Abstract Objective Zuckerkandl’s tubercle (ZT), when present, is an anatomical landmark by which surrounding structures such as the recurrent laryngeal nerve (RLN) can be identified intraoperatively. ...This study aimed to investigate the prevalence and anatomical characteristics of Zuckerkandl’s tubercle by combining cadaveric dissection with a meta-analysis. Methods Through October 2016, an extensive search of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science was completed. Extracted data, along with the findings from our cadaveric dissections, were pooled into a meta-analysis to assess the prevalence and size of ZT and its relationship to the RLN. Results The pooled prevalence estimate of a ZT was 70.2% in the general population, 65.0% of which were considered Grade 0 tubercles (<1.0 cm) and 35.0% Grade 1 (≥1.0 cm). The RLN ran posteromedially to the ZT in 82.7% of cases, laterally to it in 8.7%, and on top of it in 8.6% of hemilarynges. Conclusion RLN palsy is a common postoperative complication and cause for litigation following neck surgery. The ZT is a common component of the thyroid gland and with proper knowledge, surgeons can use it to reliably and quickly identify the RLN during operative procedures.
Introduction
The recurrent laryngeal nerves (RLN) are branches of the vagus nerve that go on to innervate most of the intrinsic muscles of the larynx. Historically, the RLN has been considered to ...branch after it enters the larynx, but numerous studies have demonstrated that it often branches before. The wide variability of this extralaryngeal branching (ELB) has significant implications for the risk of iatrogenic injury. We aimed to assess the anatomical characteristics of ELB comprehensively.
Methods
Articles on the ELB of the RLN were identified by a comprehensive database search. Relevant data were extracted and pooled into a meta-analysis of the prevalence of branching, branching pattern, distance of ELB point from the larynx, and presence of positive motor signals in anterior and posterior ELB branches.
Results
A total of 69 articles (
n
= 28,387 nerves) from both intraoperative and cadaveric modalities were included in the meta-analysis. The overall pooled prevalence of ELB was 60.0 % (95 % CI 52.0–67.7). Cadaveric and intraoperative subgroups differed with prevalence rates of 73.3 % (95 % CI 61.0–84.0) and 39.2 % (95 % CI 29.0–49.9), respectively. Cadavers most often presented with a ELB pattern of bifurcation, with a prevalence of 61.1 %, followed by no branching at 23.4 %. Branching of the RLN occurred most often at a distance of 1–2 cm (74.8 % of cases) prior to entering the larynx. A positive motor signal was most often noted in anterior RLN branches (99.9 %) but only in 1.5 % of posterior branches.
Conclusions
The anatomy of the RLN is highly variable, and ELB is likely to have been underreported in intraoperative studies. Because of its high likelihood, the possibility of ELB needs to be assessed in patients to prevent iatrogenic injury and long-term postoperative complications.
The aim of this study was to analyze the root canal morphology of maxillary third molars (MTMs) using micro-computed tomography (micro-CT).
Seventy-eight consecutively-extracted human MTMs were ...scanned using micro-CT (spatial resolution=13.68μm per pixel). Dedicated software (SkyScan®) was used to create virtual reconstructions and perform 3D-analysis. A range of anatomical features were assessed; externally (root number, length, fusion, curvature, apex), within the pulp chamber (distance between canal orifices, floor thickness) and within the root canal system (root canal number, classification, ramifications, isthmuses, apical constriction).
The donor age ranged from 19 to 73 years (mean±SD 32.3±16.5years). MTMs possessed one or three roots, which principally curved buccally/palatally (75.9%), had 1–4 root canals and typically no apical constriction (84.4%). The average external root length was 11.89±1.53mm, while root canal length was 10.18±0.35mm. The root canal diameter 1mm from the apex was 0.37±0.23mm and negatively correlated with donor’s age (r=−0.76; p=0.01), while pulp chamber thickness positively correlated with age (r=0.58; p=0.035). Significantly, furcation canals, canal loops and root canal calcifications were sporadic findings.
