'Open access' and the International Journal of Audiology.

'Open access' and the International Journal of Audiology.

Int J Audiol. 2016 Jul 29;:1-2

Authors:

PMID: 27472297 [PubMed - as supplied by publisher]

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Facial tremors in patients with and without parkinsonism.

Facial tremors in patients with and without parkinsonism.

Neurol Sci. 2016 Jul 28;

Authors: Rossi M, Wilken M, Morisset P, Fariña S, Cerquetti D, Merello M

Abstract
Facial (lip and jaw) tremors can be an early sign of Parkinson's disease (PD), essential tremor and other parkinsonisms. Its response to acute dopaminergic therapy and further predictive clinical diagnosis has not been previously addressed. The aim of this study was to evaluate facial tremors response to acute dopaminergic therapy and further predictive value for clinical diagnosis. A retrospective review of medical records from patients with recent onset of facial tremor, with or without parkinsonism, submitted to acute levodopa challenge for clinical prediction of sustained long-term dopaminergic response was conducted. Twenty-eight out of 559 patients (5 %) had facial tremors, which responded to levodopa in 46 % of patients. Facial tremors response to acute levodopa challenge showed 92 % sensitivity and 93 % specificity to predict a final PD diagnosis. In PD patients, facial tremor magnitude of response to levodopa was not different from that of hand rest tremor (p = 0.8). Facial tremors, although infrequent, can be an early sign of PD. Positive response to acute levodopa challenge predicts long-term PD diagnosis.

PMID: 27470304 [PubMed - as supplied by publisher]

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Line of Sight in Hominoids.

Line of Sight in Hominoids.

J Clin Pediatr Dent. 2016;40(3):251-258

Authors: Stock MK, Reynolds DG, Masters AJ, Bromage TG, Enlow DH

Abstract
OBJECTIVES: It remains unclear how the realignments of the face and basicranium that characterize humans were acquired, both phylogenetically and ontogenetically. The developmentally constrained nature of the skull has been previously demonstrated in other primates using Donald H. Enlow's mammalian craniofacial architectural relationships. Here, we compare crania of our closest relatives to gain greater understanding of how and why the relationship of the face and cranial base is developmentally constrained in order to inform instances of abnormal growth and clinical intervention.
STUDY DESIGN: A method for evaluating these fundamental architectural relationships using 3D landmark data was developed, thereby taking overall size and the geometric relationships among points into account. A sample of cone-beam computed tomography scans derived from humans and extant apes were analyzed (n=10 and n=6, respectively), as well as fossil hominid crania (n=7). Landmarks for 23 craniofacial architectural points were identified and recorded.
RESULTS AND CONCLUSIONS: Principal components analyses reveal that despite the similarities in craniofacial architecture between humans, extant apes and fossil hominids, appreciable trends in variation between the extant species suggest that the repositioning of the foramen magnum was only one of a constellation of traits that realigned the basicranium and face during the transition to bipedalism.

PMID: 27472575 [PubMed - as supplied by publisher]

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Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery.

Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery.

