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Oral Surgery, Oral Medicine, Oral... Dec 2022Rhinocerebral mucormycosis (RCM) is the most common variant and the presenting features in the head and neck region are seldom pathognomonic. The aim of this systematic... (Review)
Review
OBJECTIVE
Rhinocerebral mucormycosis (RCM) is the most common variant and the presenting features in the head and neck region are seldom pathognomonic. The aim of this systematic review was to obtain a thorough insight into the predisposing factors, clinical features, disease course, management protocol, outcome, and prognosis.
STUDY DESIGN
An electronic search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Web of Science, and EMBASE databases. Articles in which the clinical findings on the extra- and intraoral features of RCM were included for systematic review. Descriptive statistics was applied to obtain the results.
RESULTS
A total of 124 case studies (90 case reports, 34 case series) which yielded 219 patients. Diabetes mellitus (57.40%) was the most common comorbid condition. Neurologic manifestations were noted in 23.3% of the individuals. Maxillary/hard palate involvement was a common occurrence (59.2%). Intra-oral necrotic lesions with eschar were noted in 75/219 patients. Amphotericin B was the commonly used drug for the management, and surgical debridement was performed in majority of the cases. The mortality rate was 18.4%.
CONCLUSIONS
The clinical manifestations often mimic odontogenic symptoms, hence a sound knowledge about the pathogenesis and course of the disease will aid in the prompt diagnosis and management.
PubMed: 36184407
DOI: 10.1016/j.oooo.2022.06.006 -
Lasers in Medical Science Mar 2022This review aims to evaluate the adjunctive clinical effectiveness of diode laser (DL) to scaling and root planing (SRP) in the treatment of periodontitis, and identify... (Meta-Analysis)
Meta-Analysis Review
Clinical effectiveness of adjunctive diode laser on scaling and root planing in the treatment of periodontitis: is there an optimal combination of usage mode and application regimen? A systematic review and meta-analysis.
This review aims to evaluate the adjunctive clinical effectiveness of diode laser (DL) to scaling and root planing (SRP) in the treatment of periodontitis, and identify the optimal combination of usage mode and application regimen of DL. Eight electronic databases were searched up to January 2021. Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI), and gingival index (GI) were assessed at short-term (4-6 weeks), 3-month, and 6-month follow-ups. Based on DL usage mode, studies were divided into three groups: inside, outside pocket, and combined modes. As for application regimen, studies in each group were further subdivided into single- and multiple-session subgroups. Thirty randomized controlled trials with 825 participants were included. For inside mode, single-session DL showed significant improvements for PPD (short-term, and 3-month, p < 0.05), CAL (short-term, and 3-month, p < 0.05), PI (3- and 6-month, p < 0.05), and GI (short-term, 3-month, and 6-month, p < 0.05). For outside mode, multiple-session DL showed notable improvements for most clinical outcomes (p < 0.05). The effect of combined mode was still uncertain. Adjunctive DL had additional clinical benefits in the treatment of periodontitis. One session laser treatment is suggested when DL is applied inside pocket in future clinical practice. Meanwhile, more than one session laser treatment presents better outcomes when DL is used outside pocket. PROSPERO: CRD42020156162.
Topics: Chronic Periodontitis; Dental Scaling; Humans; Lasers, Semiconductor; Periodontal Index; Periodontitis; Randomized Controlled Trials as Topic; Root Planing; Treatment Outcome
PubMed: 34536183
DOI: 10.1007/s10103-021-03412-z -
The American Journal of Sports Medicine Dec 2021The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject.
BACKGROUND
The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject.