In some cases the anatomy of MTMs may not be as complicated as previously documented, being similar to the reported anatomy of other maxillary molars. During root canal treatment of MTMs, the frequent deviation of the apical foramen from the radiographic apex should be considered, as should the absence of an apical constriction in the majority of cases. In addition, buccal/palatal root curvature, often undiagnosed radiographically, is the most common root curvature in MTMs.
Purpose
The purpose of the study was to analyze the total prevalence, morphologic, and morphometric characteristics of the pterygospinous (PS) bar and its gender and ethnic differences among ...populations. PS bar is an ossified anatomic structure stretching between the posterior margin of the lateral pterygoid lamina to the angular spine of the undersurface of the sphenoid, with potential clinical implications. There is no consensus in the literature on its prevalence, morphologic, and morphometric characteristics.
Methods
A thorough search of databases was conducted. Data on the prevalence, morphology, i.e., ossification type (complete and incomplete), side, gender, laterality, and morphometrics, of the PS bar were extracted and pooled into a meta-analysis.
Results
A total of 35 studies (
n
= 14,047 subjects) were analyzed. The overall pooled prevalence of a complete PS bar was 4.4% (95% CI 3.7–5.1), while the overall pooled prevalence of an incomplete PS bar was significantly higher (11.6% 95% CI 8.5–15.2). A complete PS bar was more prevalent among males and was more commonly unilaterally, on the left side.
Conclusion
The overall prevalence of PS bar is quite common. It could be of importance for clinicians who should consider its potential presence when planning surgical approaches to the retropharyngeal and parapharyngeal space.
Purpose
This international EORTC validation study (phase IV) is aimed at testing the psychometric properties of a quality of life (QoL) module related to oral health problems in cancer patients.
...Methods
The phase III module comprised 17 items with four hypothesized multi-item scales and three single items. In phase IV, patients with mixed cancers, in different treatment phases from 10 countries completed the EORTC QLQ-C30, the QLQ-OH module, and a debriefing interview. The hypothesized structure was tested using combinations of classical test theory and item response theory, following EORTC guidelines. Test–retest assessments and responsiveness to change analysis (RCA) were performed after 2 weeks.
Results
Five hundred seventy-two patients (median age 60.3, 54 % females) were analyzed. Completion took <10 min for 84 %, 40 % expressed satisfaction that these issues were addressed. Analyses suggested a revision of the phase III hypothesized scale structure. Two items were deleted based on a high degree of item misfit, together with negative patient feedback. The remaining 15 items formed one eight-item scale named OH-QoL score, a two-item information scale, a two-item scale regarding dentures, and three single items (
sticky saliva
/
mouth soreness
/
sensitivity to food
/
drink
). Face and convergent validity and internal consistency were confirmed. Test–retest reliability (
n
= 60) was demonstrated as was RCA for patients undergoing chemotherapy (
n
= 117;
p
= 0.06). The resulting QLQ-OH15 discriminated between clinically distinct patient groups, e.g., low performance status vs. higher (
p
< 000.1), and head-and-neck cancer versus other cancers (
p
< 0.03).
Conclusion
The EORTC module QLQ-OH15 is a short, well-accepted assessment tool focusing on oral problems and QoL to improve clinical management.
Trial Registration
ClinicalTrials.gov
Identifier: NCT01724333.
Purpose. The aim of this meta-analysis was to provide a comprehensive evidence-based assessment, supplemented by cadaveric dissections, of the value of using the Ligament of Berry and ...Tracheoesophageal Groove as anatomical landmarks for identifying the Recurrent Laryngeal Nerve. Methods. Seven major databases were searched to identify studies for inclusion. Eligibility was judged by two reviewers. Suitable studies were identified and extracted. MetaXL was used for analysis. All pooled prevalence rates were calculated using a random effects model. Heterogeneity among included studies was assessed using the Chi2 test and the I2 statistic. Results. Sixteen studies (n=2,470 nerves), including original cadaveric data, were analyzed for the BL/RLN relationship. The RLN was most often located superficial to the BL with a pooled prevalence estimate of 78.2% of nerves, followed by deep to the BL in 14.8%. Twenty-three studies (n=5,970 nerves) examined the RLN/TEG relationship. The RLN was located inside the TEG in 63.7% (95% CI: 55.3–77.7) of sides. Conclusions. Both the BL and TEG are landmarks that can help surgeons provide patients with complication-free procedures. Our analysis showed that the BL is a more consistent anatomical landmark than the TEG, but it is necessary to use both to prevent iatrogenic RLN injuries during thyroidectomies.
