Oral corticosteroid prescribing habits of Canadian Otolaryngologist-Head and Neck Surgeons

Abstract

Background

Oral corticosteroids (OCSs) are widely prescribed in Otolaryngology-Head & Neck surgery (OtoHNS). There is evidence in the literature regarding specific dosing regimens. However, it is not known to what extent these recommendations are being implemented in practice.

Methods

An anonymous online survey was sent to Canadian Society of Otolaryngology-Head and Neck Surgery members (N = 696). Dosing, frequency and tapering of OCSs were assessed in acute rhino-sinusitis (ARS), chronic rhino-sinusitis with (CRSwP) and without polyps (CRSsP), sudden sensori-neural hearing loss (SSNHL), and idiopathic facial nerve/Bell's palsy (IFN). Participants were asked to complete for conditions treated and results were compared with current guidelines. Development of prescribing habits and observed complications were also explored.

Results

124 surveys (18 %) were completed. In CRSwP (N = 98), the median dose was 50 mg (Range: 10–100 mg) and the average duration was 8 days (Range: 1–21 days). In CRSsP (N = 29), the median dose was 50 mg (Range: 20-80 mg) and the average duration was 8 days (Range: 1–14 days). In SSNHL (N = 118), the median dose was 60 mg (Range: 10–120 mg) and the average duration was 10 days (Range: 1–21 days). In IFN (N = 108), the median dose was 50 mg (Range: 10–100 mg) and the average duration was 10 days (Range: 1–21 days). Tapering dosages were used in treating CRSwP (64 %), CRSsP (62 %), ARS (44 %), SSNHL (60 %) and IFN (53 %). Respondents most frequently perceived "Mentor/Preceptor Guidance" as a source of their prescribing habits.

Conclusion

There is significant heterogeneity in OCS prescribing habits despite the availability of fairly consistent evidence in the literature for some of the surveyed conditions. Improvements in standardization should be made with the aim of enhancing outcomes and reducing complications.

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Decisional conflict in patients considering diagnostic thyroidectomy with indeterminate fine needle aspirate cytopathology

Abstract

Background

Fine needle aspiration (FNA) cytopathology is the gold standard work-up for thyroid nodules. However, indeterminate lesions are encountered commonly and can lead to difficult treatment decisions. We sought to determine whether patients experienced decisional conflict surrounding management with diagnostic thyroidectomy in the setting of indeterminate FNA results.

Methods

Patients with indeterminate results of thyroid nodule FNA were prospectively enrolled. All consultations were carried out by three otolaryngologists in a consistent manner. After consultation, participants completed a demographics form and the Decisional Conflict Scale (DCS) questionnaire.

Results

Thirty-five patients (28 female) between the ages of 30 and 88 years (mean age 54.89) participated. The median total DCS score was 10.94 (interquartile range, 4.69–25.0). Twelve patients (34 %) scored at or above 25 on the DCS, indicating clinically significant level of decisional conflict. Patients reported feeling significantly more confident about their decision after the surgical consultation compared to before the consultation (p = 0.00). The total DCS score was significantly negatively correlated with self-reported confidence after the consultation (r = −0.421, p = 0.012).

Conclusion

Many patients experienced clinically significant decisional conflict when considering thyroidectomy for management of a thyroid nodule with indeterminate cytopathology. Future research should be directed at developing decision support tools for this patient group, and exploring the impact of decisional conflict on health outcomes.

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Bilateral Reduction Mammaplasty for Managing Breast Cancer

Is this technique an oncologically safe approach in women with breast cancer and macromastia?
ePlasty, Open Access Journal of Plastic Surgery

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Clinical Usage of an Extracellular, Collagen-rich Matrix

How do wounds with different etiologies heal after treatment with this extracellular, collagen-rich matrix?
Wounds

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World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Prebiotics

Background: The prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Prebiotics – non-digestible oligosaccharides that stimulate growth of probiotic bacteria – have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention.ObjectiveThe World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of prebiotics in the prevention of allergy. Methods: The WAO guideline panel identified the most relevant clinical questions about the use of prebiotics for the prevention of allergy. We performed a systematic review of randomized controlled trials of prebiotics, and reviewed the evidence about patient values and preferences, and resource requirements (up to January 2015, with an update on July 29, 2015). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. Results: Based on GRADE evidence to decision frameworks, the WAO guideline panel suggests using prebiotic supplementation in not-exclusively breastfed infants and not using prebiotic supplementation in exclusively breastfed infants. Both recommendations are conditional and based on very low certainty of the evidence. We found no experimental or observational study of prebiotic supplementation in pregnant women or in breastfeeding mothers. Thus, the WAO guideline panel chose not to provide a recommendation about prebiotic supplementation in pregnancy or during breastfeeding, at this time. Conclusions: WAO recommendations about prebiotic supplementation for the prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether or not to use prebiotics for the purpose of preventing allergies in healthy, term infants.

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Forkhead Box O1 Regulates Macrophage Polarization Following Staphylococcus aureus Infection: Experimental Murine Data and Review of the Literature

Abstract

The functions of macrophages that lead to effective host responses are critical for protection against Staphylococcus aureus. Deep tissue-invading S. aureus initially countered by macrophages trigger macrophage accumulation and induce inflammatory responses through surface receptors, especially toll-like receptor 2 (TLR2). Here, we found that macrophages formed sporadic aggregates in the liver during infection. Within those aggregates, macrophages co-localized with T cells and were indispensable for their infiltration. In addition, we have focused on the mechanisms underlying the polarization of macrophages in Forkhead box transcription factor O1 (FoxO1) conditional knockout Lys ^Cre/+FoxO1 ^fl/fl mice following S. aureus infection and report herein that macrophage M1-M2 polarization via TLR2 is intrinsically regulated by FoxO1. Indeed, for effective FoxO1 activity, stimulation of TLR2 is essential. However, following S. aureus challenge, there was a decrease in macrophage FoxO1, with increased phosphorylation of FoxO1 because of TLR2-mediated activation of PI3K/Akt and c-Raf/MEK/ERK pathway. Following infection in Lys ^Cre/+FoxO1 ^fl/fl mice, mice became more susceptible to S. aureus with reduced macrophage aggregation in the liver and attenuated Th1 and Th17 responses. FoxO1 abrogation reduced M1 pro-inflammatory responses triggered by S. aureus and enhanced M2 polarization in macrophages. In contrast, overexpression of FoxO1 in macrophages increased pro-inflammatory mediators and functional surface molecule expression. In conclusion, macrophage FoxO1 is critical to promote M1 polarization and maintain a competent T cell immune response against S. aureus infection in the liver. FoxO1 regulates macrophage M1-M2 polarization downstream of TLR2 dynamically through phosphorylation.

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Are the interarytenoid muscles supplied by branches of both the recurrent and superior laryngeal nerves?

Objectives/Hypothesis

It has been generally accepted that the branches of the internal branch of the superior laryngeal nerve to the interarytenoid muscle are exclusively sensory. However, some experimental studies have suggested that these branches may contain motor axons, and therefore that the interarytenoid muscle is supplied by both the superior and recurrent laryngeal nerves. The aim of this work was to determine whether motor axons to the interarytenoid muscles are present in both laryngeal nerves.

Study Design

Basic research.

Methods

Twelve human internal branches of the superior laryngeal nerve were dissected, and its branches to the interarytenoid muscle were removed and processed for choline-acetyltransferase immunohistochemistry, a method not used previously in studying the nerve fiber composition of the laryngeal nerves.

Results

The internal branch of the superior laryngeal nerve divided into two to five branches to the interarytenoid muscle. All branches contained motor axons, with the proportion of motor axons varying from 6% to 31%.

Conclusion

The present study confirms that the internal branch of the superior laryngeal nerve provides a motor innervation to the interarytenoid muscles.

Level of Evidence

N/A. Laryngoscope, 2015

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Preliminary experiences in trachea scaffold tissue engineering with segmental organ decellularization

Objectives/Hypothesis

Ideal methods for reconstructing the tracheal structure and restoring tracheal function following damage to the trachea or removal of the trachea have not been developed. The purpose of this study is to evaluate the feasibility of using a whole segment decellularized tracheal scaffold to reconstruct the trachea.

Study Design

Prospective experimental design.

Setting

In vivo rabbit model.

Methods

Trachea scaffolds were created using our previously developed freeze-dry-sonication-sodium dodecyl sulfate (SDS), [FDSS] decellularization process. After histological and mechanical testing, the scaffolds were transplanted orthotopically into segmental defects in New Zealand White Rabbits (n = 9). Another three rabbits receiving the sham operation with autologous trachea transplantations served as the control group. Two weeks after transplantation, the grafts were evaluated endoscopically and histologically.

