Role of intralesional bleomycin and intralesional triamcinolone therapy in residual haemangioma following propranolol

With the emergence of propranolol as the first choice of treatment for problematic infantile haemangioma at many centres, the number of patients with a partial or non-response to propranolol has also been growing. This study investigated the role of intralesional bleomycin and triamcinolone in patients with residual disease following propranolol therapy for infantile haemangioma. Sixty-seven patients with residual haemangioma were assigned randomly to receive either intralesional bleomycin (group A, n = 36) or intralesional triamcinolone (group B, n = 31). The response to treatment and adverse effects were assessed in both groups. All patients received at least four doses and a maximum of six doses of the assigned drug. In group A (mean follow-up 9.38 months), 47.2% had an excellent response and 44.4% a good response. In group B (mean follow-up 7.42 months), 25.8% had an excellent response and 48.4% a good response. There was no difference in overall response between the groups (P = 0.074). Among patients who were initially non-responders to propranolol, bleomycin showed a better response than triamcinolone (P = 0.037). This may be due to an overlap in the mechanism of action of propranolol and triamcinolone. Thus, intralesional bleomycin should be preferred in patients with no initial response to propranolol therapy, while bleomycin or triamcinolone can be used in patients with a partial response to propranolol therapy, as they have equal efficacy.     

Preliminary experience with promethazine hydrochloride injection in the sclerotherapy of oral mucocele

Mucoceles are common in the minor salivary and sublingual glands. Sclerotherapy is a possible treatment strategy for mucoceles. The purpose of this study was to evaluate the clinical outcomes of sclerotherapy with promethazine hydrochloride injection in treating mucoceles. Thirty-seven patients were enrolled. Sclerotherapy was performed with promethazine hydrochloride injection (25 mg/ml) through the mucosa. Patients were followed up at 1, 3, and 6 months after the last sclerotherapy. Clinical data were reviewed. The lesions (range 2–30 mm in diameter) occurred on the ventral tongue tip (20 patients), lower lip (11 patients), and floor of the mouth (six patients). The amount of sclerosant per injection ranged from 0.2 ml to 1 ml. At the 6-month follow-up, 33 patients showed resolution with no recurrence. One patient showed a significant response with a 5-mm-diameter nodule remaining after two sclerotherapies. Three patients who underwent two or more sclerotherapies failed to show an improvement. The overall cure rate was 91.9% (96.8% for mucoceles of the minor salivary gland, 66.7% for ranulas). Complications were rare and mild. Sclerotherapy with promethazine hydrochloride injection for the treatment of mucoceles is safe. It is effective for mucoceles of the minor salivary glands, but its application for ranulas requires further investigation.     

Monoethanolamine oleate sclerotherapy for the treatment of intraoral vascular anomalies: retrospective study and suggestion for a clinical guideline

Vascular anomalies are common in the head and neck, and oral lesions are most commonly found on the lips, tongue, mucosa, and palate. Monoethanolamine oleate sclerotherapy (MOS) is an option for treatment, although we know of no established protocols yet. We report the prevalence and characteristics of intraoral vascular anomalies (IVA) and the results achieved with the use of 5% MOS, and suggest a clinical guideline. Data from the medical records of patients with IVA were collected (age, sex, ethnicity, site, size, duration, and treatment). Cases treated with MOS were detailed, and data about number of applications, interval between them, dose, adverse effects, and results were recorded. A total of 65 cases of IVA were found. White-skinned women aged from 61 to 70 years (n = 21) were most likely to be affected, and the lower lip (n = 25) was the most common site. Twenty-seven were treated with MOS using a mean of 1–2 applications with a seven-day interval. The mean dose applied was 0.3 ml/section, which was diluted in local anaesthetic in 38 cases. Twenty-two resolved completely. In summary, we found a prevalence of 4.8% of IVA and European women aged 61 to 70 years were most affected. MOS 5% was effective and safe in the treatment of IVA more than 3 cm in size, with minimal morbidity and adverse effects. We therefore suggest a sclerotherapy protocol of 0.3 ml of the drug (undiluted with anaesthetic) for each 1 cm lesion (maximum 3 cm), with weekly revaluations and further applications when necessary within a 14-day period.     

