Local radiotherapy versus nonradiotherapy to distant lesions for metastatic nasopharyngeal carcinoma: A retrospective cohort study

xlomafota13 shared this article with you from Inoreader Local radiotherapy versus nonradiotherapy to distant lesions for metastatic nasopharyngeal carcinoma: A retrospective cohort study Via Head & Neck Abstract Background To evaluate the efficiency of local radiotherapy to metastatic lesions in patients with metastatic nasopharyngeal carcinoma (mNPC). Methods The overall survival was observed and compared for mNPC patients who received local radiotherapy versus nonradiotherapy to metastatic lesions by using the Kaplan–Meier method and Cox analysis. Results One hundred and nine patients with NPC were involved in this study, with 61 (56.0%) received radiotherapy to metastatic sites and 48 (44.0%) did not receive radiotherapy to metastatic sites. The 2- and 5-year OS for patients who received local radiotherapy to metastatic lesions were 65.8% and 35.7%, and for patients who did not receive radiotherapy to metastatic lesions were 45.3% and 26.2%. The multivariable adjusted hazard radios for local radiotherapy versus nonradiotherapy to metastatic lesions were 0.482 (95% confidence interval is 0.278–0.834, p = 0.009). Conclusions Local radiotherapy to metastatic lesions might be a protective factor for patients with mNPC. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Postparotidectomy sialocele: A 6‐year review of underlying factors

xlomafota13 shared this article with you from Inoreader Postparotidectomy sialocele: A 6‐year review of underlying factors Via Head & Neck Abstract Background Postparotidectomy sialocele is a frustrating challenge. Published rates of postparotidectomy fluid collections range from 6% to 39%. We report our experience of 398 parotidectomies performed over a 6-year period. Methods A retrospective chart review of parotidectomies performed over a 6-year period was completed. Drain placement, smoking status, tumor size, and postoperative utilization of scopolamine were analyzed. Binary logistical regression and odds ratio calculations were performed. Results Postparotidectomy sialocele occurred in 25% of patients. Neither suction drain placement nor usage of immediate postoperative scopolamine (in a 22-patient subset) prevented sialocele formation. Smoking status also did not correlate. Increasing resection size was linearly correlated with the risk of sialocele. Conclusion Drain placement and smoking status do not correlate with sialocele prevention after parotidectomy. Sialocele formation directly correlates with the resection size. These data may guide preoperative counseling; however, additional work is necessary to identify effective prevention mechanisms for postparotidectomy sialocele. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The role of fungus in the pathogenesis of chronic rhinosinusitis

xlomafota13 shared this article with you from Inoreader The role of fungus in the pathogenesis of chronic rhinosinusitis Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review The etiologic role of fungi in chronic rhinosinusitis remains controversial. The purpose of this review is to further our understanding of molecular immunologic pathways activated by fungi and clinical trials of antifungals in severe subtypes of asthma and allergic fungal rhinosinusitis. Recent findings Various fungal components such as protease and chitin are capable of eliciting a type 2 innate and adaptive immune response. However, definitive studies on the etiologic role of fungi in chronic rhinosinusitis (CRS) is dependent on the development of a fungi-induced murine model of CRS. Short of this model, extrapolations of observations and results from clinical trials in fungi-induced asthma subtypes support a key role of fungi in the pathophysiology of allergic fungal rhinosinusitis and possibly other CRS endotypes. Summary Fungi plays a key role in the pathophysiology of several subtypes of chronic inflammatory respiratory diseases. However, a fungi-induced murine model of CRS is needed to explicitly investigate the molecular pathways and potential therapeutic targets. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

