Treatment of Localized and Referred Masticatory Myofascial Pain with Botulinum Toxin Injection.

Botulinum toxin type A (BTA) injection is considered an available alternative treatment for myofascial pain. However, its efficacy in treating masticatory myofascial pain syndrome (MMPS) remains unclear. The purpose of this study was to evaluate whether the BTA injection into the affected muscles would significantly reduce pain and improve function, and to assess its efficacy, safety, and therapeutic indications in a randomized, single-center clinical trial. Sixty patients with MMPS were randomized into three groups evenly to receive a single session injection of saline solution (SS group), lidocaine (LD group), and BTA (BTA group) in the masseter, temporal, and pterygoid muscles after an electromyographic study. Patients' pain was classified as localized or referred according to the DC/TMD classification. Assessments were performed on pre-treatment, and subsequently, on days 7, 14, 28, 60, 90, and 180. A significant reduction in pain and improvement of mandibular movements was found in the BTA group compared to the SS and LD groups. The response lasted until day 180 and was more intense in patients with localized myalgia and focused myofascial pain than in referred remote pain. No significant adverse reactions were observed. A single BTA injection can be considered an effective treatment option in patients with localized MMPS by reducing pain and improving mandibular movements, which persisted up to 6 months

Treatment of Localized and Referred Masticatory Myofascial Pain with Botulinum Toxin Injection

Botulinum toxin type A (BTA) injection is considered an available alternative treatment for myofascial pain. However, its efficacy in treating masticatory myofascial pain syndrome (MMPS) remains unclear. The purpose of this study was to evaluate whether the BTA injection into the affected muscles would significantly reduce pain and improve function, and to assess its efficacy, safety, and therapeutic indications in a randomized, single-center clinical trial. Sixty patients with MMPS were randomized into three groups evenly to receive a single session injection of saline solution (SS group), lidocaine (LD group), and BTA (BTA group) in the masseter, temporal, and pterygoid muscles after an electromyographic study. Patients’ pain was classified as localized or referred according to the DC/TMD classification. Assessments were performed on pre-treatment, and subsequently, on days 7, 14, 28, 60, 90, and 180. A significant reduction in pain and improvement of mandibular movements was found in the BTA group compared to the SS and LD groups. The response lasted until day 180 and was more intense in patients with localized myalgia and focused myofascial pain than in referred remote pain. No significant adverse reactions were observed. A single BTA injection can be considered an effective treatment option in patients with localized MMPS by reducing pain and improving mandibular movements, which persisted up to 6 months

Synchronous occurrence of IgG4-related sialadenitis and ductal carcinoma of the parotid gland: a case report.

Immunoglobulin G4-related disease (IgG4-RD) is a rare chronic systemic inflammatory pathology that poses a diagnostic challenge since it can simulate malignancy when it affects a salivary gland as a mass-like lesion. Here, the authors report an unusual clinical case of a 42-year-old man who presented with a painless, slow-growing swelling located in the right parotid gland with a 12-month evolution. Based on imaging tests and open biopsy, a diagnosis of chronic parotitis was presumed and oral methylprednisolone was prescribed. Due to poor response to medication, a total parotidectomy preserving the facial nerve was performed. The final pathology described a unilateral IgG4-related sialadenitis (IgG4-RS) in the parotid gland in combination with a poorly differentiated multifocal ductal carcinoma. The postoperative course was uneventful except for a temporary facial paresis (grade III according to the House-Brackmann classification system) that resolved completely within 5 months. There were no systemic manifestations on the whole-body 18F-FDG PET/CT. Adjuvant radiotherapy was administered without complications. Twenty-four months follow-up after surgery showed no recurrence or evidence of systemic involvement. This clinical report highlights the importance of considering the synchronous occurrence of a carcinoma underlying an isolated parotid gland mass in the context of IgG4-RS, especially if there is no response to prior steroid medication

Anatomical features associated with venous congestion in DIEP flap using CT angiography with three-dimensional reconstruction

