Category: Nevin Manimala

J Craniofac Surg. 2021 Jun 23. doi: 10.1097/SCS.0000000000007709. Online ahead of print.

ABSTRACT

OBJECTIVES: Mandible fractures can be treated with different plate systems, that is, miniplates or three-dimensional (3D) plates. This systematic review describes the effectiveness and clinical outcomes of 3D plates used in fractures of the mandible and aims to critically evaluate its risks and benefits.

MATERIALS AND METHODS: A comprehensive electronic search was conducted without date but with restriction to articles written in English. Studies in humans, including randomized or quasi-randomized controlled trials and retrospective studies, were included. The outcome parameters measured were number of patients, fracture classification, results, follow-up period, postoperative complications, and mean age of patients. Major complications were defined as those needing additional surgical intervention, for example, malocclusion, infection or plate fracture. Accordingly, complications not needing additional surgical intervention were defined as minor (ie, dehiscence, trismus).

RESULTS: Guided by the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Interventions, the authors identified 44 publications with a total of 1790 patients. Among the articles selected for the final review, there were 32 reported prospective studies, 12 reported retrospective studies. Regarding the evaluation of quality, 8 studies showed a low value of the risk of bias, 17 a moderate risk, and 19 a high risk. There were statistically significant advantages for 3D plates in mandibular fractures in terms of postoperative complications, for example, wound dehiscences or plate fracture.

CONCLUSIONS: The 3D plate is an effective treatment modality for mandibular fractures, with low incidence of major complications, decreased length of operation time, and increased stability of osteosynthesis.

PMID:34172684 | DOI:10.1097/SCS.0000000000007709

J Craniofac Surg. 2021 Jun 23. doi: 10.1097/SCS.0000000000007712. Online ahead of print.

ABSTRACT

The purpose of this study was to investigate three-dimensional facial soft tissue changes after bimaxillary orthognathic surgery (BOGS) in patients with cleft lip and palate. The samples consisted of 34 Korean young adult patients with skeletal class III malocclusion who underwent BOGS for maxillary advancement/posterior impaction and mandibular setback. They were divided into cleft-class III (C-CIII) group (n = 18) and noncleft-class III (NC-CIII) group (n = 16). Three-dimensional computed tomography images were taken 1 month before (T1) and 3 months after (T2) surgery. After 34 hard/soft tissue landmarks were automatically identified using software, the amount and direction of change in landmarks and the amount of change in 16 soft tissue variables during T1-T2 were calculated. Then, statistical analysis was performed. Compared to NC-CIII group, C-CIII group showed more posteriorly-positioned hard/soft tissue landmarks, larger alar width, alar base width and philtrum width, and more obtuse nasal tip angle at both T1 and T2 stages. C-CIII group exhibited higher soft-to-hard tissue movement ratios at the bottom of the nose (ΔSn/ΔANS, 1.08 versus 0.81) and the upper part of the upper lip (ΔPoint A’/ΔPoint A, 1.08 versus 0.91), but a lower ratio at the lower part of the upper lip (ΔLs’/ΔIs, 0.72 versus 1.01) than NC-CIII group. The number of hard-soft tissue landmarks with high correlation (>0.90) was smaller in C-CIII group than in NC-CIII group (2 versus 6). Scar tissues and abnormal muscles in the nose and upper lip might elicit different responses in the nasolabial soft tissues to BOGS between C-CIII and NC-CIII patients.

PMID:34172680 | DOI:10.1097/SCS.0000000000007712

J Craniofac Surg. 2021 Jun 23. doi: 10.1097/SCS.0000000000007716. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effect of orthognathic surgery on the long-term quality of life of patients with presurgical skeletal Class III and to identify its strongest effect-whether esthetic, social, or functional.

MATERIALS AND METHODS: In this retrospective cohort study, the subjects were patients after orthognathic surgery for repairing skeletal Class III. Fifty-five patients who had undergone orthognathic surgery from 2013 to 2018 in the oral and maxillofacial surgery department participated in this study. Each participant completed a modified questionnaire used to assess the patient’s esthetic, social, and functional abilities after orthognathic surgery.

