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European Journal of Orthodontics Oct 2017Dentofacial deformities frequently require orthodontic treatment. Understanding of preventable risk factors is essential for reducing treatment need. Upper airway... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dentofacial deformities frequently require orthodontic treatment. Understanding of preventable risk factors is essential for reducing treatment need. Upper airway obstruction (for example due to hypertrophic adenoids and/or tonsils) has been hypothesized to be a risk factor.
OBJECTIVES
This systematic review aimed to reflect the contemporary evidence on the risk of obstruction by hypertrophic adenoids and/or tonsils, by assessing the dentofacial changes after adeno- and/or tonsillectomy.
SEARCH METHODS
A systematic search of electronic databases and manual searches of grey literature and reference lists of relevant studies was performed.
SELECTION CRITERIA
No restrictions were placed on publication language. Experimental, cohort, and case-control studies were eligible for inclusion. Studies reporting associations between treatment of adenoid and/or tonsil hypertrophy and dentofacial deformities in children were included. Adenoidectomy and/or tonsillectomy were performed in all patients; outcomes were assessed before and after surgery.
DATA COLLECTION AND ANALYSIS
Data were extracted by two independent reviewers in duplicate. The Cochrane Risk of Bias tool was used to assess the methodological quality of the included papers.
RESULTS
The initial search yielded 1196 papers, of which 16 articles could be included. All papers described controlled prospective cohort studies, reporting on a total of 461 patients and controls (mean age, 4.1-13.9 years). A descriptive and quantitative synthesis of dentofacial change postoperatively is presented. Consistent findings across studies were the normalisation towards labial inclination of the upper and lower incisors and towards a more horizontal mandibular growth pattern. No change in vertical or sagittal maxillary growth was reported after surgical treatment. Post-surgical increase in maxillary archwidth and decrease in lateral crossbite-frequency were consistently reported. Findings on overjet, overbite and angle from S to N to B (SNB-angle), mandibular arch width, and gonial angle were inconsistent.
CONCLUSION
The available literature suggests that treatment of hypertrophic adenoids and/or tonsils affects dentofacial deformity. This could indicate a relationship between nasopharyngeal obstruction (i.e. upper airway obstruction) and the dentofacial growth pattern. However, the high risk of bias and considerable diversity between studies impedes a clear conclusion regarding this effect.
REGISTRATION
None.
Topics: Adenoidectomy; Adenoids; Case-Control Studies; Humans; Hypertrophy; Incisor; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Palatine Tonsil; Prospective Studies; Tonsillectomy
PubMed: 28379334
DOI: 10.1093/ejo/cjx005 -
Otolaryngology--head and Neck Surgery :... Oct 2020To investigate the potential correlation between infection and otitis media with effusion (OME) risk in children. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate the potential correlation between infection and otitis media with effusion (OME) risk in children.
DATA SOURCES
Electronic databases were searched, including Cochrane Library, PubMed, Embase, China Biology Medicine disc, China Science and Technology Journal Database, Wanfang Database, and China National Knowledge Infrastructure Database.
REVIEW METHODS
A systematic review and meta-analysis were conducted with Revman 5.3 software. Combined odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate infection-disease association.
RESULTS
In total, 11 studies from 9 articles regarding infection and OME risk were enrolled in this meta-analysis. A significant association between infection and OME was detected for both adenoid samples from the case group (OR, 2.75; 95% CI, 1.43-5.30; = .002) and middle ear fluid samples from the case group (OR, 4.45; 95% CI, 2.52-7.88; < .00001). Subgroup analyses suggested a stronger correlation in African and Asian populations.
CONCLUSION
This study indicated the correlation between infection and increased risk of OME in children, especially in African and Asian populations. Further well-designed studies regarding the white population are strongly recommended in the future.
Topics: Asian People; Black People; Child; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Odds Ratio; Otitis Media with Effusion
PubMed: 32482139
DOI: 10.1177/0194599820921861 -
The Angle Orthodontist Jan 2017To systematically review the literature correlating upper airway parameters between lateral cephalograms (LC) and cone-beam computed tomography (CBCT) or computed... (Review)
Review
Are three-dimensional airway evaluations obtained through computed and cone-beam computed tomography scans predictable from lateral cephalograms? A systematic review of evidence.
