Orbital schwannoma with hyposmia as the only presentation: Case report and a literature review on differential diagnosis

xlomafota13 shared this article with you from Inoreader Orbital schwannoma with hyposmia as the only presentation: Case report and a literature review on differential diagnosis Via ear nose throat Ear Nose Throat J. 2021 Dec 13:1455613211059862. doi: 10.1177/01455613211059862. Online ahead of print. ABSTRACT Orbital schwannoma is a rare benign tumor, originating from the Schwann cells of the orbital peripheral nerve sheath. Orbital schwannoma is easily misdiagnosed if the patient shows atypical presentations and atypical appearance on MRI imaging. A 56-year-old male experienced hyposmia for 1 year and was misdiagnosed with cavernous hemangioma pre-operation. This case was treated by surgery through the endoscopic trans-nasal approach. After operation, the patient had no recurrence or complications. Preoperative diagnosis for these cases remains difficult. Combined imaging modalities including computed tomography (CT) and magnetic resonance imaging (MRI) can help in differential diagnosis. Surgery is the main treatment modality for treating orbital schwannoma. Outcomes in most cases are favorable without complications or recurrence. PMID:34894799 | DOI:10.1177/01455613211059862 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic role of neutrophil lymphocyte ratio and mean platelet volume in Bell's palsy: Comparison of diabetic and non-diabetic patients

xlomafota13 shared this article with you from Inoreader Prognostic role of neutrophil lymphocyte ratio and mean platelet volume in Bell's palsy: Comparison of diabetic and non-diabetic patients Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Nov 15:S1808-8694(21)00184-1. doi: 10.1016/j.bjorl.2021.10.003. Online ahead of print. ABSTRACT OBJECTIVES: A low Neutrophil Lymphocyte Ratio (NLR) has been shown to be associated with good prognosis in Bell's Palsy (BP). However, the effect of chronic diseases that may affect the NLR, including Diabetes Mellitus (DM), has not been clarified in this context. This study aimed to evaluate the relationship between NLR and Mean Platelet Volume (MPV) in BP according to whether it is accompanied by DM, and their relationship with prognosis. METHODS: A prospective observational study was conducted from May 2014 to May 2020 in a tertiary referral center, of all 79 consecutive participants diagnosed with BP in department of otolaryngology and 110 consecutive healthy participants admitted to the check-up unit. Patients diagnosed with BP were divided into two groups according to whether they were diagnosed with DM: diabetic BP patients (DM-BP, n = 33) and non-diabetic BP patients without any chronic disease (nonDM-BP, n = 46). Neutrophil (NEUT) and Lymphocyte (LYM) counts, and Mean Platelet Volume (MPV) were assessed from peripheral blood samples, and the NLR was calculated. Prognosis was evaluated using the House-Brackmann Score (HBS) six months after diagnosis. RESULTS: The mean NLR was 2.85 ± 1.85 in BP patients and 1.69 ± 0.65 in the control group. The mean NLR was significantly higher in BP patients than healthy controls (p < 0.001). The mean NLR was 2.58 ± 1.83 in the nonDM-BP group, 3.23 ± 1.83 in the DM-BP group, and 1.69 ± 0.65 in the control group. The NLR was significantly higher in the nonDM-BP and DM-BP groups than in the control group (p < 0.05). The recovery was 90% according to the HBS. The optimal cut-off value was 2.41 (p = 0.5). CONCLUSION: The NLR was increased in both diabetic and non-diabetic BP and had similar prognostic value in predicting th e HBS before treatment in diabetic and non-diabetic patients with BP. MPV wasn't significantly different in diabetic and non-diabetic BP patients compared with the normal population. PMID:34895869 | DOI:10.1016/j.bjorl.2021.10.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Critical analysis of moderate and severe retractions in the pars tensa and pars flaccida of the tympanic membrane

