Thursday, June 9, 2022

Unilateral Progressively Growing Neck Mass in a Young Adult

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An 18-year-old male presented to the primary care physici an with a 4-month history of a slowly progressive painless lateral neck mass and no history of dysphagia, dysphonia, drainage, previous neck surgery, trauma, or recent fever. What is your diagnosis?
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Upper Airway Stimulation for Children With Down Syndrome and Obstructive Sleep Apnea

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The treatment of persistent obstructive sleep apnea (OSA) after an adenotonsillectomy is a challenge, especially for children with Down syndrome. As otolaryngologists with sleep subcertification, we are keenly aware of the current limitations for both medical and secondary surgical treatment options for this cohort. We applaud the insight of Yu and colleagues for their landmark investigation in this issue of JAMA Otolaryngology–Head & Neck Surgery on upper airway stimulation (UAS) for adolescents with Down syndrome and OSA, which expan ds the role of UAS from adults to children.
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A Middle-aged Woman With Parotid Swelling

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A 53-year-old woman with a history of coronary artery dise ase and prior myocardial infarction that was treated with warfarin presents to the emergency department after awakening with right preauricular and right upper neck swelling. What is your diagnosis?
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A phase 2 pharmacodynamic dose‐finding, safety, and efficacy study of dalteparin for pediatric venous thromboembolism treatment in children with and without cancer

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Abstract

Data from registrational trials of pediatric venous thromboembolism (VTE) treatment are sparse, especially among cancer patients. We conducted a prospective, multicenter, open-label trial (NCT00952380) on dose-finding, safety, and efficacy (measured by 90-day risks of clinically relevant bleeding [CRB] and symptomatic recurrent VTE [srVTE]) of twice-daily subcutaneous dalteparin for acute VTE treatment in patients ≤18 years old. Among 38 patients (cancer, n = 26; noncancer, n = 12), median dalteparin dose requirements per kilogram varied with age but not cancer status. Risks of CRB and srVTE were <4% in cancer and noncancer subgroups. Dalteparin is an important FDA-approved treatment for pediatric VTE, particularly with cancer.
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Molecular characterization of metachronous atypical teratoid rhabdoid tumors occurring in a young man 15 years apart

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Within‐patient evaluation of chewing efficiency and maximum bite force of conventional dentures, fixed prostheses, and milled bar overdentures used for All‐on‐4 implant rehabilitation of atrophied mandibular ridges: A short‐term randomized trial

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Abstract

Purpose

This crossover study aimed to evaluate chewing efficiency and maximum bite force (BF) of conventional dentures, fixed prostheses, and milled bar overdentures (MO) used for All-on-4 implant rehabilitation of atrophied mandibular ridges.

Methods

Sixteen edentulous participants with resorbed mandibular ridges received new conventional dentures (CD, control). Four implants were inserted after 3 months in the mandible using the All-on-4 protocol and loaded immediately with acrylic prosthesis. In a crossover manner, each patient had either fixed restoration (FR, 12 occlusal units) or MO (14 occlusal units) randomly in a crossover study design. Chewing efficiency was evaluated using the mixing ability test. The hue deviation (HD) of two-colored gum was calculated after being chewed for 5, 10, 20, 30, and 50 masticatory cycles. Maximum BF was evaluated using a BF device. HD and BF were measured after using CD, FR, and MO prostheses.

Results

For all groups, the highest HD (i.e., the lowest chewing efficiency) was noted with 5 strokes, followed by 10, 20, 30 strokes, and the lowest HD (i.e., the highest chewing efficiency) was noted with 50 strokes. For all number of chewing strokes, CD showed the highest HD, then FR, and MO recorded the lowest HD. The highest BF was observed with MO, then FR, and the lowest BF was noted with CD.

