Do Gender and Age Influence Nasal Soft Tissue Widening After Bone-Borne Transpalatal Distraction?

PURPOSE: Widening of the nasal soft tissue after transpalatal distraction (TPD) is a well-known consequence of this treatment method used to correct transverse maxillary deficiency. However, because literature is scarce about the influence of gender and age, the purpose of this study is to estimate changes in the nasal soft tissue after TPD and to measure the association of gender and age with these observed changes. METHODS: In this retrospective cohort study, patients with transverse maxillary deficiency underwent combined orthodontic-surgical treatment. Maxillary and nasal anatomical landmarks were compared using superimposed cone beam computed tomography images preoperatively and approximately 1 year postoperatively. Measurements included nasal soft tissue, nasal skeletal, and maxillary parameters. Significant differences in nasal soft tissue changes were correlated with patient gender, age, maxillary, and nasal skeletal changes using regression models. RESULTS: Ninety one patients were included of which 33 were men (36%) and 58 women (64%). Independent of the maxillary widening, the mean nasal soft tissue widening was limited to 2 mm. Nasal soft tissue expansion was 60% to 80% of the nasal skeletal width and 25% to 31% of the skeletal maxillary width. The alar nasal base increased approximately 57% more than the alar nasal width. CONCLUSIONS: Significant gender-related differences in nasal soft tissue widening were observed. Age-related differences were identified only as a trend. Small age-related and gender-related differences may not be relevant clinically since there are no established threshold values to assess a layperson's perception of nasal width variations. Technical and/or aesthetic concerns regarding TPD surgery can be addressed without patient's gender and/or age consideration.

Treatment for critically impacted maxillary canines: Clinical versus scientific evidence - A systematic review.

BACKGROUND: Critically impacted maxillary canines are prone to fail to respond to conventional surgical exposure and orthodontic traction. Correct identification of a critical impaction requires enhanced diagnosis modalities and might lead to incorporating alternative surgical strategies in the treatment plan. Predictability of techniques such as apicotomy or tooth autotransplantation is, however, yet to be determined. The objective of this study was to systematically review treatment perspectives for critically impacted maxillary canines. METHODS: A systematic review of the available literature until april 2020 was conducted using an electronic search in Embase, Cochrane Central, Web of Science and PubMed databases. Randomised and non-randomised studies investigating treatment options and treatment outcome for buccally and/or palatally critically impacted maxillary canines were considered for the review. Information recorded concerned study design and setting, participants' characteristics and details regarding the type of intervention, types of outcomes measured and follow-up time. The included studies received a methodological quality scoring and risk of bias analysis according to a tool suggested by Murad et al (2018). RESULTS: Five studies were included in the quality analysis, all case series. The included studies enrolled a total of 302 patients and counted 346 critical maxillary canine impactions. Apicotomy and autotransplantation were listed as potential surgical approaches with surgical outcome presented for both surgical strategies. Adequate esthetical and/or functional outcomes were reported in most of the included studies. According to the quality assessment tool used, the reviewed studies scored medium on the proposed scale. DISCUSSION: Literature featuring protocols for identifying and treating critical maxillary canine impaction only consists of case series and case reports, which provide low level of evidence. The rather good results reported by the reviewed studies must be put into perspective as the methodology of these studies was insufficient and potential bias was identified. Comprehensive clinical research is needed to further investigate treatment options and form a basis for clinical guidelines.

Cardiac metastasis in a patient with oral squamous cell carcinoma.

A 55-year-old man initially presented with an undifferentiated, HPV-p16-negative squamous cell carcinoma (SCC) in the left tonsillar region (cT4a N0 M0), which was treated with a combination of radiotherapy and chemotherapy. Several months later, the patient developed osteoradionecrosis on the left side of the mandible as well as a second primary lesion at the left base of the tongue. Surgical resection and mandibular reconstruction with a free vascularised fibula flap was performed. Regional clinical and radiologic follow-up showed no signs of tumour recurrence. However, routine positron emission tomography (PET)-CT showed a hypermetabolic mass intracardially. MRI confirmed the presence of a mass intramurally in the left ventricle, highly indicative of metastasis. Cardiac metastasis following oral cancer is rare and usually asymptomatic. Therefore, it can be missed easily and is mostly described as a finding postmortem. Reporting these cases is important for contributing to the insight into the uncommon development of metastasis.

Impulsive-Compulsive Behaviours in Belgian-Flemish Parkinson's Disease Patients: A Questionnaire-Based Study.

BACKGROUND: Impulsive-compulsive behaviours (ICB) are a potentially harmful group of behavioural symptoms among the nonmotor aspects of Parkinson's disease (PD). OBJECTIVE: To develop and perform partial validation of a Belgian-Flemish version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) as a screening instrument for ICB in PD patients. METHODS: Using a translation-backtranslation method, we developed a Belgian-Flemish version of the QUIP, which was subsequently completed by 88 PD patients. QUIP-positive patients were invited for a semistructured diagnostic interview. RESULTS: A positive QUIP score for one or more ICB was observed in 37 patients (41%). In 15 patients (17%), a positive QUIP score for one or more impulse control disorders (ICD) was noted: pathological gambling in 1, hypersexuality in 8, compulsive shopping in 5, and compulsive eating in 8 patients. A positive QUIP score for punding, hobbyism, and/or walkabout was observed in 30 patients. The semistructured diagnostic interview was performed in 22 QUIP-positive patients. The diagnosis of ICB was confirmed in 6 patients, suggesting a positive predictive value of 27% for the Belgian-Flemish version of the QUIP. CONCLUSIONS: We have developed a Belgian-Flemish version of the QUIP, which can be used as a screening questionnaire for ICB in PD patients. Our data suggest that sensitivity is high, specificity is low, and validity of the questionnaire is similar to the original version. We confirm the necessity of additional clinical assessment of QUIP-positive patients to ascertain a diagnosis of ICB.

Impulse control disorders in Parkinson's disease: an overview from neurobiology to treatment.

Parkinson's disease (PD) is the second most common neurodegenerative brain disorder and is characterized by motor symptoms such as tremor, bradykinesia, rigidity and postural instability. A majority of the patients also develop non-motor symptoms. Impulse control disorders (ICD) are behavioural changes that often fail to be detected in clinical practice. The prevalence of ICD in PD varies widely from 6.1 to 31.2 % and treatment with dopaminergic medication is considered to be the greatest risk factor. Management consists mainly of reducing dopaminergic medication. In our experience, ICD has a tremendous impact on the quality of life of the patients and their families and should therefore not be disregarded. Studies addressing the role of ICD in PD caregiver strain are imperative. We attempt to give a comprehensive overview of the literature on the complicated neurobiology of ICD and discuss risk factors, genetic susceptibility, screening modalities and management.