OBJECTIVE
To systematically review the literature correlating upper airway parameters between lateral cephalograms (LC) and cone-beam computed tomography (CBCT) or computed tomography (CT) scans to determine the utility of using LC to predict three-dimensional airway parameters.
MATERIALS AND METHODS
Both electronic and manual searches of the included studies were performed by two reviewers, and the quality of the studies that met selection criteria were assessed.
RESULTS
A total of 11 studies from the literature met the selection criteria. Assessed outcome variables showed correlation r < .7 between the LC and CT scans. The correlation between the LC and CBCT ranged from weak to strong with -.78 ≤ r and r ≤ .93 reported in the nasopharyngeal segment. In the oropharyngeal segment, a weak to strong correlation was reported with a range of -37 ≤ r and r ≤ .83 between the CBCT and LC. All associations in the hypopharyngeal segment showed a weak correlation. Four of studies were of weak quality, five were of moderate quality, and two were rated to be of strong quality.
CONCLUSION
No strong correlations were reported between the LC and CT scans. However, the LC-derived adenoid-nasopharyngeal ratio and the linear measurement (posterior nasal spine, PNS, to posterior pharyngeal wall) had a strong correlation with upright nasopharyngeal area and volume in the CBCTs. The area measurement in conventional LC can be also used as an initial screening tool to predict the upright three-dimensional oropharyngeal volumetric data. The variability of the hypopharyngeal segment cannot be predicted by LCs. However, more well-designed studies are needed to determine the clinical utility of using LC to predict airway size.
Topics: Adenoids; Cephalometry; Cone-Beam Computed Tomography; Humans; Hypopharynx; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Nasopharynx; Oropharynx; Pharynx; Radiography
PubMed: 27463700
DOI: 10.2319/032516-243.1 -
The Cochrane Database of Systematic... Oct 2015Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in... (Review)
Review
BACKGROUND
Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructive sleep apnoea syndrome (OSAS). It affects both children and adults. In children, hypertrophy of the tonsils and adenoid tissue is thought to be the commonest cause of oSDB. As such, tonsillectomy - with or without adenoidectomy - is considered an appropriate first-line treatment for most cases of paediatric oSDB.
OBJECTIVES
To assess the benefits and harms of tonsillectomy with or without adenoidectomy compared with non-surgical management of children with oSDB.
SEARCH METHODS
We searched the Cochrane Register of Studies Online, PubMed, EMBASE, CINAHL, Web of Science, Clinicaltrials.gov, ICTRP and additional sources for published and unpublished trials. The date of the search was 5 March 2015.
SELECTION CRITERIA
Randomised controlled trials comparing the effectiveness and safety of (adeno)tonsillectomy with non-surgical management in children with oSDB aged 2 to 16 years.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS
Three trials (562 children) met our inclusion criteria. Two were at moderate to high risk of bias and one at low risk of bias. We did not pool the results because of substantial clinical heterogeneity. They evaluated three different groups of children: those diagnosed with mild to moderate OSAS by polysomnography (PSG) (453 children aged five to nine years; low risk of bias; CHAT trial), those with a clinical diagnosis of oSDB but with negative PSG recordings (29 children aged two to 14 years; moderate to high risk of bias; Goldstein) and children with Down syndrome or mucopolysaccharidosis (MPS) diagnosed with mild to moderate OSAS by PSG (80 children aged six to 12 years; moderate to high risk of bias; Sudarsan). Moreover, the trials included two different comparisons: adenotonsillectomy versus no surgery (CHAT trial and Goldstein) or versus continuous positive airway pressure (CPAP) (Sudarsan). Disease-specific quality of life and/or symptom score (using a validated instrument): first primary outcomeIn the largest trial with lowest risk of bias (CHAT trial), at seven