Phase 2, randomized, double-blind, dose-ranging study evaluating the safety, tolerability, population pharmacokinetics, and efficacy of oral torezolid phosphate in patients with complicated skin and skin structure infections

Torezolid (TR-700) is the active moiety of the prodrug torezolid phosphate ([TP] TR-701), a second-generation oxazolidinone with 4- to 16-fold greater potency than linezolid against Gram-positive species including methicillin-resistant Staphylococcus aureus (MRSA). A double-blind phase 2 study evaluated three levels (200, 300, or 400 mg) of oral, once-daily TP over 5 to 7 days for complicated skin and skin structure infections (cSSSI). Patients 18 to 75 years old with cSSSI caused by suspected or confirmed Gram-positive pathogens were randomized 1:1:1. Of 188 treated patients, 76.6% had abscesses, 17.6% had extensive cellulitis, and 5.9% had wound infections. S. aureus, the most common pathogen, was isolated in 90.3% of patients (139/154) with a baseline pathogen; 80.6% were MRSA. Cure rates in clinically evaluable patients were 98.2% at 200 mg, 94.4% at 300 mg, and 94.4% at 400 mg. Cure rates were consistent across diagnoses, regardless of lesion size or the presence of systemic signs of infection. Clinical cure rates in patients with S. aureus isolated at baseline were 96.6% overall and 96.8% for MRSA. TP was safe and well tolerated at all dose levels. No patients discontinued treatment due to an adverse event. Three-stage hierarchical population pharmacokinetic modeling yielded a geometric mean clearance of 8.28 liters/h (between-patient variability, 32.3%), a volume of the central compartment of 71.4 liters (24.0%), and a volume of the peripheral compartment of 27.9 liters (35.7%). Results of this study show a high degree of efficacy at all three dose levels without significant differences in the safety profile and support the continued evaluation of TP for the treatment of cSSSI in phase 3 trials.

Ameloblastic carcinoma of the mandible with metastasis to the skull and lung: advanced imaging appearance including computed tomography, magnetic resonance imaging and positron emission tomography computed tomography

Ameloblastic carcinoma is a very rare malignant odontogenic tumour with characteristic histopathological and clinical features, which requires aggressive surgical treatment and surveillance and, therefore, differs from ameloblastoma. Metastasis typically occurs in the lung. Only one patient with metastasis to the skull has previously been described and no prior case reports have presented MRI and positron emission tomography-CT (PET-CT) imaging findings. We describe a case of ameloblastic carcinoma with metastasis to the skull and lung with emphasis on imaging features including MRI and PET-CT.

Changes in quality of life after surgical removal of impacted mandibular third molar teeth

BACKGROUND

The decision to get impacted teeth removed is not straightforward because of the concerns about its possible outcome. Assessment of quality of life is now regarded as an essential component for assessing outcomes of dental health care. The purpose of this paper is to assess the effect of impacted third molar teeth surgery on a number of health related outcomes.

PATIENTS AND METHODS

A total of 72 patients undergoing surgical removal of their unilateral impacted mandibular third molar teeth were recruited to participate in this study. Patients were asked to complete two questionnaires, 14-item Oral Health Impact Profile (OHIP-14) and the 16-item UK Oral Health related Quality of Life measure questionnaire (OHQOLUK-16) daily for one week following surgery.

RESULTS

There was significant decrease in the mean OHQOLUK-16 score and OHIP-14 scores for the first five postoperative days. There were no significant differences in changes in the mean OHIP-14 scores or OHQOLUK-16 scores on postoperative day 6 and 7.

CONCLUSION

There was a significant deterioration in oral health related quality of life in the immediate postoperative period, which slowly returned to preoperative level by day 6. This information may be useful in creating realistic expectation for patients who are considering third molar surgery.

Complex composite odontoma associated with impacted tooth: A case report

Odontomas are the most common type of odontogenic tumors and are generally asymptomatic. This paper describes the case of a complex composite odontoma in a patient who had an asymptomatic swelling in the maxillary molar region, along with the impacted third molar. In this case, surgical excision of the lesion was performed, and the impacted third molar was intentionally left in situ so that it could erupt to the level of occlusion.

Surgical management of obstructive sleep apnea

Obstructive sleep apnea (OSA) syndrome is a common disorder that has recently received much attention by the medical community due to its potentially serious physiological consequences. The clinical significance of OSA results from hypoxemia and sleep fragmentation caused by collapse of the airway, which leads to apnea or hypopnea during sleep. This paper reviews common surgical techniques used for clinical management of OSA patients, with emphasis on jaw advancement surgical procedures.

