Guillotine vs. classic dissection adenotonsillectomy: What's the ideal technique for children in Tanzania?

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Desderius C. Chussi, Sophie W. Poelman, Niels Van Heerbeek
ObjectivesAdenotonsillectomy (ATE) is one of the most performed surgeries in children. Extensive research on which operation technique is the best in terms of minimal pain and complications, operative time and duration of hospital stay is being done mostly in highly resourced developing countries. In developing countries a need for cost effective and time saving operation techniques is essential due to the low-resource setting. This study aims to investigate whether the Guillotine Sluder operation techniques is ideal in a limited resource developing country setting.MethodsA retrospective cohort study was conducted on children below 12 years of age who underwent ATE at the Kilimanjaro Christian Medical Center, a tertiary hospital in Northern Tanzania, in a period of 2 years to compare the guillotine Sluder and classic dissection ATE techniques. All procedures were done by the same surgeon. Incomplete patient information and congenital syndromes were exclusion criteria for the study.ResultsBoth operative time and duration of hospital stay were significantly shorter in the guillotine Sluder group (3,5 min with 95% CI 1,1 to 5,9 min, and 0,4 days with 95% CI 0,2 to 0,6 days respectively). The rate of complications was not statistically different between the two groups. The overall rate of complications was comparable to that of Western countries. No difference was found in mean amount of blood loss during operation.ConclusionsOur results conclude that guillotine Sluder tonsillectomy is a safe procedure that has some advantages compared to classic dissection in children in Tanzania. The shorter operative time and time in hospital stay combined with the low complication rate makes the guillotine Sluder technique a very suitable technique for children in Tanzania and comparable limited resource developing country settings.



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Resolution of bilateral sensorineural hearing loss following ventriculoperitoneal shunt and literature review

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): A. Jamshidi, C. Glidewell, J. Murnick, S. Magge, B.K. Reilly
ObjectiveThe purpose of this study is to highlight the relationship between obstructive hydrocephalus, changes in intracranial pressure, and sensorineural hearing loss.MethodsA case of a 10-month old infant with sensorineural hearing loss secondary to obstructive hydrocephalus is reported. A literature review, with a focus on sensorineural hearing loss in the setting of changes in intracranial pressure, was performed.ResultsThe authors report the case of a 10-month old infant with metopic and bicoronal craniosynostosis who presented with bilateral moderately severe sensorineural hearing loss after failing newborn hearing screening. Imaging subsequently demonstrated obstructive hydrocephalus, which was treated with the insertion of a VP shunt. The patient had immediate improvement of her hearing post-operatively, with repeat hearing tests showed resolution of her hearing loss.ConclusionSensorineural hearing loss is a rare complication of hydrocephalus, but changes in intracranial pressure should be considered in the differential diagnosis. We put forth a flow diagram illustrating the hypothesized relationship between intracranial pressures, alterations in the levels of cochlear fluid, and hearing.



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FDG-PET/CT for systemic staging of patients with newly diagnosed breast cancer

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Advances in midface reconstruction: beyond the reconstructive ladder.

Purpose of review: This article reviews the anatomy and function of the midface, defect classifications and the breadth of common and novel reconstructive techniques including medical modeling, dental splints, and dental rehabilitation. Recent findings: Historically many classification systems for midface and maxillary defects exist but most defects are unique and an individualized approach is required. There has been an increased interest in using regional pedicled flaps with bone for reconstruction. Free flap reconstruction with the osteocutaneous radial forearm and fibula flap have been recently modified to increase the success of osseointegrated implants. Scapular free flap reconstruction has become increasingly popular because of the versatility, good bony contour match, and long pedicle length with the scapular tip flap. Dental splints are more cost effective than medical modeling and cutting guides but both techniques are complimentary in complex reconstruction. Summary: Midface reconstruction is a unique and challenging surgery demonstrated by the numerous classification systems and techniques available to reconstruct. Recent developments have further augmented these challenging reconstructions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Dental patch testing in patients with undifferentiated oral lichen planus

Abstract

Background/Objectives

Distinguishing between oral lichen planus (LP) and lichenoid reactions to dental restorations can be impossible on clinical and histopathological grounds. Epicutaneous patch testing is an investigation that may guide patients and physicians in making timely and costly decisions to replace or cover existing dental restorations. This study aimed to assess the role of epicutaneous patch testing with a battery of dental allergens in patients with undifferentiated oral LP.