months, mean scores for those instruments measuring disease-specific quality of life and/or symptoms were lower (that is, better quality of life or fewer symptoms) in children receiving adenotonsillectomy than in those managed by watchful waiting:- OSA-18 questionnaire (scale 18 to 126): 31.8 versus 49.5 (mean difference (MD) -17.7, 95% confidence interval (CI) -21.2 to -14.2);- PSQ-SRBD questionnaire (scale 0 to 1): 0.2 versus 0.5 (MD -0.3, 95% CI -0.31 to -0.26);- Modified Epworth Sleepiness Scale (scale 0 to 24): 5.1 versus 7.1 (MD -2.0, 95% CI -2.9 to -1.1).No data on this primary outcome were reported in the Goldstein trial.In the Sudarsan trial, the mean OSA-18 score at 12 months did not significantly differ between the adenotonsillectomy and CPAP groups. The mean modified Epworth Sleepiness Scale scores did not differ at six months, but were lower in the surgery group at 12 months: 5.5 versus 7.9 (MD -2.4, 95% CI -3.1 to -1.7). Adverse events: second primary outcomeIn the CHAT trial, 15 children experienced a serious adverse event: 6/194 (3%) in the adenotonsillectomy group and 9/203 (4%) in the control group (RD -1%, 95% CI -5% to 2%).No major complications were reported in the Goldstein trial.In the Sudarsan trial, 2/37 (5%) developed a secondary haemorrhage after adenotonsillectomy, while 1/36 (3%) developed a rash on the nasal dorsum secondary to the CPAP mask (RD -3%, 95% CI -6% to 12%). Secondary outcomesIn the CHAT trial, at seven months, mean scores for generic caregiver-rated quality of life were higher in children receiving adenotonsillectomy than in those managed by watchful waiting. No data on this outcome were reported by Sudarsan and Goldstein.In the CHAT trial, at seven months, more children in the surgery group had normalisation of respiratory events during sleep as measured by PSG than those allocated to watchful waiting: 153/194 (79%) versus 93/203 (46%) (RD 33%, 95% CI 24% to 42%). In the Goldstein trial, at six months, PSG recordings were similar between groups and in the Sudarsan trial resolution of OSAS (Apnoea/Hypopnoea Index score below 1) did not significantly differ between the adenotonsillectomy and CPAP groups.In the CHAT trial, at seven months, neurocognitive performance and attention and executive function had not improved with surgery: scores were similar in both groups. In the CHAT trial, at seven months, mean scores for caregiver-reported ratings of behaviour were lower (that is, better behaviour) in children receiving adenotonsillectomy than in those managed by watchful waiting, however, teacher-reported ratings of behaviour did not significantly differ.No data on these outcomes were reported by Goldstein and Sudarsan.
AUTHORS' CONCLUSIONS
In otherwise healthy children, without a syndrome, of older age (five to nine years), and diagnosed with mild to moderate OSAS by PSG, there is moderate quality evidence that adenotonsillectomy provides benefit in terms of quality of life, symptoms and behaviour as rated by caregivers and high quality evidence that this procedure is beneficial in terms of PSG parameters. At the same time, high quality evidence indicates no benefit in terms of objective measures of attention and neurocognitive performance compared with watchful waiting. Furthermore, PSG recordings of almost half of the children managed non-surgically had normalised by seven months, indicating that physicians and parents should carefully weigh the benefits and risks of adenotonsillectomy against watchful waiting in these children. This is a condition that may recover spontaneously over time.For non-syndromic children classified as having oSDB on purely clinical grounds but with negative PSG recordings, the evidence on the effects of adenotonsillectomy is of very low quality and is inconclusive.Low-quality evidence suggests that adenotonsillectomy and CPAP may be equally effective in children with Down syndrome or MPS diagnosed with mild to moderate OSAS by PSG.We are unable to present data on the benefits of adenotonsillectomy in children with oSDB aged under five, despite this being a population in whom this procedure is often performed for this purpose.
