic protocols for patients with intracranial hypertension (secondary or protocol-driven DC). In addition, the bone flap can be left out when evacuating a mass lesion, usually an acute subdural haematoma (ASDH), in the acute phase (primary DC). Even though, the principle of "opening the skull" in order to control brain oedema and raised intracranial pressure has been practised since the beginning of the 20th century, the last 20 years have been marked by efforts to develop the evidence base with the conduct of randomised trials. This article discusses the merits and challenges of this approach and provides an overview of randomised trials of DC following TBI. An update on the RESCUEicp study, a randomised trial of DC versus advanced medical management (including barbiturates) for severe and refractory post-traumatic intracranial hypertension is provided. In addition, the rationale for the RESCUE-ASDH study, the first randomised trial of primary DC versus craniotomy for adult head-injured patients with an ASDH, is presented.

PMID: 26972805 [PubMed - as supplied by publisher]

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Propensity score analysis of endoscopic and open approaches to malignant paranasal and anterior skull base tumor outcomes.

Propensity score analysis of endoscopic and open approaches to malignant paranasal and anterior skull base tumor outcomes.

Laryngoscope. 2016 Mar 12;

Authors: Farquhar D, Kim L, Worrall D, Chiu A, Lee JY, Khalili S, Grady S, O'Malley BW, Kennedy DW, Newman JG, Palmer JN, Adappa ND

Abstract
OBJECTIVES/HYPOTHESIS: Malignant sinonasal and skull base tumors are now being resected using an endoscopic technique, but there has been controversy regarding the oncologic safety of this approach. Various studies have compared the outcomes from endoscopic surgery to those from open techniques; however, all have been limited by substantial differences in the patient populations receiving each approach. In this study we compare outcomes of open and endoscopic techniques and use propensity score matching to control for these differences in the patient populations.
STUDY DESIGN: Retrospective cohort study including all patients > 18 years old receiving primary surgery for malignant sinonasal or skull base tumors at our institution from 2002 to 2013.
RESULTS: One hundred twenty-four patients met criteria; 82 received endoscopic-only surgery, and 42 had an open component to their approach. There was an 86% 3-year overall survival and a 74% disease-free survival. Without controlling for differences in the groups, the endoscopic patients fared significantly better in survival, recurrence rates, wound infections, and length of hospital stay. When using propensity score matching to account for patient comorbidities and tumor size, there were no significant differences in any outcomes except length of the hospital stay. A multivariate regression analysis yielded the same results.
CONCLUSION: In this study, endoscopic surgery was shown to be a safe alternative to the open technique, even when controlling for the favorable patient and tumor characteristics in endoscopic patients. This is the first study to account for these differences with a rigorous statistical methodology.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2015.

PMID: 26972568 [PubMed - as supplied by publisher]

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The effect of direction of force to the craniofacial skeleton on the severity of brain injury in patients with a fronto-basal fracture.

The effect of direction of force to the craniofacial skeleton on the severity of brain injury in patients with a fronto-basal fracture.

Int J Oral Maxillofac Surg. 2016 Mar 10;

Authors: Stephens JR, Holmes S, Bulters D, Evans BT

Abstract
The skull base is uniquely positioned to absorb force imparted to the craniofacial skeleton, thereby reducing brain injury. Less well understood is the effect of the direction of force imparted to the craniofacial skeleton on the severity of brain injury. Eighty-one patients from two UK major trauma centres who sustained a fronto-basal fracture were divided into two groups: those struck with predominantly anterior force and those by predominantly lateral force. The first recorded Glasgow Coma Score (GCS), requirement for intubation, and requirement for decompressive craniectomy were used as markers of the severity of brain injury. An average GCS of 5 was found in the lateral group and 14 in the anterior group; this difference was statistically significant (P<0.001). There was an increased need for both intubation and decompressive craniectomy in the lateral group compared to the anterior group (absolute risk difference 46.6% and 15.8%, respectively). These results suggest that the skeletal anatomy of the fronto-basal region influences the severity of head injury. The delicate lattice-like structure in the central anterior cranial fossa can act as a crumple zone, absorbing force. Conversely in the lateral aspect of the anterior cranial fossa, there is a lack of collapsible interface, resulting in an increased energy transfer to the brain.