Results

The mechanical properties of the decellularized trachea segment did not differ significantly from the fresh native trachea. After transplantation, whereas the autograft in the control group showed full integration and functional recovery, all of the rabbits in the decellularized scaffold transplantation group died within 7∼24 days. Although significant collapse of the tracheal tubular structures was noted, full respiratory epithelium regeneration was observed in the rabbits that survived more than 2 weeks.

Conclusion

The FDSS decellularization process is effective in creating whole-segment, subtotally decellularized trachea scaffolds. However, although the respiratory epithelium regeneration on the inner surface appeared to be satisfactory, the tubular structures were not able to be maintained after transplantation, which ultimately led to the death of the animals.

Level of Evidence

N/A. Laryngoscope, 2016

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Intraoperative use of fibrin glue dyed with methylene blue in surgery for branchial cleft anomalies

Objectives/Hypothesis

We present a new method of optimizing the results of surgery for branchial cleft anomalies based on the intraoperative injection of fibrin glue combined with methylene blue dye.

Study Design

Retrospective single-center cohort study.

Methods

The method was applied in 17 patients suffering from branchial anomalies. Six (35.29%) had a preauricular lesion; three (17.65%) had lesions derived from the first arch/pouch/groove (type I), four (23.53%) had lesions derived from the first (type II), one (5.88%) had lesions derived from the second, one (5.88%) had lesions derived from the third, and two (11.76%) had lesions derived from the fourth. The median and mean age at surgery were 10 and 10.6 years, respectively. All patients were followed by periodic clinical and ultrasonographic examination.

Results

The combination of fibrin glue with methylene blue facilitated the correct assessment of the extension of the lesions and their intraoperative manipulation. After a mean follow-up of 47.8 months, all patients were free of disease.

Conclusions

Intraoperative injection of branchial fistulae and cysts by a mixture of fibrin glue and methylene blue is an effective, easy, and safe tool to track lesions and achieve radical resection. The technique requires a definitive validation on a large cohort with adequate stratification of patients.

Level of Evidence

4 Laryngoscope, 2015

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Impact of thyroidectomy on cardiac manifestations of Graves' disease

Objectives/Hypothesis

Graves' disease (GD) has multiple adverse effects on the cardiovascular system. We aimed to examine the outcome of thyroidectomy in patients with cardiac manifestations of GD and evaluate their associated postoperative complications.

Study Design

Retrospective analysis using a prospectively collected database.

Methods

A retrospective analysis of our prospectively collected thyroid surgery database was performed. Forty patients with hyperthyroidism due to GD were identified, and each was appropriately age matched to a euthyroid patient with multinodular goiter (MNG). All patients underwent total thyroidectomy. Data relating to cardiac comorbidities were collected from preoperative and postoperative clinic notes, hospital admissions, electrocardiograms, echocardiograms, and blood work. Perioperative biochemical, cardiovascular, and postoperative outcomes were analyzed.

Results

Twenty-four (60%) GD patients and 14 (35.0%) MNG patients had cardiac manifestations (P = .001). Hypertension resolved in 41.7% of GD patients and 7.7% of MNG patients (P = .00002). Two of the three GD patients with congestive heart failure (CHF) had resolution of CHF with significant improvement in ejection fraction, whereas the one MNG patient with CHF saw no change. Additionally, the majority of GD patients saw a resolution of their tachycardia (68.8%) and atrial fibrillation (100%). Four postoperative complications occurred in both the GD and MNG groups (4/40, 10%).

Conclusions

Surgical treatment of GD in patients with cardiac manifestations offers rapid clinical improvement of hypertension, impaired left ventricular systolic function, and arrhythmias. When performed by a high-volume surgeon, the complication rate is similar to thyroidectomy for other benign disease.

Level of Evidence

3 Laryngoscope, 2015

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Elective central node dissection: Comparison of open to minimally invasive video-assisted approach

Objectives/Hypothesis

Compare outcomes of concomitant primary thyroidectomy with elective central neck dissection (CND) by the standard open versus minimally invasive video-assisted (MIVA) approach.

Study Design

Case series chart review, single institution, tertiary referral center.

Methods

Current Procedural Terminology code 60252 was used to identify patients undergoing CND from February 2005 through June 2012. Therapeutic CND and revision cases were excluded. The MIVA approach was performed in patients with low-risk thyroid carcinoma (cT1 or 2, cN0). Primary outcomes included nodal yield and complications, and secondary outcomes included recurrence.

Results

Of 87 eligible patients, 38 were open and 49 were MIVA. The MIVA group was more likely female (88% vs. 68%, P = .03), but groups were similar in age (46.0 vs. 48.6 mean years, P = .37) and percentage of unilateral dissection (69.4% vs. 71.0%, P = .86). The MIVA group was more often pT1 or 2 (86.9% vs. 76.4%, P = .02). Pathological node positivity was 40% overall and not significantly different between groups (43.5% vs. 35.3%, P = .46). Nodal yield was similar between groups (6.4 vs. 6.8, P = .73). Transient recurrent laryngeal nerve paralysis rates were similar (4.1% vs. 2.6%, P = .71). Transient hypoparathyroidism (postanesthesia care unit parathyroid hormone ≤15 pg/mL) was lower in the MIVA group but not statistically significant (29.2% vs. 45.2%, P = .15). No patients experienced permanent hypoparathyroidism or developed clinically detectable structural recurrence. Rates of biochemical response were similar (any thyroglobulin >1 ng/dL) (13.8% vs. 8.0%, P = .86).

Conclusions

Concomitant MIVA thyroidectomy with elective CND appears to be a safe and effective alternative to the open approach for low-risk thyroid carcinoma with similar nodal yield, complications, and recurrence.

Level of Evidence

4 Laryngoscope, 2016

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Relationships among measures of physical activity and hearing in African Americans: The Jackson Heart Study

Objectives/Hypothesis

To evaluate the relationships among measures of physical activity and hearing in the Jackson Heart Study.

Study Design

Prospective cohort study.

Methods

We assessed hearing on 1,221 Jackson Heart Study participants who also had validated physical activity questionnaire data on file. Hearing thresholds were measured across frequency octaves from 250 to 8,000 Hz, and various frequency pure-tone averages (PTAs) were constructed, including PTA4 (average of 500, 1,000, 2,000, and 4,000 Hz), PTA-high (average of 4,000 and 8,000 Hz), PTA-mid (average of 1,000 and 2,000 Hz), and PTA-low (average of 250 and 500 Hz). Hearing loss was defined for pure tones and pure-tone averages as >25 dB HL in either ear and averaged between the ears. Associations between physical activity and hearing were estimated using linear regression, reporting changes in decibel hearing level, and logistic regression, reporting odds ratios (OR) of hearing loss.

Results

Physical activity exhibited a statistically significant but small inverse relationship with PTA4, −0.20 dB HL per doubling of activity (95% confidence interval [CI]: −0.35, −0.04; P = .016), as well as with PTA-low and pure tones at 250, 2,000, and 4,000 Hz in adjusted models. Multivariable logistic regression modeling supported a decrease in the odds of high-frequency hearing loss among participants who reported at least some moderate weekly physical activity (PTA-high, OR: 0.69 [95% CI: 0.52, 0.92]; P = .011 and 4000 Hz, OR: 0.75 [95% CI: 0.57, 0.99]; P = .044).

Conclusions

Our study provides further evidence that physical activity is related to better hearing; however, the clinical significance of this relationship cannot be estimated given the nature of the cross-sectional study design.

Level of Evidence

2b Laryngoscope, 2015

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New instrumentation in endoscopic medial orbital decompression

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Impact of adenotonsillectomy on nocturnal enuresis in children with sleep-disordered breathing: A prospective study

Objectives/Hypothesis

To investigate the relationship between sleep-disordered breathing (SDB) and nocturnal enuresis (NE) in children and to prospectively evaluate the effectiveness of adenotonsillectomy on resolving enuresis in indicated SDB patients with NE.

Methods

We prospectively collected data from 183 children (121 males, mean age 8.17 ± 2.84 years) who underwent adenotonsillectomy to treat SDB between July 2011 and July 2013, and analyzed the prevalence of NE. Before and 3 months after surgery, all parents were requested to answer a self-reported SDB scale questionnaire (22 questions, 0–22 points) and a NE questionnaire (episodes of enuresis per month). Paired t test, Student t test, and Chi-square test were used to analyze the data.

Results

Overall prevalence of NE was 9.3% (17 patients) preoperatively and 1.5% postoperatively (four patients). After adenotonsillectomy, prevalence of NE and the mean SDB scale were significantly decreased (both P values < 0.001). After adenotonsillectomy, 13 of the 17 NE patients (76.5%) showed complete resolution. There was significantly higher prevalence of NE in patients with obstructive sleep apnea (OSA) than those without OSA (13.1%, 14 of 107 vs. 3.9%, 3 of 76; P = 0.036).