J Neurosurg. 2016 Jul 29;:1-9

Authors: Lee JY, Pierce JT, Sandhu SK, Petrov D, Yang AI

Abstract
OBJECTIVE Endoscopic surgery has revolutionized surgery of the ventral skull base but has not yet been widely adopted for use in the cerebellopontine angle. Given the relatively normal anatomy of the cerebellopontine angle in patients with trigeminal neuralgia (TN), the authors hypothesized that a fully endoscopic microvascular decompression (E-MVD) might provide pain outcomes equivalent to those of microscopic MVD (M-MVD) but with fewer complications. METHODS The authors conducted a single-institution, single-surgeon retrospective study with patients treated in the period of 2006-2013. Before surgery, all patients completed a questionnaire that included a validated multidimensional pain-outcome tool, the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory-Facial), an 11-point scale that measures pain intensity, interference with general activities of daily living (ADLs), and facial-specific ADLs. Using a standardized script, independent research assistants conducted follow-up telephone interviews. RESULTS In total, 167 patients were available for follow-ups (66.5% female; 93 patients underwent M-MVD and 74 underwent E-MVD). Preoperative characteristics (i.e., TN classification, PFPS components, and medication use) were similar for the 2 surgical groups except for 2 variables. Patients in the M-MVD group had slightly higher incidence of V3 pain, and the 2 groups differed in the date of surgery and hence in the length of follow-up (2.4 years for the M-MVD group and 1.3 years for the E-MVD group, p < 0.05). There was a trend toward not finding neurovascular conflict at the time of surgery more frequently in the M-MVD than in the E-MVD group (11% vs 7%, p = 0.052). Internal neurolysis was more often performed in the E-MVD group (26% vs 7%, p = 0.001). The 2 groups did not significantly differ in the length of the MVD procedure (approximately 2 hours). Self-reported headaches at 1 month postoperatively were present in 21% of the patients in the M-MVD group versus 7% in the E-MVD group (p = 0.01). Pain outcomes at the most recent followup were equivalent, with patients reporting a 5- to 6-point (70%-80%) improvement in pain intensity, a 5-point (85%) improvement in pain interference with ADLs, and a 6-point (85%) improvement in interference with facial-specific ADLs. Actuarial freedom from pain recurrence was equivalent in the 2 groups, with 80% pain control at 3 years. CONCLUSIONS Both the fully endoscopic MVD and the conventional M-MVD appear to provide patients with equivalent pain outcomes. Complication rates were also similar between the groups, with the exception of the rate of headaches, which was significantly lower in the E-MVD group 1 month postoperatively.

PMID: 27471895 [PubMed - as supplied by publisher]

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Endoscopic Management of Middle Ear and Temporal Bone Lesions.

Endoscopic Management of Middle Ear and Temporal Bone Lesions.

Otolaryngol Clin North Am. 2016 Jul 25;

Authors: Isaacson B, Nogueira JF

Abstract
Tantamount to the management of temporal bone neoplasms is the ability to visualize the pathology and its relationship with the numerous critical structures housed therein. Transcanal endoscopic ear surgery provides the surgeon with an unparalleled view of the entire middle ear. This article presents the latest information on the usefulness of transcanal endoscopic ear surgery in the management of middle ear and temporal bone neoplasms.

PMID: 27468636 [PubMed - as supplied by publisher]

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Anatomy of the Eustachian Tube.

Anatomy of the Eustachian Tube.

Otolaryngol Clin North Am. 2016 Jul 25;

Authors: Leuwer R

Abstract
The eustachian tube consists of 2 compartments: the Rüdinger's safety canal and the auxiliary gap. It is surrounded by a cartilaginous wall on the craniomedial side and a membranous wall on the inferolateral side. The eustachian tube cartilage is firmly attached to the skull base by the lateral and the medial suspensory ligaments, which are separated by the medial Ostmann fat pad. The function of the isometric tensor veli palatini muscle is modulated by hypomochlia, which have an influence on the muscular force vectors.

PMID: 27468634 [PubMed - as supplied by publisher]

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[CLOSURE OF NASOCRANIAL FISTULAS WITH "BATH-PLUG" TECHNIQUE AND MULTILAYER RECONSTRUCTION].

[CLOSURE OF NASOCRANIAL FISTULAS WITH "BATH-PLUG" TECHNIQUE AND MULTILAYER RECONSTRUCTION].