PURPOSE
To better understand the efficacy of different surgical modalities and nonoperative treatment of OCD as assessed by radiological and clinical outcomes and return to sports.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review of all treatment studies published between January 1975 and June 2020 was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 76 clinical studies, including 1463 patients, were suitable for inclusion. Aggregate analysis and subgroup analysis of individual patient data were performed to compare the functional and radiographic outcomes between the various nonoperative and surgical treatment options for capitellar OCD. A unified grading system (UGS; grades 1-4) was developed from existing validated classification systems to allow a comparison of patients with similar-grade OCD lesions in different studies according to their treatment. Patient-level data were available for 352 patients. The primary outcome measures of interest were patient-reported functional outcome, range of motion (ROM), and return to sports after treatment. The influences of the capitellar physeal status, location of the lesion, and type of sports participation were also assessed. Each outcome measure was evaluated according to the grade of OCD and treatment method (debridement/microfracture, fragment fixation, osteochondral autograft transplantation [OATS], or nonoperative treatment).
RESULTS
No studies reported elbow scores or ROM for nonoperatively treated patients. All surgical modalities resulted in significantly increased postoperative ROM and elbow scores for stable (UGS grades 1 and 2) and unstable lesions (UGS grades 3 and 4). There was no significant difference in the magnitude of improvement or overall scores according to the type of surgery for stable or unstable lesions. Return to sports was superior with nonoperative treatment for stable lesions, whereas surgical treatment was superior for unstable lesions. Patients with an open capitellar physis had superior ROM for stable and unstable lesions, but there was no correlation with lesion location and the outcomes of OATS versus fragment fixation for high-grade lesions.
CONCLUSION
Nonoperative treatment was similar in outcomes to surgical treatment for low-grade lesions, whereas surgical treatment was superior for higher grade lesions. There is currently insufficient evidence to support complex reconstructive techniques for high-grade lesions compared with microfracture/debridement alone.
Topics: Bone Transplantation; Elbow Joint; Humans; Osteochondritis Dissecans; Range of Motion, Articular; Transplantation, Autologous; Treatment Outcome
PubMed: 33886390
DOI: 10.1177/03635465211000763 -
Clinical Otolaryngology : Official... Feb 2015Chronic rhinosinusitis is a significant health problem, and the optimal postoperative treatment regime for patients post functional endoscopic sinus surgery has been a... (Review)
Review
BACKGROUND
Chronic rhinosinusitis is a significant health problem, and the optimal postoperative treatment regime for patients post functional endoscopic sinus surgery has been a topic debated for years.
OBJECTIVE OF REVIEW
To systematically review and critically evaluate the evidence relating to postoperative debridement of the nasal cavity following functional endoscopic sinus surgery to guide best practice.
SEARCH STRATEGY
A search of the following databases was performed: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, and Cochrane Central Register of Control Trials. Ovid Medline, EMBASE, Pubmed. The following key words were used: Postoperative, functional endoscopic sinus surgery, sinus surgery, debridement, follow-up, from 1970 to 2013.
EVALUATION METHOD
Two independent reviewers assessed the relevant articles using the consort guidance on systematic reviews Moher et al. BMJ 2010; 340: c869.
RESULTS
The best evidence available was 1B, with six Randomsied control trial (RCTs) identified. Four studies compared debridement against no debridement, and two looked at the frequency of the debridement. Cumulatively, results for 337 patients were included. Visual analogue scores were used in all studies. None of the results at the long-term follow-up showed any difference in sino-nasal outcome test scores or objective endoscopic scores. Four of the six studies demonstrated some benefit in symptom scores but only one in the long term. Two papers demonstrated the debridement group suffered more pain in the postoperative period.
CONCLUSIONS
Currently, there is no clear evidence for frequent postoperative debridement. Further well-designed RCTs are required to establish clear benefit, optimal frequency, extent and timing of debridement.
Topics: Debridement; Endoscopy; Humans; Rhinitis; Sinusitis; Treatment Outcome
PubMed: 25314101
DOI: 10.1111/coa.12330 -
The Surgeon : Journal of the Royal... Dec 2021Arthroscopic debridement, the most commonly applied surgical technique for focal cartilage lesions in the knee, is not included in most treatment algorithms because of... (Review)
Review
BACKGROUND AND PURPOSE OF THE STUDY
Arthroscopic debridement, the most commonly applied surgical technique for focal cartilage lesions in the knee, is not included in most treatment algorithms because of discouraging results in the management of osteoarthritis of the knee. The present systematic review evaluates the outcome of arthroscopic cartilage debridement as the primary treatment of focal knee chondral lesions in adults, and defines its indications and role as the primary treatment of focal knee chondral lesions.
