Antiseptic, Hemostatic, and Wound Activity of Poly(vinylpyrrolidone)-Iodine Gel with Trimethyl Chitosan.

Wound management practices have made significant advancements, yet the search for improved antiseptics persists. In our pursuit of solutions that not only prevent infections but also address broader aspects of wound care, we investigated the impact of integrating trimethyl chitosan (TMC) into a widely used poly(vinylpyrrolidone)-iodine gel (PVP-I gel). Our study assessed the antimicrobial efficacy of the PVP gel with TMC against Escherichia coli, Staphylococcus aureus, multidrug-resistant S. aureus MRSA, and Candida albicans. Additionally, we compared hemostatic effects using a liver puncture bleeding model and evaluated wound healing through histological sections from full-thickness dermal wounds in rats. The results indicate that incorporating TMC into the commercially available PVP-I gel did not compromise its antimicrobial activity. The incorporation of TMC into the PVP-I gel markedly improves its hemostatic activity. The regular application of the PVP-I gel with TMC resulted in an increased blood vessel count in the wound bed and facilitated the development of thicker fibrous tissue with a regenerated epidermal layer. These findings suggest that TMC contributes not only to antimicrobial activity but also to the intricate processes of tissue regeneration. In conclusion, incorporating TMC proves beneficial, making it a valuable additive to commercially available antiseptic agents.

Anatomical study of gasless transoral thyroidectomy and clinical application.

BACKGROUND: Transoral thyroidectomy is becoming a preferred technique because it has the advantage of not leaving a scar after surgery. However, it is not yet standard because of the anatomic nerve complexity of this oral cavity and difficulty of approach. The aim of this study was to determine the safety zone of a gasless transoral thyroidectomy approach using an anatomical study and to evaluate the efficacy of this approach on clinical application. METHODS: Phase 1, twenty unilateral specimens from fresh cadavers underwent staining by the modified Sihler's method to identify nerves around the oral vestibules. Then, the safety zone of the transoral thyroidectomy approach was proposed. Phase 2, a comparative analysis of the clinical outcomes of gasless transoral thyroidectomy through the safety zone versus transcutaneous thyroidectomy approach. RESULTS: In phase 1, numerous inferior labial branches diverged from the mental nerve and were distributed across the lower lip. In most cases, the most lateral branch reached almost to the corner of the mouth, whereas a nerve-free area was present at the medial region of the lower lip. The suggested safety zone was presented as a trapezoid shape. In phase 2, there were no significant differences in age, mass size, or complications between the two groups. However, the operation time in the transoral thyroidectomy group was longer than in the transcutaneous group (p = 0.001). CONCLUSIONS: Based on the anatomical study, we suggested a safety zone for the gasless transoral thyroidectomy. On application of this safety zone, gasless transoral thyroidectomy is a safe and feasible procedure.

Protective Effect of Alpha-Lipoic Acid on Salivary Dysfunction in a Mouse Model of Radioiodine Therapy-Induced Sialoadenitis.

Radioiodine (RI) therapy is known to cause salivary gland (SG) dysfunction. The effects of antioxidants on RI-induced SG damage have not been well described. This study was performed to investigate the radioprotective effects of alpha lipoic acid (ALA) administered prior to RI therapy in a mouse model of RI-induced sialadenitis. Four-week-old female C57BL/6 mice were divided into four groups (n = 10 per group): group I, normal control; group II, ALA alone (100 mg/kg); group III, RI alone (0.01 mCi/g body weight, orally); and group IV, ALA + RI (ALA at 100 mg/kg, 24 h and 30 min before RI exposure at 0.01 mCi/g body weight). The animals in these groups were divided into two subgroups and euthanized at 30 or 90 days post-RI treatment. Changes in salivary 99mTc pertechnetate uptake and excretion were tracked by single-photon emission computed tomography. Salivary histological examinations and TUNEL assays were performed. The 99mTc pertechnetate excretion level recovered in the ALA treatment group. Salivary epithelial (aquaporin 5) cells of the ALA + RI group were protected from RI damage. The ALA + RI group exhibited more mucin-containing parenchyma and less fibrotic tissues than the RI only group. Fewer apoptotic cells were observed in the ALA + RI group compared to the RI only group. Pretreatment with ALA before RI therapy is potentially beneficial in protecting against RI-induced salivary dysfunction.

