Transoral Ultrasound-Guided Core Biopsy for Minimally Invasive Sampling of Hard-to-Access Oropharyngeal Cancers.

Pathological diagnosis plays a pivotal role in risk classification and personalized treatment planning for patients with oropharyngeal cancers. However, challenges arise in cases involving trismus and tumors with submucosal spread, hindering traditional endoscopic biopsies and open incisional biopsies. In this study, we examined the clinical and pathological data of patients with trismus who underwent transoral ultrasound-guided core biopsy (USCB) for their oropharyngeal tumors, comparing this method with existing diagnostic approaches. Seventeen patients presenting with oropharyngeal tumors and trismus underwent transoral USCB for diagnosis. Of these, 14 patients were diagnosed with squamous cell carcinoma, while the remaining 3 were diagnosed with lymphoma. The procedure resulted in minimal wound size and effective bleeding control through compression, without encountering any complications. In conclusion, transoral USCB emerges as a precise diagnostic tool for patients with oropharyngeal tumors and trismus, offering a valuable adjunct to conventional open and endoscopic biopsies.

Clinical outcomes and patient-reported outcomes after oncoplastic breast surgery in breast cancer patients: A matched cohort study.

BACKGROUND: Surgery is the recommended treatment for breast cancer, the most common cancer in women in Taiwan and the leading cause of cancer-related deaths. Although breast-conserving surgery (BCS) has good prognosis, in some cases, BCS may cause more significant deformities and interfere with the patient's psychosocial well-being. Oncoplastic breast surgery (OBS) is the treatment option in these cases. This study aimed to determine the outcomes of OBS and BCS regardless of clinical and patient-reported esthetic outcomes. METHODS: Between 2015 and 2020, 50 patients who underwent OBS at our hospital after complete treatment were enrolled. With 1:2 matched ratios, 100 patients were enrolled in the BCS control group. Clinical outcomes were analyzed. The BREAST-Q questionnaire was then assessed 6 months after the completion of treatment for subjective patient-reported outcomes. RESULTS: Due to the matching process, no difference was noted between the two groups in terms of demographic data such as age, comorbidities, or tumor characteristics. There were no significant differences in the local recurrence rate, disease-free survival, overall survival, positive margin rate, rewide excision rate, conversion to mastectomy rate, or complication rate (major or minor) between both groups. However, the OBS group showed higher satisfaction with breasts in the BREAST-Q questionnaire ( p < 0.001). The mean follow-up time was 38.77 ± 14.70 months in the BCS group and 29.59 ± 14.06 months in the OBS group. CONCLUSION: OBS seems to be a safe and feasible surgery in breast cancer patients because clinical outcomes are compatible with BCS. Moreover, the OBS group had better patient-reported outcomes in terms of satisfaction.

Identifying major predictors of lower-extremity amputation in patients with diabetic foot ulcers.

BACKGROUND: The aim of the present study was to investigate the risk factors for amputation in patients with diabetic foot ulcer (DFU). METHODS: Between 2012 and 2017, 646 patients with DFU were admitted to our diabetic foot care center. A retrospective chart review was performed, and the end point was limb salvage and minor or major amputation. Chi-square test, dependent t test, and a multivariate logistic regression analysis were performed to identify risk factors in patients with DFUs. RESULTS: A total of 399 male and 247 female patients (mean age 64.6 years) were included in this study, of whom 159 (24.6%) underwent lower limb amputation (minor, 17.5; major, 7.1%). Independent risk factors of amputation were peripheral arterial disease (PAD) (odds ratio [OR], 3.196; p < 0.001), C-reactive protein (CRP) level (OR, 1.046; p = 0.001), and hospital stay (OR, 1.019; p = 0.001). Subgroup analysis based on all patients with PAD who underwent amputation showed that endovascular intervention (OR, 0.271; p = 0.049) was a protective factor for major amputation in addition to CRP level (OR, 1.116; p = 0.008). CONCLUSION: DFU remains a major medical and public health issue. PAD, CRP level, and hospital stay are independent risk factors for amputation. Endovascular intervention is an independent protective factor against major amputation among patients with PAD who underwent amputation.

Hyperglycemia and risk of adverse outcomes following microvascular reconstruction of oncologic head and neck defects.