COVID-19 related olfactory dysfunction

xlomafota13 shared this article with you from Inoreader COVID-19 related olfactory dysfunction Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review This article reviews the literature on COVID-19 related anosmia, focusing on the epidemiology, pathophysiology recovery rates, current available treatment options, and research regarding novel treatments. Recent findings Loss of sense of smell is one of the most prevalent symptoms reported by patients after COVID-19 infection. Even though there is a high self-reported recovery rate, recent studies have demonstrated that up to 7% of the patients remain anosmic more than 12 months after onset, leaving millions worldwide with severe olfactory dysfunction. Olfactory training remains the first line recommended treatment. Given the paucity of effective medical treatments options researchers are exploring novel therapeutic options. Summary Olfactory dysfunction remains a significant and persistent legacy of the COVID-19 pandemic, but heightened awareness may stimulate research that leads to the development of much-needed treatment options. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of the middle turbinate during and after sinus surgery

xlomafota13 shared this article with you from Inoreader Management of the middle turbinate during and after sinus surgery Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Treatment of the middle turbinate (MT) during and after endoscopic sinus surgery (ESS) has been controversial. Historically, there has been concern that resection of the MT may result in smell loss and frontal sinus stenosis. However, these concerns must be balanced by knowledge that a residual diseased MT may result in surgical failure. This review discusses the current evidence on treatment of the MT during and after ESS. Recent findings Several review articles have shown the safety of performing MT resection. Studies have not shown increase rates of frontal sinus stenosis, olfactory loss, or empty nose syndrome. However, the benefit of MT resection is highly debated. There have also been many recent advances and technological developments to assist in management of the postoperative MT. Summary The literature supports the safety of performing MT resection, however, the benefit of resection over preservation is controversial. New technologies and techniques exist that may aid in preventing postoperative MT lateralization. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The role of nasopharyngectomy in the management of nasopharyngeal carcinoma

xlomafota13 shared this article with you from Inoreader The role of nasopharyngectomy in the management of nasopharyngeal carcinoma Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Recently, endoscopic nasopharyngectomy (ENPG) has become an effective treatment for locally recurrent nasopharyngeal carcinoma (NPC). This article reviews recent publications on ENPG and specifically addresses the surgical anatomy of the nasopharynx and discusses several important issues regarding ENPG. Recent findings The surgical techniques for ENPG have been previously described in several studies. The latest published data revealed good outcomes of ENPG compared with intensity-modulated radiation therapy (IMRT) in recurrent NPC. In addition, ENPG avoids severe reirradiation side effects. This review highlights the surgical anatomy of ENPG, which is important in preventing possible serious complications. Summary ENPG is a good option for managing recurrent NPC. Careful preoperative evaluation and a full understanding of the surgical anatomy help in preventing damage to nearby critical neurovascular structure. Long-term follow-up is still needed to evaluate its eventual morbidity and efficacy. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Emerging concepts in sinonasal tumor research

xlomafota13 shared this article with you from Inoreader Emerging concepts in sinonasal tumor research Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Sinonasal malignancies are rare and understudied, often diagnosed at late stages, and may behave aggressively. This review explores investigative diagnostic, therapeutic, and scientific advances specific to sinonasal undifferentiated carcinoma (SNUC), intestinal-type adenocarcinoma (ITAC), and olfactory neuroblastoma (ONB). Recent findings A number of studies have recently contributed more robust knowledge of the genetic and molecular landscapes of SNUC, ITAC, and ONB. These analyses have identified SMARCB1 and IDH2 mutations in SNUC, potentially allowing for the tumor's subdivision. Recent studies have also defined a role for induction chemotherapy in SNUC. Somatic mutations for ITAC have been identified and may be potentially targetable with FDA approved therapies. Studies defining the tumor microenvironment for ITAC and ONB have introduced the possibility of immune checkpoint inhibition for these tumor types. Summary Studies reviewed here detail promising results of the most current and novel characterization of SNUC, ITAC, and ONB genetic and molecular landscapes, which have informed ongoing therapeutic discovery. With continued multi-institutional efforts, the field of sinonasal tumor research will achieve higher disease control and improved treatment outcomes for patients afflicted with these rare cancers. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Postoperative pain and opioid use after breast reduction with or without preoperative nerve block

