Asymptomatic radiolucent lesion of the posterior mandible.
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Adenocarcinoma↗
Biomedical subjects
Joseph I Helman
Publications and source records attributed to Joseph I Helman.
Obstructive sleep apnea: diagnosis, medical management and dental implications.
BACKGROUND: Patients with undiagnosed obstructive sleep apnea (OSA) represent a major public health problem, and studies suggest that the incidence of OSA may be even higher than estimated. TYPES OF STUDIES REVIEWED: The authors reviewed current literature describing comorbidities of patients with OSA. RESULTS: Sleep medicine is a relatively new field. Dental practitioners may lack educational exposure and, as a result, feel uncomfortable asking their patients sleep-related questions. While patients with well-controlled OSA present few difficulties for routine dental treatment, it is imperative that health care professionals understand the comorbidities associated with OSA and that untreated OSA may contribute to increased morbidity and mortality. CLINICAL IMPLICATIONS: Dental professionals have a unique doctor-patient relationship that affords them a role in recognizing sleep disorders by exploring the history of patients who are sleepy.
Continuous Positive Airway Pressure↗
Nuclear medicine in oral and maxillofacial diagnosis: a review for the practicing dental professional.
Nuclear medicine studies often play a significant role in the diagnosis and treatment of oral and maxillofacial diseases. While not commonly used in everyday dental practice, the dental provider should have a conversational knowledge of these imaging modalities and understand the indications and limitations of these studies. The purpose of this review is to discuss the nuclear medicine studies that have applications in the head and neck region as well as their indications, limitations, and diagnostic conclusions that can be drawn from these studies.
Citrates↗
Sleep-disordered breathing in Michigan: a practice pattern survey.
OBJECTIVES: This survey sought to determine whether self-professed sleep specialists in the State of Michigan show practice variations in the diagnosis and management of sleep-disordered breathing (SDB), and whether such variations occur between pulmonologists and neurologists. METHODS: Questionnaires on practice volume and patterns during the prior 12 months were mailed to physician members of the Michigan Sleep Disorders Association ( n = 119); 67 were completed and returned. RESULTS: Respondents reported that they personally saw a median of 8 new patients each week for suspected SDB; estimates were that 86% of these patients were eventually confirmed to have SDB. Most patients (82%) had laboratory-based polysomnography after an initial clinic evaluation, and most (69%) of those treated for SDB received continuous positive airway pressure. However, practice patterns differed substantially among respondents, even when the analysis was limited to the 42 who reported board certification by the American Board of Sleep Medicine. For example, among all surveyed practices the likelihood that suspected SDB would be evaluated with a split-night diagnostic and treatment polysomnogram varied from 0 to 90%. The likelihood of SDB treatment with bilevel positive airway pressure varied from 0 to 50%, with automatically titrating devices from 0 to 100%, with surgery from 0 to 100% (0 to 50% among certified practitioners), and with oral appliances from 0 to 20%. The practice patterns of pulmonologists and neurologists did not differ significantly. CONCLUSION: Approaches to SDB vary widely in Michigan, though not according to clinician background in pulmonary medicine or neurology. A patient's experience, in both assessment and treatment, could differ substantially based on which clinician is consulted.
Humans↗
The role of midfacial degloving approach for maxillary cysts and tumors.
PURPOSE: The midfacial degloving approach has been used as a surgical approach to gain access to regions of the midface that would otherwise require external incisions. This article describes the role of this technique for various maxillary lesions. PATIENTS AND METHODS: Thirteen patients underwent the midfacial degloving technique for 8 maxillary benign lesions and 5 malignant lesions. This procedure uses 4 basic incisions: 1) sublabial incision, 2) bilateral intercartilaginous incisions, 3) septocolumellar-complete transfixion incisions, and 4) bilateral piriform aperture incisions extending to the vestibule. RESULTS: All patients successfully underwent the planned procedures after the midfacial degloving technique for the treatment of benign or malignant lesions without significant complications. Postoperative sequelae were nasal crusting and infraorbital hypesthesia, both of which resolved. CONCLUSIONS: The midfacial degloving approach offers good exposure of the mid third of the face with excellent cosmetic results. This approach may be combined with downfracture of the maxilla for access to expose and resect sinonasal malignancies. The midfacial degloving technique is a viable procedure with low morbidity and excellent cosmetic outcomes.