RESULTS: The rate of esthetic improvement in orthognathic surgery patients was 88%. More than four-fifths (81.8%) of the patients reported improvement in their personal and social self-esteem and confidence. Finally, 40.7% of the patients reported functional improvement. No significant differences between male and female patients were found. All but one of the patients recommended orthognathic surgery for patients with similar problems. One in six (17.3%) patients was dissatisfied with the nasal appearance after the surgical procedure, while almost a quarter (21.8%) reported worsening of their mouth opening, and 25.4% reported worsening of TMJ (Temporo-Mandibular Joint) symptoms. Analysis of the results revealed no statistically significant pattern connecting preoperative overjet or overbite measures with satisfaction rates.

CONCLUSIONS: In this study, patient satisfaction with the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance, mouth opening, and TMJ complaints.

PMID:34172683 | DOI:10.1097/SCS.0000000000007716

Otol Neurotol. 2021 Jun 25. doi: 10.1097/MAO.0000000000003202. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess a middle ear simulator as a surgical training tool among a cohort of novice trainees.

STUDY DESIGN: Prospective pilot study.

SETTING: The George Washington University Hospital (tertiary care academic hospital).

PARTICIPANTS: Twenty one medical students and physician assistant students completed the protocol. Each student produced four recordings over 10 attempts. The two raters were attending surgeons from the George Washington University Hospital.

INTERVENTIONS: Stapedotomies performed on a high-fidelity middle ear simulator. Participants were assessed at baseline with a Purdue pegboard test and trained with video and a low fidelity middle ear simulator.

MAIN OUTCOME MEASURES: Two experts rated recordings on scales based upon a validated objective skills assessment test (OSAT) format.

RESULTS: Inter-rater reliability was strong across all stapedotomy skills scores and global rating scores. Participants demonstrated statistically significant improvement up to the third recording (seventh attempt), but the scores on the fourth recording (tenth attempt) were not significantly different from the third. One participant failed to improve in score over 10 attempts. Pegboard test performance was not correlated with score improvement. Low-fidelity trial time was significantly correlated to stapedotomy and global rating scores.

CONCLUSIONS: This pilot study serves as the first investigation of this middle ear simulator amongst a cohort of trainees. A high-fidelity middle ear simulator may serve as a measurement tool to select future surgical trainees, customize training pathways, and assess surgical capacity before graduation.

PMID:34172652 | DOI:10.1097/MAO.0000000000003202

Otol Neurotol. 2021 Jun 25. doi: 10.1097/MAO.0000000000003245. Online ahead of print.

ABSTRACT

HYPOTHESIS: We hypothesized that an anomalous change of Notch signaling might be involved in the pathophysiology of cholesteatoma.

BACKGROUND: The Notch signaling pathway regulates integrated growth and differentiation control of keratinocytes. Its involvement in cholesteatoma proliferation has not been elucidated.

METHODS: We obtained cholesteatoma and external auditory canal (EAC) skin samples from patients with middle ear cholesteatoma who underwent tympanomastoid surgery. We performed polymerase chain reaction using the RT2 Profiler™ PCR Array Human Notch Signaling Pathway (Qiagen) in the cholesteatoma and EAC skin samples (n = 6 each). This was followed by immunohistochemical staining of Notch1, enhancer of split-1 (HES1), and p53 in 41 and 8 cholesteatoma and EAC skin samples, respectively.

RESULTS: The fold change of Notch1 gene expression was lowest in cholesteatoma, with a statistically significant difference (p = 0.0424). Moreover, the fold change of HES1 expression decreased (p = 0.272). The positive rates of Notch1 and HES1 protein expressions in the cholesteatoma (48.5 ± 32.4% and 44.9 ± 17.8%, respectively) were significantly lower than in the EAC skin (83.4 ± 17.5% and 55.7 ± 7.1%, respectively) (p < 0.001 and p < 0.01). In contrast, the positive rate of p53 expression in the cholesteatoma (8.5 ± 11.4%) was significantly higher than in the EAC skin (0.5 ± 0.7%) (p < 0.001).

CONCLUSION: The decreases in Notch1 and HES1 protein expression might play an important role in the hyperproliferative character of the keratinizing squamous epithelium in cholesteatoma. An increase in p53 might reflect the reaction to cellular hyperproliferation.

