Head & Face Medicine最新文献

Objective: Exploring the temporal bone Computed Tomography (CT) features and clinical characteristics of patients with ethmoid sinus lesions (ESL) combined with high jugular bulb (HJB) and pulsatile tinnitus symptoms.

Methods: A retrospective analysis was conducted on the clinical data of pulsatile tinnitus (PT) patients. Patients with both ESL and HJB were classified into the combined group, while others were assigned to the non-combined group. The severity of tinnitus was assessed using the Tinnitus Evaluation Questionnaire (TEQ), along with the comparison of the clinical characteristics and treatment outcomes. Meanwhile, univariate analysis and multivariate regression analysis were performed to identify factors affecting the prognosis of patients.

Results: Among patients with hearing loss in the combined group, the severity of hearing impairment was primarily moderate (65.85%), while that in the non-combined group was mainly mild (49.61%), with differences between the two groups (P < 0.05). In the hearing threshold curve classification, meanwhile, the combined group predominantly showed high-frequency hearing loss (64.63%), with the non-combined group mainly exhibiting low-frequency hearing loss (58.10%), and the differences between the two groups were significant (P < 0.05). The overall response rate of treatment in the combined group was lower than that in the non-combined group (P < 0.05). Moreover, prognostic regression analysis suggested the severity of hearing loss and the presence of ESL + HJB as independent risk factors affecting the prognosis of PT patients (P < 0.05).

Conclusion: PT patients are predominantly affected on the right side, primarily manifested as intermittent tinnitus. The severity of hearing loss and the presence of ESL + HJB are independent factors affecting the prognosis of PT patients.

Objective: This study aims to investigate the association between patients with migraine headaches and brain magnetic resonance imaging (MRI) findings.

Background: Migraine is a frequently encountered primary headache disorder with a disproportionate female predominance. Diagnosis is usually based on the patient's clinical history with neuroimaging reserved for severe or atypical presentations to exclude other pathologies. Migraine patients often experience a profound impact on their quality of life.

Methods: A retrospective study was conducted at King Abdullah University Hospital, Jordan, involving patients with a clinical diagnosis of migraine who had undergone MRI brain imaging between January 2021 to March 2023. Descriptive data were documented, with two independent neuro-radiologists interpreting MRI findings.

Results: Our study included 670 migraine patients (510 females; mean age, 40.3 years). White matter hyperintensity lesions were found in 309 patients (46.1%), significantly affecting older age groups with a mean age of 46.8 years (p > 0.001). Additionally, gender played a role, with a higher prevalence of these lesions in female migraine patients, accounting for 79.6% (p = 0.05). Multiple logistic regression analysis proved age to be an independent risk factor for the presence of white matter hyperintensity lesions (OR: 1.0688, 95% CI: 1.0546-1.0831, p > 0.001).

Conclusion: White matter hyperintensity lesions were seen in the MRI imaging of a subset of migraine patients. Patients with these lesions tend to be older and of female gender. However, the clinical significance of these findings remains unclear.

Purpose: Deep neck infection is a potentially life-threatening condition, and thus, early identification and treatment are essential. This study explored the diagnostic challenges and preceding treatment in patients with repeated healthcare contacts due to an odontogenic or a peritonsillar abscess.

Methods: A retrospective study of oropharyngeal abscesses in hospitalized patients was conducted. Included were inpatients with an odontogenic or a peritonsillar abscess during 2019. Excluded were patients with other infection type and patients with an odontogenic abscess preceded by tooth removal. The main outcome variable was repeated healthcare visit(s) due to the current infection prior to hospitalization. The primary predictor variable was source of infection. Explanatory variables comprised age, sex, duration of symptoms (days), clinical findings, and referring unit. Additional analyses were conducted for patients with repeated healthcare visits. Study groups were compared using Fisher's exact test, Student's t-test, test where appropriate. A 2 × 2 risk analysis was performed.