Topics: Adenoidectomy; Adolescent; Child; Child, Preschool; Humans; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 26465274
DOI: 10.1002/14651858.CD011165.pub2 -
Head and Neck Pathology Dec 2022Polymorphous adenocarcinoma (PAC) is a rare variant of minor salivary gland tumors. Because of its architectural diversity, histological diagnosis of PAC can be... (Meta-Analysis)
Meta-Analysis
Polymorphous adenocarcinoma (PAC) is a rare variant of minor salivary gland tumors. Because of its architectural diversity, histological diagnosis of PAC can be difficult especially for small biopsies, and immunohistochemistry is of great help in differentiating it from its histologic mimics. The aim of this study is to conduct a systematic literature review to identify reliable immunohistochemical markers for PAC. We conducted an electronic literature search of the MEDLINE, ScienceDirect, SpringerLink, and Wiley Online Library databases, covering the literature published in the period between 1988 and 2021. The eligibility criteria included case reports and retrospective studies of PAC cases with details of immunohistochemical markers. Following the search and selection process, 32 studies with 409 cases were included in this systematic review. Overall, > 90% positivity was observed for pan-cytokeratin (CK) (97.3%), CK7 (96.8%), CK7/8 (97.4%), E-cadherin (90.0%), Vimentin (92.5%), S100 (97.0%), p63 (91.7%), and SOX10 (100%), while little to no positivity was observed for CK20 (0.0%), p40 (0.0%), and GFAP (5.0%). The average MIB-1 labeling index was 3.78%. The results of this systematic review indicate that CK7+/CK20-, p63+/p40-, S100+, Vimentin+, and GFAP- immunophenotype have diagnostic value for PAC. In addition, the use of S100, MSA, p40, and c-Kit provide additional layers of information helpful to differentiate PAC from adenoid cystic carcinoma, one of challenging differential diagnoses.
Topics: Humans; Salivary Glands, Minor; Retrospective Studies
PubMed: 35507302
DOI: 10.1007/s12105-022-01453-6 -
Technology in Cancer Research &... 2024Head and neck adenoid cystic carcinoma (HNACC) is a radioresistant tumor. Particle therapy, primarily proton beam therapy and carbon-ion radiation, is a potential... (Meta-Analysis)
Meta-Analysis
Head and neck adenoid cystic carcinoma (HNACC) is a radioresistant tumor. Particle therapy, primarily proton beam therapy and carbon-ion radiation, is a potential radiotherapy treatment for radioresistant malignancies. This study aims to conduct a meta-analysis to evaluate the impact of charged particle radiation therapy on HNACC. A comprehensive search was conducted in Pubmed, Cochrane Library, Web of Science, Embase, and Medline until December 31, 2022. The primary endpoints were overall survival (OS), local control (LC), and progression-free survival (PFS), while secondary outcomes included treatment-related toxicity. Version 17.0 of STATA was used for all analyses. A total of 14 studies, involving 1297 patients, were included in the analysis. The pooled 5-year OS and PFS rates for primary HNACC were 78% (95% confidence interval [CI] = 66-91%) and 62% (95% CI = 47-77%), respectively. For all patients included, the pooled 2-year and 5-year OS, LC, and PFS rates were as follows: 86.1% (95% CI = 95-100%) and 77% (95% CI = 73-82%), 92% (95% CI = 84-100%) and 73% (95% CI = 61-85%), and 76% (95% CI = 68-84%) and 55% (95% CI = 48-62%), respectively. The rates of grade 3 and above acute toxicity were 22% (95% CI = 13-32%), while late toxicity rates were 8% (95% CI = 3-13%). Particle therapy has the potential to improve treatment outcomes and raise the quality of life for HNACC patients. However, further research and optimization are needed due to the limited availability and cost considerations associated with this treatment modality.