METHODS
Two independent investigators searched PubMed, Cochrane CENTRAL, and Virtual Health Library databases using the terms "knee", "cartilage", "chondral", "lesions", "injury", "damage", "debridement", "chondroplasty", "chondrectomy", alone and in combination. Clinical studies evaluating the effect of mechanical cartilage debridement in adults with symptomatic focal cartilage lesions in the knee joint regardless of the defect size and depth were included. We excluded studies if patients had a concomitant ligament or meniscus injury, and/or had additional debridement with monopolar radiofrequency energy.
MAIN FINDINGS
Available studies suggest good to excellent short and medium-term functional outcomes (KOOS, LKSS, Tegner scale) for focal cartilage lesions treated with debridement regardless of the defect size and depth. Data are lacking comparing cartilage debridement versus other cartilage repair techniques.
CONCLUSIONS
Arthroscopic debridement of focal articular cartilage lesions of the knee is associated with good to excellent short and medium-term postoperative outcomes, especially in terms of functional improvement. Arthroscopic debridement may be considered in the primary treatment of focal cartilage injuries regardless of the defect size and depth. However, available studies are limited and the level of evidence is low.
Topics: Adult; Arthroscopy; Cartilage Diseases; Cartilage, Articular; Debridement; Humans; Knee Joint
PubMed: 33423921
DOI: 10.1016/j.surge.2020.11.011 -
Diagnostics (Basel, Switzerland) Jun 2021Open tibial fractures are complex injuries with variable outcomes that significantly impact patients' lives. Surgical debridement is paramount in preventing detrimental... (Review)
Review
INTRODUCTION
Open tibial fractures are complex injuries with variable outcomes that significantly impact patients' lives. Surgical debridement is paramount in preventing detrimental complications such as infection and non-union; however, the exact timing of debridement remains a topic of great controversy. The aim of this study is to evaluate the association between timing of surgical debridement and outcomes such as infection and non-union in open tibial fractures.
MATERIALS AND METHODS
We performed a systematic review and meta-analysis of the literature to capture studies evaluating the association between timing of initial surgical debridement and infection or non-union, or other reported outcomes. We searched the MEDLINE, PubMed Central, EMBASE, SCOPUS, Cochrane Central and Web of Science electronic databases. Our methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane handbook for systematic reviews of interventions.
RESULTS
The systematic review included 20 studies with 10,032 open tibial fractures. The overall infection rate was 14.3% (314 out of 2193) and the overall non-union rate 14.2% (116 out of 817). We did not find any statistically significant association between delayed debridement and infection rate (OR = 0.87; 95% CI, 0.68 to 1.11; = 0.23) or non-union rate (OR = 0.70; 95% CI, 0.42 to 1.15; = 0.13). These findings did not change when we accounted for the effect of different time thresholds used for defining early and late debridement, nor with the Gustilo-Anderson classification or varying study characteristics.
CONCLUSION
The findings of this meta-analysis support that delayed surgical debridement does not increase the infection or non-union rates in open tibial fracture injuries. Consequently, we propose that a reasonable delay in the initial debridement is acceptable to ensure that optimal management conditions are in place, such that the availability of surgical expertise, skilled staff and equipment are prioritised over getting to surgery rapidly. We recommend changing the standard guidance around timing for performing surgical debridement to 'as soon as reasonably possible, once appropriate personnel and equipment are available; ideally within 24-h'.