Results: Altogether 294 patients, 153 (52.0%) with an odontogenic abscess and 141 (48.0%) with a peritonsillar abscess, were included in the study. Source of infection was unidentified more often in patients with an odontogenic than a peritonsillar abscess (P < .001). In all, 106 patients (36.1%) had repeated healthcare visits prior to hospitalization, which was significantly associated with an odontogenic abscess (P = .039). Active intervention was conducted in only 34.0% of the patients with repeated healthcare visits.

Conclusions: Clinicians have challenges in recognizing a developing odontogenic abscess, which remains essential for prompt and effective surgical intervention.

Objectives: Although frequently applied, inferior alveolar nerve block (IANB) is associated with high rate of complications, beside its unpredictable success; partly due to improper needle choice. Evidence of the ideal needle contradicts in literature. Therefore, this review aims to assess the effect of needle characteristics on the outcomes of IANB.

Materials and methods: A systematic search was performed on MedLine via Pubmed, Cochrane Library, LILACS, Science Open, EBSCOhost, Scopus, Egyptian Knowledge Bank (EKB), and Google scholar; beside searching grey literature and hand searching. The review included randomized controlled trials comparing needles of difference in any of the characteristics (gauge, length, bevel, alloy) used for IANB regarding their effects on pain, success of anesthesia and aspiration. The authors ran the search, selected the eligible studies, assessed the risk of bias using RoB 1 and extracted the data of the finally included studies. All the steps were performed in duplicates.

Results: The search yielded a total of 2,812 records. After de-duplication and excluding ineligible studies by title and abstract then by full text, the review included nine eligible studies. The compared needle interventions included: gauges (23G, 24G, 25G, 26G, 27G and 30G), lengths (12 mm, 25 mm, 32 mm, 35 mm, 42 mm), and internal diameters (0.265 mm, 0.215 mm, 0.3 mm and 0.4 mm). All studies had high risk of bias, adopted different assessment methods for the outcomes, and included participants with differences in baseline characteristics.

Conclusions: The level of the available evidence introduced by primary studies hinder concluding the optimal needle characteristics; keeping the research question unanswered. However, within the limitations of the heterogenous studies, available data favors thinner needles for less pain during needle insertion; otherwise, data of the other outcomes was inconclusive.

Clinical relevance: Thinner needles are favored for less pain during insertion; but standardized future studies are essentially needed for solid conclusions. A detailed standard protocol is, therefore, proposed.

Background: The precise localization of stones within the submandibular duct is crucial for the successful intraoral removal in sialolithiasis. Customizing surgical approaches based on the stone's ductal location is imperative. Particularly challenging are stones beneath the lingual nerve, requiring a landmark-guided approach due to their non-palpable nature. This study aimed to comprehend stone positioning, location-specific characteristics, and develop suitable surgical approaches. We conducted a thorough analysis of numerous preoperative computed tomography (CT) scans for this purpose.

Methods: We performed a retrospective review of the medical records of patients who underwent intraoral stone removal between 2006 and 2022. Two different surgical approaches were applied based on the stone location as determined by preoperative CT scans. The mediolingual approach was used for superficial stones, while the laterogingival approach was reserved for deeper stones. Patient demographics, sialolithiasis features, and postoperative complications were analyzed. T-test was performed to compare stone characteristics between different locations, and a receiver operating characteristic curve analysis was used to identify the critical size threshold for predicting stone location.

Results: Medical records of 465 patients were reviewed. Out of 616 stones, 614 were successfully removed with two distinct surgical approaches guided by preoperative CT scans. Two patients reported retention, and 11 experienced postoperative tongue sensation changes. The hilum was the most common stone location, and deeper stones, approached laterolingually, were generally larger. Analysis identified a 4.25 mm width as the most sensitive and specific threshold for deep stones. Stone volume showed no statistically significant difference between smokers and non-smokers, alcohol consumers and non-consumer.

Conclusion: The result of the study underscore the significance of precise stone localization and endorse the efficacy of landmark-guided surgical approaches in managing sialolithiasis.

Background: This study aims to compare the complications and satisfaction associated with favorable allografts, Fresh Frozen Rib Graft (FFRG) and Irradiated Homologous Costal Cartilage (IHCC), in revision rhinoplasty.

