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The British Journal of Oral &... Oct 2022Surgical management of temporomandibular joint (TMJ) ankylosis involves various techniques from which interpositional arthroplasty (IPA) involves using several... (Meta-Analysis)
Meta-Analysis Review
Comparison of surgical outcomes related to interpositional arthroplasty materials used in patients with temporomandibular joint ankylosis: a systematic review and meta-analysis.
Surgical management of temporomandibular joint (TMJ) ankylosis involves various techniques from which interpositional arthroplasty (IPA) involves using several materials. The objectives of this study were to assess and compare post arthroplasty maximum mouth opening (MMO), symptoms like pain and discomfort in jaw opening and movements, failures such as reankylosis, neurosensory disturbances, and the effect of confounding variables such as age, gender, physiotherapy, etc. The search (conducted in September, 2021) included studies published in English on otherwise healthy individuals (11 months to 88 years) having undergone arthroplasty with a minimum of six months' follow up. We used search engines such as Cochrane database, PubMed, Embase, Scopus, EBSCO host, Pro quest, J gate, Google Scholar, and manual search to include books and grey literature. Randomised clinical (RCT) and non-randomised clinical trials, observational studies, case series and reports meeting the inclusion criteria were selected. Two reviewers (HD and NP) independently extracted the data. Risk of bias was assessed using the Cochrane tool, Rangel checklist, and Joanna Briggs Institute. Data were analysed using RevMan (Version 5.4). Fifty studies with 1524 participants (442 bilateral and 891 unilateral joints) were included; six RCTs, 31 retrospective, 10 prospective, and three case series and reports. Amongst all interpositional materials, the highest increase in mouth opening was seen with dermis fat graft with a mean difference (Pooled MD) being 35.29mm (95% CI [32.36 to 38.22]). Comparison of temporalis myofascial with gap arthroplasty (GA) showed significant increase in MMO (Pooled MD in mm 1.30 95% CI [0.14 to 2.45]). Recurrence was significantly reduced when (IPA) was used, compared with GA (Risk difference 0.08mm 95% CI [-0.15 to -0.02]) and for Temporalis Myofascial Flap (TMF) when compared with GA (Risk difference -0.07mm 95% CI [-0.15 to 0]). Higher odds for developing neurosensory disturbances were seen with Al-Kayat Bramley incision (Pooled OR 0.11 95% CI [0.04 to 0.34]) compared to pre-auricular incision (Pooled OR 0.03 95% CI [0.01 to 0.09]). IPA was superior to GA with respect to maximum mouth opening (MMO) (Pooled MD in mm 1.21 95% CI [0.41 to 2.07]). Dermis fat graft offers the highest MMO. The overall quality of evidence for RCTs is poor while that of observational studies is moderate as per the relevant assessment of quality of evidence. More research with appropriate study designs is needed. Similar to the findings from the previous reviews, outcomes with IPA were superior when compared to GA in terms of mouth opening and less recurrence.
Topics: Ankylosis; Arthroplasty; Humans; Prospective Studies; Retrospective Studies; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 35906111
DOI: 10.1016/j.bjoms.2022.05.005 -
The Journal of Oral Implantology Apr 2023This study was done to perform a systematic review and meta-analysis of the studies on the efficacy of acellular dermal matrix (ADM) in increasing the soft tissue... (Meta-Analysis)
Meta-Analysis
This study was done to perform a systematic review and meta-analysis of the studies on the efficacy of acellular dermal matrix (ADM) in increasing the soft tissue thickness (STT) and keratinized mucosal width (KMW) around dental implants. The PubMed, Scopus, Cochrane, Web of Science, and ProQuest databases were searched by July 2020 to retrieve relevant studies. Depending upon the heterogeneity of included studies, the weighted mean difference (WMD) with 95% CI was calculated using either fixed or random-effects model. Based on the meta-analysis of 6 studies, the effect of ADM on STT and KMW was significant (WMD: 1.07 [95% CI: 0.34-1.79], P = .004, and WMD: 1.99 [95% CI: 0.88-3.09], P < .001, respectively). Further, a comparison between the efficacy of the ADM and the control group, which included the autogenous soft tissue augmentation techniques, showed no statistically significant differences between groups (STT: WMD: 0.24 [95% CI: -0.26 to 0.74], P = .161 and KMW: WMD: -0.23 [95% CI: -0.68 to 0.22], P = .324). The subgroup analysis showed that simultaneous augmentation and implant placement were increased by 0.23 mm in the KMW, and the placement of ADM around loaded implants caused 0.5 mm decrease in the KMW, which was not statistically significant. Accordingly, it is possible to substitute ADM for soft tissue augmentation around dental implants.