Conclusion

There is strong association between NE and SDB, and adenotonsillectomy can markedly improve enuresis in the majority of children with NE and SDB.

Levels of Evidence

4. Laryngoscope, 2016

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Brachytherapy for radiotherapy-resistant head and neck cancer: A review of a single center experience

Objectives/Hypothesis

Despite advances in radiotherapy and chemotherapy treatments for head and neck cancers, the local failure rate is high. In most radiotherapy-resistant cases, surgery is performed; however, some cases are considered unresectable. No standard treatment for these situations has been established. In this study, we review our experience with brachytherapy (BT), which has a different biological mechanism than standard radiotherapy.

Methods

All patients received prior radiation to the recurrence area. Median high-dose radiation BT dose was 50 Gy, administered in 5 to 10 Gy fractions twice daily for 5 days. High-dose radiation was given via four to 10 catheters inserted under local anesthesia (3 patients) or general anesthesia with preventive tracheostomy (10 patients).

Results

Thirteen patients received BT from 2010 to 2014. Male:female ratio was 1.6:1, and median age was 66 years (range 23–89). Of those 13 patients, 10 patients were diagnosed with squamous cell carcinoma (SCC) of the oral cavity, two patients with SCC of the nasal mucosa, and one patient with eccrine duct carcinoma. Prior radiation dose ranged from 60 to 70 Gy. Local control was achieved in 11 of 13 patients; only 15.3% (2 of 13) had in-field recurrence. Five patients developed local out-of-field recurrence, and two developed distant metastases. Five patients are alive with no evidence of disease. No major toxicities were encountered. Two patients had severe mucositis and recovered within several weeks.

Conclusion

Brachytherapy for radiotherapy-resistant head and neck cancers is feasible with minor adverse events, which enables good local control. However, many advanced head and neck cancers develop regional or distant metastases; therefore, additional treatment should be suggested.

Level of Evidence

4. Laryngoscope, 2016

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Response to “Tympanic membrane repair using silk fibroin and acellular collagen scaffolds”

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Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma

Objectives/Hypothesis

To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies.

Study Design

Retrospective review and cost analysis.

Methods

Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single-stage or second-look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre-/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow-up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits.

Results

One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall-up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single-stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre-/postoperative ABG and WRS between second look and single stage (P > 0.05). Compared to second-look patients, single-stage patients had significantly fewer postoperative visits (6.32 vs. 10.4; P = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411; P < 0.0001).

Conclusion

The goal of cholesteatoma surgery is to produce a safe ear, and a second-look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty-mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second-look strategy should be individually tailored and not universally performed.

Level of Evidence

4. Laryngoscope, 2016

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Day-case stapes surgery: Day-case versus inpatient stapes surgery for otosclerosis: a randomized controlled trial

Otosclerosis is characterized by bony deposits in the otic capsule, resulting in stapes fixation and progressive hearing loss. It can be treated effectively by surgically removing (part of) the stapes and repl...

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T Regulatory Cell Biology in Health and Disease

Abstract

Regulatory T (Treg) cells that express the transcription factor forkhead box protein P3 (FOXP3) play an essential role in enforcing immune tolerance to self tissues, regulating host-commensal flora interaction, and facilitating tissue repair. Their deficiency and/or dysfunction trigger unbridled autoimmunity and inflammation. A growing number of monogenic defects have been recognized that adversely impact Treg cell development, differentiation, and/or function, leading to heritable diseases of immune dysregulation and autoimmunity. In this article, we review recent insights into Treg cell biology and function, with particular attention to lessons learned from newly recognized clinical disorders of Treg cell deficiency.

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Perfusionsanalyse innerhalb von Speicheldrüsentumoren bei der kontrastmittelverstärkten Sonografie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-100282

Hintergrund: Ergänzend zur konventionellen Sonografie erlaubt die kontrastverstärkte Ultraschalluntersuchung (CEUS) eine genauere Perfusionsanalyse von Speicheldrüsentumoren zur Einschätzung ihrer Dignität. Bisher wurde bei der Anwendung von CEUS noch kein Vergleich der Perfusion in unterschiedlichen regions of interest (ROI) innerhalb von Speicheldrüsentumoren durchgeführt. Diese Arbeit soll die Perfusion verschiedener Areale innerhalb von Speicheldrüsentumoren untersuchen und vergleichen. Material und Methoden: In dieser Studie wurden 25 Patienten mit Speicheldrüsentumoren mittels B-Mode- Sonografie, Farbdopplersonografie sowie CEUS untersucht. Die Parameter: Durchmesser, Echoverhalten, Abgrenzbarkeit und insbesondere das Perfusionsverhalten wurden bestimmt. Die vorliegende Arbeit beschreibt eine neue Methode zur Perfusionsanalyse in 6 peripheren und 2 zentralen standardisierten ROI, welche in den Tumoren verteilt wurden. Die Perfusion wurde dabei zwischen den Tumordignitäten und vor allem innerhalb der Tumoren in den standardisiert angelegten ROI miteinander verglichen. Ergebnisse: Es zeigte sich ein auffälliges Areal der Perfusion (sog. „hotspots") in der Tiefe der Peripherie der Raumforderungen, welches besondere Charakteristika ihrer Perfusion aufwies. Dabei bestanden signifikante Unterschiede zwischen den benignen und malignen Tumoren. Schlussfolgerungen: Die beschriebene neue Methode der Auswertung scheint daher die Aussagekraft der CEUS im Bezug auf die Dignitätsdiagnose zu verbessern.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Best Masking Sound For Tinnitus

Tinnitus is a condition often described as a "ringing" or "buzzing" sound in the ears. Tinnitus can be continuous or intermittent, and the sound may be loud or soft and subtle. The condition is fairly common, and many people simply adjust to the ongoing sounds in their ears without huge difficulty. For some people, however, the condition can be very loud and extreme. It can interfere with normal hearing, even though the Tinnitus is not necessarily causing the hearing loss.

Searching For Relief

Tinnitus can appear for many reasons. The top cause is exposure to loud noise, like gunshots or loud machinery. Infections and ear blockages can also bring on the condition. Some medications, including aspirin and antidepressants, can bring on Tinnitus. For some people the sound can be continuous and go on through the night, causing sleep loss. This can bring on a vicious circle, as fatigue and stress are also thought to be linked to Tinnitus.

There is no known cure for Tinnitus at this time, but some people have found relief by listening to another sound that helps block the sound. This is called a "masking sound." The best masking sound for Tinnitus may vary for different people, but here are a few sounds that are said to work well to alleviate the symptoms of tinnitus.

Sound Therapies

Finding the best masking sound for Tinnitus is an important part of therapy for this condition. The best masking sound for Tinnitus, whether it is the sound of rainfall, a relaxing ocean surf sound, or the quiet sound of general "white noise," can work in several ways to ease the anxiety that Tinnitus can bring on in a patient.

The best masking sound for Tinnitus is one that can completely cover the sound inside the ear, or at least enough to be a distraction. The element of distraction is important as it can ease symptoms of the condition immediately. The sound masking treatment also helps to train the patient's brain in a way that makes it tune out the Tinnitus sound. The American Tinnitus Association calls this brain training a way of "classifying" the sound as an "unimportant" (and thus easier to ignore) sound. The ATA also refers to a neuromodulation effect that comes with sound masking, as the masking sounds can help relieve hyperactivity in the brain that is also thought to bring on Tinnitus.

Today there are many options for masking sounds, ranging from peaceful ocean sounds to nature sounds to white noise, or white noise without high frequencies. Masking sounds can be played from a special player or even put in ear pieces.

The good news is that masking sounds do bring relief and they bring it in a way that is low cost and has no side effects. That's a great bit of news for Tinnitus sufferers everywhere, to be sure.

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Distinct antibody species: structural differences creating therapeutic opportunities

Serge Muyldermans | Vaughn V Smider

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Oral corticosteroid prescribing habits of Canadian Otolaryngologist-Head and Neck Surgeons

Oral corticosteroids (OCSs) are widely prescribed in Otolaryngology-Head & Neck surgery (OtoHNS). There is evidence in the literature regarding specific dosing regimens. However, it is not known to what extent...

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Decisional conflict in patients considering diagnostic thyroidectomy with indeterminate fine needle aspirate cytopathology

Fine needle aspiration (FNA) cytopathology is the gold standard work-up for thyroid nodules. However, indeterminate lesions are encountered commonly and can lead to difficult treatment decisions. We sought to ...