头颈部淋巴管畸形的治疗及影响预后的因素分析

目的：对头颈部淋巴管畸形的治疗方法和影响预后的因素进行评价。方法：149例淋巴管畸形患者中单纯手术切除106例,单纯平阳霉素硬化治疗17例,手术治疗＋硬化治疗22例,硬化治疗＋激光治疗4例。对本组149例头颈部淋巴管畸形的发病年龄、发病部位、是否有伴随症状、手术切除范围及病变类型与治疗效果的关系进行统计学分析。结果：149例中治愈49例,基本治愈48例,好转46例,无效6例。1岁以内发病者复发率为37％,1岁以后发病者复发率为26％,两者比较无显著性差异（P〉O．05）：有伴随症状者复发率为42％,无伴随症状者复发率为28％,两者比较无显著性差异（P〉O．05）：单发于颈部者复发率12．5％,发生在其它部位者复发率为37％,两者比较有显著性差异（p〈O．05）：手术完全切除者复发率13％,不全切除者为43％,两者比较有显著性差异（P〈O．05）：大囊型复发率为14％,小囊型复发率为35％,两者比较有显著性差异（P〈O．05）。结论：淋巴管畸形的预后与发病年龄、有无伴随症状并无明显关系,主要与手术切除范围、发病部位以及病变类型有关。应根据患者年龄、发病部位、大小、病变类型选择合适的治疗方法。     

Antibiotic prophylaxis for bilateral sagittal split osteotomies: a randomized,double-blind clinical study

The goal of this study was to determine the efficacy of one dose and a short course (3 doses) of amoxycillin therapy for the prevention of infection following bilateral sagittal split osteotomy (BSSO). Patients who qualified for the trial were randomly divided into two groups: group I patients were given a single injection of amoxycillin 1.0 g administered preoperatively followed by two postoperative doses of saline four hourly (single dose group); group II patients were given single injection amoxycillin 1.0 g administered preoperatively followed by two postoperative doses of amoxycillin 0.5 g four hourly. The 60 patients included in this study were divided into two groups of 30. The patients were evaluated for 2 months for postoperative infections. In the postoperative period, six patients required rescue antibiotics in the single dose group and one in the short course group (P = 0.04). There was a statistical difference in the rates of infection between the two groups (P = 0.04). The findings indicate that a short postoperative course of antibiotics is more effective than a single preoperative dose for the prevention of infection following BSSO.     

Magnetic resonance angiography for free fibula harvest: anatomy and perforator mapping

The purpose of this study was to outline lower leg vessel anatomy and to investigate reliability and limitations of magnetic resonance angiography (MRA) in patients proposed for microvascular fibula transplantation (free fibula flap (FFF)).We retrospectively investigated MRAs of 99 patients considered for FFF. Frontal MRA planes and maximal intensity projections (MIPs) were evaluated for fibula lengths, anatomical branching pattern, arterial stenoses and fibular perforator positions in both legs (n = 198).Normal branching patterns were observed in 168 (85.3%) legs. Twenty-nine (14.7%) legs presented abnormal branching patterns. Once (0.5%) the anterior, 19 times (9.6%) the posterior tibial artery were absent or hypoplastic. Nine (4.6%) lower legs presented an arteria peronea magna. Average length of the tibiofibular trunk (TFT) was 3.3 ± 0.15 cm. A total of 492 perforators were found with an average of 2.5 (± 0.82 ± 0.99) perforators per leg. A mapping of perforator run-offs was illustrated true to scale. Lower limb stenoses were distributed in the anterior tibial artery (14.1%), in the posterior tibial artery (11.1%) and in the fibular artery (8.1%). Smoking (P = 0.828), diabetes (P = 0.727) and peripheral arterial occlusive disease (P = 0.172) did not correlate with presence of stenoses.Preoperative lower limb angiography avoids postoperative complications. MRA reliably and non-invasively identifies anatomical variants and arterial stenoses without radiation. Illustration of perforator run-offs enhances incision planning for fibula harvest.     

