Faculty Bibliography

The objective of this split-mouth clinical study was to compare a combination of in-office and at-home dental bleaching with at-home bleaching alone. Two applications of in-office bleaching were performed, with one appointment per week, using 38% hydrogen peroxide. At-home bleaching was performed with or without in-office bleaching using 10% carbamide peroxide in a custom-made tray every night for 2 weeks. The factor studied was the bleaching technique on two levels: Technique 1 (in-office bleaching combined with home bleaching) and Technique 2 (home bleaching only). The response variables were color change, dental sensitivity, morphology, and surface roughness. The maxillary right and left hemiarches of the participants were submitted to in-office placebo treatment and in-office bleaching, respectively (Phase 1), and at-home bleaching (Phase 2) treatment was performed on both hemiarches, characterizing a split-mouth design. Enamel surface changes and roughness were analyzed with scanning electron microscopy and optical interferometry using epoxy replicas. No statistically significant differences were observed between the bleaching techniques for either the visual or the digital analyses. There was a significant difference in dental sensitivity when both dental bleaching techniques were used, with in-office bleaching producing the highest levels of dental sensitivity after the baseline. Microscopic analysis of the morphology and roughness of the enamel surface showed no significant changes between the bleaching techniques. The two techniques produced similar results in color change, and the combination technique produced the highest levels of sensitivity. Neither technique promoted changes in morphology or surface roughness of enamel.

INTRODUCTION: Keloids represent a challenging problem for plastic surgeons and patients. Surgical excision remains the definitive treatment for immediate lesion debulking. However, post-excisional recurrence rates are reported to be 45% - 100%. We present a series of 5 patients undergoing excision of keloids and a staged reconstructive approach using a dermal regeneration substrate and epidermal grafting to minimize recurrence and donor site morbidity. METHODS: Keloids were completely excised down to normal subcutaneous tissue or perichondrium. A bilaminar dermal regeneration matrix (Integra, Integra Lifesciences Corp.) was approximated to the entire wound, with the silicone lamina oriented superficially. Reconstruction was delayed for at least 21 days to allow for neo-dermal ingrowth. The silicone lamina was then removed, and an epidermal skin graft was harvested from the thigh using an epidermal graft harvesting system (CelluTome, KCI Inc.) and secured to the neo-dermis with non-occlusive dressing (Tegaderm, 3M). Dressings were removed after 7-14 days. Reconstructed defects and donor sites were assessed for recurrence of keloids and scar appearance. RESULTS: 5 patients underwent treatment. Two patients had keloids involving the superior helix of the ear with average area of 2.6 cm. Two patients had keloids involving the chest with average area of 28 cm. One patient had a keloid in the pubic region with an area of 10 cm. All had failed at least one previous treatment with direct excision and steroid injections. Mean follow up was 48.8 weeks [38-60 weeks]. Patients required an average of 5.5 weeks for complete wound epithelialization. There were no instances of infection or cellulitis. All reconstructed defects were aesthetically acceptable and remained flat without significant widening. There were no long-term complaints of pruritis or pain, and no evidence of scarring at donor sites. CONCLUSION: Epidermal graft harvesting devices are a new weapon in the armamentarium of reconstructive surgeons. Epidermal grafting provides significant advantages when used in conjunction with a dermal regeneration matrix. This approach obviates reliance on skin creep and flap undermining to achieve primary closure. Exclusion of dermis and significant extracellular matrix components limits contracture exerted by the graft, further facilitating tension-free wound healing. Scarring response within the donor site and graft are also minimized because the dermis is not violated.

Background Surgical management of head and neck cancer is resource intensive and physiologically demanding. In patients with incurable disease, although the indications for surgery are not well defined, palliative benefit can be significant. The goal of this investigation was to compare outcomes of patients who underwent resection and reconstruction of head and neck cancer with curative intent with those who underwent similar procedures with palliative intent. Methods A retrospective review of patients who underwent reconstruction for head and neck cancer between 2008 and 2014 was conducted. Patients were divided into curative and palliative groups. Outcomes assessed included postoperative complications and survival. Results A total of 147 patients who underwent 156 operations met inclusion criteria (27 palliative and 129 curative). In both cohorts, the most common histology was squamous cell carcinoma (SCC) and the most common primary tumor site was the oral cavity. There was no significant difference between the cohorts in the rates of systemic and reconstructive complications, postoperative hospital length of stay, 30-day mortality, and flap survival. Overall survival in palliative patients was significantly shorter compared with curative patients (median OS, 6.2 months vs. 56.1 months, respectively; p < 0.0001). Among patients undergoing palliative surgery, patients without carotid involvement and those with non-SCC were significantly more likely to have longer survival. Conclusion Surgical resection with reconstruction is possible in head and neck oncologic patients undergoing palliative treatment. Palliative patients have similar short-term outcomes when compared with patients undergoing resection for curative intent. Quality-of-life and economic implications of these approaches deserve closer scrutiny.

OBJECTIVE: To analyze indications and outcomes for primary premaxillary setback. DESIGN: Retrospective. SETTING: Academic children's hospital. PATIENTS: All children with bilateral complete cleft lip age