Topics: Dental Implants; Dental Implantation, Endosseous; Acellular Dermis; Mucous Membrane
PubMed: 35881814
DOI: 10.1563/aaid-joi-D-21-00021 -
Oral Surgery, Oral Medicine, Oral... Jul 2022The aim of this study was to evaluate the efficacy of acellular dermal matrix (ADM) use in reducing Frey syndrome (FS) rates in patients postparotidectomy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this study was to evaluate the efficacy of acellular dermal matrix (ADM) use in reducing Frey syndrome (FS) rates in patients postparotidectomy.
STUDY DESIGN
We performed a systematic review and meta-analysis of existing literature comparing rates of FS with and without ADM use.
RESULTS
Eight studies were shortlisted for qualitative study, of which 7 compared rates of FS with and without the use of ADM. A total of 211 patients underwent parotidectomy with the use of ADM. Of these, mean patient age was 44.7 (SD ± 7.2); 89 of 159 were pleomorphic adenoma (55.9%), 29 of 159 with histological diagoses stated were Warthin's tumor (18.2%), and 159 of 211 were other histologic diagnoses (25.7%). Subjective and objective incidence rates for FS were 23 of 211 (10.9%) and 7 of 211 (3.3%), respectively. Patients in whom ADM barriers were used had significantly lower rates of subjective and objective FS (relative risk = 0.22; 95% confidence interval, 0.09-0.57; P = .002; and relative risk = 0.07; 95% confidence interval, 0.07-0.33; P < .001), respectively, compared to patients with no ADM.
CONCLUSION
The use of ADM was associated with lower FS rates compared to no ADM and should be considered in routine use to prevent this condition.
Topics: Acellular Dermis; Adenoma, Pleomorphic; Humans; Sweating, Gustatory
PubMed: 35431179
DOI: 10.1016/j.oooo.2021.12.123 -
Journal of Plastic, Reconstructive &... Aug 2022Prepectoral implant-based breast reconstruction (PIBR) has regained popularity, despite decades-long preference for subpectoral implant placement. This paper aims to... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Prepectoral implant-based breast reconstruction (PIBR) has regained popularity, despite decades-long preference for subpectoral implant placement. This paper aims to compare patient-reported outcomes (PRO) between prepectoral and subpectoral approaches to implant-based breast reconstruction (IBBR). The primary PRO was with the BREAST-Q, and postoperative pain scores, while the secondary outcomes were complication rates.
METHODS
A comprehensive literature search of the PubMed library was performed. All studies on patients undergoing IBBR after mastectomy that compared prepectoral to subpectoral placement and PROM or postoperative pain were included.
RESULTS
A total of 3789 unique studies of which 7 publications with 216 and 332 patients who received prepectoral and subpectoral implants, respectively, were included for meta-analysis. Patients with prepectoral implant placement had significantly higher satisfaction with the outcome (p = 0.03) and psychosocial well-being (p = 0.03) module scores. The pain was lower in patients with prepectoral implants on postoperative day 1 (p<0.01) and day 7 (p<0.01). The subgroup analysis of prepectoral breast implants showed that complete acellular dermal matrix coverage had lower rates of wound dehiscence (p<0.0001), but there were no significant differences in complications between one-stage and two-stage procedures.
CONCLUSION
Overall, patients with prepectoral implants reported higher BREAST-Q scores and lower postoperative pain and lower complications rates than patients with subpectoral implants. In appropriately selected patients, prepectoral implant placement with ADM coverage, be it the primary placement of an implant or placement of a tissue expander before definitive implant placement, should be the modality of choice in patients who choose IBBR. Further research should focus on patient selection, strategies to reduce cost and cost-benefit analysis of PIBR.
Topics: Acellular Dermis; Breast Implantation; Breast Implants; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Pain, Postoperative; Pectoralis Muscles; Quality of Life; Retrospective Studies
PubMed: 35393263
DOI: 10.1016/j.bjps.2022.02.019 -
Journal of Surgical Oncology Aug 2022Cutaneous metastases (CM) are neoplastic lesions involving the dermis or subcutaneous tissues, originating from another primary tumor. Breast cancer is commonest primary... (Review)
Review
Cutaneous metastases (CM) are neoplastic lesions involving the dermis or subcutaneous tissues, originating from another primary tumor. Breast cancer is commonest primary solid tumor, representing 24%-50% of CM patients. There is no "standard of care" on management. In particular, the role of surgery in the treatment of cutaneous metastases from breast carcinoma (CMBC) remains controversial. This systematic review evaluates the role of cutaneous metastasectomy in breast cancer and provides an overview of existing treatment types.