Efficacy of dexamethasone with controlled hypotension on intraoperative bleeding,postoperative oedema and ecchymosis in rhinoplasty

PurposeThe aim of this retrospective study was to evaluate the efficacy of dexamethasone with controlled hypotension on intraoperative bleeding and postoperative morbidity in rhinoplasty.Materials and methodsSixty rhinoplasty patients required hump resection and lateral osteotomy were included in this study. The patients were randomized into four groups. In group I (n = 15), a single dose of 10 mg/kg dexamethasone was intravenously administered at the beginning of the operation. In group II (n = 15), the patients were given 2 doses of 10 mg/kg intravenously dexamethasone at the beginning of the operation, and 24 hours after the operation. In group III (n = 15), 3 doses of 10 mg/kg intravenously dexamethasone were given at the beginning of the operation, before osteotomy and 24 hours after the operation. Group IV (n = 15) was assigned as control group and the patients were neither administered dexamethasone nor applied hypotension. All cases in groups I, II and III were operated under controlled hypotension. Systolic arterial pressure was aimed to keep between 65 and 75 mmHg for controlled hypotensive anaesthesia. Controlled hypotension was achieved by a remifentanil infusion of 0.1–0.5 microg/kg/min, following a bolus of 1 microg/kg. Degree of eyelid oedema and periorbital soft-tissue ecchymosis was evaluated separately using a scale of 0–4. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and postoperative days 2, 5, 7, and 10.ResultsIn groups I, II and III, intraoperative bleeding was more decreased and the operation time was significantly shorter compared with control group (P < 0.001). Eyelid oedema and periorbital ecchymosis were significantly decreased in groups I, II and III at the following postoperative 7 and 10 days (P < 0.001). There was statistically significant difference between group III and other groups at the postoperative 5 and 7 days in lower eyelid oedema (P < 0.001), upper and lower eyelid ecchymosis (P < 0.001 and 0.004, respectively). There were no postoperative complications with using steroid in any of the groups.ConclusionThree doses of dexamethasone with controlled hypotension considerably reduced postoperative morbidities of rhinoplasty with osteotomy as well as intraoperative bleeding. Thus, in group III receiving 3 doses of steroid, when compared to other groups, more uneventful postoperative period were provided for surgeon and the patients.     

Percutaneous sclerotherapy of massive macrocystic lymphatic malformations of the face and neck using fibrin glue with OK-432 and bleomycin

Picibanil (OK-432) and bleomycin have been used as alternative sclerosing agents for lymphatic malformations. This study evaluated the clinical curative effect of sclerotherapy using fibrin glue combined with OK-432 and bleomycin for the treatment of macrocystic lymphatic malformations of the face and neck. Fifteen paediatric patients (6 males; 9 females, aged 13 months to 14 years) who had received percutaneous sclerotherapy for massive macrocystic lymphatic malformations of the face and neck were retrospectively reviewed. Affected regions included the neck, parotid region and parapharynx, mouth floor, face and cheek, and orbital regions. All patients showed preoperative symptoms of space-occupying lesions between 4 cm × 5 cm and 12 cm × 16 cm in size. Fibrin glue with OK-432 and bleomycin was injected under general anaesthesia. All patients received preoperative and follow-up CT scans. Outcomes were assessed by three surgeons. All patients exhibited mid-facial swelling for 3-4 weeks after surgery, but no major complications. Follow-up periods ranged from 8 to 16 months. Eight lesions were completely involuted, five were mostly involuted, and two were partially involuted. Percutaneous sclerotherapy using fibrin glue with OK-432 and bleomycin provided a simple, safe, and reliable alternative treatment for massive macrocystic lymphatic malformations of the face and neck.     

Stress hyperglycaemia or diabetes mellitus in cervicofacial infections? A Maxillofacial Surgery Trainee Research Collaborative (MTReC) study