PubMed: 34199379
DOI: 10.3390/diagnostics11061017 -
European Journal of Orthopaedic Surgery... Oct 2020Endoprosthetic reconstructions have become increasingly common in the setting of significant bone loss. Indications include revision arthroplasty, trauma, and... (Review)
Review
BACKGROUND
Endoprosthetic reconstructions have become increasingly common in the setting of significant bone loss. Indications include revision arthroplasty, trauma, and reconstruction in the setting of primary malignancies or bony metastases. Although the use of endoprostheses has several advantages, they carry a high risk of infection. The purpose of this review is to determine the success rates of surgical management of infected endoprostheses.
METHODS
The authors searched databases for relevant studies and screened in duplicate. Data extracted included overall infection rate, timing of infection, follow-up, isolated pathogen and operative treatment strategy, and subsequent failure rate. The overall quality of the evidence with the Methodological Index for non-randomized studies criteria.
RESULTS
A total of 16 studies and 647 patients met the inclusion criteria. 400 patients had operative management and reported outcomes. Failure rates of patients undergoing debridement, antibiotics, and implant retention (DAIR) were 55.1%. Failure rates of patients who underwent one-stage revision were 45.5%. Failure rates of patients undergoing two-stage revision were 27.3%. Failure occurred at 31.4 months (range, 0-228) postoperatively.
CONCLUSIONS
Rates of periprosthetic joint infection remain high in endoprosthetic reconstructions. Although DAIR procedures were found to have a low success rate, they remain a reasonable option in acute infections given the morbidity of staged revisions. There is a lack of comparative data in the current literature and the heterogeneity and low level of evidence does not allow for between group comparisons of results.
Topics: Anti-Bacterial Agents; Debridement; Extremities; Humans; Prostheses and Implants; Prosthesis-Related Infections; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 32405759
DOI: 10.1007/s00590-020-02699-y -
World Neurosurgery Feb 2018Suboccipital decompressive craniectomy (SDC) for cerebellar infarction has been traditionally performed with minimal high-quality evidence. The aim of this systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Suboccipital decompressive craniectomy (SDC) for cerebellar infarction has been traditionally performed with minimal high-quality evidence. The aim of this systematic review and meta-analysis is to investigate the impact of SDC on functional outcomes, mortality, and adverse events in patients with cerebellar infarcts.
METHODS
A systematic review and meta-analysis in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Our primary outcome was the proportion of patients with moderate-severe disability after SDC. Secondary outcomes included mortality and adverse events. A sensitivity analysis was conducted to examine the roles of age, preoperative neurologic status, external ventricular drain insertion, and debridement of infarcted tissue on SDC outcomes.
RESULTS
Eleven studies (with 283 patients) met our inclusion criteria. The pooled event rate for moderate-severe disability was 28% (95% confidence interval [CI], 20%-37%) and for mortality, it was 20% (95% CI, 12%-31%). The estimated overall rate of adverse events for SDC was 23% (95% CI, 14%-35%). Sensitivity analysis found less mortality with mean age <60 years, higher rates of concomitant external ventricular drain insertion, and debridement of infarcted tissue. Several factors were identified for heterogeneity between studies, including follow-up time, outcomes scale, extent of infarction, and other neuroimaging features.
CONCLUSIONS
The best available evidence for SDC is based on retrospective observational studies. SDC for cerebellar infarction is associated with better outcomes compared with decompressive surgery for hemispheric infarctions. Lack of standardized reporting methods for SDC is a considerable drawback to the development of a better understanding of the impact of this surgery on patient outcomes.
Topics: Brain Infarction; Cerebellar Diseases; Decompressive Craniectomy; Humans
PubMed: 29104155
DOI: 10.1016/j.wneu.2017.10.144 -
Journal of Clinical Orthopaedics and... Apr 2021Non-tuberculous pyogenic spinal infection (PSI) incorporates a variety of different clinical conditions. Surgical interventions may be necessary for severe cases where... (Review)
Review
Posterior stabilisation without formal debridement for the treatment of non-tuberculous pyogenic spinal infection in frail and debilitated population - A systematic review and meta-analysis.