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Extraction of impacted mandibular third molars - the effect of osteotomy at two speeds on peripheral bone: a histopathological analysis

The aim of this study was to find out the ideal speed for making a precise osteotomy with minimal damage to the surrounding bone. Thirty-six patients were divided into two groups (n=18 in each) depending on the speed of the handpiece used for osteotomy (slow=20000rpm and fast=40000rpm). Samples were taken from the peripheral bone and examined histologically to measure the margins of the osteotomy, the amount of debris produced, and the degree of thermal osteonecrosis. The osteotomy made with the high speed handpiece was better than that made with the low speed one on all counts.

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Immediate facial reanimation in oncological parotid surgery with neurorrhaphy of the masseteric-thoracodorsal-facial nerve branch

The extracranial facial nerve may be sacrificed together with the parotid gland during a radical parotidectomy, and immediate reconstruction of the facial nerve is essential to maintain at least part of its function. We report five patients who had had radical parotidectomy (two with postoperative radiotherapy) and immediate (n=3) or recent (n=2) reconstructions of the masseteric-thoracodorsal-facial nerve branch. The first mimetic musculature movements started 6.2 (range 4–8.5) months postoperatively.

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Intraorbital aspergilloma: a rare cause of orbital apex syndrome

A 43-year-old man presented to our department with weakness of vision, ptosis, proptosis, and impaired eye movement, all on the left side. Magnetic resonance imaging (MRI) (Fig. 1) showed an extraconal mass in the superointernal quadrant of his left eye socket, without extension to the ethmoid sinus. With the presumptive diagnosis of orbital inflammatory pseudotumour, we started him on a course of prednisolone. When there was no improvement, we excised the pearly white, cartilaginous mass through an upper eyelid approach.

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Platysma flap using dual skin paddles

The platysma myocutaneous flap is rarely reported as an option for reconstruction in the head and neck. In our experience it is a reliable flap that is easy to raise, has a limited risk of morbidity at the donor site, and allows for early recommencement of oral function. We report a patient with an unusually aggressive orocutaneous fistula that complicated the simple extraction of teeth. We modified the platysma flap to provide two independent skin paddles so we could reconstruct both the intraoral and cutaneous defects simultaneously with a good clinical outcome.

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Increasing the survival of transverse rectus abdominis musculocutaneous flaps with a Botulinum Toxin-A Injection: A comparison of surgical and chemical flap delay methods

Botulinum Toxin type-A (Btx-A) is a commonly used drug for both cosmetic and therapeutic purposes. The effects of Btx-A on skin and muscle flaps and the related mechanisms have been described previously. In this study, we used a rat transverse rectus abdominis musculocutaneous (TRAM) flap model to examine the effects of Btx-A on the skin island, which is perfused by the rectus abdominis muscle according to the angiosome concept.

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How do voice restoration methods affect the psychological status of patients after total laryngectomy?

Abstract

Objective

This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients.

Methods

The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically.

Results

Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients' anxiety and depression status did not vary.

Conclusion

Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

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The role of Toll-like receptors in periodontitis

Abstract

Periodontitis is a common infectious disease. Recent studies have indicated that the progression of periodontitis may be regulated by interactions between host immunity and periodontopathic bacteria. Although periodontopathic bacteria can destroy periodontal tissue, a dysfunctional host immune response triggered by the bacteria can lead to more severe and persistent destruction. Toll-like receptors (TLRs), a type of pattern recognition receptor (PRR) that recognize pathogens, have been implicated in host innate immune responses to periodontopathic bacteria and in the activation of adaptive immunity. TLR-targeted drugs may hold promise to treat periodontal disease. This review summarizes recent studies on the role of TLRs in periodontitis and discusses areas needing further research. We believe TLRs may be an effective biomarker for the prevention, diagnosis, and treatment of periodontitis in the near future.

This article is protected by copyright. All rights reserved.

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The role of Toll-like receptors in periodontitis

Abstract

Periodontitis is a common infectious disease. Recent studies have indicated that the progression of periodontitis may be regulated by interactions between host immunity and periodontopathic bacteria. Although periodontopathic bacteria can destroy periodontal tissue, a dysfunctional host immune response triggered by the bacteria can lead to more severe and persistent destruction. Toll-like receptors (TLRs), a type of pattern recognition receptor (PRR) that recognize pathogens, have been implicated in host innate immune responses to periodontopathic bacteria and in the activation of adaptive immunity. TLR-targeted drugs may hold promise to treat periodontal disease. This review summarizes recent studies on the role of TLRs in periodontitis and discusses areas needing further research. We believe TLRs may be an effective biomarker for the prevention, diagnosis, and treatment of periodontitis in the near future.

This article is protected by copyright. All rights reserved.

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Usefulness of rhinomanometry in the identification and treatment of patients with obstructive sleep apnoea: an algorithm for predicting the relationship between nasal resistance and continuous positive airway pressure. A retrospective study

Abstract

Objectives

We try to assess the relationship between nasal resistance measured by rhinomanometry and the pressure used in CPAP.

Design

Retrospective medical case series review, January 2004 to December 2014.

Setting

Tertiary care academic medical center.

Participants

38 patients (m=56.55 years; male=90.5%) with CPAP settings ≤8 and 39 patients (m=57.49 years; male=74.9%) with pressure settings ≥12.

Main outcome measures

Study variables were BMI, neck circumference, Epworth Sleepiness Scale score, nasopharyngeal examination and computerized anterior active rhinomanometry, sitting and supine, in basal conditions and after intranasal administration of oxymetazoline (0.05%). Nocturnal polysomnography was performed to calculate the apnoea-hypopnoea index without and with CPAP to analysis the effectiveness of the treatment.

Results

BMI and resistance in supine position after vasoconstriction at 150 Pa were useful variables to predict the pressure setting that should be used. We obtained an equation to calculate the probability that a patient requires a pressure greater than 12 cm H₂O as a function of their BMI and total nasal airflow at 150 Pascal in supine position after vasoconstriction.

Conclusions

Rhinomanometry is useful to predict the impact of structural nasal modifications on the positive pressure to support decision-making in relation to surgery.

This article is protected by copyright. All rights reserved.

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Incidence and reporting of sharps injuries amongst ENT surgeons

Research Articles
A Vijendren, J Sanchez, M Yung
The Journal of Laryngology & Otology,FirstView Article(s), 6 pages

Abstract


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The role of Toll-like receptors in periodontitis

Abstract

Periodontitis is a common infectious disease. Recent studies have indicated that the progression of periodontitis may be regulated by interactions between host immunity and periodontopathic bacteria. Although periodontopathic bacteria can destroy periodontal tissue, a dysfunctional host immune response triggered by the bacteria can lead to more severe and persistent destruction. Toll-like receptors (TLRs), a type of pattern recognition receptor (PRR) that recognize pathogens, have been implicated in host innate immune responses to periodontopathic bacteria and in the activation of adaptive immunity. TLR-targeted drugs may hold promise to treat periodontal disease. This review summarizes recent studies on the role of TLRs in periodontitis and discusses areas needing further research. We believe TLRs may be an effective biomarker for the prevention, diagnosis, and treatment of periodontitis in the near future.

This article is protected by copyright. All rights reserved.

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Usefulness of rhinomanometry in the identification and treatment of patients with obstructive sleep apnoea: an algorithm for predicting the relationship between nasal resistance and continuous positive airway pressure. A retrospective study

Abstract

Objectives

We try to assess the relationship between nasal resistance measured by rhinomanometry and the pressure used in CPAP.

Design

Retrospective medical case series review, January 2004 to December 2014.

Setting

Tertiary care academic medical center.

Participants

38 patients (m=56.55 years; male=90.5%) with CPAP settings ≤8 and 39 patients (m=57.49 years; male=74.9%) with pressure settings ≥12.

Main outcome measures

Study variables were BMI, neck circumference, Epworth Sleepiness Scale score, nasopharyngeal examination and computerized anterior active rhinomanometry, sitting and supine, in basal conditions and after intranasal administration of oxymetazoline (0.05%). Nocturnal polysomnography was performed to calculate the apnoea-hypopnoea index without and with CPAP to analysis the effectiveness of the treatment.

Results

BMI and resistance in supine position after vasoconstriction at 150 Pa were useful variables to predict the pressure setting that should be used. We obtained an equation to calculate the probability that a patient requires a pressure greater than 12 cm H₂O as a function of their BMI and total nasal airflow at 150 Pascal in supine position after vasoconstriction.

Conclusions

Rhinomanometry is useful to predict the impact of structural nasal modifications on the positive pressure to support decision-making in relation to surgery.

This article is protected by copyright. All rights reserved.

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Incidence and reporting of sharps injuries amongst ENT surgeons

Research Articles
A Vijendren, J Sanchez, M Yung
The Journal of Laryngology & Otology,FirstView Article(s), 6 pages

Abstract


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Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity.

Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity.