Ideggyogy Sz. 2016 Mar 30;69(5-6):211-6

Authors: Piski Z, Büki A, Nepp N, Burián A, Révész P, Gerlinger I

Abstract
BACKGROUND AND PURPOSE: In case of dehiscenses developing on the anterior scull base, complete closure resulting in the cessation of the communication between the nasal cavity and the intracranial space is mandatory as soon as possible, in order to prevent serious complications. With the development of the endoscopic techniques, the endonasal management for the reconstruction has become available in recent decades.
METHODS: We aim to present the reconstruction techniques applied in our department in the cases of two patients recently operated at our institute. The choice of methods primarily depends on the size and the localization of the defect. Dehiscenses under 5 mm of diameter can be closed with the so called "bath-plug" technique, while bigger defects, where the required closure of the plug is not possible, can be solved with multilayer reconstruction. We use autogenous fascia, fat and muco-periosteum in both cases.
RESULTS: Our patient, who underwent the aforementioned "bath-plug" procedure, could be discharged after a few days of uneventful postoperative period. During a ten-month follow-up period new fistula formation was not observed. In the case of a patient who underwent multilayer reconstruction, meningitis occurred postoperatively, which was resolved after antibiotic therapy. During a 17-month follow-up period recurrent liquorrhoea did not occur.
CONCLUSION: With suitable technical background and appropriate endoscopic skills the surgeries of the anterior skull base cerebrospinal fluid fistulas can be performed efficiently and with low complication rate. These are minimally invasive procedures accompanied by less surgical trauma, morbidity and shorter hospitalization, hence these techniques are considered to be cost-effective and well-tolerated for the patients.

PMID: 27468611 [PubMed - in process]

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Relationship between soluble Semaphorin4D and cognitive impairment in patients with obstructive sleep apnea-hypopnea syndrome.

Relationship between soluble Semaphorin4D and cognitive impairment in patients with obstructive sleep apnea-hypopnea syndrome.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: He Y, Xiang L, Zhao LP, Chan SP, Chen R

Abstract
To investigate the relationship between plasma soluble semaphorin4D (sSema4D) and obstructive sleep apnea-hypopnea syndrome (OSAHS), and to ascertain the effect of sSema4D on cognitive dysfunction in patients with OSAHS. We prospectively recruited 30 men with moderate-severe OSAHS diagnosed by polysomnography, and 30 healthy controls with matched gender, age and education level. Montreal Cognitive Assessment (MoCA) was administered to determine cognitive impairment. Plasma sSema4D levels were measured. Among the total of 60 study patients, the overall plasma sSema4D level was 7.81 ± 1.91 ng/ml. Plasma sSema4D level in OSAHS group was significantly higher than that in controls (8.92 ± 1.79 vs 6.70 ± 1.28 ng/ml, p < 0.001). In OSAHS subgroup, patients with cognition impairment (CI) had higher plasma sSema4D level (10.50 ± 1.16 vs 8.00 ± 1.41 ng/ml, p < 0.001) and apnea-hypopnea index (AHI) (48.1 ± 14.0 vs 30.3 ± 9.2, p < 0.001) than those in non-CI group. Multiple logistic regression revealed that plasma sSema4D level (AOR 2.824, 95 % CI 1.562-5.103; p = 0.001) and BMI (AOR 2.237, 95 % CI 1.345-3.722; p = 0.002) were significantly associated with OSAHS, and plasma sSema4D was a significant predictor of CI after adjustment for other confounders (AOR 4.956, 95 % CI 1.581-15.538; p = 0.006). OSAHS patients, especially those with cognition impairment, are featured by elevated plasma sSema4D level, and sSema4D is significantly associated with cognition impairment induced by OSAHS.

PMID: 27470118 [PubMed - as supplied by publisher]

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Overexpression of DCLK1 is predictive for recurrent disease in major salivary gland malignancies.

Overexpression of DCLK1 is predictive for recurrent disease in major salivary gland malignancies.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: Kadletz L, Aumayr K, Heiduschka G, Schneider S, Enzenhofer E, Lill C

Abstract
Salivary gland carcinomas are a rare malignancy. Therefore, little is known about biomarkers and cancer stem cells in salivary gland malignancies. Double cortin-like kinase 1 (DCLK1) is a promising therapeutic target and cancer stem cell marker, predominantly investigated in pancreatic and colorectal cancer. The purpose of this study was to investigate the expression of DCLK1 in major and minor salivary gland carcinomas and its influence on survival. We examined a total of 80 patients with major or minor salivary gland cancer in this retrospective study. Immunohistochemistry with anti-DCLK1 antibody was applied to assess the expression of DCLK1. Moreover, we evaluated the impact of DCLK1 on overall and disease-free survival. DCLK1 expression could be detected in 66.3 % of all examined cases. Overexpression of DCLK1 was associated with reduced overall and disease-free survival in patients with major salivary gland cancer. Disease-free survival reached statistical significance (p = 0.0107). However, expression of DCLK1 had no influence on survival in patients with minor salivary gland cancer. Since treatment of recurrent disease in oncologic patients is utterly challenging, DCLK1 may be a promising prognostic biomarker that helps to identify patients with a high risk for recurrence of major salivary gland carcinoma.