Revisiting the Topographic Anatomy of the Marginal Mandibular Branch of Facial Nerve Relating to the Surgical Approach.

BACKGROUND: The marginal mandibular branch (Mbr) of the facial nerve is vulnerable to damage during rhytidoplasty, surgical reduction of the mandibular angle, parotidectomy, and excision of the submandibular gland. OBJECTIVES: The authors sought to map the Mbr and determine the relationship between the number of Mbr offshoots and the course of the Mbr. METHODS: The Mbr was examined in 29 hemifaces from 12 embalmed and 4 fresh cadavers (10 males, 6 females; mean age, 73.7 years). RESULTS: The Mbr was located ≤5 mm from the gonion (Go) in 24 of 29 hemifaces (82.8%) and ≤10 mm from the intersection of the facial artery and mandible (ie, FM) in 26 hemifaces (89.7%). In 16 hemifaces (55.2%), offshoots arose from the Mbr inferior to the mandible. The Mbr ran below the Go in 14 hemifaces (48.3%) and ran below FM in 13 hemifaces (44.8%). Except for minute offshoots deep to the platysma, the Mbr was not found to pass >2 cm below the mandible. The mean (± standard deviation) quantity of Mbr offshoots was 1.5 (± 0.6). A greater number of offshoots was associated with a higher likelihood of an inferiorly located nerve. The Mbr proceeded under the lower border of the mandible in 13 hemifaces (44.8%) and reached the mandible at a mean distance of 33.1±5.2 mm anterior to the Go. CONCLUSIONS: To avoid damaging the Mbr, surgical maneuvers should be positioned 4.5 cm anterior to the Go and 2 cm below the mandible.

Role of Transient Receptor Potential Vanilloid 1 in Sonic Hedgehog-Dependent Taste Bud Differentiation.

Taste bud cell differentiation is extremely important for taste sensation. Immature taste bud cells cannot function during taste perception transmission to the nerve. In this study, we investigated whether hedgehog signaling affected taste bud cell differentiation and whether transient receptor potential vanilloid 1 (TRPV1) played a key role in dry mouth. The induction of dry mouth due to salivary gland resection (SGR) was confirmed on the basis of reduced salivation and disrupted fungiform papillae. The expression of keratin 8 (K8) of taste bud cells, neurofilament (NF), sonic hedgehog (Shh), and glioma-associated oncogene homolog 1 (Gli1) around taste bud cells was downregulated; however, the expression of TRPV1, P2X purinoceptor 3 (P2X3), and hematopoietic stem cell factor (c-Kit) was upregulated at the NF ends in the dry mouth group. To investigate the effect of TRPV1 defect on dry mouth, we induced dry mouth in the TRPV-/- group. The K8, NF, and P2X3 expression patterns were the same in the TRPV1 wild-type and TRPV1-/- dry mouth groups. However, Shh and c-Kit expression decreased regardless of dry mouth in the case of TRPV1 deficiency. These results indicated that TRPV1 positively regulated proliferation during taste bud cell injury by blocking the Shh/Gli1 pathway. In addition, not only cell proliferation but also differentiation of taste bud cells could not be regulated under TRPV1-deficiency conditions. Thus, TRPV1 positively regulates taste bud cell innervation and differentiation; this finding could be valuable in the clinical treatment of dry mouth-related taste dysfunction.

Quaternary ammonium N,N,N-trimethyl chitosan derivative and povidone­iodine complex as a potent antiseptic with enhanced wound healing property.