Diabetes mellitus (DM) is thought to be associated with poor outcomes in cervicofacial infections (CFI), yet little is known about the prevalence of DM in these cases. Stress hyperglycaemia (SHG), a normal physiological response to inflammation, is distinct from DM, though they overlap and may be conflated. We aimed to establish the prevalence of DM and SHG in CFI, and to determine the effect of each on severity of disease and outcome measures. The Maxillofacial Surgery Trainee Research Collaborative (MTReC) carried out an audit of all patients with CFI admitted to 25 hospitals between May and October 2017. To the best of our knowledge this created the largest prospective database on CFI, with information collected on presentation, source of infection, biological data, and outcomes. We recorded 1002 admissions, of which 78 (7.8%) had DM. Random blood glucose was measured on admission in 401 patients (40%), of which 45 (11%) displayed SHG. Patients diagnosed with DM were more likely to have infections arising from a salivary source (13% vs 4%, p < 0.00), more returns to theatre (9% vs 2%, p < 0.00), and a longer hospital stay (median (range) 2 (0-34) vs 1 (0-139) day, p = 0.01) than non-DM patients. In contrast, patients with SHG had more severe disease (multiple fascial spaces involved in 59% vs 19%, p = 0.01, and systemic inflammatory response syndrome present in 66% vs 45% p = 0.03), but did not have significantly more returns to theatre (2% vs 3%, p = 0.91) or longer stays in hospital (median (range) 1 (0-63) vs 1 (0-6), p = 0.55) than normoglycaemic patients. The prevalence of DM in our cohort was only marginally higher than in the general population, despite previous retrospective case reviews suggesting a significantly higher prevalence. SHG was not associated with poor outcomes in our cohort, but is likely to be associated with a small increased risk of subsequent diagnosis of DM, which can be quantified using a calculator tool. On discharge, it is important to give appropriate advice about diet, lifestyle, exercise, and weight loss to all patients with CFI.     

Antimicrobial prophylaxis in open reduction and internal fixation of compound mandibular fractures: a collaborative regional audit of outcome

We conducted a regional 2-stage prospective audit involving 5 different maxillofacial units in the Yorkshire region of the UK to evaluate the effectiveness of perioperative antimicrobial prophylaxis in the treatment of mandibular fractures. In the first stage (145 patients) we surveyed current practice concerning antimicrobial prophylaxis and found out the current infection rate after open reduction and internal fixation (ORIF) of mandibular fractures. In the second stage (157 patients) we implemented a common antimicrobial protocol in all units and recorded the infection rates using the new regimen. In the first stage a wide range of antimicrobial prophylaxis was used in different units. The agreed perioperative antimicrobial protocol in the second stage was to begin amoxicillin or clarithromycin and metronidazole intravenously on admission and include 2 postoperative doses. The infection rates were 10.3% and 8.9%, respectively, and the difference between the two groups was not significant (χ² = 0.051, df = 1, p = 0.83). The infection rate in the Yorkshire region was similar to results from other centres. We recommend short perioperative antimicrobial prophylaxis with a maximum of 2 postoperative doses after ORIF of mandibular fractures.     

DEFB1 polymorphisms and salivary hBD-1 concentration in Oral Lichen Planus patients and healthy subjects

ObjectivesThe aetiology of Oral Lichen Planus (OLP), a chronic inflammatory disease of oral mucosa, is not yet well understood. Since innate immunity may be hypothesized as involved in the susceptibility to OLP, we studied human beta defensin 1 (hBD-1) an antimicrobial peptide constitutively expressed in the saliva, looking at functional genetic variants possibly able to diminish hBD-1 production an consequently conferring major susceptibility to OLP.DesignWe analysed three DEFB1 polymorphisms at 5′ UTR, −52G > A (rs1799946), −44C > G (rs1800972), −20G > A (rs11362) and two DEFB1 polymorphisms at 3′UTR, c*5G > A (rs1047031), c*87A > G (rs1800971), with the aim of correlating these genetic variants and hBD-1 salivary level in a group of OLP patients and in healthy subjects. We also evaluated hBD-1 salivary concentrations, using ELISA, in OLP and healthy controls.ResultsWe compared hBD-1 concentrations in OLP and healthy subjects: hBD-1 concentration was significantly higher in OLP patients respect to control.When considering the correlation between DEFB1 polymorphisms genotypes and hBD-1 expression levels, significant results were obtained for SNPs −52G > A (p = 0.03 both in OLP patients and healthy individuals) and −44C > G (p = 0.02 in OLP patients).ConclusionshBD-1 production was different between OLP and healthy subjects (not age-matched with OLP). DEFB1 gene polymorphisms, −52G > A and −44C > G, correlated with hBD-1 salivary concentrations.     