xlomafota13 shared this article with you from Inoreader Critical analysis of moderate and severe retractions in the pars tensa and pars flaccida of the tympanic membrane Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Nov 15:S1808-8694(21)00186-5. doi: 10.1016/j.bjorl.2021.10.005. Online ahead of print. ABSTRACT OBJECTIVES: Analyze the prevalence of retractions in different areas of the Tympanic Membrane (TM), the correlations between the involvement of the Pars Tensa (PT) and Pars Flaccida (PF), and the air-bone gaps. METHODS: A cross-sectional study. Patients with moderate and/or severe TM retraction of 2200 consecutive patients with chronic otitis media between August 2000 and January 2019 were included. Ears with previous surgery were excluded. Ears were classified as isolated PF and PT retractions and association of both. The degrees of severity and presence of effusion were evaluated. The data were analyzed using the SPSS Statistics software program. RESULTS: 661 ears were included. The prevalence of isolated atical retractions was 24.9%, of isolated posterior quadrants was 10.6%, and of association of quadrants was 64%. There was no correlation between the retractions in the different areas of the TM (posterior and attic quadrants: r = 0.13; p = 0.041; anterior and posterior quadrants: r = 0.23; p = 0.013, anterior and attic quadrants: r = 0.06; p = 0.043). Effusion was present in 30.7% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05); 72% of the ears had an ABG ≤ 20 dB HL. For severity of the retraction of PF, the ABG was similar across groups. For the PT, there was a global difference in the medians of ABG in terms of the degree of severity, with a moderate correlation. CONCLUSION: The prevalence of moderate and severe retractions was 24.5%; 64% of the ears had an association of affected regions. There was no correlation between the retraction in the different areas of the TM. We found a significant correlation between the severity of retraction and the worsening of ABG t hreshold, only for PT. EVIDENCE LEVEL: 4. PMID:34896036 | DOI:10.1016/j.bjorl.2021.10.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Spontaneous Herniation of Temporomandibular Joint Into the External Auditory Canal

xlomafota13 shared this article with you from Inoreader Spontaneous Herniation of Temporomandibular Joint Into the External Auditory Canal Via ear nose throat Ear Nose Throat J. 2021 Dec 13:1455613211064236. doi: 10.1177/01455613211064236. Online ahead of print. NO ABSTRACT PMID:34894808 | DOI:10.1177/01455613211064236 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

UK Guidelines for Lipomodelling of the Breast on behalf of Plastic, Reconstructive and Aesthetic Surgery and Association of Breast Surgery Expert Advisory Group

xlomafota13 shared this article with you from Inoreader UK Guidelines for Lipomodelling of the Breast on behalf of Plastic, Reconstructive and Aesthetic Surgery and Association of Breast Surgery Expert Advisory Group Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 19:S1748-6815(21)00473-3. doi: 10.1016/j.bjps.2021.09.033. Online ahead of print. ABSTRACT Lipomodelling has become increasingly popular for reconstructive, aesthetic and therapeutic indications. The guidelines summarise available evidence for indications, training, technique, audit and outcomes in lipomodelling and also highlight areas for further research. PMID:34895855 | DOI:10.1016/j.bjps.2021.09.033 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A systematic review of immunomodulatory strategies used in skin-containing preclinical vascularized composite allotransplant models

xlomafota13 shared this article with you from Inoreader A systematic review of immunomodulatory strategies used in skin-containing preclinical vascularized composite allotransplant models Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 13:S1748-6815(21)00548-9. doi: 10.1016/j.bjps.2021.11.003. Online ahead of print. ABSTRACT BACKGROUND: Acute rejection remains a vexing problem in vascularized composite allotransplantation (VCA). Available immunosuppressive regimens are successful at minimizing alloimmune response and allowing VCA in humans. However, repeated rejection episodes are common, and systemic side effects of the current standard regimen (Tacrolimus, MMF, Prednisone) are dose limiting. Novel immunomodulatory approaches to improve allograft acceptance and minimize systemic toxicity are continuously explored in preclinical models. We aimed to systematically summarize past and current approaches to help guide future research in this complex field. METHODS: We conducted a systematic review of manuscripts listed in the MEDLINE and PubMed databases. For inclusion, articles had to primarily investigate the effect of a th erapeutic approach on prolonging the survival of a skin-containing preclinical VCA model. Non-VCA studies, human trials, anatomical and feasibility studies, and articles written in a language other than English were excluded. We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. RESULTS: The search retrieved 980 articles of which 112 articles were ultimately included. The majority of investigations used a rat model. An orthotopic hind limb VCA model was used in 53% of the studies. Cell and drug-based approaches were investigated 58 and 52 times, respectively. We provide a comprehensive review of immunomodulatory strategies used in VCA preclinical research over a timeframe of 44 years. CONCLUSION: We identify a transition from anatomically non-specific to anatomical models mimicking clinical needs. As limb transplants have been most frequently performed, preclinical research focused on using the hind limb model. We also id entify a transition from drug-based suppression therapies to cell-based immunomodulation strategies. PMID:34895853 | DOI:10.1016/j.bjps.2021.11.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