PMID: 26972160 [PubMed - as supplied by publisher]

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Can blockage or sacrifice of the middle meningeal artery lead to hydrocephalus?

Can blockage or sacrifice of the middle meningeal artery lead to hydrocephalus?

Childs Nerv Syst. 2016 Mar 14;

Authors: Tubbs RS, Demerdash A, V D'Antoni A, Loukas M, Kulwin C, Oskouian RJ, Cohen-Gadol A

Abstract
BACKGROUND: The middle meningeal artery (MMA) is often sacrificed during neurosurgical procedures in the region of the pterion. This maneuver, herein, is hypothesized to be a potential reason for the development of postoperative hydrocephalus by injuring the vascular supply to the arachnoid granulations near the vertex of the skull, and thus disrupting their ability to allow for transfer of CSF from the subarachnoid space to the venous system.
MATERIALS AND METHODS: To test this theory, the middle meningeal artery was isolated at the skull base and injected with India ink. Next, the superior sagittal sinus was opened and the arachnoid granulations inspected.
RESULTS: All specimens demonstrated ink within the arachnoid granulations indicating that their blood supply is completely or at least partially via the middle meningeal artery. This finding with an illustrative case of surgical cautery of the middle meningeal artery at the skull base with subsequent development of hydrocephalus supports our hypothesis of potential role of iatrogenic MMA injury causing hydrocephalus.
CONCLUSIONS: Our cadaveric study shows that the blood supply of the arachnoid granulations of the superior sagittal sinus is via the middle meningeal artery. Additional cases of postoperative hydrocephalus following middle meningeal artery sacrifice are needed to support our hypothesis.

PMID: 26971502 [PubMed - as supplied by publisher]

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Mean platelet volume may not be increased in patients with idiopathic subjective tinnitus.

Mean platelet volume may not be increased in patients with idiopathic subjective tinnitus.

Eur Arch Otorhinolaryngol. 2016 Mar 14;

Authors: Beyan C, Beyan E

PMID: 26972569 [PubMed - as supplied by publisher]

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Oncological and surgical outcome of total laryngectomy in combination with neck dissection in the elderly.

Oncological and surgical outcome of total laryngectomy in combination with neck dissection in the elderly.

Eur Arch Otorhinolaryngol. 2016 Mar 14;

Authors: Teymoortash A, Bohne F, Kissing L, Daniel H, Kurt B, Wilhelm T, Halmos GB, Hoch S

Abstract
There are controversial data on oncological and surgical outcome after major head and neck cancer surgery in the elderly. The aim of this study was to evaluate the outcome of elderly cancer patients after total laryngectomy in combination with neck dissection. A total of 58 patients separated into two age groups (28 < 65 vs. 30 ≥ 65 years) with hypopharyngeal and laryngeal cancer who underwent total laryngectomy and neck dissection were enrolled. Comorbidities of both age groups using the Charlson comorbidity index, hospitalization days as well as surgical complications evaluated by the Clavien-Dindo classification were examined. Overall and disease-free survivals of all patients were analyzed. The average follow-up was 2.9 years. Surgical complication rate was significantly increased in elderly (p = 0.04). However, complications could be treated without surgical intervention in most cases without significant extension of hospitalization. Locoregional and distant control did not significantly differ in both age groups. Disease-free and overall survival showed no significant differences for the two age groups by the Kaplan-Meier analysis (p = 0.66 and 0.08, respectively). Total laryngectomy in combination with neck dissection can be considered in elderly patients with satisfactory oncological and surgical outcome.

PMID: 26972426 [PubMed - as supplied by publisher]

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