Treatment of symptomatic oral lichen planus (OLP) with 0.1% tacrolimus powder in Oraguard-B – A pilot prospective study

ObjectivesThe purpose of this study was to investigate the efficacy and safety of 0.1% tacrolimus powder in Oraguard-B for the treatment of patients with symptomatic oral lichen planus (OLP).MethodsThis was a nonrandomized, nonblinded study conducted in the outpatient department. The 20 patients with symptomatic OLP oral lichen planus who were asked to participate in the study were provided with 20-g containers of the study medication. Patients were asked to use the medication over the symptomatic areas three times a day until resolution of the lesion. Patients were recalled to assess the drug response every 15 days.ResultsThe duration of treatment ranged from 30 to 183 days, with a mean of 81.8 ± 44.4 days; all 20 patients reported a favourable response to the topical tacrolimus therapy. Eleven patients had complete resolution of their lesions. In 16 of 20 patients, there was marked resolution in symptoms as recorded by visual analogue scale. Out of 10 patients followed up for a period of 3 months, 5 had recurrence of their lesions but with less intensity, and the patients were symptomless. No serious side effects were associated with the study medication.ConclusionTopical tacrolimus 0.1% in Oraguard-B was effective and safe in treating patients with OLP. However, there is still a need to undertake more detailed and objective clinical studies to determine the exact benefit of tacrolimus compared with conventional therapies and examine the influence of different dose regimes and formulations and assess the incidence of recurrence.     

“A comparative evaluation between single noncompression titanium miniplate and three dimensional titanium miniplate in treatment of mandibular angle fracture” – A randomized prospective study

PurposeThe aim of this study was to compare efficacy between the single non-compression titanium miniplate and single three-dimensional titanium miniplate in mandibular angle fracture treatment.Method and materialsA prospective study of 20 patients with mandibular angle fractures. Patients were randomly categorized into two groups with 10 patients in each group. Group-I patients were treated with single 2.0 mm conventional titanium miniplate, Group-II patients were treated with single 2.0 mm three-dimensional titanium miniplate according to Champy's principles. Parameters such as stability of fracture fragments, occlusion, mouth opening, additional fixation required and complications were evaluated at different time intervals.ResultsIn Group-I, about 40% (n = 4) of patients showed unstable fracture fragments on immediate postoperative day whereas in Group-II only 10% (n = 1) of patients with fracture instability. In Group-I, 30% (n = 3) had mild occlusal derangement and 20% (n = 2) had deranged occlusion on immediate postoperative day, where as in Group-II only 20% (n = 2) of patients had mild occlusal derangement. Additional fixation required in 30% (n = 3) of patients in group-I, and 10% (n = 1) in Group-II. 20% (n = 2) of patients in Group-I developed infection. All patients in both the groups had inadequate mouth opening on immediate post operative day, later resumed normal mouth opening. 10% (n = 1) in group-I and 20% (n = 2) of patients in group-II presented with postinjury/preoperative inferior alveolar nerve sensory disturbance with no incidence of postoperative sensory disturbance. None of the patients in both the groups had malunion, nonunion, plate fracture, and loosening of plates and screws.Conclusion3-D titanium miniplates showed more favorable results compared to single conventional titanium miniplate with respect to initial interfragmentary stability and complications.     

Validation of the UICC 8th edition staging of oral cavity squamous cell carcinoma in a UK cohort

The eighth edition of the Union for International Cancer Control (UICC) staging manual was recently introduced. The staging of oral cavity squamous cell carcinoma saw changes in relation to depth of invasion and extra-nodal extension. We aimed to evaluate this system and its prognostic ability in a UK cohort. A retrospective review was undertaken of patients diagnosed with squamous cell carcinoma (SCC) of the oral cavity between January 2009 and December 2013. Data were collected on demographics, histology, and recurrence-free (RFS) and five-year overall survival (OS). Patients were staged using both the seventh and eighth editions of the UICC staging manual. Stage-specific survival analysis was performed using the Kaplan-Meier method. A total of 191 records were reviewed and 87 were included in the analysis. The mean (range) age was 60 (37-88) years, and 53% were male. The tongue was the most common site (51%). Using the seventh edition patients were staged as stage I = 30, II = 14, III = 7, IVa = 35, and IVb = 1. Applying the eighth edition, 26 patients (30%) were upstaged (I = 24, II = 15, III = 14, IVa = 17, IVb = 17). Ten were upstaged based on pT and 16 on pN status. Both staging manuals showed statistically significant discrimination between stages for both OS and RFS. Patients upstaged from stage IVa in the seventh edition had significantly worse OS in the new system (p = 0.043). Both staging systems discriminated accurately between stages. Patients upstaged in stage IVa showed significantly worse OS suggesting improved prognostication with the eighth edition and the changes introduced.     