PMID: 27470117 [PubMed - as supplied by publisher]

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Comparison of drain versus no-drain thyroidectomy: a meta-analysis.

Comparison of drain versus no-drain thyroidectomy: a meta-analysis.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: Tian J, Li L, Liu P, Wang X

Abstract
Despite minimal evidence, thyroid drains are routinely used as a precaution against hematoma in thyroidectomy. We undertook the present meta-analysis to evaluate the patient outcomes associated with post-surgical drainage, and whether it offers any advantage over no drainage in patients undergoing thyroidectomy. Randomized and two-arm studies comparing the efficacy of total or partial thyroidectomy with or without post-surgery drainage, in patients undergoing thyroid surgery were included. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until January 22, 2015, using the terms, "thyroidectomy, subtotal thyroidectomy, total thyroidectomy, drainage, thyroid cancer, and goiter." The primary outcome of interest includes postoperative complications such as infection, hematoma, hemorrhage, hypoparathyroidism, recurrent laryngeal nerve palsy, seroma, and duration of hospital stay. 14 studies comprising of 1927 patients were included in the present analysis. The overall analysis revealed that patients in the drain group were more likely to have a higher postoperative infection rate than no-drain group (pooled OR = 2.94, 95 % CI 1.27-6.85, P = 0.012). Similarly, patients in the drain group had a longer hospital stay in comparison to those in the no-drain group (pooled difference in mean = 1.16, 95 % CI 0.72-1.59, P < 0.001). No statistically significant differences between the groups were found for hematoma, hemorrhage, hypoparathyroidism, recurrent laryngeal nerve palsy, and seroma. In conclusion, the current practice of post-surgical drainage in thyroidectomy did not offer any significant advantage. On the contrary, post-surgical infection rate and duration of hospital stay was higher in patients in the drain group.

PMID: 27470116 [PubMed - as supplied by publisher]

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Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil.

Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: Karabayirli S, Ugur KS, Demircioglu RI, Muslu B, Usta B, Sert H, Ark N

Abstract
To compare dexmedetomidine with remifentanil in functional endoscopic sinus surgery (FESS) in regards to intra-operative bleeding, anesthetic consumption and post-operative recovery. Randomized, double blind study. Tertiary care medical center. Fifty patients with nasal polyposis who had been scheduled for FESS were randomly divided into two groups. In group D (n = 25), dexmedetomidine 1 µg/kg infused intravenous (IV) over 10 min before anesthesia induction, followed by a continuous of 0.7 µg/kg/h infusion during operation. In group R (n = 25), 1 µg/kg remifentanil IV bolus, was administered with induction of anesthesia and continued 0.25-0.50 µg/kg/min during operation. Heart rates, mean arterial pressure, end tidal CO2, end tidal sevoflurane were recorded. The amount of bleeding, surgical field condition for bleeding and the time to reach Aldrete recovery score 9-10 were recorded. Postoperative nausea, vomiting, pain, shivering, sedation were followed up over 24 h. There was no significant difference between groups according to the amount of bleeding during surgery, assessment of surgical field condition, consumption of sevoflurane, scores of postoperative VAS, rates of nausea and vomiting, shivering, demands of additional analgesic medication (P > 0.05). The time to reach Aldrete recovery score 9-10, sedation scores at the postoperative first hour were significantly higher in group D (P = 0.001). We concluded that in comparison to remifentanil, dexmedetomidine during FESS for controlled hypotension is of limited value as it has no additional benefits in terms of control of hypotension and amount of bleeding in the surgical field and it is associated with higher recovery time and first-hour postoperative sedation scores.

PMID: 27470115 [PubMed - as supplied by publisher]

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The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy.