The importance of developing more potent antimicrobials and robust infection prevention practices has been highlighted recently with the increase in reports of emerging bacterial resistance mechanisms and the development of antibiotic-resistant microbes. In this study, a quaternary ammonium chitosan derivative, N,N,N-trimethyl chitosan chloride (TMC) with inherent bactericidal property was synthesized and complexed with povidone­iodine (PVP-I) to create a potentially more potent antiseptic solution that could also significantly enhance the wound healing process. TMC, a positively charged, water-soluble derivative of chitosan, formed stable solutions with PVP-I at 5% w/v TMC concentration (TMC5/PVP-I). TMC5/PVP-I was significantly effective against multidrug-resistant bacteria S. aureus compared with PVP-I alone. TMC/PVP-I solutions also showed fungicidal property against C. albicans, with no cytotoxic effects when tested against human fibroblast cells cultured in vitro. Wound healing assessment in vivo revealed early collagen formation and re-epithelialization for TMC5/PVP-I treated wounds in rats relative to control and PVP-I only. Formulation of TMC/PVP-I solutions presented in the study can be easily adapted in the existing production of commercial PVP-I creating a new product with more potent bactericidal and enhanced wound healing properties for optimal wound care.

No-Scar Transoral Thyroglossal Duct Cyst Excision in Children.

BACKGROUND: No-scar transoral thyroglossal duct cyst (TGDC) excision is a newly developed treatment for TGDC, but limited information is available regarding the clinical outcomes in children. The aim of this study was to evaluate the safety, efficacy, and effects of transoral TGDC excision in children. METHODS: Forty-four children <10 years of age received operative treatment for TGDC from January 2013 to December 2014, and follow-up was performed over 24 months. Clinicopathologic, surgical, and follow-up data were collected and analyzed. The primary outcome variable was feasibility of the procedure, and the secondary outcome was patient's cosmetic satisfaction after each operation. RESULTS: Twenty-one patients underwent transoral TGDC excision, and 21 patients underwent conventional excision. No significant differences were observed between the two groups in terms of the overall patient and operation factors. However, the rate of identifying the thyroglossal duct during transoral excision was superior to that during conventional excision (p < 0.05), and cosmetic satisfaction was much better in the transoral TGDC excision group (p < 0.001). CONCLUSION: No-scar transoral TGDC excision in children is a potentially safe and effective methodology that can achieve easy removal of the thyroglossal duct and excellent cosmetic outcomes.

Transoral Dermoid Cyst Excision: A Multicenter Prospective Observational Study.

OBJECTIVE: Transoral surgery is becoming a preferred technique because it does not leave any scar after surgery. However, transoral surgery for a dermoid cyst of the oral cavity is not standardized yet, due to the anatomic complexity of this region. The aim of this study was to evaluate the safety and efficacy of a transoral dermoid cyst excision. STUDY DESIGN: Multicenter prospective observational study. SETTING: University hospital. SUBJECTS AND METHODS: This study was designed as a 4-year prospective multicenter evaluation of dermoid cyst excisions within the floor of mouth. Clinical outcomes and complications related to procedures were evaluated among patients. The primary outcome was the efficacy of the procedure, and the secondary outcome was cosmetic satisfaction of each procedure. RESULTS: Twenty-one patients underwent transoral dermoid cyst excisions, and 22 underwent transcervical excisions. In the transoral surgery group, the mean size of the dermoid cyst was 5.35 cm (95% CI, 4.79-5.91), and in the transcervical surgery group, it was 6.19 cm (95% CI, 5.67-6.71). There was no significant differences with respect to overall demographic characteristics between the groups. However, the duration of the operation was shorter with the transoral group than with the transcervical group ( P = .001), and cosmetic satisfaction was much better in the transoral group ( P < .001). CONCLUSION: Transoral dermoid cyst excision is a potentially safe and effective method that can lead to easy and quick removal of an oral cavity dermoid cyst, with excellent cosmetic outcomes.

Calcium Hydroxylapatite Pulmonary Embolism after Percutaneous Injection Laryngoplasty.