Cortex. 2016 Feb 4;77:95-118

Authors: François C, Ripollés P, Bosch L, Garcia-Alix A, Muchart J, Sierpowska J, Fons C, Solé J, Rebollo M, Gaitán H, Rodriguez-Fornells A

Abstract
Brain imaging methods have contributed to shed light on the possible mechanisms of recovery and cortical reorganization after early brain insult. The idea that a functional left hemisphere is crucial for achieving a normalized pattern of language development after left perinatal stroke is still under debate. We report the case of a 3.5-year-old boy born at term with a perinatal ischemic stroke of the left middle cerebral artery, affecting mainly the supramarginal gyrus, superior parietal and insular cortex extending to the precentral and postcentral gyri. Neurocognitive development was assessed at 25 and 42 months of age. Language outcomes were more extensively evaluated at the latter age with measures on receptive vocabulary, phonological whole-word production and linguistic complexity in spontaneous speech. Word learning abilities were assessed using a fast-mapping task to assess immediate and delayed recall of newly mapped words. Functional and structural imaging data as well as a measure of intrinsic connectivity were also acquired. While cognitive, motor and language levels from the Bayley Scales fell within the average range at 25 months, language scores were below at 42 months. Receptive vocabulary fell within normal limits but whole word production was delayed and the child had limited spontaneous speech. Critically, the child showed clear difficulties in both the immediate and delayed recall of the novel words, significantly differing from an age-matched control group. Neuroimaging data revealed spared classical cortical language areas but an affected left dorsal white-matter pathway together with right lateralized functional activations. In the framework of the model for Social Communication and Language Development, these data confirm the important role of the left arcuate fasciculus in understanding and producing morpho-syntactic elements in sentences beyond two word combinations and, most importantly, in learning novel word-referent associations, a building block of language acquisition.

PMID: 26922507 [PubMed - as supplied by publisher]

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Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

J Med Humanit. 2016 Feb 27;

Authors: Salisbury L, Code C

Abstract
This article explores the relationship between automatic and involuntary language in the work of Samuel Beckett and late nineteenth-century neurological conceptions of language that emerged from aphasiology. Using the work of John Hughlings Jackson alongside contemporary neuroscientific research, we explore the significance of the lexical and affective symmetries between Beckett's compulsive and profoundly embodied language and aphasic speech automatisms. The interdisciplinary work in this article explores the paradox of how and why Beckett was able to search out a longed-for language of feeling that might disarticulate the classical bond between the language, intention, rationality and the human, in forms of expression that seem automatic and "readymade".

PMID: 26922435 [PubMed - as supplied by publisher]

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Usefulness of rhinomanometry in the identification and treatment of patients with obstructive sleep apnoea: an algorithm for predicting the relationship between nasal resistance and continuous positive airway pressure. A retrospective study

Abstract

Objectives

We try to assess the relationship between nasal resistance measured by rhinomanometry and the pressure used in CPAP.

Design

Retrospective medical case series review, January 2004 to December 2014.

Setting

Tertiary care academic medical center.

Participants

38 patients (m=56.55 years; male=90.5%) with CPAP settings ≤8 and 39 patients (m=57.49 years; male=74.9%) with pressure settings ≥12.

Main outcome measures

Study variables were BMI, neck circumference, Epworth Sleepiness Scale score, nasopharyngeal examination and computerized anterior active rhinomanometry, sitting and supine, in basal conditions and after intranasal administration of oxymetazoline (0.05%). Nocturnal polysomnography was performed to calculate the apnoea-hypopnoea index without and with CPAP to analysis the effectiveness of the treatment.

Results

BMI and resistance in supine position after vasoconstriction at 150 Pa were useful variables to predict the pressure setting that should be used. We obtained an equation to calculate the probability that a patient requires a pressure greater than 12 cm H₂O as a function of their BMI and total nasal airflow at 150 Pascal in supine position after vasoconstriction.

Conclusions

Rhinomanometry is useful to predict the impact of structural nasal modifications on the positive pressure to support decision-making in relation to surgery.

This article is protected by copyright. All rights reserved.

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Incidence and reporting of sharps injuries amongst ENT surgeons

Research Articles
A Vijendren, J Sanchez, M Yung
The Journal of Laryngology & Otology,FirstView Article(s), 6 pages

Abstract


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Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity.

Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity.

Cortex. 2016 Feb 4;77:95-118

Authors: François C, Ripollés P, Bosch L, Garcia-Alix A, Muchart J, Sierpowska J, Fons C, Solé J, Rebollo M, Gaitán H, Rodriguez-Fornells A

Abstract
Brain imaging methods have contributed to shed light on the possible mechanisms of recovery and cortical reorganization after early brain insult. The idea that a functional left hemisphere is crucial for achieving a normalized pattern of language development after left perinatal stroke is still under debate. We report the case of a 3.5-year-old boy born at term with a perinatal ischemic stroke of the left middle cerebral artery, affecting mainly the supramarginal gyrus, superior parietal and insular cortex extending to the precentral and postcentral gyri. Neurocognitive development was assessed at 25 and 42 months of age. Language outcomes were more extensively evaluated at the latter age with measures on receptive vocabulary, phonological whole-word production and linguistic complexity in spontaneous speech. Word learning abilities were assessed using a fast-mapping task to assess immediate and delayed recall of newly mapped words. Functional and structural imaging data as well as a measure of intrinsic connectivity were also acquired. While cognitive, motor and language levels from the Bayley Scales fell within the average range at 25 months, language scores were below at 42 months. Receptive vocabulary fell within normal limits but whole word production was delayed and the child had limited spontaneous speech. Critically, the child showed clear difficulties in both the immediate and delayed recall of the novel words, significantly differing from an age-matched control group. Neuroimaging data revealed spared classical cortical language areas but an affected left dorsal white-matter pathway together with right lateralized functional activations. In the framework of the model for Social Communication and Language Development, these data confirm the important role of the left arcuate fasciculus in understanding and producing morpho-syntactic elements in sentences beyond two word combinations and, most importantly, in learning novel word-referent associations, a building block of language acquisition.

PMID: 26922507 [PubMed - as supplied by publisher]

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Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

J Med Humanit. 2016 Feb 27;

Authors: Salisbury L, Code C

Abstract
This article explores the relationship between automatic and involuntary language in the work of Samuel Beckett and late nineteenth-century neurological conceptions of language that emerged from aphasiology. Using the work of John Hughlings Jackson alongside contemporary neuroscientific research, we explore the significance of the lexical and affective symmetries between Beckett's compulsive and profoundly embodied language and aphasic speech automatisms. The interdisciplinary work in this article explores the paradox of how and why Beckett was able to search out a longed-for language of feeling that might disarticulate the classical bond between the language, intention, rationality and the human, in forms of expression that seem automatic and "readymade".

PMID: 26922435 [PubMed - as supplied by publisher]

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Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity.

Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity.

Cortex. 2016 Feb 4;77:95-118

Authors: François C, Ripollés P, Bosch L, Garcia-Alix A, Muchart J, Sierpowska J, Fons C, Solé J, Rebollo M, Gaitán H, Rodriguez-Fornells A

Abstract
Brain imaging methods have contributed to shed light on the possible mechanisms of recovery and cortical reorganization after early brain insult. The idea that a functional left hemisphere is crucial for achieving a normalized pattern of language development after left perinatal stroke is still under debate. We report the case of a 3.5-year-old boy born at term with a perinatal ischemic stroke of the left middle cerebral artery, affecting mainly the supramarginal gyrus, superior parietal and insular cortex extending to the precentral and postcentral gyri. Neurocognitive development was assessed at 25 and 42 months of age. Language outcomes were more extensively evaluated at the latter age with measures on receptive vocabulary, phonological whole-word production and linguistic complexity in spontaneous speech. Word learning abilities were assessed using a fast-mapping task to assess immediate and delayed recall of newly mapped words. Functional and structural imaging data as well as a measure of intrinsic connectivity were also acquired. While cognitive, motor and language levels from the Bayley Scales fell within the average range at 25 months, language scores were below at 42 months. Receptive vocabulary fell within normal limits but whole word production was delayed and the child had limited spontaneous speech. Critically, the child showed clear difficulties in both the immediate and delayed recall of the novel words, significantly differing from an age-matched control group. Neuroimaging data revealed spared classical cortical language areas but an affected left dorsal white-matter pathway together with right lateralized functional activations. In the framework of the model for Social Communication and Language Development, these data confirm the important role of the left arcuate fasciculus in understanding and producing morpho-syntactic elements in sentences beyond two word combinations and, most importantly, in learning novel word-referent associations, a building block of language acquisition.