INTRODUCTION: Our aim is to examine the correlation between perioperative hyperglycemia and post-operative outcomes following microvascular reconstruction of head and neck defects. PATIENTS AND METHODS: Retrospective review of a prospectively collected database of 350 consecutive patients who underwent microvascular reconstruction of malignant head and neck defects over a 2 year period. The relationship between perioperative hyperglycemia (≥ 180 mg/dL) and the incidence of the following complications was evaluated: flap loss, flap-related complications and surgical site infections (SSI). Sub-group analysis based on timing of hyperglycemia was also performed. RESULTS: We identified 313 patients (89.4%) in the normoglycemic group and 37 patients (10.6%) in the hyperglycemic group. Baseline demographics, tumor stage, operative variable were comparable. There were no significant differences in flap-related complications and overall mortality. SSI were significantly higher in the hyperglycemic cohort (48% vs. 28%, p = 0.01). On multivariate analysis, hyperglycemia [OR 2.07; 95% CI, 1.87-4.89], perioperative insulin administration [OR 4.805; 95% CI, 2.18-10.60], prolonged operative time [OR 1.003; 95% CI, 1.002-1.025] and higher Charlson co-morbidity indices [II: OR 2.286 & III: OR 2.284] were independent predictors of SSI. On sub-group analysis, only patients with early (POD 1) post-operative hyperglycemia had a significant OR for SSI (OR 1.88; 95% CI, 1.07-3.29). CONCLUSION: Our findings suggest that perioperative hyperglycemia, specifically during the first 24 h post-operatively, is associated with SSI in microvascular head and neck reconstruction. This association highlights the need for strict screening of head and neck patients for hyperglycemia especially in the immediate post-operative period.

Third Repeat Microvascular Reconstruction in Head and Neck Cancer Patients Aged 65 Years and Older: A Longitudinal and Sequential Analysis.

Performing a sequential third free flap for reconstruction of a head and neck defect after cancer resection can be challenging, and the problem is further compounded in elderly patients. The outcomes in this clinical scenario are currently unknown and this study aims to compare the results in elderly patients with younger patients in a high-volume microsurgical unit. A retrospective review of 126 consecutive patients who had undergone three sequential free flap reconstructions after head and neck cancer was performed. The patients were divided into two groups - older or younger than 65 years old (n = 105 and n = 21, respectively). Patient demographics, intraoperative and postoperative outcomes were noted and analyzed. The overall flap success in this patient cohort was 94.4% (7 flap losses in 126 patients). Cardiovascular complications were significantly more common in the older group (19% vs. 1.9%, p = 0.001). Delirium occurred more frequently in the older group compared with the younger group (23.8% vs. 6.7%, p = 0.023). There were no significant differences regarding surgical complications. With adequate planning, a sequential third free flap can be performed safely and successfully in patients who are more than 65 years of age. Particular attention to the perioperative morbidity in elderly patients is crucial for successful outcomes.

Influence of mastication and edentulism on mandibular bone density.

The aim of this study was to demonstrate that external loading due to daily activities, including mastication, speech and involuntary open-close cycles of the jaw contributes to the internal architecture of the mandible. A bone remodelling algorithm that regulates the bone density as a function of stress and loading cycles is incorporated into finite element analysis. A three-dimensional computational model is constructed on the basis of computerised tomography (CT) images of a human mandible. Masticatory muscle activation involved during clenching is modelled by static analysis using linear optimisation. Other loading conditions are approximated by imposing mandibular flexure. The simulations predict that mandibular bone density distribution results in a tubular structure similar to what is observed in the CT images. Such bone architecture is known to provide the bone optimum strength to resist bending and torsion during mastication while reducing the bone mass. The remodelling algorithm is used to simulate the influence of edentulism on mandibular bone loss. It is shown that depending on the location and number of missing teeth, up to one-third of the mandibular bone mass can be lost due to lack of adequate mechanical stimulation.

Simulation of peri-implant bone healing due to immediate loading in dental implant treatments.

The goal of this work was to investigate the role of immediate loading on the peri-implant bone healing in dental implant treatments. A mechano-regulatory tissue differentiation model that takes into account the stimuli through the solid and the fluid components of the healing tissue, and the diffusion of pluripotent stem cells into the healing callus was used. A two-dimensional axisymmetric model consisting of a dental implant, the healing callus tissue and the host bone tissue was constructed for the finite element analysis. Poroelastic material properties were assigned to the healing callus and the bone tissue. The effects of micro-motion, healing callus size, and implant thread design on the length of the bone-to-implant contact (BIC) and the bone volume (BV) formed in the healing callus were investigated. In general, the analysis predicted formation of a continuous layer of soft tissue along the faces of the implant which are parallel to the loading direction. This was predicted to be correlated with the high levels of distortional strain transferred through the solid component of the stimulus. It was also predicted that the external threads on the implant, redistribute the interfacial load, thus help reduce the high distortional stimulus and also help the cells to differentiate to bone tissue. In addition, the region underneath the implant apex was predicted to experience high fluid stimulus that results in the development of soft tissue. The relationship between the variables considered in this study and the outcome measures, BV and BIC, was found to be highly nonlinear. A three-way analysis of variance (ANOVA) of the results was conducted and it showed that micro-motion presents the largest hindrance to bone formation during healing.