xlomafota13 shared this article with you from Inoreader Postoperative pain and opioid use after breast reduction with or without preoperative nerve block Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 29:S1748-6815(21)00630-6. doi: 10.1016/j.bjps.2021.11.089. Online ahead of print. ABSTRACT BACKGROUND: Physician-prescribed opioids have been implicated as key contributing factors in the current opioid epidemic in the United States. Breast reduction mammoplasty is one of the most commonly performed procedures in plastic surgery and patients are often prescribed large amounts of postoperative opioids. Here we investigate the effects of erector spinae nerve blocks on postoperative pain, opioid consumption, and quality of life after breast reduction. METHODS: Following the institutional review board (IRB) approval, a prospective cohort study of some patients undergoing breast reduction mammoplasty at Montefiore Medical Center between June and September 2019 was undertaken. The patients were stratified into two cohorts for further analysis: those who received preoperative erector spinae nerve block and those who did not. Primary outcomes measures analyzed included Likert pain scores, patient-reported outcome measures, and opioid consumption for the first five postoperative days. RESULTS: Forty-seven patients were enrolled in the analysis. Thirteen patients (28%) received nerve blocks, 34 (72%) did not. On average, the patients were prescribed 114.3 (±34.6) morphine equivalents postoperatively and they consumed 45% (±35.3) by the end of the first five days post-surgery. There were no significant differences between cohorts in morphine equivalents prescribed or consumed, postoperative pain scores, or patient-reported outcome measures. CONCLUSIONS: Following breast reduction mammoplasty, patients on average consumed < 50% of prescribed opioids, suggesting over-prescription of postoperative opioids for breast reduction recovery. Preoperative nerve block did not improve pain scores or decrease opioid consumption for the first five days after surgery. PM ID:34961696 | DOI:10.1016/j.bjps.2021.11.089 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nail-based reconstruction strategies for Wassel-Flatt type IVh thumb polydactyly with a floating ulnar digit: A preliminary report with 63 thumbs

xlomafota13 shared this article with you from Inoreader Nail-based reconstruction strategies for Wassel-Flatt type IVh thumb polydactyly with a floating ulnar digit: A preliminary report with 63 thumbs Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 30:S1748-6815(21)00617-3. doi: 10.1016/j.bjps.2021.11.071. Online ahead of print. ABSTRACT PURPOSE: To present a surgical regimen based on nail morphology for Wassel-Flatt type IVh thumb polydactyly with a floating ulnar digit. METHODS: Cases within six years were retrospectively analyzed and followed up for an average of 18 months. Three types of classifications were defined based on nail morphology ‒ ulnar nail dominant type with two subtypes of nail lateral fold symmetric or asymmetric, radial nail dominant type, and equal nail size type. One out of three procedures, on-top plasty (Ⅰ), soft tissue augmentation (Ⅱ), and the combination of the above two (Ⅲ), was performed. The Tada scoring system was used to evaluate the results. RESULTS: Sixty-three thumbs were enrolled, forty-one of better ulnar nail type underwent top transposition, and in cases of asymmetric nail lateral fold subtype, the result of procedure Ⅲ was better than that of procedure Ⅰ, thirteen of the radial nail dominant type and nine of equal nail size type both had procedure Ⅱ. The equal nail size type was the least effective among groups, with an average Tada of four points. Six cases underwent secondary revision surgery. According to the Tada scoring system, the results were excellent in 61, fair in two. CONCLUSIONS: Classifications based on the morphology of the nail can guide surgical planning. On-top plasty is suitable for symmetric nail lateral fold subtype. Soft tissue augmentation is ideal for radial nail dominant type and equal nail size type, and the combination of the two procedures is a better option for asymmetric nail lateral fold subtype. PMID:34961698 | DOI:10.1016/j.bjps.2021.11.071 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Flap survival and functional outcomes in elbow soft tissue reconstruction: A 25-year systematic review