PMID: 26922507 [PubMed - as supplied by publisher]

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Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

J Med Humanit. 2016 Feb 27;

Authors: Salisbury L, Code C

Abstract
This article explores the relationship between automatic and involuntary language in the work of Samuel Beckett and late nineteenth-century neurological conceptions of language that emerged from aphasiology. Using the work of John Hughlings Jackson alongside contemporary neuroscientific research, we explore the significance of the lexical and affective symmetries between Beckett's compulsive and profoundly embodied language and aphasic speech automatisms. The interdisciplinary work in this article explores the paradox of how and why Beckett was able to search out a longed-for language of feeling that might disarticulate the classical bond between the language, intention, rationality and the human, in forms of expression that seem automatic and "readymade".

PMID: 26922435 [PubMed - as supplied by publisher]

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The Influence of Cognitive Factors on Outcomes with Frequency Lowering

 IntroductionSince frequency lowering technology has become commercially available in modern digital hearing aids, researchers have set out to determine what benefits this technology could provide hearing-impaired patients. There is an abundance

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Understanding and Treating Severe and Profound Hearing Loss

Oticon has a history of creating excellent solutions for patients with severe-to-profound hearing loss. With the release of Oticon Dynamo, Sensei Super Power, and the Plus Power products in our performance line categories, we have again raised the ba

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Robotic-assisted surgery for the management of velopharyngeal insufficiency and nasopharyngeal stenosis

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The Influence of Cognitive Factors on Outcomes with Frequency Lowering

 IntroductionSince frequency lowering technology has become commercially available in modern digital hearing aids, researchers have set out to determine what benefits this technology could provide hearing-impaired patients. There is an abundance

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Understanding and Treating Severe and Profound Hearing Loss

Oticon has a history of creating excellent solutions for patients with severe-to-profound hearing loss. With the release of Oticon Dynamo, Sensei Super Power, and the Plus Power products in our performance line categories, we have again raised the ba

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Robotic-assisted surgery for the management of velopharyngeal insufficiency and nasopharyngeal stenosis

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Moffett's solution and the new 2015 UK drug-driving laws: the case for consenting patients for its use

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Minimal-show orthognathic surgical splint

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Jonathan L. Jones, Stephen Evans, Simon D. Jones




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The index of orthognathic functional treatment need accurately prioritises those patients already selected for orthognathic surgery within the NHS

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Rupal Shah, John Breeze, Mohit Chand, Peter Stockton
The index of orthognathic functional treatment need (IOFTN) is a newly-proposed system to help to prioritise patients for orthognathic treatment. The five categories are similar to those used in orthodontics, but include additional parameters such as sleep apnoea and facial asymmetry. The aim of this audit was to validate the index and find out the potential future implications, should such a system ever be adopted by commissioners.We calculated the IOFTN category of 100 consecutive patients who had orthognathic surgery between 2010-14 using clinical notes, photographs, study models, and radiographs, and determined the number in categories 4 or 5, analogous to the current indications for orthodontic treatment within the NHS.Sufficient clinical information was available to categorise 59/100 patients, and 56 of the 59 (95%) were in either category 4 or 5. All three of the remaining patients (in categories 1-3) who were operated on were treated because of the anticipated favourable impact on their quality of life.The IOFTN has been proposed for use in future commissioning of orthognathic services within the NHS, and this study has confirmed its efficacy in prioritising treatment accurately, with 95% of patients being in categories 4 or 5. We recommend that the orthognathic treatment index be adapted to include additional psychosocial assessment so that patients who fall into the lower functional categories are not automatically excluded from this potentially life-changing treatment.



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Nerve injury associated with orthognathic surgery. Part 1: UK practice and motor nerve injuries

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D.C. Bowe, E.A. Gruber, N.M.H. McLeod
The head and neck is anatomically complex, and several nerves are at risk during orthognathic operations. Some injuries to nerves are reported more commonly than others. To find out what consultant surgeons tell their patients about the prevalence of common nerve injuries before orthognathic operations, we did a postal survey of fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS). We also reviewed published papers to find out the reported incidence of injuries to cranial motor nerves during orthognathic operations. Only injuries to the facial nerve were commonly reported, and we found only case reports about injuries to the oculomotor, abducens, and trochlear nerves. The risk of temporary facial nerve palsy reported was 0.30/100 nerves (95% CI 0.23 to 0.50) and permanent facial nerve palsy was 0.06/100 nerves (95% CI 0.02 to 0.15).



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Kinetics of gene expression of alkaline phosphatase during healing of alveolar bone in rats

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Willian Caetano Rodrigues, André Luís da Silva Fabris, Jaqueline Suemi Hassumi, Alaíde Gonçalves, Celso Koogi Sonoda, Roberta Okamoto
Immunohistochemical studies and molecular biology have enabled us to identify numerous proteins that are involved in the metabolism of bone, and their encoding genes. Among these is alkaline phosphatase (ALP), an enzyme that is responsible for the initiation of mineralisation of the extracellular matrix during alveolar bone repair. To evaluate the gene expression of ALP during this process, we studied nine healthy adult male rats, which had their maxillary central incisors extracted from the right side and were randomly divided into three groups. During three experimental periods, 7 days, 14 days, and 28 days, the alveoli were curetted, the rats killed, and samples analysed by real-time reverse transcription polymerase chain reaction (qRT-PCR). The RNAm that encodes the gene for the synthesis of ALP was expressed during the three periods analysed, but its concentration was significantly increased at 14 and 28 days compared with at 7 days. There was no significant difference between 14 and 28 days (p=0.0005). We conclude that genes related to ALP are expressed throughout the healing process and more intensively during the later periods (14 and 28 days), which coincides with the increased formation of mineralised bone.



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Internal Mammary Vessels - Alternate Recipient Vessels in Microvascular Head and Neck Reconstruction

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Paul M. Buck, Mark K. Wax, Daniel I. Petrisor




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AAOMS Informational Campaign Communicates the OMS Story

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): William J. Nelson




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Central Giant Cell Granuloma of the Mandible Requiring Multiple Treatment Modalities – A Case Report

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): David Jerkins, Maximilian Malotky, Reza Miremadi, Mukund Dole
Central giant cell granuloma (CGCG) is a relatively rare non-neoplastic, intraosseous lesion which exhibits a wide spectrum of clinical behavior and its management can be particularly challenging even for experienced clinicians. The etiopathogenesis of this disease process remains unclear, although factors such as trauma, inflammatory foci and a genetic predisposition have been implicated. While multiple treatment modalities have been used with varying degrees of success, there is no accepted algorithm for therapeutic intervention and little is known about the reasons for success or failure of a given treatment. This paper reviews the epidemiology, presentation, classification, and currently used therapies for CGCG, while describing the clinical course and successful therapeutic outcome of a young female with an aggressive CGCG of the mandible.



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Three-dimensional accuracy of virtual planning and surgical navigation for mandibular reconstruction with free fibula flap

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yao Yu, Wen-Bo Zhang, Xiao-Jing Liu, Chuan-Bin Guo, Guang-Yan Yu, Xin Peng
ObjectiveAlthough free fibula flaps are widely used for mandibular reconstruction, their three-dimensional position is difficult to control during conventional surgery. We aimed to improve this process by using computer-aided design (CAD) and surgical navigation.MethodsWe retrospectively reviewed 29 benign tumor patients who underwent primary unilateral mandibular reconstruction with free fibula flap. Patients were divided into three groups: group A, 10 patients, reconstruction based on surgeon's experience; group B, 7 patients, reconstruction based on CAD; and group C, 12 patients, reconstruction based on CAD and surgical navigation. Condyle and gonion positions and mandibular angles were measured. Operative times were recorded.ResultsIn the 17 patients who underwent condyle resection, the average condyle shift was greater in group A than in groups B and C (P < 0.05). The average gonion shift was greater in groups A and B than in group C (P < 0.05). The difference between the reconstructed and contralateral mandibular angle was greater in group A than in groups B and C (P < 0.05). Mean operative time did not differ between the three groups.ConclusionCAD can guide mandibular angle remodeling and condyle placement. CAD and surgical navigation increase reconstruction accuracy without prolonging operative time.



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Three-dimensional computed tomographic analysis of variations of the carotid artery

Although the terms tortuous, coiling, and kinking have been used to describe the curvature of the carotid artery, the prevalence rates of these patterns have differed among studies. We morphologically evaluated the characteristics of the carotid artery by means of threedimensional computed tomography (3DCT) to clarify the prevalence of tortuosity, coiling, and kinking. We present our results and discuss the clinical impact of our findings.

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Bad splits in bilateral sagittal split osteotomy: systematic review of fracture patterns

An unfavourable and unanticipated pattern of the mandibular sagittal split osteotomy is generally referred to as a 'bad split'. Few restorative techniques to manage the situation have been described. In this article, a classification of reported bad split pattern types is proposed and appropriate salvage procedures to manage the different types of undesired fracture are presented. A systematic review was undertaken, yielding a total of 33 studies published between 1971 and 2015. These reported a total of 458 cases of bad splits among 19,527 sagittal ramus osteotomies in 10,271 patients.