Peri-implant bone remodeling around an extraction socket: predictions of bone maintenance by finite element method.

PURPOSE: The aim of this study was to investigate peri-implant bone remodeling as a response to biomechanical factors, including implant size and contour, magnitude of occlusal load, and properties of osteogenic bone grafts through the use of a computational algorithm. MATERIALS AND METHODS: A bone-remodeling algorithm was incorporated into the finite element method, where bone remodeling takes place as a result of the biomechanical alteration caused by dental implant placement and continues until the difference between the homeostatic state and the altered state is minimized. The site-specific homeostatic state was based on a model consisting of a natural tooth. Three long (11-mm) implants and two short (5-mm) implants were investigated. A three-dimensional segment of the mandible was constructed from a computed tomographic image of the premolar region, and an extraction socket was filled with bone graft. RESULTS: Generally, the extent of bone loss in the cortical region was greater and denser bone developed at both the implant crest and apex with increased occlusal loads. The areas between implant threads were prone to bone resorption. Bone graft materials that were relatively stiff and that had high equilibrium stimulus values appeared to cause increased bone loss. CONCLUSIONS: Short implants are better for conserving the mechanotransductive signaling environment of the natural tooth than long implants. Also, short implants are predicted to lead to less interfacial bone loss at high loads over the long term, while long implants are associated with a more consistent level of bone loss for different amounts of loading. It is also predicted that in the long term, bone grafts with relatively low elastic modulus lead to lower levels of interfacial bone loss.

Combined effects of implant insertion depth and alveolar bone quality on periimplant bone strain induced by a wide-diameter, short implant and a narrow-diameter, long implant.

STATEMENT OF PROBLEM: Strain levels in periimplant bone are affected by implant dimensions, bone quality, and implant insertion depth, resulting in different bone maintenance characteristics. PURPOSE: The purpose of this study was to evaluate the biomechanical response of the jaw bone to a wide-diameter, short (WDS) implant, and a narrow-diameter, long (NDL) implant for various simulated clinical scenarios. MATERIAL AND METHODS: The finite element method was used to evaluate periimplant bone strain distribution for 5 × 6-mm (WDS) and 3.5 × 10.7-mm (NDL) implants. A 3-dimensional segment of the mandible was constructed from a computerized tomography image of the premolar region. Occlusal force was simulated by applying a 100-N oblique load on the abutment. Bone strain distributions for 5 different implant insertion depths and 2 different levels of alveolar bone quality were evaluated. RESULTS: For an NDL implant, approximately 60% to 80% of the bone volume surrounding the implant was subjected to 200-1000 µstrain (µÉ›), and 15% to 35% was subjected to 1000-3000 µÉ›, regardless of the alveolar bone quality. For a WDS implant, the bone volume subjected to 1000-3000 µÉ› increased, and the bone volume subjected to 200-1000 µÉ› decreased in lower quality alveolar bone. For both implant types, bone volume experiencing strain levels less than 200 µÉ›, and/or greater than 3000 µÉ›, was predicted to be relatively small. CONCLUSIONS: In general, the thread design promoted relatively high strain around the thread tips, and the bone inside grooves was less strained. A more even and higher strain distribution in the periimplant bone was generated by the WDS implant as compared to the NDL implant. Regardless of the implant dimensions and simulated clinical scenarios, the development of high strain in the alveolar region was inevitable. Strain levels in periimplant bone were reduced as the insertion depth of the implant was increased.

Predictions of bone remodeling around dental implant systems.

This study presents the implementation of a mathematical bone remodeling algorithm to bone adaptation in the premolar area of the mandible around various dental implant systems, and thus sheds a new perspective to the complex interactions in dental implant mechanics. A two-dimensional, plane strain model of the bone was built from a CT-scan. The effect of implant contour on internal bone remodeling was investigated by considering four dental implant systems with contours similar to commercially available ones and another four with cylindrical and conical cross-sections. The remodeling algorithm predicts non-homogeneous density/elastic modulus distribution; and, implant contour has some effect on how this is distributed. Bone density is predicted to increase on the tips of the threads of the implants, but to decrease inside the grooves. Threadless implants favor to develop a softer bone around their periphery, compared to implant systems that have threads. The overall contour (dimensions and the shape) of an implant affect the bone density redistribution, but the differences between different implant systems are relatively small.