Topics: Humans; Carcinoma, Adenoid Cystic; Head and Neck Neoplasms; Proton Therapy; Heavy Ion Radiotherapy; Treatment Outcome
PubMed: 38773763
DOI: 10.1177/15330338241246653 -
The Cochrane Database of Systematic... Jan 2020Obstructive sleep apnoea (OSA) is characterised by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obstructive sleep apnoea (OSA) is characterised by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy being the most common underlying risk factor. Surgical removal of enlarged adenoids or tonsils is the currently recommended first-line treatment for OSA due to adenotonsillar hypertrophy. Given the perioperative risk and an estimated recurrence rate of up to 20% following surgery, there has recently been an increased interest in less invasive alternatives to adenotonsillectomy. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory drugs have been proposed as a potential non-surgical treatment option in children with OSA.
OBJECTIVES
To assess the efficacy and safety of anti-inflammatory drugs for the treatment of OSA in children.
SEARCH METHODS
We identified trials from searches of the Cochrane Airways Group Specialised Register, CENTRAL and MEDLINE (1950 to 2019). For identification of ongoing clinical trials, we searched ClinicalTrials.gov and the World Health Organization (WHO) trials portal.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing anti-inflammatory drugs against placebo in children between one and 16 years with objectively diagnosed OSA (apnoea/hypopnoea index (AHI) ≥ 1 per hour).
DATA COLLECTION AND ANALYSIS
Two authors independently performed screening, data extraction, and quality assessment. We separately pooled results for the comparisons 'intranasal steroids' and 'montelukast' against placebo using random-effects models. The primary outcomes for this review were AHI and serious adverse events. Secondary outcomes included the respiratory disturbance index, desaturation index, respiratory arousal index, nadir arterial oxygen saturation, mean arterial oxygen saturation, avoidance of surgical treatment for OSA, clinical symptom score, tonsillar size, and adverse events.
MAIN RESULTS
We included five trials with a total of 240 children aged one to 18 years with mild to moderate OSA (AHI 1 to 30 per hour). All trials were performed in specialised sleep medicine clinics at tertiary care centres. Follow-up time ranged from six weeks to four months. Three RCTs (n = 137) compared intranasal steroids against placebo; two RCTs compared oral montelukast against placebo (n = 103). We excluded one trial from the meta-analysis since the patients were not analysed as randomised. We also had concerns about selective reporting in another trial. We are uncertain about the difference in AHI (MD -3.18, 95% CI -8.70 to 2.35) between children receiving intranasal corticosteroids compared to placebo (2 studies, 75 participants; low-certainty evidence). In contrast, children receiving oral montelukast had a lower AHI (MD -3.41, 95% CI -5.36 to -1.45) compared to those in the placebo group (2 studies, 103 participants; moderate-certainty evidence). We are uncertain whether the secondary outcomes are different between children receiving intranasal corticosteroids compared to placebo: desaturation index (MD -2.12, 95% CI -4.27 to 0.04; 2 studies, 75 participants; moderate-certainty evidence), respiratory arousal index (MD -0.71, 95% CI -6.25 to 4.83; 2 studies, 75 participants; low-certainty evidence), and nadir oxygen saturation (MD 0.59%, 95% CI -1.09 to 2.27; 2 studies, 75 participants; moderate-certainty evidence). Children receiving oral montelukast had a lower respiratory arousal index (MD -2.89, 95% CI -4.68 to -1.10; 2 studies, 103 participants; moderate-certainty evidence) and nadir of oxygen saturation (MD 4.07, 95% CI 2.27 to 5.88; 2 studies, 103 participants; high-certainty evidence) compared to those in the placebo group. We are uncertain, however, about the difference in desaturation index (MD -2.50, 95% CI -5.53 to 0.54; 2 studies, 103 participants; low-certainty evidence) between the montelukast and placebo group. Adverse events were assessed and reported in all trials and were rare, of minor nature (e.g. nasal bleeding), and evenly distributed between study groups. No study examined the avoidance of surgical treatment for OSA as an outcome.