'Identification of Essential Assessment Criteria in Facial Botulinum Toxin Injections'

xlomafota13 shared this article with you from Inoreader "Identification of Essential Assessment Criteria in Facial Botulinum Toxin Injections" Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 15:S1748-6815(21)00584-2. doi: 10.1016/j.bjps.2021.11.040. Online ahead of print. ABSTRACT INTRODUCTION: Facial botulinum toxin injections represent the most commonly performed aesthetic non-surgical procedures by plastic surgeons; however, post-graduate programs remain devoid of objective tools to adequately assess competence in trainees. In this study, the authors employ the Delphi methodology to establish a list of essential assessment criteria in facial botulinum toxin injections. METHODS: A list of 10 suggested criteria was generated through a literature search and in consultation with an expert plastic surgeon. A panel of content experts was selected to which an online survey was administered; skills were ranked for their relevance using a 1-10 Likert scale. Recommendations for additional skills were solicited and survey rounds were repeated until consensus was achieved. The latter wa s a measure of panelist reliability and assessed using Cronbach α (≥0.8); skills with a rating of 7 or above were taken to be essential. RESULTS: The survey process was successful at achieving consensus following two rounds of survey administration. Twenty-one participants completed the first round representing a response rate of 38%. Percent agreement among the panel was 83% and Cronbach α was computed as 0.78, necessitating further rounds. The response rate in the second round was 90%; one additional skill was added; percent agreement and Cronbach α improved to 88% and 0.87, respectively. CONCLUSION: Nine assessment criteria were identified as essential in facial botulinum toxin injections; these findings provide the groundwork necessary for the development of an objective assessment tool for the more appropriate training of marginalized aesthetic procedures in plastic surgery. PMID:34896042 | DOI:10.1016/j.bjps.2021.11.040 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long-term results of a standardized enhanced recovery protocol in unilateral, secondary autologous breast reconstructions using an abdominal free flap

xlomafota13 shared this article with you from Inoreader Long-term results of a standardized enhanced recovery protocol in unilateral, secondary autologous breast reconstructions using an abdominal free flap Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 14:S1748-6815(21)00563-5. doi: 10.1016/j.bjps.2021.11.019. Online ahead of print. ABSTRACT BACKGROUND: In 2015, we published one of the first reports using an enhanced recovery protocol (ERP) in microsurgery1, and in 2016, our final ERP setup in autologous breast reconstruction (ABR) using free abdominal flaps2. We showed that by adhering to a few simple, easy to measure, functional discharge criteria, it was possible to safely discharge the patients by the third postoperative day (POD). However, one of the challenges of interpreting studies using ERP in ABR is the often heterogenous patient populations and the need to clearly distinguish between primary and secondary and unilateral and bilateral reconstructions. MATERIALS AND METHODS: In the 5-year period from 2016-2020, the same surgical team, performed 147 unilateral, delayed breast reconstructions (135 DIEP, 9 MS-T RAM-2, and 3 SIEA flaps) according to our previous analgesic protocol and surgical strategy. Data were collected prospectively. RESULTS: Three flaps were lost (2%) and 82% of the patients(n=128) were discharged to home by POD 2 (n=8%) or 3 (74%). The remaining 18% (n=26) were discharged by POD 4 (12.5%) or 5 (5.5%). Ten patients (7%) were reoperated, and 17 patients (12%) had minor complications within POD 30 (infection, seroma, etc.) that did not necessitate hospital admission. CONCLUSION: Using our ERP, unproblematic discharge directly to home is possible on POD 3 in more than 80% of patients after ABR. ERP is no longer a research tool but considered standard of care in microsurgical breast reconstruction. PMID:3489 5856 | DOI:10.1016/j.bjps.2021.11.019 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A double-blind, placebo-controlled randomised trial of intraparenchymal administration of local anaesthetic in elective breast augmentation

