The red ear syndrome: five new cases Dear Sir We read with great attention the article of Kumar and Swanson (1), which report two new cases of red ear syndrome (RES), since we are very interested in this disorder (2).In the last years we have diagnosed other five patients with this syndrome whose reports we believe can complement the cases published before.We have summarized the clinical and laboratory findings of our cases in Table 1.We would like to emphasize some aspects of our series. First, the motive of consultation was not in any case a reddening of the ear, but facial paralysis (case 1) and headache or facial pain in the remainder. Second, we have observed in addition to the two cases reported by Lance (3) another patient who presented the syndrome associated with a temporomandibular joint dysfunction (case 5).As for the aetiology, besides the case associated with dysfunction of the temporomandibular joint, two others were the result of injury of the upper cervical roots of infectious (virus herpes zoster, case 1) and compressive cause (Chiari I malformation, case 3). In this case, the RES was presumably caused by temporary compression of the cerebellar tonsils during physical activity (sexual); this sensitivity to exercise is consistent with reduced compliance of the subarachnoid space (4).
Background
Short implants are proposed as a less invasive alternative with fewer complications than standard implants in combination with sinus lift. The aim of this systematic review and meta-analysis was to state the efficacy of placing short implants (≤ 6 mm) compared to standard-length implants (≥ 8 mm) performing sinus lift techniques in patients with edentulous posterior atrophic jaws. Efficacy will be evaluated through analyzing implant survival (IS) and maintenance of peri-implant bone (MBL).
Methods
Screening process was done using the National Library of Medicine (MEDLINE by PubMed), EMBASE, the Cochrane Oral Health, and Web of Science (WOS). The articles included were randomized controlled trials. Risk of bias was evaluated according to The Cochrane Collaboration’s tool. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). A random-effects model was applied. Secondary outcomes such as surgical time, patient satisfaction, mucositis and peri-implantitis, pain, and swelling were analyzed.
Results
Fourteen studies (597 patients and 901 implants) were evaluated. IS was 1.02 risk ratio, ranging from 1.00 to 1.05 (CI 95%) (p = 0.09), suggesting that IS was similar when both techniques were used. MBL was higher in patients with standard-length implants plus sinus lift elevation (p = 0.03). MBL was 0.11 (0.01–0.20) mm (p = 0.03) and 0.23 (0.07–0.39) mm (p = 0.005) before and after 1 year of follow-up, respectively, indicating that the marginal bone loss is greater for standard-length implants.
Discussion
Within the limitations of the present study, as relatively small sample size, short dental implants can be used as an alternative to standard-length implants plus sinus elevation in cases of atrophic posterior maxilla. Higher MBL was observed in the groups where standard-length implants were used, but implant survival was similar in both groups. Moreover, with short implants, it was observed a reduced postoperative discomfort, minimal invasiveness, shorter treatment time, and reduced costs.
Clinical Clinical relevance
The low MBL promoted by short implants does contribute to a paradigm shift from sinus grafting with long implants to short implants. Further high-quality long-term studies are required to confirm these findings.
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