Aim: Computed tomography angiography (CTA) using three-dimensional (3D) virtual reconstruction has been increasingly used in planning deep inferior epigastric artery perforator (DIEP) breast reconstruction. Although the most common complication associated with this surgery is diffuse venous congestion, its origin remains unclear. The aim of this study was to assess the anatomical characteristics of the anterior abdominal wall vessels that could predict venous congestion, using CTA with 3D virtual reconstruction.Methods: A retrospective case-control study was conducted and a total of 169 DIEP flaps were reviewed. An abdominal CTA with 3D virtual reconstruction was analyzed with regard to anatomical features of the abdominal wall vessels. Seven venous congestive cases were identified. For each case, 3 controls that had not exhibited any vascular complications were randomly selected.Results: The global venous congestion rate was 4.14%. No statistically significant differences were found between the groups’ superficial inferior epigastric vein (SIEV) diameter (P = 0.915), number of branches of SIEV (P = 0.371), number of perforators per flap (P = 0.255), flap subcutaneous tissue thickness (P = 0.652), direct communications between SIEV-perforators (P = 0.418), and communications of both SIEVs across the abdominal midline (P = 0.371).Conclusion: The present study provided new information concerning the identification of the controversial anatomical features associated with venous congestion in DIEP flaps. CTA and 3D virtual reconstruction were useful tools for evaluating the abdominal wall anatomy and for planning DIEP breast surgery, but neither for predicting nor preventing the diffuse congestive phenomenon

Estimated projection of oral cavity and oropharyngeal cancer deaths in Spain to 2044.

Oral cavity cancer (OCC) and oropharyngeal cancer (OPC) are two common malignancies whose mortality is worryingly increasing worldwide. However, few studies have estimated the mortality trends for these cancers in the coming years. This study analysed the mortality rates for OCC and OPC observed between 1980 and 2019 to generate a predictive model for the next 25 years in Spain. Mid-year population data and death certificates for the period 1980-2019 were obtained from the Spanish National Institute of Statistics. The Nordpred program (Norwegian Cancer Registry, Oslo, Norway) was used to calculate adjusted mortality rates as well as estimated mortality projections with an age-period-cohort model for the period 2020-2044. The specific mortality rate per 100,000 inhabitants for OCC decreased from 2.36 (1980-1984) to 2.17 (2015-2019) and is expected to decline to 1.68 (2040-2044), particularly in males. For OPC, mortality rates rose from 0.67 (1980-1984) to 1.23 (2015-2019) and are projected to drop to 0.71 (2040-2044). In the group of females > 65 years predictions showed rising mortality rates for both OCC and OPC. The predictive model projects more deaths in females than in males for OCC in the period 2040-2044, while deaths for OPC will decrease in males and gradually increase in females. Although OCC mortality rates have been found to decrease in males in the last observed decades, there is still room to improve them in females > 65 years in the future by promoting campaigns against smoking and alcohol consumption. OPC mortality will become a growing health problem. Vaccination campaigns for the prevention of human papillomavirus-associated cancers may have a long-term impact on the mortality of these cancers, which should be evaluated in upcoming studies. Our findings highlighted the importance of closely monitoring OCC and OPC mortality rates in the coming years by age group and sex, and the need to continue preventive measures against the main known risk factors, such as tobacco, alcohol, and human papillomavirus infection

Infrahyoid flap in oropharyngeal reconstruction following carcinoma resection: A study of 6 patients and literature review

The present study aimed to describe the techniques used and the results obtained with the infrahyoid flap for the reconstruction of medium-sized oropharyngeal defects following resection for advanced squamous cell cancer. During a period of 1 year, six patients with oropharyngeal defects were reconstructed using the infrahyoid flap. The tumor characteristics, location and size of the defect, resective and reconstructive techniques employed and the complications and outcomes of the speech and swallowing functions, as identified in the follow-up visits every 3 months, were evaluated. All flaps were performed simultaneously in association with tumoral excision and ipsilateral supraomohyoid neck dissection. The mean size of the skin paddle was 7.0x3.5 cm. The donor site was primarily sutured. The postoperative course was uneventful and all flaps were viable. One case of marginal skin paddle loss occurred without affecting the survival of the flap. Five patients received postoperative radiotherapy and one patient received concurrent postoperative chemotherapy. During the follow-up period (mean, 63 months), all patients showed excellent oral swallowing. Speech was excellent in five patients and in one patient speech was classified as good. The aesthetic results of the cervical donor site were good. Based on the present case report and the literature review, the infrahyoid flap is a simple and safe procedure for the reconstruction of the oropharynx, with a high success rate, minimal donor site morbidity and good aesthetic and functional results. The infrahyoid flap is a valid surgical option that may be considered in selected oncological patients undergoing reconstruction of medium-size oropharyngeal defects