The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: Bosi M, De Vito A, Gobbi R, Poletti V, Vicini C

Abstract
The objective of this study is to highlight the importance of anatomical and not-anatomical factors' identification for customized therapy in OSAHS patients. The data sources are: MEDLINE, The Cochrane Library and EMBASE. A systematic review was performed to identify studies that analyze the role of multiple interacting factors involved in the OSAHS pathophysiology. 85 out of 1242 abstracts were selected for full-text review. A variable combinations pathophysiological factors contribute to realize differentiated OSAHS phenotypes: a small pharyngeal airway with a low resistance to collapse (increased critical closing pressure), an inadequate responses of pharyngeal dilator muscles (wakefulness drive to breathe), an unstable ventilator responsiveness to hypercapnia (high loop gain), and an increased propensity to wake related to upper airway obstruction (low arousal threshold). Identifying if the anatomical or not-anatomical factors are predominant in each OSAHS patient represents the current challenge in clinical practice, moreover for the treatment decision-making. In the future, if a reliable and accurate pathophysiological pattern for each OSAHS patient can be identified, a customized therapy will be feasible, with a significant improvement of surgical success in sleep surgery and a better understanding of surgical failure.

PMID: 27470114 [PubMed - as supplied by publisher]

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'Open access' and the International Journal of Audiology.

'Open access' and the International Journal of Audiology.

Int J Audiol. 2016 Jul 29;:1-2

Authors:

PMID: 27472297 [PubMed - as supplied by publisher]

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Use of a mid-scala and a lateral wall electrode in children: insertion depth and hearing preservation.

Use of a mid-scala and a lateral wall electrode in children: insertion depth and hearing preservation.

Acta Otolaryngol. 2016 Jul 29;:1-7

Authors: Benghalem A, Gazibegovic D, Saadi F, Tazi-Chaoui Z

Abstract
CONCLUSIONS: Atraumatic insertion of the HiFocus(TM) Mid-Scala (HFMS) electrode via the round window was successfully achieved in seven children. Residual hearing 6 months post-operatively was preserved to within 10 dB HL of the pre-operative audiogram at 500 Hz for six children, indicating minimal initial insertion trauma to the cochlea.
OBJECTIVES: The objectives were to document the clinical experience and evaluate differences between HFMS and HiFocus(TM) 1j (HF1j) by means of insertion depth and hearing preservation results.
METHOD: Nineteen children were prospectively recruited and consecutively implanted with the HF1j electrode (n = 12) or the HFMS electrode (n = 7) via the round window. Average median angular insertion depths and the amount of residual hearing preserved at 6 months post-operatively were compared between the two electrode groups.
RESULTS: The median angular insertion depth for the HF1j was 439° and for the HFMS 435°. Preservation of residual hearing at 500 Hz was assessed in seven HFMS subjects and 11 HF1j subjects. Based on the Skarzynski formula, three out of seven subjects (42%) in the HFMS group had their residual hearing completely preserved at 500 Hz. In the control group, no subjects had complete hearing preservation and five subjects had a complete loss of residual hearing.

PMID: 27472299 [PubMed - as supplied by publisher]

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The role of human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.

The role of human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.

Acta Otolaryngol. 2016 Jul 29;:1-8

Authors: Zhu X, Wang Y, Zhu H, Lou W

Abstract
CONCLUSION: HPV + HNSCC patients have improved Overall Survival (OS), Disease Specific Survival (DSS), Disease Free Survival (DFS), and Progression Free Survival (PFS). The radiotherapy treatment can't improve the Survival of the HPV-negative HNSCC patients.
OBJECTIVE: To investigate the role of Human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.
METHODS: A search in PubMed and Chinese CNKI (2000-2015) was performed. This meta-analysis was done using RevMan 5.1 software. Outcomes included OS, DSS, DFS, PFS, and Treatment responses rates (RR).
RESULTS: A total of 2620 patients in 10 studies were included. The Positive detective rates of HPV and P16 are 32.5% (425/1309) and 42.5% (526/1239). OS and PFS were improved in HPV + patients compared to HPV - patients (HR = 0.48; 95% CI = 0.37-0.62, p < 0.0001) and (HR = 0.49; 95% CI = 0.31-0.78, p < 0.0001). The survival benefit was similar in HPV-16 + patients (adjusted HR = 0.39; 95% CI = 0.21-0.60, p < 0.0001). The DFS of P16 + patients improved (HR = 0.70; 95% CI = 0.55-0.89, p < 0.0001). The treatment response of p16 + patients didn't significantly improve compared with p16- patients (HR = 1.44; 95% CI = 1.01-2.05, p = 0.05).