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Minimal-show orthognathic surgical splint

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Jonathan L. Jones, Stephen Evans, Simon D. Jones




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The index of orthognathic functional treatment need accurately prioritises those patients already selected for orthognathic surgery within the NHS

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Rupal Shah, John Breeze, Mohit Chand, Peter Stockton
The index of orthognathic functional treatment need (IOFTN) is a newly-proposed system to help to prioritise patients for orthognathic treatment. The five categories are similar to those used in orthodontics, but include additional parameters such as sleep apnoea and facial asymmetry. The aim of this audit was to validate the index and find out the potential future implications, should such a system ever be adopted by commissioners.We calculated the IOFTN category of 100 consecutive patients who had orthognathic surgery between 2010-14 using clinical notes, photographs, study models, and radiographs, and determined the number in categories 4 or 5, analogous to the current indications for orthodontic treatment within the NHS.Sufficient clinical information was available to categorise 59/100 patients, and 56 of the 59 (95%) were in either category 4 or 5. All three of the remaining patients (in categories 1-3) who were operated on were treated because of the anticipated favourable impact on their quality of life.The IOFTN has been proposed for use in future commissioning of orthognathic services within the NHS, and this study has confirmed its efficacy in prioritising treatment accurately, with 95% of patients being in categories 4 or 5. We recommend that the orthognathic treatment index be adapted to include additional psychosocial assessment so that patients who fall into the lower functional categories are not automatically excluded from this potentially life-changing treatment.



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Nerve injury associated with orthognathic surgery. Part 1: UK practice and motor nerve injuries

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D.C. Bowe, E.A. Gruber, N.M.H. McLeod
The head and neck is anatomically complex, and several nerves are at risk during orthognathic operations. Some injuries to nerves are reported more commonly than others. To find out what consultant surgeons tell their patients about the prevalence of common nerve injuries before orthognathic operations, we did a postal survey of fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS). We also reviewed published papers to find out the reported incidence of injuries to cranial motor nerves during orthognathic operations. Only injuries to the facial nerve were commonly reported, and we found only case reports about injuries to the oculomotor, abducens, and trochlear nerves. The risk of temporary facial nerve palsy reported was 0.30/100 nerves (95% CI 0.23 to 0.50) and permanent facial nerve palsy was 0.06/100 nerves (95% CI 0.02 to 0.15).



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Kinetics of gene expression of alkaline phosphatase during healing of alveolar bone in rats

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Willian Caetano Rodrigues, André Luís da Silva Fabris, Jaqueline Suemi Hassumi, Alaíde Gonçalves, Celso Koogi Sonoda, Roberta Okamoto
Immunohistochemical studies and molecular biology have enabled us to identify numerous proteins that are involved in the metabolism of bone, and their encoding genes. Among these is alkaline phosphatase (ALP), an enzyme that is responsible for the initiation of mineralisation of the extracellular matrix during alveolar bone repair. To evaluate the gene expression of ALP during this process, we studied nine healthy adult male rats, which had their maxillary central incisors extracted from the right side and were randomly divided into three groups. During three experimental periods, 7 days, 14 days, and 28 days, the alveoli were curetted, the rats killed, and samples analysed by real-time reverse transcription polymerase chain reaction (qRT-PCR). The RNAm that encodes the gene for the synthesis of ALP was expressed during the three periods analysed, but its concentration was significantly increased at 14 and 28 days compared with at 7 days. There was no significant difference between 14 and 28 days (p=0.0005). We conclude that genes related to ALP are expressed throughout the healing process and more intensively during the later periods (14 and 28 days), which coincides with the increased formation of mineralised bone.



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Internal Mammary Vessels - Alternate Recipient Vessels in Microvascular Head and Neck Reconstruction

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Paul M. Buck, Mark K. Wax, Daniel I. Petrisor




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AAOMS Informational Campaign Communicates the OMS Story

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): William J. Nelson




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Central Giant Cell Granuloma of the Mandible Requiring Multiple Treatment Modalities – A Case Report

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): David Jerkins, Maximilian Malotky, Reza Miremadi, Mukund Dole
Central giant cell granuloma (CGCG) is a relatively rare non-neoplastic, intraosseous lesion which exhibits a wide spectrum of clinical behavior and its management can be particularly challenging even for experienced clinicians. The etiopathogenesis of this disease process remains unclear, although factors such as trauma, inflammatory foci and a genetic predisposition have been implicated. While multiple treatment modalities have been used with varying degrees of success, there is no accepted algorithm for therapeutic intervention and little is known about the reasons for success or failure of a given treatment. This paper reviews the epidemiology, presentation, classification, and currently used therapies for CGCG, while describing the clinical course and successful therapeutic outcome of a young female with an aggressive CGCG of the mandible.



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Three-dimensional accuracy of virtual planning and surgical navigation for mandibular reconstruction with free fibula flap

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yao Yu, Wen-Bo Zhang, Xiao-Jing Liu, Chuan-Bin Guo, Guang-Yan Yu, Xin Peng
ObjectiveAlthough free fibula flaps are widely used for mandibular reconstruction, their three-dimensional position is difficult to control during conventional surgery. We aimed to improve this process by using computer-aided design (CAD) and surgical navigation.MethodsWe retrospectively reviewed 29 benign tumor patients who underwent primary unilateral mandibular reconstruction with free fibula flap. Patients were divided into three groups: group A, 10 patients, reconstruction based on surgeon's experience; group B, 7 patients, reconstruction based on CAD; and group C, 12 patients, reconstruction based on CAD and surgical navigation. Condyle and gonion positions and mandibular angles were measured. Operative times were recorded.ResultsIn the 17 patients who underwent condyle resection, the average condyle shift was greater in group A than in groups B and C (P < 0.05). The average gonion shift was greater in groups A and B than in group C (P < 0.05). The difference between the reconstructed and contralateral mandibular angle was greater in group A than in groups B and C (P < 0.05). Mean operative time did not differ between the three groups.ConclusionCAD can guide mandibular angle remodeling and condyle placement. CAD and surgical navigation increase reconstruction accuracy without prolonging operative time.



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Minimal-show orthognathic surgical splint

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Jonathan L. Jones, Stephen Evans, Simon D. Jones




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The index of orthognathic functional treatment need accurately prioritises those patients already selected for orthognathic surgery within the NHS

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Rupal Shah, John Breeze, Mohit Chand, Peter Stockton
The index of orthognathic functional treatment need (IOFTN) is a newly-proposed system to help to prioritise patients for orthognathic treatment. The five categories are similar to those used in orthodontics, but include additional parameters such as sleep apnoea and facial asymmetry. The aim of this audit was to validate the index and find out the potential future implications, should such a system ever be adopted by commissioners.We calculated the IOFTN category of 100 consecutive patients who had orthognathic surgery between 2010-14 using clinical notes, photographs, study models, and radiographs, and determined the number in categories 4 or 5, analogous to the current indications for orthodontic treatment within the NHS.Sufficient clinical information was available to categorise 59/100 patients, and 56 of the 59 (95%) were in either category 4 or 5. All three of the remaining patients (in categories 1-3) who were operated on were treated because of the anticipated favourable impact on their quality of life.The IOFTN has been proposed for use in future commissioning of orthognathic services within the NHS, and this study has confirmed its efficacy in prioritising treatment accurately, with 95% of patients being in categories 4 or 5. We recommend that the orthognathic treatment index be adapted to include additional psychosocial assessment so that patients who fall into the lower functional categories are not automatically excluded from this potentially life-changing treatment.



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Nerve injury associated with orthognathic surgery. Part 1: UK practice and motor nerve injuries

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D.C. Bowe, E.A. Gruber, N.M.H. McLeod
The head and neck is anatomically complex, and several nerves are at risk during orthognathic operations. Some injuries to nerves are reported more commonly than others. To find out what consultant surgeons tell their patients about the prevalence of common nerve injuries before orthognathic operations, we did a postal survey of fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS). We also reviewed published papers to find out the reported incidence of injuries to cranial motor nerves during orthognathic operations. Only injuries to the facial nerve were commonly reported, and we found only case reports about injuries to the oculomotor, abducens, and trochlear nerves. The risk of temporary facial nerve palsy reported was 0.30/100 nerves (95% CI 0.23 to 0.50) and permanent facial nerve palsy was 0.06/100 nerves (95% CI 0.02 to 0.15).