Survival of oral mucosal melanoma according to treatment,tumour resection margin,and metastases

Because of the poor prognosis and of oral mucosal melanoma, and patients’ short survival, large, randomised, clinical studies are difficult. We have investigated its demographic characteristics and analysed the effect of treatment, resection margins, and metastases on survival. We recorded age, sex, site of primary tumour, and types of treatment, survival, and metastases in 74 patients treated at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Survival was analysed based on bony invasion, depth of invasion, and resection margins, and we found that it varied depending on the primary site (p = 0.002), and declined with liver (p = 0.001) or brain (p = 0.033) metastases. The two-year survival according to the primary site was as follows: palate 85% (n = 32), anterior maxillary gingiva 53% (n = 13), mandible 58% (n = 13), and posterior maxillary gingival 74% (n = 10) and buccal mucosa 50% (n = 4). The two-year survival was 34% (n = 8) in patients with liver metastases and 23% (n = 7) in patients with brain metastases. In cases of bony invasion (p = 0.005), depth of invasion (p = 0.042), unclear resection margin (p = 0.023), or higher T stages (p = 0.009), the survival declined considerably. Neck dissection did not affect survival (p = 0.343). Survival of the patients given chemotherapy was significantly lower (p = 0.013) and the two-year survival was 54.0%. The patients given radiotherapy showed no significant difference in survival compared with those not given radiotherapy (p = 0.107). In conclusion, primary site, bony invasion, resection margins, depth of invasion and systemic metastases were critical to predict prognosis and selection of treatment of oral mucosal melanoma.     

Non-syndromic cleft lip with or without cleft palate in Asian populations: Association analysis on three gene polymorphisms of the folate pathway

ObjectiveOrofacial clefts (OFCs) are one of the most common birth defects in humans. They are the subject of a number of investigations aimed at elucidating the bases of their complex mode of inheritance involving both genetic and environmental factors. Genes belonging to the folate pathway have been among the most studied. The aim of the investigation was to replicate previous studies reporting evidence of association between polymorphisms of folate related genes and the occurrence of non-syndromic cleft lip with or without cleft palate (NSCL/P), using three independent samples of different ancestry: from Tibet, Bangladesh and Iran, respectively.DesignSpecifically, the polymorphisms rs1801133 of MTHFR, rs1801198 of TCN2, and rs4920037 of CBS, were tested.ResultsA decreased risk of NSCL/P was observed in patients presenting the C677T variant at MTHFR gene (relative risk for heterozygotes = 0.53; 95% confidence interval [C.I.] = 0.32–0.87). The investigated polymorphisms mapping at TCN2 and CBS genes did not provide any evidence of association.ConclusionOverall, these results indicate that NSCL/P risk factors differ among populations and confirm the importance of testing putative susceptibility variants in different genetic backgrounds.     

Effects of prostaglandin E2 on clonogenicity,proliferation and expression of pluripotent markers in human periodontal ligament cells

Background and objectiveBased on our earlier work on the response of periodontal ligament (PDL) cells to mechanical stress by induction of cyclooxygenase expression and production of prostaglandin PGE₂ that could regulate mineralization of PDL cells, it was hypothesized that PGE₂ had potential effects on PDL stemness. In this study, we aimed to investigate clonogenicity, proliferation and expression of certain pluripotent markers, considered to be characteristics of PDL stemness, in response to treatment with exogenously-added PGE₂.Material and methodsHuman PDL cells were cultured and treated with various doses of PGE₂, and the aforementioned characteristics of PDL stemness were analyzed.ResultsThe clonogenicity and proliferation were significantly enhanced by PGE₂ at low concentrations (0.01, 0.1 and 1 ng/ml; P < 0.05), but only the proliferation was significantly diminished by PGE₂ at a high concentration (100 ng/ml; P < 0.05). Expression of NANOG and OCT4 mRNA and protein was increased by PGE₂ treatment at 0.1 and 1 ng/ml. Consistently, expression of stage-specific embryonic antigen 4, a putative stem cell marker, was significantly augmented by PGE₂ treatment at 1 ng/ml (P < 0.05).ConclusionOur findings suggest that although a high dose of PGE₂ (100 ng/ml) inhibits proliferation of PDL cells, PGE₂ at low doses appears to play a role in the maintenance of PDL stemness.     