AUTHORS' CONCLUSIONS
There is insufficient evidence for the efficacy of intranasal corticosteroids for the treatment of OSA in children; they may have short-term beneficial effects on the desaturation index and oxygen saturation in children with mild to moderate OSA but the certainty of the benefit on the primary outcome AHI, as well as the respiratory arousal index, was low due to imprecision of the estimates and heterogeneity between studies. Montelukast has short-term beneficial treatment effects for OSA in otherwise healthy, non-obese, surgically untreated children (moderate certainty for primary outcome and moderate and high certainty, respectively, for two secondary outcomes) by significantly reducing the number of apnoeas, hypopnoeas, and respiratory arousals during sleep. In addition, montelukast was well tolerated in the children studied. The clinical relevance of the observed treatment effects remains unclear, however, because minimal clinically important differences are not yet established for polysomnography-based outcomes in children. Long-term efficacy and safety data on the use of anti-inflammatory medications for the treatment of OSA in childhood are still not available. In addition, patient-centred outcomes like concentration ability, vigilance, or school performance have not been investigated yet. There are currently no RCTs on the use of other kinds of anti-inflammatory medications for the treatment of OSA in children. Future RCTs should investigate sustainability of treatment effects, avoidance of surgical treatment for OSA, and long-term safety of anti-inflammatory medications for the treatment of OSA in children and include patient-centred outcomes.
Topics: Acetates; Adenoidectomy; Adolescent; Anti-Inflammatory Agents; Child; Child, Preschool; Cyclopropanes; Female; Humans; Infant; Male; Quinolines; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Sulfides; Tonsillectomy
PubMed: 31978261
DOI: 10.1002/14651858.CD007074.pub3 -
Lung Cancer (Amsterdam, Netherlands) Jun 2019Malignant tumors of the trachea (MTT) account for 0.01-0.4% of all cancer cases. The rarity of the tumor along with different histologies makes it is a great challenge...
BACKGROUND
Malignant tumors of the trachea (MTT) account for 0.01-0.4% of all cancer cases. The rarity of the tumor along with different histologies makes it is a great challenge on how to optimally treat tracheal tumors and most of the available data is from small retrospective data series. We performed a systematic review and individual patient data analysis to evaluate the patterns of care and survival outcomes in patient with MTT.
METHODOLOGY
A comprehensive search in Pub Med and Google scholar was done to find all possible publications related to malignant tumors of the trachea. The data on patient demograpphy, treatment, survival and recurrence pattern of individual patient was collected from the published data and was entered in a predesigned proforma. Progression free survival [PFS] and overall survival [OS] was calculated from the date of diagnosis to the date of documented progression and death respectively. Kaplan- Meier method was used for survival analysis and uni-variate analysis was performed using log rank test. SPSS v16 was used for all statistical analysis.
RESULTS
733 patients were included in this analysis. The most common histology was adenoid cystic carcinoma (ACC) followed by squamous cell carcinoma (SCC). The gender ratio was 4.43: 1[male: female] in patients with SCC while it was 0.85:1[male: female] in ACC. Smoking and age >50 years were associated with worse OS. The estimated median overall survival for entire cohort was 96 months. Survival was significantly better in patients with ACC than in patients with SCC [165 vs. 14 months, p < 0.001]. The use of definitive surgery was associated with a significantly better survival of 180 months when compared to 48 months with radiation as local therapy, [p < 0.001]. The radiation dose used also affected survival in patients with SCC with a better median OS of 24 months in patients who recieved more than 60 Gy vs 6 months in whom the dose was less than 60 Gy although not statistically significant (p = 0.011).
CONCLUSION
ACC and SCC are the most common MTT. ACC has better prognosis compared to SCC. Surgery seems to provide better outcomes than radiation for ACC and sarcoma. Role of definitive radiotherapy versus surgery in SCC needs to be further studied.