PMID:34172659 | DOI:10.1097/MAO.0000000000003245

Otol Neurotol. 2021 Jun 25. doi: 10.1097/MAO.0000000000003251. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess outcomes after surgery for vestibular schwannoma in patients over 70 years of age.

STUDY DESIGN: Retrospective chart review.

SETTING: Two tertiary otology and neurotology centers.

PATIENTS AND INTERVENTIONS: Patients undergoing primary surgery for vestibular schwannoma between 2007 and 2018.

MAIN OUTCOME MEASURES: Postoperative complications and surgical outcomes.

RESULTS: A total of 452 patients met inclusion criteria, 31 of whom (6.9%) were over 70 years of age. Age ranged from 18 to 90 years with a mean of 53 years. Elderly patients were more likely to have pre-existing hypertension (58.1% versus 34.0%, p = 0.007) and diabetes mellitus (19.4% versus 7.4%, p = 0.02). Elderly patients were less likely to undergo gross total resections of their tumors (35.5% versus 60.6%, p = 0.05) although they were not statistically significantly more likely to undergo subtotal (<95%) resections (25.8% versus 14.7%, p > 0.05). Elderly patients were also less likely to undergo second stage procedures (0% versus 9.5%, p = 0.04). There were no significant differences between elderly and non-elderly patients in the rates of any complications, ultimate facial nerve function, or duration of surgery. No patients over 70 years of age expired within 1 year of surgery.

CONCLUSIONS: Conservative surgery for vestibular schwannoma in appropriately selected elderly patients is appropriate and safe, given adequate consideration to risk-benefit analysis and goals of care.

PMID:34172668 | DOI:10.1097/MAO.0000000000003251

J Strength Cond Res. 2021 Jun 22. doi: 10.1519/JSC.0000000000004089. Online ahead of print.

ABSTRACT

Gomez-Hixson, K, and Brown, ML. Implementation of an educational fueling station for a NCAA division III athletic program. J Strength Cond Res XX(X): 000-000, 2021-The purpose of this project was to evaluate the effectiveness and sustainability of an educational fueling station for National Collegiate Athletic Association (NCAA) Division III student-athletes. Subjects included student-athletes participating in the fall 2018 athletic season (n = 82). Once the mobile fueling station was established, the athletes were informed of the mobile fueling station policies and educated on the appropriate use and timing of the fueling station. The fueling station remained in operation until the end of the 2018 fall athletic season, after which the effectiveness and athlete acceptance of the mobile fueling station was assessed. An anonymous online survey was used as the assessment tool and was created by the authors based on the information pertinent to our institution and mobile fueling station goals and objectives. An itemized inventory usage tracking system was used to calculate actual costs. Data analysis was limited to basic descriptive statistics including the overall response rate and the frequency and percentage of responses to the survey questions. Outcome assessment indicated that 97% of athletes found that the foods provided helped their performance; 95% felt they were properly oriented to the fueling station, and 51% used the fueling station 1-2 times per week on game days. Furthermore, inventory tracking revealed that the operational costs came in under the projected budget. Overall, the mobile fueling station was successfully implemented for student-athletes within a NCAA Division III university and demonstrated feasibility and sustainability within a low-budget athletic program. Establishing proof of concept led to the permanent adoption of the mobile fueling station.

PMID:34172635 | DOI:10.1519/JSC.0000000000004089

J Strength Cond Res. 2021 Jun 22. doi: 10.1519/JSC.0000000000004081. Online ahead of print.