xlomafota13 shared this article with you from Inoreader Flap survival and functional outcomes in elbow soft tissue reconstruction: A 25-year systematic review Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Dec 2:S1748-6815(21)00637-9. doi: 10.1016/j.bjps.2021.11.091. Online ahead of print. ABSTRACT INTRODUCTION: Different elbow flap reconstructions have been described in the literature. We aim to define the optimal flap technique based on defect size and etiology. METHODS: A systematic review was undertaken using the terms "(Elbow reconstruction) AND ((Soft tissue) OR (flap))". Flaps were grouped under fasciocutaneous (FCF), muscular (MF), distant pedicled (DPF), and free flaps (FF). The primary outcome was flap survival. The secondary outcomes were postoperative complications and range of motion (pROM). RESULTS: Twenty articles with 224 patients were included. Defect sizes were small (<10 cm2) (18%), medium (10-30 cm2) (23%), large (30-100 cm2) (43%), and massive (>100 cm2) (16%). Etiologies included trauma (26%), burn contractures (26%), i nfection (26%), hardware coverage (16%), and others (6%). FCF (54%) was the preferred flap followed by MF (28%), DPF (13%), and FF (5%). The rate of flap necrosis was 4% and that of other complications was 10%. The postoperative range of motion (pROM) (reported in 154 patients) was >100°, 50-100°, and <50° in 82%, 17%, and 1% of the cases, respectively. Small defects were most commonly reconstructed with MFs (83%), medium defects were reconstructed with MFs (52%) or FCFs (46%), and large defects were reconstructed with FCFs (91%). Massive defects predominantly required DPFs (60%) and FFs (26%). FCFs were the most common reconstruction method for burn contractures (84%), infections (55%), and traumatic defects (51%). Hardware coverage was predominantly performed using MFs (86%). No difference in complications and pROM was found between flap techniques. CONCLUSION: Elbow flap reconstruction can be performed using different techniques. FCFs are the most commonly used rec onstruction method. MFs are useful for smaller defects and hardware coverage. DPFs and FFs are needed for massive injuries. PMID:34961697 | DOI:10.1016/j.bjps.2021.11.091 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Patients with mild cognitive impairment diagnosed at dementia clinic display decreased maximum occlusal force: a cross-sectional study

xlomafota13 shared this article with you from Inoreader Patients with mild cognitive impairment diagnosed at dementia clinic display decreased maximum occlusal force: a cross-sectional study Via swallowing exercises BMC Oral Health. 2021 Dec 27;21(1):665. doi: 10.1186/s12903-021-02027-8. ABSTRACT BACKGROUND: Previous research indicates that patients with mild cognitive impairment (MCI) are more likely to have poor oral health and impairments in oral functions, which may be due to few remaining teeth and impaired tongue and lip motor function. However, the oral health of those patients following comprehensive cognitive assessment by a dementia specialist has not been sufficiently investigated. Therefore, this study aimed to clarify the oral function of patients with MCI and the association between oral health and lower cognitive function. METHODS: This cross-sectional study included 96 participants (men: 35; women: 61; mean age: 73.3 ± 8.5 years) who visited a dementia clinic between December 2017 and January 2020. Participants' cognitive function was assessed by a dementia specialist using neuropsychological and hematological tests and neuroimaging immediately after enrollment. The participants were divided into the healthy and MCI groups according to comprehensive cognitive assessment. Participants' age, sex, body mass index, primary disease, education level, drinking habits, smoking habits, living environment, employment status, and exercise habits were evaluated. Moreover, oral outcomes, including the number of existing teeth, number of functional teeth (natural and prosthetic teeth which were occluded with antagonists), denture use, oral dryness, tongue and li p motor function, tongue pressure, occlusal force, masticatory ability, and swallowing ability were recorded. The Mann-Whitney U test, χ2, and Fisher's exact tests were used for between-group comparisons. Furthermore, logistic regression analysis using MCI diagnosis as the target variable was performed. RESULTS: A comprehensive evaluation of the cognitive function of the study participants by the dementia specialist revealed that 48 participants (mean age: 69.8 ± 8.8 years) were healthy and 48 (mean age: 76.9 ± 6.7 years) had MCI. MCI participants were significantly older (p < 0.001) and had significantly fewer existing teeth (p = 0.031) and lower maximum occlusal force (p = 0.019) than healthy participants. Age (odds ratio: 1.126, p = 0.002) and maximum occlusal force (odds ratio: 0.978, p = 0.048) were significantly associated with lower cognitive function. CONCLUSIONS: Patients with MCI had poorer oral health than healthy individuals. Decreased maximu m occlusal force was independently associated with lower cognitive function, even when adjusted for age and sex. PMID:34961506 | DOI:10.1186/s12903-021-02027-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.