xlomafota13 shared this article with you from Inoreader A double-blind, placebo-controlled randomised trial of intraparenchymal administration of local anaesthetic in elective breast augmentation Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 7:S1748-6815(21)00442-3. doi: 10.1016/j.bjps.2021.09.003. Online ahead of print. ABSTRACT INTRODUCTION: Several methods of controlling pain post-bilateral breast augmentation (BBA) have been described. BBA is frequently performed as a day case procedure; therefore, a simple effective method of controlling pain in the immediate post-operative period is desired. METHODS: We conducted a prospective, double-blinded, placebo-controlled randomised study of 20 women undergoing BBA. Women were randomly assigned to receive intraparenchymal infiltration intra-operatively prior to implant placement with either local anaesthetic (LA) (chirocaine) or normal saline. The primary outcome was post-operative pain scores immediately, and at 6 h. Our secondary endpoint was post-operative narcotic consumption. RESULTS: Twenty patients were included in this study. The average pain score in the immediate po st-operative period was 3.4 in the control group versus 0.7 in the treatment group (p = 0.013). In 6 h post-operatively, the average pain score was 2.4 in the control group versus 0.9 in the treatment group (p = 0.03). Sixty-six percentage of patients in the control arm required post-operative opiates compared with 27% in the treatment group (p = 0.17) CONCLUSION: This randomised controlled trial demonstrates a technique of intraparenchymal infiltration of LA that significantly reduces post-operative pain scores after BBA. PMID:34895854 | DOI:10.1016/j.bjps.2021.09.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgical risk prediction for nasolacrimal duct obstruction in radioactive iodine treated thyroid cancer: A nationwide cohort study

xlomafota13 shared this article with you from Inoreader Surgical risk prediction for nasolacrimal duct obstruction in radioactive iodine treated thyroid cancer: A nationwide cohort study Via radioactive iodine Thyroid. 2021 Dec 12. doi: 10.1089/thy.2021.0418. Online ahead of print. ABSTRACT BACKGROUND: To estimate the incident risk of surgical intervention for nasolacrimal duct obstruction after radioactive iodine (RAI) treatment and elucidate the high-risk group of patients with thyroid cancer (TC). METHODS: This is a nationwide, population-based, cohort study using data from the Korean National Health Claims database. Among the entire South Korean population aged between 20 and 8 0 years from 2007 to 2019, all patients with TC were included. Among all TC patients, a cohort was established by classifying it into the RAI and non-RAI groups according to whether RAI treatment was performed during the recruitment period. A log-rank analysis was used to evaluate the risk of nasolacrimal duct obstruction surgery in the RAI group compared to that in the non-RAI group. The cox proportional hazards regression analysis was performed to calculate the adjusted hazard ratio (HR). The analysis was performed stratified by the age group, sex, frequency of RAI treatment, and cumulative dose of I131. RESULTS: Among 55371 TC patients, who received RAI treatment, 515 (0.93%) underwent NLDO surgeries, and among 56950 TC patients, who did not receive RAI treatment, 72 (0.13%) underwent the surgeries. The average timing of incident nasolacrimal duct obstruction surgery was 3.8 ± 2.1 years after the first exposure to RAI. The incidence rate of nasolacrimal duct obstruction su rgery was 104.04/100000 person-years in the RAI group. There was a significantly higher risk of nasolacrimal duct obstruction surgery (HR 7.50, 95% confidence interval [CI]: 5.86-9.60, p < 0.001) in the RAI group than in the non-RAI group. The risks significantly increased in the high-dose group (HR 14.15, 95% CI: 10.88-18.39) and those younger than 50 years (HR 15.54, 95% CI: 9.76-24.72). CONCLUSION: We quantified the risk of RAI-induced nasolacrimal duct obstruction surgery through a long-term follow-up of 9 years, which may contribute to estimating the general health care burden related to RAI treatment for TC patients in a practical setting. Great attention should be paid to its risk in patients younger than 50 years, especially in those treated with high doses. PMID:34894720 | DOI:10.1089/thy.2021.0418 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Botulinumtoxin-Behandlung der großen Speicheldrüsen bei chronischer Sialorrhö

xlomafota13 shared this article with you from Inoreader Botulinumtoxin-Behandlung der großen Speicheldrüsen bei chronischer Sialorrhö Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1556-0949 Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.