Purpose
Communication between patients and professionals is one major aspect of the support offered to cancer patients. The European Organisation for Research and Treatment of Cancer (EORTC) Quality ...of Life Group (QLG) has developed a cancer-specific instrument for the measurement of different issues related to the communication between cancer patients and their health care professionals.
Methods
Questionnaire development followed the
EORTC QLG Module Development Guidelines
. A provisional questionnaire was pre-tested (phase III) in a multicenter study within ten countries from five cultural areas (Northern and South Europe, UK, Poland and Taiwan). Patients from seven subgroups (before, during and after treatment, for localized and advanced disease each, plus palliative patients) were recruited. Structured interviews were conducted. Qualitative and quantitative analyses have been performed.
Results
One hundred forty patients were interviewed. Nine items were deleted and one shortened. Patients’ comments had a key role in item selection. No item was deleted due to just quantitative criteria. Consistency was observed in patients’ answers across cultural areas. The revised version of the module EORTC QLQ-COMU26 has 26 items, organized in 6 scales and 4 individual items.
Conclusions
The EORTC COMU26 questionnaire can be used in daily clinical practice and research, in various patient groups from different cultures. The next step will be an international field test with a large heterogeneous group of cancer patients.
Abstract Purpose This validation study was designed to assess the psychometric validity and quality of the Polish translation of the EORTC QLQ-LMC21 questionnaire in Polish colorectal patients ...suffering with liver metastases. Methods Patients with either histopathological or imaging confirmation of colorectal cancer with liver metastases, with a minimum of three months survival, were eligible for this study. These patients completed the Polish version of the EORTC core QLQ-C30, the QLQ-LMC21 module, and a demographic data questionnaire. The questionnaires were completed twice, once before undergoing either hepatectomy (n = 63) or palliative treatment (n = 97) and three months after the primary treatment. Standardized analyses of validity and reliability were performed. Results One hundred and sixty patients were enrolled in this study with the mean age of the hepatectomy group 64.3 ± 14.1 and 66.1 ± 12.7 for the palliative treatment group. The QLQ-LMC21 exhibited positive internal consistency with Cronbach's alpha coefficients ranging from 0.72 to 0.90. The multi-trait scaling analysis demonstrated adequate convergent and discriminant validity. Test-retest reliability was undertaken with 40 patients (25%) with the ICCs for each item ranging from 0.64 to 0.88. The hepatectomy group had a significantly greater Karnofsky Performance Score than the palliative treatment group (p.<0.001). Overall there were weak correlations between the two questionnaires which confirm that the QLQ-LMC21 addresses health issues not assessed in the QLQ-C30. Conclusion The Polish version of the QLQ-LMC21 proved to be a valid and reliable questionnaire to use in conjunction with the QLQ-C30 core questionnaire.
The pterygoalar (PA) bar is a bony bridge resulting from the partial or complete ossification of a PA ligament. The aim of this meta-analysis was to systematically analyze and provide the most ...comprehensive data on the prevalence, morphology and topographical anatomy of the PA bar.
A comprehensive search of the major electronic databases (PubMed, Embase, ScienceDirect, SciELO, BIOSIS, and Web of Science) was conducted in order to identify relevant studies. Studies reporting the prevalence, side of occurrence, gender dimorphism and morphometry of the PA bar were included in the current study.
A total of 25 articles (n = 16,168 subjects) were included in the meta-analysis. The overall pooled prevalence of the complete PA bar was 4.4% (95% CI: 3.0–6.0) and of the incomplete was 8.4% (95% CI: 4.6–13.3). The PA bar was most often observed unilaterally, on the left side. Analysis of geographical subgroups revealed considerable differences, with the lowest prevalence rates in Europe for both incomplete and complete PA bars.
Considering the prevalence and anatomical characteristics of the PA bar, caution is recommended while planning or performing transfacial needle approach to the foramen ovale and when considering a differential diagnosis for nerve compression or entrapment syndromes.
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