Methods: The PRISMA guidelines were adhered to in the conduct of this systematic review. No limitations were applied to the types of studies included. Studies in English were selected without any time limitations. Five databases, PubMed/Medline, Cochrane Library, Embase, Scopus, Google Scholar, and also, the reference lists of included studies were searched. The ROBINS-I was employed for risk of bias assessment. Patients who underwent revision rhinoplasty utilizing allografts (FFRG and IHCC) were considered.

Results: The initial search yielded a total of 503 studies. After duplicate removal and paper screening, 7 studies were included. A total of 406 patients for FFRG and 66 patients for IHCC who underwent revision rhinoplasty with the use of FFRG and IHCC were incorporated. Various complications were assessed, including warping, infective/noninfective resorption, infection, extrusion/displacement, and other less common occurrences. The overall complication rates were 9.25% and 15.7% for FFRG and IHCC, respectively. The main complication associated with the two was infection. Notably, both FFRG and IHCC demonstrated significant improvements in patient satisfaction following revision surgery across all subjected studies.

Conclusion: Based on this review, FFRGs present a lower rate of complications in comparison with IHCCs. However, the biocompatibility makes the autologous rib cartilage the gold standard graft, but in case of donor site limitations to harvesting, FFRG and IHCC would be a safe and reliable alternative.

Background: Virtual surgical planning for orthognathic surgery typically relies on two methods for intraoperative plan transfer: CAD/CAM occlusal splints and patient-specific implants (PSI). While CAD/CAM splints may offer limited accuracy, particularly in the vertical dimension, PSIs are constrained by higher costs and extended preparation times. Surgical navigation has emerged as a potential alternative, but existing protocols often involve invasive registration or lack transparent evaluation. This study introduces a novel protocol for point-based optical navigation using modified CAD/CAM splints for non-invasive registration and transparent intraoperative evaluation, assessing its effectiveness in maxillary positioning.

Methods: This prospective case-control study included 20 patients undergoing bimaxillary orthognathic surgery. The experimental group employed surgical navigation with modified CAD/CAM splints, while the control group used standard CAD/CAM splints. Surgical accuracy was evaluated by measuring translational and rotational discrepancies between the planned and achieved maxillary positions. A mixed ANOVA was conducted to assess other factors, aside from surgical navigation, that might influence surgical accuracy.

Results: Surgical navigation significantly improved accuracy in translational movements along the x-axis (right-left: -0.81 mm; p = 0.021) and z-axis (down-up: -0.82 mm; p = 0.014), as well as in yaw rotation (-0.45°; p = 0.045). Other movements also showed improved precision in the navigated group, though not statistically significant; y-axis (back-front): -0.60 mm (p = 0.094); pitch rotation: -0.70° (p = 0.071); roll rotation: -0.04° (p = 0.428). Besides the use of surgical navigation, the amount of planned movement significantly impacted surgical accuracy, although no specific factors could be identified to predict which cases would particularly benefit from surgical navigation.

Conclusions: Surgical navigation with modified CAD/CAM splints enhances surgical accuracy without requiring invasive procedures, offering a straightforward and transparent protocol suitable for routine clinical practice that allows intraoperative evaluation of maxillary positioning. However, the clinical significance and cost-effectiveness compared to PSI need further investigation. These findings suggest new directions for future developments, especially with advancements in mixed reality technologies, which could broaden the application of surgical navigation.

Trial registration: Retrospectively registered with the German Clinical Trials Register (DRKS00034795).