Knowledge about pressure ulcer prevention,classification and management: A survey of registered nurses working with trauma patients in the emergency department

AimOne group of patients who are at risk of pressure ulcer development is trauma patients. The present study aimed to examine trauma nurses’ knowledge about pressure ulcer prevention, classification and management.MethodsIn a cross sectional exploratory study all qualified registered nurses working with trauma patients in the emergency department (ED) of Kashani and Bahonar hospitals, Iran were invited to participate. To assess the nurses’ knowledge about pressure ulcer prevention classification and management Pieper’s Pressure Ulcer Knowledge Test (PPUKT) was used.ResultsOf 185 eligible nurses, 159 participated in the study (response rate of 86%). Of these, 80.5% (n = 128) were women and 19.5% (n = 31) were men. The mean years of nurses’ experience was 10.3 ± 7.2 years. The percentage of correctly answered questions was 64.6%. Nurses had the highest level of knowledge in the section about wound characteristics (77.3%) and the lowest level in the section about pressure ulcer onset (57%).ConclusionThis is the first study that specifically examines trauma nurses knowledge about pressure ulcer prevention, classification and management. According to the results, nurses did not have sufficient knowledge about pressure ulcer prevention, classification and management. There is a need to improve their knowledge with educational programs.     

Racial disparity of Crouzon syndrome in maxilla and mandible

The racial disparity of facial features in craniosynostosis patients is not fully understood. The aim of this study was to explore the difference in maxillary and mandibular morphology and spatial position in Asian and Caucasian Crouzon syndrome patients. Ninety-one computed tomography scans were included (12 Asian Crouzon syndrome patients, 22 Asian controls; 16 Caucasian Crouzon syndrome patients, 41 Caucasian controls) and measured using Materialise software. The maxillary and mandibular volumes of Asian patients were both reduced by 19% (P = 0.102 and P = 0.187), and those of Caucasian patients were reduced by 15% (P = 0.142) and 14% (P = 0.211) when compared to the respective race-specific controls. Maxilla length of Asian patients was reduced by 6.36 mm (14%, P = 0.003), while the reduction in Caucasian patients was 4.88 mm (10%, P = 0.038). ANS was retracted 11.99 mm (P < 0.001) in Asian patients and 11.54 mm (P < 0.001) in Caucasian patients. The ANB angle was narrowed by 13.17° (P < 0.001) in Asian patients compared to Asian controls, and by 7.02° (P < 0.001) in Caucasian patients compared to Caucasian controls. The retrusive midface profiles of Asian and Caucasian Crouzon syndrome look similar; both result from the combined effect of hypoplastic size and backward displacement. However, the insufficiency was found to be more a failure of the anteroposterior maxillary length in Asian patients, and more due to posterior maxillary positioning in Caucasian patients. Therefore, prognathism in Crouzon syndrome patients is more likely caused by displacement rather than elongation of mandibular length in both races. Crouzon syndrome results in the same extent of overall volume deficiency of the maxilla and mandible in these races.     

Screening for maternal coeliac disease as a potential risk factor for orofacial clefts—a pilot study

There is increasing evidence that dietary folic acid deficiency in utero may increase the risk of developing the ‘cleft lip with or without cleft palate’ (CL ± P) variant of orofacial cleft. Coeliac disease is a common cause of folic acid malabsorption, and in the majority of cases remains undiagnosed. This pilot study assessed the seroprevalence of undiagnosed coeliac disease in a cohort of mothers of infants with CL ± P in the Hyderabad area of India. The seroprevalence of coeliac disease of 1.15% (95% confidence interval 0.37–2.66%) was little different from the expected figure based on published population studies, making a clinically significant association unlikely.