Bardach's triple-legged rotation flap as single-staged 3D helical upper-third reconstruction: A technical note.

BACKGROUND: Reconstruction of the helical upper-third is often technically demanding, especially when the defect is huge and the ear is severely deformed. The aim of this short communication was to present an alternative technique to rebuild this difficult task, using a modification of the Bardach's three-legged rotation flap for scalp closure. METHODS: To achieve the flap design, we raised the retro- and supraauricular tissue with the Dieffenbach's postauricular advancement fl ap. The Gillies' V-Y advancement fl ap helped to develop the preauricular fl ap, and the Mustardé's otoplastik technique was used to reduce the gap between the resected ear cartilage and the temple. CONCLUSION: This flap technique appears simple and quick; thereby, it can be used as a single-staged reconstruction alternative in aging patients with multiple comorbidities.

Ameloblastoma of the maxillary sinus: conservative surgical management considering high recurrence risk potential.

Ameloblastoma (AM) in the maxillary sinus is rare. This benign entity shows locally invasive, destructive and aggressive behaviour and a high rate of recurrence. Therefore, the course of treatment is radical resection. We report the case of a 38-year-old man presenting with signs of recurrent sinusitis in the Ear, Nose and Throat Department. Transnasal flexible endoscopy revealed a cystic mass in the right inferior and middle nasal passage. CT scan showed an obliterated right maxillary sinus with a ballooning effect and pressure atrophy of the lateral sinus wall, without possible differentiation of the middle and low nasal turbinate. The patient was treated with transnasal functional sinus surgery; pathology stated AM. AM in the maxillary sinus is rare, locally destructive and therefore as a gold standard is resected radically to prevent recurrence. We demonstrate a conservative approach; explicitly, we combined a transvestibular and functional endoscopic sinus surgery resection of the AM to maintain function and reduce the possibility of postoperative impairments. Whether the strategy of treatment for AM is conservative, it nonetheless can result in a recurrence-free status. Nevertheless, inclusion into an oncological follow-up-programme with regularly performed MRI and CT is recommended.

Factors associated with epiphora following orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty.

PURPOSE: The aims of the study were to estimate the frequency of epiphora and to identify factors associated with epiphora after orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty (OSOSM-MWFILB). METHODS: We performed a retrospective cohort study enrolling a sample derived from the patient population undergoing OSM-MWFILB over a 7-year period. The predictor variables were grouped into demographic, related health status, anatomic, tumor-specific, and therapeutic categories. The primary outcome variable was the presence of postmaxillectomy epiphora (PME). Descriptive, univariate, and multivariate regression mixed-effect models were computed. RESULTS: The study sample was composed of 134 patients (46.3% females; 71.6% squamous cell carcinomas) with a mean age of 64.7 ± 12.2 years. There were 23 (17.2%) PME events, which were significantly associated with eight variables: male gender, poor general health (ASA III-IV), large vertical defect (Brown and Shaw's class III-IV), squamous cell carcinoma tumor type, big tumor size (T3-4), cervical lymph node metastasis (N1-2), long operating time > 3 h, and adjuvant radio(chemo)therapy in both univariate mixed regression and multivariate Cox hazards analyses. Healing of PME in irradiated patients was significantly delayed. CONCLUSIONS: Ophthalmologic consequences in patients undergoing OSM-MWFILB require particular attention, especially in case of advanced tumors, multiple comorbidities, or long surgery with postoperative radio(chemo)therapy. This emphasizes the importance of appropriate cooperation between the surgeons and ophthalmic colleagues.

The influence of bisphosphonates on human osteoblast migration and integrin aVb3/tenascin C gene expression in vitro.

BACKGROUND: Bisphosphonates are therapeutics of bone diseases, such as Paget's disease, multiple myeloma or osteoclastic metastases. As a severe side effect the bisphosphonate induced osteonecrosis of the jaw (BONJ) often requires surgical treatment and is accompanied with a disturbed wound healing.Therefore, the influence on adhesion and migration of human osteoblasts (hOB) after bisphosphonate therapy has been investigated by morphologic as well as gene expression methods. METHODS: By a scratch wound experiment, which measures the reduction of defined cell layer gap, the morphology and migration ability of hOB was evaluated. A test group of hOB, which was stimulated by zoledronate 5 × 10(-5)M, and a control group of unstimulated hOB were applied. Furthermore the gene expression of integrin aVb3 and tenascin C was quantified by Real-Time rtPCR at 5 data points over an experimental period of 14 days. The bisphosphonates zoledronate, ibandronate and clodronate have been compared with an unstimulated hOB control. RESULTS: After initially identical migration and adhesion characteristics, zoledronate inhibited hOB migration after 50 h of stimulation. The integrinavb3 and tenascin C gene expression was effected by bisphosphonates in a cell line dependent manner with decreased, respectively inconsistent gene expression levels over time. The non-nitrogen containing bisphosphonates clodronate led to decreased gene expression levels. CONCLUSION: Bisphosphonates seem to inhibit hOB adhesion and migration. The integrin aVb3 and tenascin C gene expression seem to be dependent on the cell line. BONJ could be enhanced by an inhibition of osteoblast adhesion and migration. The gene expression results, however, suggest a cell line dependent effect of bisphosphonates, which could explain the interindividual differences of BONJ incidences.

Development and validation of a high-throughput screening method for two polymorphisms in the serotonin transporter gene.

BACKGROUND AND AIM: The human serotonin (5-hydroxytryptamine) transporter, encoded by the SLC6A4 gene on chromosome 17q11.1-q12, is the cellular reuptake site for serotonin and a site of action for several drugs with central nervous system effects, including both therapeutic agents (e.g. antidepressants) and drugs of abuse (e.g. cocaine). It is known that the serotonin transporter plays an important role in the metabolic cycle of a broad range of antidepressants, antipsychotics, anxiolytics, antiemetics, and antimigraine drugs. The identification and characterization of variations that increase the response to common medications is a challenging and increasingly important task with regard to prediction of drug response. Therefore, the aim of this study was to establish a high-throughput single nucleotide polymorphism (SNP) screening method for two polymorphisms in the serotonin transporter gene, focusing on the SLC6A4 variations rs140701 and rs2066713. METHODS: We developed a classical restriction fragment length polymorphism (RFLP) PCR protocol as a reference, followed by a new protocol established for the LightCycler real-time PCR method. To validate the method, the allele frequencies in 169 individuals (112 women, 57 men) were determined and compared with published data. The population was divided into two groups: one group comprised 87 individuals with various mental disorders and the other consisted of 82 healthy persons. RESULTS: No difference was found in the prevalence of the two SNPs between the two populations. Subsequently, the determined allele frequencies were compared with previously published data. We found that 68% of the whole study population (groups I and II) carried a mutated allele of the rs140701 variation. With regard to the rs2066713 polymorphism, we found an allele frequency of 61% in the population. Both results are consistent with published data. CONCLUSION: The developed protocol for RT-PCR analysis of both variations turned out to be reliable and economical, and thus suitable for routine laboratory use.