Injection medialization laryngoplasty is a procedure that has many advantages in treating vocal fold paralysis; however, undesired complications can occur. We experienced a case of a pulmonary embolism, suspected in a patient who had undergone an injection laryngoplasty with calcium hydroxylapatite (CaHA). The patient suffered dyspnea after undergoing the injection laryngoplasty. Chest embolism computed tomography (CT) scan revealed a new lesion of enhancing materials at the pulmonary vasculature in the right upper lobe. The CaHA embolism was suspected, and the patient was treated with warfarin for 12 months. The patient's symptom of dyspnea nearly disappeared and a follow up chest embolism CT scan revealed no signs of the previous lesion. Thus, we would like to report this rare case along with a review of the literature.

Buccinator Myomucosal Flap for Treatment of Osteoradionecrosis of the Mandible.

The use of a myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. In this paper, we report the clinical advantages of using a buccinator myomucosal flap for the treatment of partial mandibular defects caused by osteoradionecrosis. We implemented a buccinator myomucosal flap for the reconstruction of a partial mandibular defect in a 55-year-old man with tonsil cancer and partial mandibular defects caused by osteoradionecrosis. The total operating time was 90 minutes. Twelve months after the reconstruction, the patient remains free of disease. A buccinator myomucosal flap can be used for the reconstruction of partial mandibular defects caused by osteoradionecrosis. It is a reliable method for reconstructing small mandibular defects.

Endoscope-assisted transoral accessory parotid mass excision.

BACKGROUND: Accessory parotid gland tissue is salivary tissue adjacent to Stensen's duct that is distinctly separate from the main body of the parotid gland. Surgical removal of an accessory parotid mass is usually accomplished through an external neck incision. However, this procedure inevitably results in a neck scar. METHODS: We report the case of a 55-year-old man with an accessory parotid mass. We applied a modified approach to accessory parotid mass removal through the mouth with an endoscope system. RESULTS: The patient, who was diagnosed with a benign pleomorphic adenoma, underwent endoscope-assisted transoral accessory parotid mass excision. The follow-up time was 6 months. The patient experienced no serious postoperative complications or recurrence. CONCLUSION: Resection of an accessory parotid mass can be performed via an endoscope-assisted transoral approach. In this study, we describe the procedure of the endoscope-assisted transoral resection.

Anatomical study of the submandibular gland duct after removal of a distal stone without sialodochoplasty: a sialographic evaluation of a clinical phase II trial.

Transoral removal of a distal salivary stone is common. We have used postoperative sialography to evaluate the results and changes in the salivary ducts after removal of a salivary distal stone without sialodochoplasty. Of 20 patients who had had transoral operations for submandibular stones, 19 recovered normally with no recurrence. One developed partial stenosis and one a spontaneous neo-opening as a result of severe adhesions and inflammation between the salivary stone and the duct. None of the patients had any symptoms of recurrence during the 12-month follow-up. Sialodochoplasty may not be necessary in patients who have had a distal salivary stone removed. Removal without sialodochoplasty resulted in full anatomical recovery of the salivary ducts.

Proposal for methods of diagnosis of fish bone foreign body in the Esophagus.

OBJECTIVE: To investigate the methods of diagnosis of fish bone foreign body in the esophagus and suggest a diagnostic protocol. STUDY DESIGN: Prospective cohort study. METHODS: A prospective study was performed on 286 patients with a history of fish bone foreign body impaction. Among them, 88 patients had negative findings in the oral cavity and laryngopharynx. Subsequent radiologic assessment of these patients included plain radiography and computed tomography (CT). Sixty-six patients showed positive findings in the esophagus, and an attempt was made to remove the obstruction using transnasal esophagoscopy. RESULTS: In 66 patients, a fish bone foreign body was detected in the esophagus by CT. In contrast, plain radiography detected a foreign body in only 30 patients. The overall detection rate of plain radiography compared with CT for fish bones was 45.5%. Plain radiography detected 35.9% of the simple type fish bones and 54.5% of the gill bone detected by CT. However, jaw bones had a detection rate of 100% with both methods. The fish bone foreign bodies were most commonly located in the upper esophagus (n=65, 98.5%), followed by the lower esophagus (n=1, 1.5%). CONCLUSION: CT is a useful method for identification of esophageal fish bone foreign bodies. Therefore, CT should be considered as the first-choice technique for the diagnosis of esophageal fish bone foreign body. LEVEL OF EVIDENCE: 4.