ABSTRACT

Hibbert, JE, Klawiter, DP, Schubert, MM, Nessler, JA, and Asakawa, DS. Strength, cardiovascular fitness, and blood lipid measures in law enforcement personnel after a 12-week health promotion program. J Strength Cond Res XX(X): 000-000, 2021-Law enforcement personnel often have high rates of cardiovascular disease and injury. Health promotion programs have been found to successfully encourage behavior change among law enforcement personnel, but these programs can often be intensive and expensive. Thus, the purpose of this study was to examine the efficacy of a health promotion program on body composition, metabolic health, muscle strength, and cardiovascular endurance in law enforcement personnel. Active duty officers from a local law enforcement agency were invited to participate in a 12-week health promotion program that included activity tracking and exercise and nutrition education. Eighteen subjects underwent measurements of body composition, V[Combining Dot Above]O2max through treadmill test, knee extensor strength, and blood lipids. An a priori alpha level for significance was set at 0.05, and comparisons were assessed using paired t-tests. Overall, subjects improved blood lipid levels evidenced by movement of mean values toward established healthy ranges. Although 8 subjects improved their V[Combining Dot Above]O2max (range: 1.3-30% change), there was large variability and no statistically significant differences in measures of V[Combining Dot Above]O2max (pre: 38.48 ± 5.86 ml·kg·min-1; post: 39.27 ± 5.26 ml·kg·min-1), body composition (pre: 26.52 ± 8.02% body fat; post: 26.44 ± 7.45% body fat), and strength normalized to body mass (isometric pre: 1.45 ± 0.45; post: 1.08 ± 0.36). Although no significant changes were noted, promising trends in these data suggest that health promotion programs with a modified focus may lead to positive changes in overall health.

PMID:34172638 | DOI:10.1519/JSC.0000000000004081

Otol Neurotol. 2021 Jun 25. doi: 10.1097/MAO.0000000000003163. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe a new stapedotomy in which is removed only the stapes head not the entire stapes superstructure and its long-term results.

STUDY DESIGN: Prospective study.

PATIENTS: The study was started on January 2015 and ended on September 2020. Seventy patients with otosclerosis were included in the study. They underwent stapedotomy from January 2015 to April 2016. The main follow-up for the study group was (5.1 yrs). The study group was divided into two groups (A and B) according the short hearing results (1 yr) and long hearing results (5.1 yrs). Group A including short hearing results. Group B including long hearing results. For all patients in groups A and B, the surgeon (M.G.), microscope, the anesthesia (local), the approach (transcanal), the prostheses (piston-type), and the new stapedotomy (removal of the stapes head only and not of the entire stapes superstructure), were identical.

RESULTS: No patients exhibited postoperative dizziness or worsening of bone conduction. Cutting the stapes neck never caused bleeding or footplate complications. The average time to perform the new stapedotomy was 15 minutes. Air-bone gap (ABG) closure to within 10 dB was achieved in 66 of 70 (94.28%) cases in group A and in 65 of 70 (92.85%) cases in group B. This difference was not statistically significant.

CONCLUSION: The Malafronte’s stapedotomy is an easy, safety, minimally invasive, and fast surgical technique. Its hearing outcomes are good and stable over time.

PMID:34172650 | DOI:10.1097/MAO.0000000000003163

J Glaucoma. 2021 Jun 24. doi: 10.1097/IJG.0000000000001903. Online ahead of print.

ABSTRACT

PRECIS: A small increase in optic nerve head vessel density (VD), but not macular VD, in the evening compared to the morning is observed in healthy subjects.

PURPOSE: To evaluate the diurnal variation of the macular and optic nerve head (ONH) vessel density (VD) in healthy eyes as measured with optical coherence tomography angiography (OCT-A).

METHODS: In this prospective study of healthy individuals older than 18 years old, VD parameters, including macular whole image vessel density (wiVD), parafoveal vessel density (pfVD), ONH whole image vessel density (ONH-wiVD), ONH whole image capillary density (ONH-wiCD), circumpapillary vessel density (cpVD), and circumpapillary capillary density (cpCD), were measured with OCT-A at four time points throughout the day (8 AM, 12 PM, 4 PM, and 8 PM).

RESULTS: Twenty nine healthy eyes were included from 15 subjects (mean age: 30.9 years). After adjustment for age and mean ocular perfusion pressure (MOPP), a significant positive rate of change was found for cpVD (0.05%/hour; P=0.027). In contrast, macular VD changes were not significantly different. When comparing morning (8 AM and 12 PM) and evening (4 PM and 8 PM) measurements, there were small, but statistically significant, increases for all ONH measurements. The greatest increase was found for cpVD (0.58%; P=0.022). Significant but small increases in mean arterial pressure and MOPP were also observed.

CONCLUSIONS: There was a small increase in ONH VD, but not macular VD, in the evening compared to the morning in healthy human eyes. As the observed difference was within the measurement variability, our results suggest the timing of OCT-A examination does not affect retinal VD measurements.

PMID:34172629 | DOI:10.1097/IJG.0000000000001903