Growth-differentiation factor 15 (GDF-15) is a cytokine involved in cellular stress responses and inflammation. This meta-analysis evaluates the association between circulating GDF-15 levels and functional outcomes in patients with acute ischemic stroke (AIS). A comprehensive search of Medline, Web of Science, Embase, Wanfang, and CNKI was conducted up to July 15, 2024. Observational studies with longitudinal follow-up that measured GDF-15 levels within 24 h of stroke onset and reported functional outcomes, defined as a modified Rankin Scale (mRS) score of ≥ 2, were included. Odds ratios (OR) with 95% confidence intervals (CI) were used to quantify associations. Heterogeneity was evaluated using I² statistics, and a random-effects model was used to pool the results by incorporating the influence of heterogeneity. Ten studies involving 4,231 patients were included. The pooled OR indicated that high circulating GDF-15 levels were associated with a significantly higher risk of poor functional outcomes at 3 months (OR: 2.60, 95% CI: 1.95 to 3.46, p < 0.001). Sensitivity analyses by excluding one study at a time did not significantly change the results. Subgroup analyses revealed stronger associations in studies with GDF-15 cutoff values < 1200 ng/L as compared to ≥ 1200 ng/L, and in those defining poor outcomes as mRS ≥ 3 as compared to those ≥ 2. In conclusion, elevated circulating GDF-15 levels are associated with worse functional outcomes following AIS. These findings support the potential use of GDF-15 as a prognostic biomarker in stroke patients. Further research is warranted to confirm these results and explore clinical applications.

Background: Headaches are a common and often debilitating condition among youth. The Inflammatory Burden Index (IBI), a simple surrogate marker of systemic inflammation, has been linked to various diseases. However, evidence for its relationship with headaches, particularly in youth, is lacking. This study aimed to investigate the association between IBI and persistent headache in youth, with a focus on evaluating gender-specific responses to IBI exposure.

Methods: We analyzed data from 2,210 young people in the 2001-2004 National Health and Nutrition Examination Survey (NHANES). The association between IBI and frequent or severe headaches in the past year was investigated using weighted logistic regression models. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated, and threshold effect analyses were performed.

Results: Youths in the highest IBI quartile (Q4) had a 46% higher risk of severe headaches compared to the lowest quartile (Q1) (OR: 1.46, 95% CI: 1.12-1.91, P = 0.0051). Gender-stratified analysis revealed a significant association between high IBI and headache risk in females (OR: 1.48; 95% CI: 1.03-2.11, P = 0.0324), but not in males. Threshold effect analysis identified an IBI breakpoint of 3.78, below which the headache risk increased significantly in females under 18 years (OR: 1.12, 95% CI: 1.01-1.25, P = 0.0385).

Conclusions: Our findings demonstrate a significant association between elevated IBI and increased headache risk in youth, particularly in females. This gender-specific effect suggests that inflammatory processes may play a more prominent role in headache pathophysiology among female youth. These results underscore the importance of considering inflammatory markers in the early identification and prevention of youth headaches, especially in females.

Aim: This consecutive retrospective study compared Mini-implant Assisted Slow Palatal Expansion (MASPE) with rapid palatal expansion (MARPE) using a bone-borne skeletal expander in adults with a narrow maxilla. CBCT scans analyzed transverse changes and potential pterygoid process deformation before (T1) and after expansion (T2).

Materials and methods: The Force Controlled PolyCyclic (FCPC) SLOW palatal expansion group (FCPC-MASPE-G) comprised 35 adults aged 18-54 years and received a skeletal expander limiting expansive force only allowing 500 cN at the activation wrench (force control). Discontinuous, polycyclic activations according to the FCPC-protocol were applied. The MARPE-group (n = 6) underwent continuous RAPID activation without FCPC until the desired width was reached. CBCT scans were taken pre and post-expansion. Inclusion criteria for both groups were successful outcomes without surgical assistance.

Results: The maxilla opened transversally in both groups mildly V-shaped, with a pyramidal shape in the coronal plane, impacting the zygomatic bone. Width measurements at T2 indicated superior mechanical response in FCPC-MASPE-G. Response of zygomaticomaxillary sutures was similar in both groups (p < 0.001 to 0.025). Pterygoid process deformations were notably less in FCPC-MASPE-G (0.87-1.35 mm, p < 0.001) compared to MARPE-G (2.70-3.04 mm, p < 0.001 to 0.009). Dental measurements were similar (p < 0.001 to 0.023), but the ratio "Mid-palatal suture Opening Related to Expander opening" (M.O.R.E.-factor) was better with 84% in FCPC-MASPE-G than with 50% in MARPE-G.

Conclusion: Slow expansion with FCPC protocol effectively widens the maxilla in adults, with significant impact on bones and sutures and less pterygoid process deformation compared to rapid expansion. Cranial complications were absent in both groups.