Clinical and radiological assessment of rhinomaxillary syndrome in Hansen's disease.

Background More than four million people today live with Hansen's disease, and 200,000 new cases are diagnosed every year. Lifetime effects of Hansen's disease manifest as changes to bones of the face, hands and feet, resulting in physical impairment, secondary complications and facial changes that can be detrimental to quality of life, particularly among the elderly. Aims This study aimed to perform a detailed characterization of rhinomaxillary syndrome and its clinical manifestations in older persons treated in the past for Hansen's disease. Methods This was a cross-sectional study to characterize rhinomaxillary syndrome among older persons (age 60+ years) resident at Pedro Fontes Hospital, Cariacica, Espírito Santo, Brazil. Computed tomography images were examined with three-dimensional reconstructions to assess alterations to maxillofacial bones according to criteria for radiological rhinomaxillary syndrome. Participants were examined to assess facial alterations according to criteria for clinical rhinomaxillary syndrome. Results Rhinomaxillary syndrome was investigated in 16 participants (ten females and six males), median age 70 (range 60-89) years, age at diagnosis 20 (6-43) years and time since diagnosis 46 (26-70) years. Four participants fully met radiological rhinomaxillary syndrome criteria, four partially. All participants with full radiological rhinomaxillary syndrome presented with facial changes which met criteria for clinical rhinomaxillary syndrome, including "saddle nose" (loss of nasal dorsal height and shortened length of nose, due to cartilaginous and/or bone collapse), concave middle third of the face with sunken nose, maxillary retrognathia and inverted upper lip. Limitations Clinical histories were incomplete for some participants because records were lost at the hospital over time. Conclusion Until Hansen's disease is eliminated from endemic countries, persons affected will continue to present with rhinomaxillofacial alterations caused by Mycobacterium leprae infection. Clinical protocols for assessment and long-term care need to include otorhinolaryngological evaluation, mainly to prevent secondary complications. When rhinomaxillofacial bone changes are suspected, this evaluation should be supported by computed tomography imaging, if available.

Live imaging the foreign body response in zebrafish reveals how dampening inflammation reduces fibrosis.

Implanting biomaterials in tissues leads to inflammation and a foreign body response (FBR), which can result in rejection. Here, we live image the FBR triggered by surgical suture implantation in a translucent zebrafish model and compare with an acute wound response. We observe inflammation extending from the suture margins, correlating with subsequent avascular and fibrotic encapsulation zones: sutures that induce more inflammation result in increased zones of avascularity and fibrosis. Moreover, we capture macrophages as they fuse to become multinucleate foreign body giant cells (FBGCs) adjacent to the most pro-inflammatory sutures. Genetic and pharmacological dampening of the inflammatory response minimises the FBR (including FBGC generation) and normalises the status of the tissue surrounding these sutures. This model of FBR in adult zebrafish allows us to live image the process and to modulate it in ways that may lead us towards new strategies to ameliorate and circumvent FBR in humans.This article has an associated First Person interview with the first author of the paper.

Host-Biomaterial Interactions in Zebrafish.

Host-biomaterial interactions are critical determinants of the success or failure of an implant. However, detailed understanding of this process is limited due to a lack of dynamic tools for in vivo analyses. Here we characterize host-biomaterial interactions in zebrafish (Danio rerio), which are optically translucent and genetically tractable. Histological and immunohistochemical analyses following polypropylene suture implantation into adult zebrafish showed prolonged elevation of immune cell recruitment and collagen deposition, resembling a foreign body response. Live in vivo analysis showed that adsorption of the immunomodulatory cytokine interleukin-10 to a polystyrene microparticle, microinjected into transgenic larval zebrafish, inhibited neutrophil recruitment after 24 h compared to control microparticles, with no change in macrophage recruitment. This study illustrates that zebrafish are useful to investigate host-biomaterial interactions and have potential for high-throughput analysis of novel immunomodulatory biomaterials.

Transcervical repair of tracheal diverticulum.

Tracheal diverticula are rare congenital or acquired abnormalities of the posterior tracheal wall. They are usually asymptomatic, and therefore treatment has not been widely reported. We describe the entity and surgical management of a symptomatic tracheal diverticulum.

A ten year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: complications and treatment.

Maxillofacial trauma is often associated with injuries to the cranium, especially in high-energy trauma. The management of such cases can be challenging and requires close cooperation between oral and maxillofacial surgery and neurosurgical teams. There are few reports in the current literature describing the complications that develop in patients with maxillofacial trauma and traumatic brain injury (TBI). Complications can be categorized as early or late and/or minor and major. The exact definition of complications and their categorization remains a matter of current debate. We present a 10 year retrospective study of complications and their subsequent management in patients receiving maxillofacial and neurosurgical treatment for maxillofacial trauma associated with TBI. The study population consisted of 47 people, excluded from a maxillofacial trauma population of 579 patients. The severity of the trauma was scored as mild, moderate or severe, using the Glasgow Coma Scale at presentation of the Emergency Department. In total 36 patients (76.6%) developed complications. Patients involved in road traffic collision were most likely to develop complications (92.3%). This was followed by falls (66.7%) as mechanism of the injury. Patients aged 60-69 years experienced the highest complication rate (5), followed by patients aged 20-29 years (4.1) and 30-39 years (3.5). The majority of complications were infection and inflammation (36.4%), followed by neurological deficit (24.0%), physiological dysregulation (11.6%) and facial bone deformity (8.3%). Patients who developed no complications, most often presented with mild TBI (72.7%). The most common treatment modality employed to manage complications was pharmacological, followed by antibiotic treatment, conservative treatment and decompression therapy. The mean hospital stay after the trauma for the patients with complications was 28 days. Thirteen patients (36.1%) were transferred to a rehabilitation centre, a nursing home, or a home for the elderly. Nine patients (25%) completely recovered from their complications and 4 patients (11.1%) died after the trauma. This report provides useful data concerning the rate and type of complications that occur, and the multidisciplinary treatment that is required in traumatic maxillofacial and brain injury patients.

Airway compromise by dislodged obturator in a patient with severe trismus.

A patient presented with impending airway obstruction due to a dislodged interim maxillary obturator. The removal was complicated by the presence of severe trismus due to previous maxillectomy and recent radiotherapy. An emergency tracheotomy with the patient under local anesthetic was required to provide a definitive airway and to permit subsequent removal of the obturator with the patient under general anesthesia. The situation highlights the risks associated with interim obturators while awaiting the provision of an ideally fitted, well-retained, definitive obturator. Displaced obturators are potentially life threatening and difficult to remove in emergency situations.