Topics: Breast Neoplasms; Female; Humans; Lung Neoplasms; Metastasectomy; Skin Neoplasms
PubMed: 35389520
DOI: 10.1002/jso.26870 -
Orbit (Amsterdam, Netherlands) Aug 2022Management of pediatric anophthalmia and resultant micro-orbitism is challenging. The efficacy and safety of treatment methods vary with age as bony changes grow... (Review)
Review
Management of pediatric anophthalmia and resultant micro-orbitism is challenging. The efficacy and safety of treatment methods vary with age as bony changes grow recalcitrant to implants in those at skeletal maturity and osteotomies become technically challenging following frontal sinus pneumatization. This study aims to review methods for managing micro-orbitism and develop an age-based treatment approach. A systematic literature review was conducted. Data were screened and extracted by two investigators and relevant English-language primary-literature was analyzed. Information on sample-size, number of orbits, intervention, age, complications, and prosthetic retention was obtained. Representative case reports are presented, in addition. Nineteen studies met inclusion: 294 orbits in 266 patients were treated. Two studies reported distraction-osteogenesis. Two studies utilized bone grafting. Osteotomies were performed in 41 patients from three studies. Use of solid implants was detailed in two studies. Three studies described osmotic implant. Four studies described inflatable implants. Other techniques were described by three of the included studies, two of which utilized dermis-fat grafting. All but one study were observational case reports or case series. Across all studies regardless of surgical technique, risk of bias and heterogeneity was high due to attrition bias and selective outcomes-reporting. Selection of therapy should be tailored to skeletal-age to optimize outcomes; those 0-4 yrs are managed with dermis-fat grafts, 5-7 yrs managed with implants, and 8+ yrs managed with osteotomies. For those 8+ yrs with aerated frontal sinuses or insufficient bone stock, we propose onlay camouflage prosthetics which improve projection, increase orbital volume, and avoid risk for frontal sinus injury.
Topics: Algorithms; Anophthalmos; Bone Transplantation; Child; Frontal Sinus; Humans; Orbit
PubMed: 35298326
DOI: 10.1080/01676830.2022.2043391 -
JSES Reviews, Reports, and Techniques Aug 2022is a commensal intradermal microorganism that is commonly isolated at revision shoulder arthroplasty. Standard practice chlorhexidine gluconate (CHG) skin preparation... (Review)
Review
BACKGROUND
is a commensal intradermal microorganism that is commonly isolated at revision shoulder arthroplasty. Standard practice chlorhexidine gluconate (CHG) skin preparation agents have limited effectiveness at eradicating in the dermis. Benzoyl peroxide (BPO) has demonstrated effectiveness against . This meta-analysis compares the efficacy of at-home shoulder decolonization before surgery using CHG vs. BPO to reduce shoulder burden.
METHODS
This was a Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review. PubMed and MEDLINE databases were searched for studies evaluating the effects of CHG and BPO in reducing at the shoulder. Trial results were extracted and pooled using a random effects model, separating data from randomized controlled trials (RCTs) and non-RCTs. Methodologic quality of studies was assessed using the Cochrane Risk of Bias Assessment Tools.
RESULTS
Ten studies (589 patients) were included. RCTs showed that both BPO and CHG led to significant reductions in culture positivity compared with negative controls (risk ratio [RR] with 95% confidence interval [CI] = 0.20 [0.13, 0.30], < .0001 and 0.46 [0.37, 0.57], < .0001, respectively). Non-RCT data demonstrated similar results comparing BPO and CHG to the control (RR with 95% CI = 0.34 [0.21, 0.57], < .0001 and 0.31 [0.20, 0.49], < .0001, respectively). Comparing BPO and CHG, RCT data showed a significant reduction in culture positivity with BPO (RR with 95% CI = 0.46 [0.27, 0.77], < .009). Of RCTs, 5 were low and one was of moderate risk of bias. Of non-RCTs, 3 had low risk of bias, whereas one had moderate risk of bias.
CONCLUSION
This review demonstrated that preoperative CHG and BPO can reduce at the shoulder. However, BPO exhibits greater efficacy than CHG, potentially because of the compound's ability to penetrate the dermis. BPO is a simple and economical agent that may reduce joint exposure to in shoulder surgery.