Non-tuberculous pyogenic spinal infection (PSI) incorporates a variety of different clinical conditions. Surgical interventions may be necessary for severe cases where there is evidence of spinal instability or neurological compromise. The primary surgical procedure, for late-stage PSI, focuses on the anterior approach with aggressive debridement of the infected tissue regions. An alternative treatment method that employs a posterior approach without any formal debridement, is seen as controversial. To the best of our knowledge, few case series and no systematic reviews are assessing the value of this posterior technique. We aim to evaluate the effectiveness of the posterior approach formal debridement and the associated clinical outcomes, for PSI cases requiring surgical intervention. Several databases including MEDLINE, NHS Evidence, and the Cochrane database were searched from the date of creation of each database to December 16, 2019. A selection of the keywords used includes: "posterior approach", "debridement" and "discitis". Studies were excluded if they involved the anterior approach, carried out formal debridement, or were tuberculous spinal infection cases. We accepted any study type which included adult patients, with spinal infection at any level of the vertebral column. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to follow standard systematic review structure. The main clinical outcomes evaluated include pain, neurological recovery (Frankel Grading System, FGS) post-operative complications, and functional outcomes (Kirkaldy-Willis Criteria and Spine Tango Combined Outcome Measure Index, COMI). Post-surgical neurological improvement was demonstrated with a mean FGS improvement of 1.12 in 102 patients over the included four articles. Post-operative neurological function was found to be improved at a statistically significant level when a random-effects model was applied, with the effect size found to be at 0.68 (p < 0.001). Pain level was improved significantly postoperatively. There were also enhanced functional outcomes post-intervention when the Kirkaldy-Willis criteria and COMI scores were assessed in certain studies. Within the limit of the available literature, our results showed that the posterior approach with posterior stabilisation without formal debridement can result in successful infection resolution, improved pain scores and neurological outcomes. However, Larger series with longer follow-up duration is strongly recommended.
PubMed: 33717910
DOI: 10.1016/j.jcot.2020.11.009 -
Clinical Implant Dentistry and Related... Apr 2022Nonsurgical treatment of peri-implantitis may help in reducing microbial load and inflammatory parameters. The potential clinical benefits of using different treatment... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nonsurgical treatment of peri-implantitis may help in reducing microbial load and inflammatory parameters. The potential clinical benefits of using different treatment approaches, in the initial nonsurgical treatment phase, particularly the airflow, are still not clear. The aim of this systematic review and meta-analyses was to evaluate the outcomes of nonsurgical treatment of peri-implantitis using airflow method in terms of changes in periodontal parameters, peri-implant marginal bone level, postoperative pain/discomfort, and patient satisfaction.
METHODS
Electronic databases were searched to identify randomized controlled trials (RCTs) that compared airflow with mechanical debridement using ultrasonic/curettes. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program.
RESULTS
A total of 316 studies were identified, of which, five RCTs with 288 dental implants in 174 participants were included. Overall meta-analysis showed more reduction in probing pocket depths at 1-3 months (mean difference [MD] -0.23; 95% confidence interval [CI] -0.50-0.05; p = 0.10) and 6 months (MD -0.04; 95% CI -0.34 to 0.27; p = 0.80) in favor of airflow, but the difference was not statistically significant. The use of airflow was associated with significant reduction in bleeding on probing and increase in peri-implant mucosal recession. The differences in plaque score, peri-implant marginal bone level changes, and patient reported outcomes between airflow and mechanical debridement were not statistically significant.
CONCLUSIONS
The short-term clinical and radiographic outcomes following nonsurgical treatment of peri-implantitis using airflow or mechanical debridement were comparable. The airflow has short-term positive effects on reducing bleeding on probing. Further evidence from RCTs are still required to substantiate the current findings.
Topics: Dental Implants; Humans; Peri-Implantitis
PubMed: 35156296
DOI: 10.1111/cid.13072