Adolescent↗
Clinical application of the temporoparietal-galeal flap in closure of a chronic oronasal fistula: review of the anatomy, surgical technique, and report of a case.
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Adenocarcinoma↗
A model to facilitate outcome assessment of obstructive sleep apnea.
OBJECTIVES: Obstructive sleep apnea is a common disorder with significant morbidity and effects on quality of life. Management can include a range of mechanical, behavioral, and surgical approaches. This paper aims to devise a model of management options to assist in initial cost-effectiveness investigations. METHODS: In the absence of practice pattern data and widely accepted guidelines, we reviewed published literature and devised a model of treatment options to facilitate initial studies of outcomes, costs, and cost-effectiveness. RESULTS: Obstructive sleep apnea is rarely addressed by conservative behavioral-based strategies because these options, while inexpensive, have only limited effectiveness. Effective treatment most often relies on nasal continuous positive airway pressure, but poor tolerance or compliance sometimes leads to treatment with oral appliances or surgery. Patients treated by one modality may try another if the initial strategy is ineffective. Laboratory evidence that sleep apnea is effectively treated, and long-term follow-up, are necessary regardless of the treatment modality chosen. CONCLUSIONS: Each patient's treatment plan must be individually tailored, but the management model proposed here reflects available evidence-based literature and the authors' impression of current practice patterns. This model should be useful for initial cost-effectiveness investigations.
Cost-Benefit Analysis↗
Effects of pH on human bone marrow stromal cells in vitro: implications for tissue engineering of bone.
The objective of this study was to address the hypothesis that changes in extracellular pH alter collagen gene expression, collagen synthesis, and alkaline phosphatase activity in bone marrow stromal cells (BMSCs). Potential effects of pH on cell function are of particular importance for tissue engineering because considerable effort is being placed on engineering biodegradable polymers that may generate a local acidic microenvironment on degradation. Human and murine single-cell marrow suspensions were plated at a density of 2 x 10(4) cells/cm(2). After 7 days in culture, the pH of the culture medium was adjusted to one of six ranges: > or = 7.8, 7.5.-7.7, 7.2-7.4, 6.9-7.1, 6.6-6.8, or < or = 6.5. After 48 h of exposure to an altered pH, alkaline phosphatase activity and collagen synthesis decreased significantly with decreasing pH. This decrease was two-to threefold as pH decreased from 7.5 to 6.6. In contrast, alpha1(I) procollagen mRNA levels increased two- to threefold as pH was decreased. The trend in osteocalcin mRNA expression was opposite to that of collagen. Small shifts in extracellular pH led to significant changes in the ability of BMSCs to express markers of the osteoblast phenotype. These pH effects potentially relate to the microenvironment supplied by a tissue-engineering scaffold and suggest that degrading polymer scaffolds may influence the biologic activity of the cells in the immediate environment.
Alkaline Phosphatase↗
The posteriorly based platysma flap in oral and facial reconstruction: A case series.
PURPOSE: The purpose of this study was to assess the reliability and use of the posteriorly based platysma flap for oral and facial reconstruction. PATIENTS AND METHODS: This case series consists of 7 patients who were reconstructed with a posteriorly based platysma flap for various tumor resection defects of the oral and facial region. The flaps were monitored for complications, including skin loss and ischemia in the postoperative period. RESULTS: Three of the patients (43%) in this study had no complications. Three patients (43%) had some skin sloughing, but the underlying muscle remained viable and mucosalized normally. One patient (14%) had 40% flap loss of the distal end, possibly due to vascular compromise that occurred during a concomitant neck dissection. CONCLUSION: The posteriorly based platysma flap is a reliable reconstruction option for defects in the facial and oral region. If skin sloughing occurs, it is usually inconsequential for intraoral reconstruction as the underlying muscle remains viable and undergoes epithelialization.
Aged↗