Conclusion

Within the limitations of this short-term investigation, both FR and MO used for All-on-4 implant rehabilitation of patients with resorbed mandibular ridges improve masticatory efficiency and maximum BFs compared to CD. However, MO was associated with significantly higher chewing efficiency and maximum BFs than fixed prosthesis.
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Evaluation of anterolateral thigh flap dimensions with virtual flap models

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Free flaps are commonly used for head and neck reconstruction. However, flap dimensions are still evaluated by visual and tactile assessment. The aim of this study was to enable preoperative planning of flap dimensions for soft tissue reconstruction based on clinical parameters. Computed tomography records from 230 patients dated from 2009 to 2019 were analysed retrospectively. A virtual, three-dimensional anterolateral thigh flap model was standardized, aligned to segmented leg models in two positions, and flap thicknesses and volumes were determined. (Source: International Journal of Oral and Maxillofacial Surgery)
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Epithelial –myoepithelial carcinoma of the maxillofacial and sinonasal region: a systematic review of presenting characteristics, treatment modalities, and associated outcomes

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Epithelial –myoepithelial carcinoma (EMC) is a rare salivary gland malignancy. Controversy exists in the literature regarding the effectiveness of treatment modalities employed in the management of EMC. This systematic review was undertaken to understand the presenting characteristics of EMC and identify the most common treatment modalities and their associated outcomes, in order to help guide an evidenced-based approach to the algorithm of care. The MEDLINE (PubMed) and Embase databases were searched (up to February 23, 2022), and the review was performed in accordance with the PRISMA statement. (Source: International Journal of Oral and Maxillofacial Surgery)
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Oncological outcome of contralateral submental artery island flap versus primary closure in tongue squamous cell carcinoma: randomized non-inferiority clinical trial

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The aim of this study was to test the non-inferiority of the contralateral submental island flap (CSIF) compared with primary closure (PC) regarding local recurrence after partial glossectomy in patients with oral tongue squamous cell carcinoma (OTSCC). This open-label, non-inferiority randomized controlled trial enrolled patients with cT1 –2 lateralized OTSCC. The primary outcome was local recurrence by 12 months postoperative. Non-inferiority would be declared if the upper limit of the two-sided 95% confidence interval (CI) for the proportion difference in local recurrence between the two groups did not exceed a non-inferiority ma rgin of 15.0%. (Source: International Journal of Oral and Maxillofacial Surgery)
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Omicron (BA.1) and Sub‐Variants (BA.1.1, BA.2 and BA.3) of SARS‐CoV‐2 Spike Infectivity and Pathogenicity: A Comparative Sequence and Structural‐based Computational Assessment

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ABSTRACT

The Omicron variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has now spread throughout the world. We used computational tools to assess the spike infectivity, transmission, and pathogenicity of Omicron (BA.1) and sub-variants (BA.1.1, BA.2, and BA.3) in this study. BA.1 has 39 mutations, BA.1.1 has 40 mutations, BA.2 has 31 mutations, and BA.3 has 34 mutations, with 21 shared mutations between all. We observed 11 common mutations in Omicron's receptor-binding domain and sub-variants. In pathogenicity analysis, the Y505H, N786K, T95I, N211I, N856K, and V213R mutations in omicron and sub-variants are predicted to be deleterious. Due to the major effect of the mutations characterising in the receptor-binding domain (RBD), we found that Omicron and sub-variants had a higher positive electrostatic surface potential. This could increase interaction between RBD and negative electrostatic surface potential human angiotensin-converting enzy me 2 (hACE2). Omicron and sub-variants had a higher affinity for hACE2 and the potential for increased transmission when compared to the wild type. Negative electrostatic potential of NTD value indicates that the Omicron variant binds receptors less efficiently than the Wild type. Given that at least one receptor is highly expressed in lung and bronchial cells, the electrostatic potential of NTD negative value could be one of the factors contributing to why the Omicron variant is thought to be less harmful to the lower respiratory tract. Among Omicron sub-lineages, BA.2 and BA.3 have a higher transmission potential than BA.1 and BA.1.1. We predicted that mutated residues in BA.1.1 (K478), BA.2 (R400, R490, R495), and BA.3 (R397 and H499) formation of new salt bridges and hydrogen bonds. Omicron and sub-variant mutations at Receptor-binding Motif (RBM) residues such as Q493R, N501Y, Q498, T478K, and Y505H all contribute significantly to binding affinity with human ACE2. Interactions with Omicron variant mutations at residues 493, 496, 498, and 501 seem to restore ACE2 binding effectiveness lost due to other mutations like K417N.

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