PubMed: 37588870
DOI: 10.1016/j.xrrt.2022.02.002 -
Dermatology Research and Practice 2021Photoaging can significantly contribute to lower quality of life. Medium-deep peeling using trichloroacetic acid allows controlled keratocoagulation through the dermis... (Review)
Review
Photoaging can significantly contribute to lower quality of life. Medium-deep peeling using trichloroacetic acid allows controlled keratocoagulation through the dermis and into the dermal papillary layer that is effective for skin rejuvenation. The purpose of this article is to give updates regarding the efficacy, possible adverse events, and patient satisfaction of trichloroacetic acid (TCA) peeling for skin rejuvenation by assessing various photoaging parameters. A systematic review of prospective trial articles collected from PubMed, MEDLINE, EMBASE, Cochrane, and Scopus databases was conducted on November 2, 2020. Treatment efficacy was assessed based on the photoaging parameters used by each study. Adverse events and patient satisfaction as the secondary outcome were assessed based on patients-perceived improvements. Five studies included three randomized comparison studies and two prospective cohort studies. These studies show that TCA peeling significantly improve the cosmesis of photoaged facial skin. Low concentration is effective for superficial sun damage. Medium-depth peels using a higher concentration of TCA or as combination therapy are effective as skin resurfacing agents to reduce wrinkles. Some adverse effects may occur but usually resolve within weeks. Overall patients were satisfied with the treatment result. An equivalent basic skin preparation such as topical retinoic acid skin priming prior to intervention is necessary for more objective comparison. Further research studies with a larger sample size and longer follow-up period are required. This evidence suggests that TCA peeling is effective in photoaging treatment, either as monotherapy or as combination therapy with other modalities.
PubMed: 34504524
DOI: 10.1155/2021/3085670 -
Frontiers in Medicine 2021The skin is a flexible organ that forms a barrier between the environment and the body's interior; it is involved in the immune response, in protection and regulation,...
The skin is a flexible organ that forms a barrier between the environment and the body's interior; it is involved in the immune response, in protection and regulation, and is a dynamic environment in which skin lipids play an important role in maintaining homeostasis. The different layers of the skin differ in both the composition and amount of lipids. The epidermis displays the best characteristics in this respect. The main lipids in this layer are cholesterol, fatty acids (FAs) and ceramides. FAs can occur in free form and as components of complex molecules. The most poorly characterized FAs are very long-chain fatty acids (VLCFAs) and ultra long-chain fatty acids (ULCFAs). VLCFAs and ULCFAs are among the main components of ceramides and are part of the free fatty acid (FFA) fraction. They are most abundant in the brain, liver, kidneys, and skin. VLCFAs and ULCFAs are responsible for the rigidity and impermeability of membranes, forming the mechanically and chemically strong outer layer of cell membranes. Any changes in the composition and length of the carbon chains of FAs result in a change in their melting point and therefore a change in membrane permeability. One of the factors causing a decrease in the amount of VLCFAs and ULCFAs is an improper diet. Another much more important factor is mutations in the genes which code proteins involved in the metabolism of VLCFAs and ULCFAs-regarding their elongation, their attachment to ceramides and their transformation. These mutations have their clinical consequences in the form of inborn errors in metabolism and neurodegenerative disorders, among others. Some of them are accompanied by skin symptoms such as ichthyosis and ichthyosiform erythroderma. In the following review, the structure of the skin is briefly characterized and the most important lipid components of the skin are presented. The focus is also on providing an overview of selected proteins involved in the metabolism of VLCFAs and ULCFAs in the skin.
PubMed: 34497816
DOI: 10.3389/fmed.2021.730855 -
International Journal of Dermatology Jun 2022Exogenous ochronosis is a potential side effect associated with hydroquinone, and treatment is often unsatisfactory. Our study objectives were to review data on... (Review)
Review
Exogenous ochronosis is a potential side effect associated with hydroquinone, and treatment is often unsatisfactory. Our study objectives were to review data on hydroquinone-associated ochronosis to determine risk factors for patients experiencing this adverse event. On September 27, 2020 (MEDLINE/PubMed), and October 30, 2020 (Scopus and Web of Science), databases were searched for "ochronosis + hydroquinone" by both authors to reduce risk basis. PRISMA reporting guidelines were used to select 56 articles with a total of 126 patients with hydroquinone-associated ochronosis. Included articles described hydroquinone-associated ochronosis. Articles were excluded if they had irrelevant content, were non-English language text, and were non-case studies. Full text articles were assessed and recorded. Cross-tabulation analysis was performed on categorical data, and Fisher exact test was performed. Ochronosis was most often reported in middle-aged women (53.2%), of African descent (45.2%), Black races (55.5%), and Fitzpatrick skin types V-VI (52.4%). It was most frequently reported with unknown and hydroquinone concentrations greater than 4% (32.5 and 35.7% cases, respectively). Median duration of use was 5 years, with only four cases reported with courses 3 months or shorter and eight cases reported with use 1 year or less. All patients presented with facial blue-black or gray-blue macules in a reticulate, lace-like fashion. Histopathology consistently showed solar elastosis and brownish-yellow, 'banana-shaped' fibers between degenerated collagen fibers of the papillary dermis. Based on these findings, we conclude that hydroquinone in concentrations above 4% and in treatment courses longer than 3 months may be associated with new-onset ochronosis.
Topics: Alkaptonuria; Female; Humans; Hydroquinones; Middle Aged; Ochronosis
PubMed: 34486734
DOI: 10.1111/ijd.15878