Endoscope-assisted transoral thyroidectomy using a frenotomy incision.

OBJECTIVE: Natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) has generated excitement among surgeons as potentially scar-free surgery. We developed this technique while taking into consideration that it could also be applied to transoral thyroid surgery. PATIENT AND METHODS: We report the case of a 35-year-old woman with a 0.5×0.5-cm papillary thyroid microcarcinoma. We implemented a modified approach for the removal of the thyroid by using a frenotomy incision of the mouth, accompanied by an endoscope system. RESULTS: A modified approach for the removal of the thyroid was used on the patient. The total operating time was 120 minutes, and there were no specific complications. The patient continues to be free of any diseases 12 months after the excision. CONCLUSIONS: Thyroidectomy can be performed by a transoral endoscope-assisted approach through a frenotomy incision of the mouth. We describe the detailed procedures for an endoscope-assisted transoral thyroidectomy using a frenotomy incision.

Anatomical recovery of the duct of the submandibular gland after transoral removal of a hilar stone without sialodochoplasty: evaluation of a phase II clinical trial.

Transoral removal of stones for the treatment of submandibular sialolithiasis has been popularised, even for stones in the hilum. Without sialodochoplasty after surgical retrieval, the affected glands seem to recover well functionally, even without sialodochoplasty. However, the anatomical changes of structural recovery have not been fully studied. We investigated the outcomes and the changes to the salivary duct system after transoral removal of hilar stones using postoperative sialography. We enrolled 28 patients (29 sides) who had transoral removal of stones for submandibular hilar sialolithiasis without sialodochoplasty, and prospectively analysed the structural outcomes 3 months and 12 months postoperatively using sialography. We found 23 ducts (79%) recovered with a normal size, while 4 ducts (14%) developed saccular dilatation and one duct (3%) partially stenosed. Saccular dilatation developed after removal of stones larger than 10mm in diameter, but patients had no recurrent symptoms. By the 12 months' follow up, one stone had formed severe adhesions to the salivary duct that caused stenosis, and this patient had recurrent symptoms. Transoral removal of submandibular hilar stones without sialodochoplasty is an effective treatment with good anatomical restoration of the salivary duct and flow.

Endoscope-assisted intraoral removal of the thyroid isthmus mass using a frenotomy incision.

OBJECTIVE: A thyroid isthmus nodule is a relatively rare condition. A small number of patients will present with thyroid mass isolated at the thyroid isthmus, which can cause discomfort in swallowing and cosmetic problems. Thus, some patients choose to have these nodules excised. The surgical removal of the thyroid isthmus mass is usually accomplished through an external incision of the neck. However, this procedure inevitably results in a neck scar. PATIENT AND METHODS: We report a case of an 18-year-old woman with a thyroid isthmus mass. We implemented a modified approach for the removal of the thyroid isthmus mass by using a frenotomy incision of the mouth, accompanied by an endoscope system. RESULTS: A modified approach for the removal of the thyroid isthmus mass was used on the patient. The total operating time was 70 minutes. The patient continues to be free of any diseases 12 months after the excision. CONCLUSIONS: Resection of the thyroid isthmus mass can be performed by an intraoral endoscope-assisted approach through a frenotomy incision of the mouth. We described the detailed procedures for an endoscope-assisted transoral thyroid isthmus mass excision using a frenotomy incision.

Endoscope-assisted intraoral removal of ectopic thyroid tissue using a frenotomy incision.