Topics: Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Humans; India; Practice Patterns, Physicians'; Prognosis; Retrospective Studies; Socioeconomic Factors; Survival Analysis; Tracheal Neoplasms; Treatment Outcome
PubMed: 31097099
DOI: 10.1016/j.lungcan.2019.04.017 -
Journal of Oral and Maxillofacial... 2024c-KIT is an important diagnostic marker in salivary gland tumours and is expressed in most adenoid cystic carcinomas. Histologically similar salivary gland tumours with... (Review)
Review
c-KIT is an important diagnostic marker in salivary gland tumours and is expressed in most adenoid cystic carcinomas. Histologically similar salivary gland tumours with variable immunohistochemical expression for c-KIT pose a challenge and make diagnostic reliability ambivalent. An electronic search was performed in MEDLINE by PubMed, Google Scholar, Scopus, Trip, Cochrane Library, and EMBASE up to 31 December 2023, without period restriction. The articles that investigated CD117 or c-KIT in salivary gland tumours were included for review. Sensitivity, specificity, and positive and negative predictive values of c-KIT immunohistochemical expressions were derived and subjected to meta-analysis using Open Meta analyst for Sierra software. The risk of bias in selected studies was analysed using the QUADAS-2 tool, and RevMan 5.4 was used to output the result. Forty-three articles were reviewed, and 2285 salivary gland cases were analysed. Adenoid cystic carcinoma had an overall expression of 84.9%. A similar expression was found in epimyoepithelial carcinoma (79.1%), lymphoepithelial carcinoma (75%), myoepithelial carcinoma (60.8%), monomorphic adenoma (94.1%), and pleomorphic adenoma (74.7%). The sensitivity, specificity, and positive and negative predictive values of c-KIT/CD117 for adenoid cystic carcinoma with other salivary gland tumours were 84.99%, 69.09%, 84.79%, and 69.41%, respectively. Current evidence shows that c-KIT, despite its sensitivity, is not specific and therefore cannot be a useful diagnostic marker for distinguishing adenoid cystic carcinoma from other salivary gland tumours. Further research on other salivary gland tumours that exhibit comparable expression is necessary to validate the diagnostic accuracy of c-KIT.
PubMed: 38800447
DOI: 10.4103/jomfp.jomfp_70_24 -
Clinical Otolaryngology : Official... Jul 2024Leukotrienes play a significant role in the pathogenesis of adenoid hypertrophy (A.H.). Therefore, we aimed to analyse the role of montelukast, a leukotriene receptor... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Leukotrienes play a significant role in the pathogenesis of adenoid hypertrophy (A.H.). Therefore, we aimed to analyse the role of montelukast, a leukotriene receptor antagonist, alone or in combination with mometasone, a potent local intranasal steroid, for the treatment of A.H.
METHODS
Participants were children with A.H. were treated with montelukast alone or montelukast and mometasone furoate. The main outcome measures were effect of montelukast on clinical symptoms of A.H. A literature review was conducted using online search engines, Cochrane Library, PubMed, Web of Science and Scopus, for randomized clinical trials assessing children with A.H. treated with montelukast alone or montelukast and mometasone furoate. Seven randomized clinical trials (RCTs) were included with 742 children.
RESULTS
Our study reveals that montelukast alone or in combination with intranasal mometasone furoate significantly improves clinical symptoms of adenoid hypertrophy such as snoring, sleeping disturbance, mouth breathing and A/N ratio. Montelukast was superior to placebo in decreasing snoring (SMD = -1.00, 95% CI [-1.52, -0.49]), sleep discomfort (SMD = -1.26, 95% CI [-1.60, -0.93]), A/N ratio (MD = -0.11, 95% CI [-0.14, -0.09]) and mouth breathing (SMD = -1.36, 95% CI [-1.70, -1.02]). No difference was detected between montelukast and mometasone versus mometasone alone in snoring (SMD = -0.21, 95%CI [-0.69, 0.27]); however, the combination group was superior to the mometasone alone in mouth breathing (SMD = -0.46, 95% CI [-0.73, -0.19]).
CONCLUSIONS
The limitation of studies included a small sample size, with an overall low to medium quality. Thus, further larger, higher-quality RCTs are recommended to provide more substantial evidence.
Topics: Humans; Adenoids; Cyclopropanes; Quinolines; Acetates; Sulfides; Hypertrophy; Child; Mometasone Furoate; Leukotriene Antagonists; Administration, Intranasal; Drug Therapy, Combination; Treatment Outcome
PubMed: 38700144
DOI: 10.1111/coa.14169