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via IFTTT

Kinetics of gene expression of alkaline phosphatase during healing of alveolar bone in rats

Publication date: Available online 28 February 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Willian Caetano Rodrigues, André Luís da Silva Fabris, Jaqueline Suemi Hassumi, Alaíde Gonçalves, Celso Koogi Sonoda, Roberta Okamoto
Immunohistochemical studies and molecular biology have enabled us to identify numerous proteins that are involved in the metabolism of bone, and their encoding genes. Among these is alkaline phosphatase (ALP), an enzyme that is responsible for the initiation of mineralisation of the extracellular matrix during alveolar bone repair. To evaluate the gene expression of ALP during this process, we studied nine healthy adult male rats, which had their maxillary central incisors extracted from the right side and were randomly divided into three groups. During three experimental periods, 7 days, 14 days, and 28 days, the alveoli were curetted, the rats killed, and samples analysed by real-time reverse transcription polymerase chain reaction (qRT-PCR). The RNAm that encodes the gene for the synthesis of ALP was expressed during the three periods analysed, but its concentration was significantly increased at 14 and 28 days compared with at 7 days. There was no significant difference between 14 and 28 days (p=0.0005). We conclude that genes related to ALP are expressed throughout the healing process and more intensively during the later periods (14 and 28 days), which coincides with the increased formation of mineralised bone.



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Internal Mammary Vessels - Alternate Recipient Vessels in Microvascular Head and Neck Reconstruction

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Paul M. Buck, Mark K. Wax, Daniel I. Petrisor




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AAOMS Informational Campaign Communicates the OMS Story

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): William J. Nelson




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via IFTTT

Central Giant Cell Granuloma of the Mandible Requiring Multiple Treatment Modalities – A Case Report

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): David Jerkins, Maximilian Malotky, Reza Miremadi, Mukund Dole
Central giant cell granuloma (CGCG) is a relatively rare non-neoplastic, intraosseous lesion which exhibits a wide spectrum of clinical behavior and its management can be particularly challenging even for experienced clinicians. The etiopathogenesis of this disease process remains unclear, although factors such as trauma, inflammatory foci and a genetic predisposition have been implicated. While multiple treatment modalities have been used with varying degrees of success, there is no accepted algorithm for therapeutic intervention and little is known about the reasons for success or failure of a given treatment. This paper reviews the epidemiology, presentation, classification, and currently used therapies for CGCG, while describing the clinical course and successful therapeutic outcome of a young female with an aggressive CGCG of the mandible.



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Three-dimensional accuracy of virtual planning and surgical navigation for mandibular reconstruction with free fibula flap

Publication date: Available online 27 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yao Yu, Wen-Bo Zhang, Xiao-Jing Liu, Chuan-Bin Guo, Guang-Yan Yu, Xin Peng
ObjectiveAlthough free fibula flaps are widely used for mandibular reconstruction, their three-dimensional position is difficult to control during conventional surgery. We aimed to improve this process by using computer-aided design (CAD) and surgical navigation.MethodsWe retrospectively reviewed 29 benign tumor patients who underwent primary unilateral mandibular reconstruction with free fibula flap. Patients were divided into three groups: group A, 10 patients, reconstruction based on surgeon's experience; group B, 7 patients, reconstruction based on CAD; and group C, 12 patients, reconstruction based on CAD and surgical navigation. Condyle and gonion positions and mandibular angles were measured. Operative times were recorded.ResultsIn the 17 patients who underwent condyle resection, the average condyle shift was greater in group A than in groups B and C (P < 0.05). The average gonion shift was greater in groups A and B than in group C (P < 0.05). The difference between the reconstructed and contralateral mandibular angle was greater in group A than in groups B and C (P < 0.05). Mean operative time did not differ between the three groups.ConclusionCAD can guide mandibular angle remodeling and condyle placement. CAD and surgical navigation increase reconstruction accuracy without prolonging operative time.



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via IFTTT

Three-dimensional computed tomographic analysis of variations of the carotid artery

Although the terms tortuous, coiling, and kinking have been used to describe the curvature of the carotid artery, the prevalence rates of these patterns have differed among studies. We morphologically evaluated the characteristics of the carotid artery by means of threedimensional computed tomography (3DCT) to clarify the prevalence of tortuosity, coiling, and kinking. We present our results and discuss the clinical impact of our findings.

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In vivo imaging in autoimmune diseases in the central nervous system

Publication date: Available online 28 February 2016
Source:Allergology International
Author(s): Naoto Kawakami
Intravital imaging is becoming more popular and is being used to visualize cellular motility and functions. In contrast to in vitro analysis, which resembles in vivo analysis, intravital imaging can be used to observe and analyze cells directly in vivo. In this review, I will summarize recent imaging studies of autoreactive T cell infiltration into the central nervous system (CNS) and provide technical background. During their in vivo journey, autoreactive T cells interact with many different cells. At first, autoreactive T cells interact with endothelial cells in the airways of the lung or with splenocytes, where they acquire a migratory phenotype to infiltrate into the CNS. After arriving at the CNS, they interact with endothelial cells of the leptomeningeal vessels or the choroid plexus before passing through the blood–brain barrier. CNS-infiltrating T cells become activated by recognizing endogenous autoantigens presented by local antigen-presenting cells (APCs). This activation was visualized in vivo by using protein-based sensors. One such sensor detects changes in intracellular calcium concentration as an early marker of T cell activation. Another sensor detects translocation of Nuclear factor of activated T-cells (NFAT) from cytosol to nucleus as a definitive sign of T cell activation. Importantly, intravital imaging is not just used to visualize cellular behavior. Together with precise analysis, intravital imaging deepens our knowledge of cellular functions in living organs and also provides a platform for developing therapeutic treatments.



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Anaphylaxis caused by casein used in artificially marbled beef: A case report

Publication date: Available online 28 February 2016
Source:Allergology International
Author(s): Shigeyuki Narabayashi, Ikuo Okafuji, Yuya Tanaka, Satoru Tsuruta, Nobue Takamatsu




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In vivo imaging in autoimmune diseases in the central nervous system

Publication date: Available online 28 February 2016
Source:Allergology International
Author(s): Naoto Kawakami
Intravital imaging is becoming more popular and is being used to visualize cellular motility and functions. In contrast to in vitro analysis, which resembles in vivo analysis, intravital imaging can be used to observe and analyze cells directly in vivo. In this review, I will summarize recent imaging studies of autoreactive T cell infiltration into the central nervous system (CNS) and provide technical background. During their in vivo journey, autoreactive T cells interact with many different cells. At first, autoreactive T cells interact with endothelial cells in the airways of the lung or with splenocytes, where they acquire a migratory phenotype to infiltrate into the CNS. After arriving at the CNS, they interact with endothelial cells of the leptomeningeal vessels or the choroid plexus before passing through the blood–brain barrier. CNS-infiltrating T cells become activated by recognizing endogenous autoantigens presented by local antigen-presenting cells (APCs). This activation was visualized in vivo by using protein-based sensors. One such sensor detects changes in intracellular calcium concentration as an early marker of T cell activation. Another sensor detects translocation of Nuclear factor of activated T-cells (NFAT) from cytosol to nucleus as a definitive sign of T cell activation. Importantly, intravital imaging is not just used to visualize cellular behavior. Together with precise analysis, intravital imaging deepens our knowledge of cellular functions in living organs and also provides a platform for developing therapeutic treatments.



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Anaphylaxis caused by casein used in artificially marbled beef: A case report

Publication date: Available online 28 February 2016
Source:Allergology International
Author(s): Shigeyuki Narabayashi, Ikuo Okafuji, Yuya Tanaka, Satoru Tsuruta, Nobue Takamatsu




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via IFTTT

In vivo imaging in autoimmune diseases in the central nervous system

Publication date: Available online 28 February 2016
Source:Allergology International
Author(s): Naoto Kawakami
Intravital imaging is becoming more popular and is being used to visualize cellular motility and functions. In contrast to in vitro analysis, which resembles in vivo analysis, intravital imaging can be used to observe and analyze cells directly in vivo. In this review, I will summarize recent imaging studies of autoreactive T cell infiltration into the central nervous system (CNS) and provide technical background. During their in vivo journey, autoreactive T cells interact with many different cells. At first, autoreactive T cells interact with endothelial cells in the airways of the lung or with splenocytes, where they acquire a migratory phenotype to infiltrate into the CNS. After arriving at the CNS, they interact with endothelial cells of the leptomeningeal vessels or the choroid plexus before passing through the blood–brain barrier. CNS-infiltrating T cells become activated by recognizing endogenous autoantigens presented by local antigen-presenting cells (APCs). This activation was visualized in vivo by using protein-based sensors. One such sensor detects changes in intracellular calcium concentration as an early marker of T cell activation. Another sensor detects translocation of Nuclear factor of activated T-cells (NFAT) from cytosol to nucleus as a definitive sign of T cell activation. Importantly, intravital imaging is not just used to visualize cellular behavior. Together with precise analysis, intravital imaging deepens our knowledge of cellular functions in living organs and also provides a platform for developing therapeutic treatments.



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