Methods

A retrospective review of the medical records of patients with biopsy-proven oral LP referred by an oral medicine specialist and who presented for dental epicutaneous patch testing at a dermatology clinic in Perth, Western Australia between 2009 and 2016 was performed.

Results

In total, 68 patients were included, of whom 54 (79%) had positive patch tests. Gold 26 (48%), mercury 24 (44%), nickel 22 (41%), copper 19 (35%), potassium dichromate 14 (26%) and methylhydroquinone 13 (24%) were the most common allergens for which patients tested positive. Hypothyroidism and non-steroidal anti-inflammatory drugs were associated with negative patch tests (P = 0.01 and 0.04, respectively). Smoking history, other medications and comorbidities, the location of the dental restorations and unilateral or bilateral disease were not significantly associated with the patch test results. Restorations were removed in 23 patients: 21 of these (91%) had positive epicutaneous patch tests. Of the 20 patients followed up, 19 (95%) experienced some improvement, among whom 11 (58%) had complete remission.

Conclusion

Epicutaneous patch testing disclosed a high proportion of relevant positives. This guided the clinical decision to change dental restorations, with high rate of clinical improvement.

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Dental patch testing in patients with undifferentiated oral lichen planus

Abstract

Background/Objectives

Distinguishing between oral lichen planus (LP) and lichenoid reactions to dental restorations can be impossible on clinical and histopathological grounds. Epicutaneous patch testing is an investigation that may guide patients and physicians in making timely and costly decisions to replace or cover existing dental restorations. This study aimed to assess the role of epicutaneous patch testing with a battery of dental allergens in patients with undifferentiated oral LP.

Methods

A retrospective review of the medical records of patients with biopsy-proven oral LP referred by an oral medicine specialist and who presented for dental epicutaneous patch testing at a dermatology clinic in Perth, Western Australia between 2009 and 2016 was performed.

Results

In total, 68 patients were included, of whom 54 (79%) had positive patch tests. Gold 26 (48%), mercury 24 (44%), nickel 22 (41%), copper 19 (35%), potassium dichromate 14 (26%) and methylhydroquinone 13 (24%) were the most common allergens for which patients tested positive. Hypothyroidism and non-steroidal anti-inflammatory drugs were associated with negative patch tests (P = 0.01 and 0.04, respectively). Smoking history, other medications and comorbidities, the location of the dental restorations and unilateral or bilateral disease were not significantly associated with the patch test results. Restorations were removed in 23 patients: 21 of these (91%) had positive epicutaneous patch tests. Of the 20 patients followed up, 19 (95%) experienced some improvement, among whom 11 (58%) had complete remission.

Conclusion

Epicutaneous patch testing disclosed a high proportion of relevant positives. This guided the clinical decision to change dental restorations, with high rate of clinical improvement.

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Life quality improvement in hoarse patients with early glottic cancer after transoral laser microsurgery

Abstract

Background

The purpose of this study was to evaluate the recovery kinetics of voice and quality of life (QOL) over time in patients with early glottic cancer who underwent transoral laser microsurgery (TLM).

Methods

A prospective cohort study was conducted in which acoustic and aerodynamic voice assessments and QOL analyses were done using health-related questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions [EORTC-QLQ-C30] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35-questions [EORTC-QLQ-H&N35]) were administered at designated times.

Results

Most voice laboratory parameters worsened during the first month, then recovered to baseline after 6 months. The QLQ-H&N35 speech subscale was significantly improved. Among the voice laboratory parameters, pretreatment harmonics-to-noise ratio was an independent predictor (P = .041) for improvement on the speech subscale at the endpoint.

Conclusion

Despite an initial deterioration of voice and QOL in the first month, patients who underwent TLM recovered to a plateau since the sixth month and then to better than preoperative status afterward. A greater improvement in QOL was seen in patients with poorer baseline voice quality.

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