BACKGROUND: Ectopic thyroid tissue is a relatively rare condition and a developmental anomaly characterized by the aggregation of thyroid tissue. Usually, it occurs along the path of descent of the developing thyroid primordium from the foramen caecum, the most common being in the anterior midline of the neck at or below the level of the hyoid bone. Surgical removal of ectopic thyroid tissue is usually accomplished through an external incision in the neck. However, this procedure inevitably results in a neck scar. METHODS: We report the case of a 30-year-old woman with ectopic thyroid tissue. We implemented a modified approach to ectopic thyroid tissue removal through a frenotomy incision of the mouth using an endoscope system. RESULTS: A modified approach to ectopic thyroid tissue removal was used in this patient. The total operative time was 50 minutes, and the patient remains free of disease 15 months after excision. CONCLUSION: Resection of ectopic thyroid tissue can be performed by a transoral endoscope-assisted approach through a frenotomy incision of the mouth.

Buccinator myomucosal flap for reconstruction of glossectomy defects.

OBJECTIVE: The use of the myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. We report the clinical advantages and pitfalls of using the buccinator myomucosal flap for tongue reconstruction after intraoral resection of tongue cancer. STUDY DESIGN: Prospective study. SETTING: University hospital. SUBJECTS AND METHODS: We used buccal artery-based buccinator myomucosal flaps for tongue reconstruction in 11 partial or total edentulous patients who underwent resection of tongue cancer. The size and site of the tongue defect ranged from one-third to one-half of the tongue in the lateral border. We analyzed the clinical features and oncologic and functional outcomes to define adequate indications. RESULTS: All flaps were successfully harvested and transposed, and the donor sites were primarily closed. The pedicles were safely divided 2 to 3 weeks postoperatively. In 8 of 11 patients, concurrent upper neck dissection was performed without compromising blood supply to the flap. The range of tongue motion and the volume of the reconstructed tongue were satisfactory, and the patients experienced no difficulties in swallowing or speech. CONCLUSION: Particularly in edentulous patients, the buccal myomucosal flap can be a good option for reconstructing partial tongue defects after cancer surgery.

Plasma gel as a new augmentation material for injection laryngoplasty in rabbit model: histologic analysis.

OBJECTIVES: Currently, a variety of materials are available for the treatment of glottal insufficiency. Ideal injection materials should be inexpensive, easily obtainable, nontoxic, and biocompatible. Plasma gel has recently been developed as an injectable, autologous material used in plastic surgery. The aim of this study was to evaluate the histological changes in rabbit vocal folds (VFs) after an injection of plasma gel, compared with collagen (Artecoll) or hyaluronic acid (Reviderm Intra). STUDY DESIGN: Experimental prospective animal study. SETTING: Animal laboratory. SUBJECTS AND METHODS: Blood samples were collected from 12 New Zealand rabbits. Plasma collected from each rabbit was centrifuged and processed using a gel heating system. All rabbits received a 0.05 ml injection of plasma gel into the right VF, while an equivalent volume of Artecoll or Reviderm Intra was injected into the left VFs of each 6 rabbits randomly. The larynges were collected 2, 4, and 8 weeks after injection, and the tissues were stained for histological analysis. RESULTS: In comparison with left VFs injected with Artecoll or Reviderm Intra, there was significantly less inflammatory response and foreign body reaction in the plasma gel injected right VFs (P < .05). Multinucleated foreign body type giant cells were also more prevalent in the left VFs. There were no quantitative differences in the rates of neovascularization or collagen deposition between groups. CONCLUSION: Plasma gel is a biologically compatible material that may serve as a suitable augmentation material in injection laryngoplasty. Further studies that examine the long-term effects in a larger number of subjects are needed.

Endoscope-assisted intraoral resection of external dermoid cyst.

BACKGROUND: Surgical removal of a dermoid cyst is usually accomplished through an external neck incision. However, this procedure inevitably results in a neck scar. METHODS: We report the case of a 17-year-old woman with a submental mass. We implemented a modified approach to dermoid cyst removal through the floor of the mouth using an endoscope system. RESULTS: The patient received a modified approach to dermoid cyst removal and remains free of disease 6 months after excision. CONCLUSION: Resection of the submental type dermoid cyst can be performed by an intraoral endoscope-assisted approach through the floor of the mouth. We describe the procedure of the endoscope-assisted intraoral resection.