Stability of maxillary advancement using rigid fixation and porous-block hydroxyapatite grafting: cleft palate versus non-cleft patients

This study was undertaken to evaluate the stability of maxillary advancement using bone plates for skeletal stabilization and porous block hydroxyapatite (PBHA) as a bone graft substitute for interpositional grafting in cleft and non-cleft patients. The records of 74 patients (41 females, 33 males) who underwent Le Fort I maxillary advancement using rigid fixation and PBHA interpositional grafting were evaluated retrospectively. All patients also underwent simultaneous sagittal split mandibular ramus osteotomies. Patients were divided into 2 groups for study purposes: group 1 consisted of 17 cleft palate patients and group 2 consisted of 57 non-cleft patients. Each group was further subdivided into 2 subgroups based on the concurrent vertical positioning of the maxillary incisors: groups 1a and 2a, where the maxilla underwent 3 mm or more of inferior repositioning, and groups 1b and 2b, where the maxilla underwent minimal vertical change (< or = 1 mm). Presurgery, immediate postsurgery, and longest follow-up lateral cephalometric tracings were superimposed and analyzed to calculate surgical change and long-term stability of results by assessing horizontal and vertical changes at point A, incisor superius, and the mesial cusp tip of maxillary first molar. The average follow-up time in group 1 was 37.9 months (range 12 to 136) and in group 2 was 28.77 months (range 17 to 88). Average maxillary advancement at point A was: group 1a, 5.4 mm; group 1b, 5.25 mm; group 2a, 5.48 mm; group 2b, 5.46 mm. Average relapse at point A was: group 1a, -0.75 mm; group 1b, -1 mm; group 2a, -0.47 mm; group 2b, -0.48 mm. Average horizontal and/or vertical relapse at the central incisors and first molars was 1 mm or less in group 1 and less than 0.5 mm in group 2. Although there was a slightly greater relapse in group 1, no statistically significant difference was observed between the groups. Maxillary advancement with Le Fort 1 osteotomies using rigid fixation and interpositional PBHA grafting during bimaxillary surgery is a stable procedure with good predictability in cleft and non-cleft patients, regardless of the direction of vertical maxillary movement.

The Mitek mini anchor for TMJ disc repositioning: surgical technique and results

This study evaluated our treatment outcomes in 105 patients (188 discs) using the Mitek mini anchor for temporomandibular joint (TMJ) articular disc repositioning surgery, with 88 patients having simultaneous orthognathic surgery. Criteria for inclusion into the study were: (1) Presurgical TMJ disc displacement with salvageable disc; (2) No prior TMJ surgery; (3) TMJ disc repositioning with the Mitek mini anchor; (4) Absence of connective tissue/autoimmune disease; (5) Absence of postsurgical trauma; and (6) Minimum of 12 months postsurgery follow up. Presurgery (T1), immediately postsurgery (T2), and longest follow up (LFU) clinical and radiographic evaluations were performed. The mean age of the patients was 32.6 years (range 14-57 years), and mean follow-up time was 46.2 months (range 14-84 months). Radiographic evaluation at LFU demonstrated no significant condylar resorption or positional changes of the anchors. At LFU, there was a statistically significant reduction in: TMJ pain, facial pain, headaches, TMJ noises and disability, and improvement in jaw function and diet. Maximum incisal opening improved slightly and lateral excursive movements decreased slightly. The Mitek mini anchor provides a predictable method for stabilizing the TMJ articular disc to the condyle and a high success rate in decreasing TMJ dysfunction and pain in patients with no previous TMJ surgery.

Mitek anchors for treatment of chronic mandibular dislocation

OBJECTIVE

The purpose of this study was to present a new technique for limiting mandibular translation in patients with chronic mandibular dislocation. TECHNIQUE DESIGN: This relatively simple procedure uses 2 Mitek mini bone anchors with osseointegration potential. One anchor is placed in the lateral pole of the condyle, and the other is placed in the posterior root of the zygomatic arch. Heavy suture material is threaded through the eyelet of each anchor and tightened to function as a restraining ligament.

RESULTS

This technique has been used on 5 patients with a follow-up of 2 to 4 years, with no failures.

CONCLUSIONS

This technique provides an effective method for the prevention of condylar dislocation while permitting some controlled translation.