PMID: 27472193 [PubMed - as supplied by publisher]

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An assessment of olfactory function in patients with laryngopharyngeal reflux disease.

An assessment of olfactory function in patients with laryngopharyngeal reflux disease.

Acta Otolaryngol. 2016 Jul 29;:1-7

Authors: Emre Dinc M, Dalgic A, Avincsal MO, Ulusoy S, Celik A, Develioglu ON

Abstract
CONCLUSIONS: The results reported here indicate that there was a statistically significant difference in the olfactory functions of laryngopharyngeal reflux patients vs the healthy group. To the best of the authors' knowledge, this study is the first to evaluate the olfactory function of patients diagnosed with laryngopharyngeal reflux using an objective method, 24-h pH monitoring.
OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate olfactory functions in laryngopharyngeal reflux (LPR) patients and compare the results with healthy controls.
METHODS: A total of 60 participants; 30 men and women with a diagnosis of laryngopharyngeal reflux and 30 healthy controls, were included in the study. Patients in the laryngopharyngeal reflux group were evaluated by the Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and finally 24-h pH monitoring to confirm the diagnosis of laryngopharyngeal reflux. The Sniffin' Sticks olfactory test results of the laryngopharyngeal reflux and control groups were compared, and the relationship between the study findings and the olfactory parameters were evaluated.
RESULTS: The odor threshold, odor discrimination, odor identification, and TDI scores of the laryngopharyngeal reflux group were significantly lower than those of the control group. Also there was a statistically significant negative correlation detected between the olfactory test and some symptom and finding scores.

PMID: 27472044 [PubMed - as supplied by publisher]

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Two cases of prostheses for flap protection after buccal mucosal incision.

Related Articles

Two cases of prostheses for flap protection after buccal mucosal incision.

Bull Tokyo Dent Coll. 2014;55(1):49-54

Authors: Nomoto S, Sato T, Yoshida S, Saito S, Kamiyama I, Ito A, Tanaka J

Abstract
Here we describe two patients in whom prostheses were applied for flap protection after buccal mucosal incision. In the first case, the patient was a 65-year-old man with a diagnosis of buccal mucosa squamous cell carcinoma (T2N0M0). Left buccal mucosa squamous cell tumor resection and dermoplasty were performed, followed by alveolar ridge augmentation and buccal mucosal graft in the scar area. The carcinoma recurred, however, and left buccal mucosa carcinoma resection was performed, followed by reconstruction surgery using a free forearm flap. After a 12-week healing period, a molar support was constructed on the unaffected side and a protective prosthesis placed on the affected side. Training in ingestion and swallowing were given postoperatively. The patient in the second case was a 62-year-old woman with a diagnosis of buccal mucosa squamous cell carcinoma (T2N1M0). Right buccal mucosa carcinoma resection and supraomohyoid neck dissection were performed, followed by reconstruction surgery using a free forearm flap. A molar support was constructed on the unaffected side and a protective prosthesis placed on the affected side at 5 months postoperatively. Training was given in ingestion and swallowing postoperatively. The prostheses prevented bite wounds to the flaps in the affected areas due to jaw movement during swallowing or speaking. The postoperative courses were uneventful, and the average masticatory score was 92.5 (85, 100), not affecting daily life. The prostheses were placed after reconstruction surgery using free flaps after buccal mucosa squamous cell carcinoma resection. Dysphasia recovered to the preoperative level by dysphasia and pronunciation training in both cases. The postoperative prognosis was favorable, with the prosthesis preventing damage to the flap.

PMID: 24717930 [PubMed - indexed for MEDLINE]

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