A 45-degree Upward Tension-Releasing Epicanthoplasty Performed in 712 Consecutive Cases

xlomafota13 shared this article with you from Inoreader A 45-degree Upward Tension-Releasing Epicanthoplasty Performed in 712 Consecutive Cases Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 20:S1748-6815(21)00220-5. doi: 10.1016/j.bjps.2021.03.116. Online ahead of print. ABSTRACT BACKGROUND: Medial epicanthoplasty is commonly used to enhance the aesthetic outcomes of double-eyelid operations in Asia. However, epicanthoplasty can cause problems such as scarring and excessive exposure of the lacrimal lakes. OBJECTIVES: To resolve the problems associated with epicanthoplasty and to create more natural and long-lasting double-eyelid fold lines while minimizing incisions, we performed a 45-degree upward tension-releasing epicanthoplasty. MATERIALS AND METHODS: A total of 712 patients underwent 45-degree upward tension-releasing epicanthoplasty, with or without double eyelidplasty. A triangular skin flap was elevated at a 45-degree angle from the epicanthal fold. The surrounding area was dissected to eliminate the rigid connective tissue between the orbicularis muscle and the skin, which creates skin tension. The incisions were sutured, and a small incision toward the medial canthus was added to further decrease tension and create space for the triangular flap to be transposed. RESULTS: A total of 707 patients underwent 45-degree upward tension-releasing epicanthoplasty with the double-eyelid procedure, and 5 patients underwent 45-degree upward tension-releasing epicanthoplasty alone. No complications were observed for any patients, and 95% of patients were satisfied with this technique. CONCLUSIONS: The 45-degree upward tension-releasing epicanthoplasty can release the tension in the epicanthal fold, minimize scarring, and control lacrimal lake exposure. In particular, this method was effective for creating an in-out double-fold line starting from the epicanthus and for maintaining the double-eyelid line, which can reduce unnecessary incisional double-eyelid surgery. PMID:34049838 | DOI:10.1016/j.bjps.2021.03.116 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Acute limb shortening or creation of an intentional deformity to aid in soft tissue closure for IIIB/IIIC open tibia fractures

xlomafota13 shared this article with you from Inoreader Acute limb shortening or creation of an intentional deformity to aid in soft tissue closure for IIIB/IIIC open tibia fractures Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 20:S1748-6815(21)00207-2. doi: 10.1016/j.bjps.2021.03.105. Online ahead of print. ABSTRACT BACKGROUND: Ring fixator techniques can precisely correct complex long bone deformities. In select patients, controlled shortening or intentional fracture deformation with delayed correction can also aid in complex wound coverage and limb salvage. METHODS: This retrospective cohort study analyzed all patients who underwent acute limb shortening or intentional temporary fracture deformation between 2005 and 2020. Patients were divided into three groups based on reason for acute shortening or intentional deformity: (1) skeletal indications alone, with traditional flap coverage; (2) skeletal and soft tissue indications, to augment traditional reconstructive measures; and (3) skeletal and soft tissue indications, to avoid microsurgery altogether. Comorbidities, orthopedic and reconstructive methods, and f unctional outcomes were recorded. RESULTS: Eighteen patients were identified: six in Group 1, five in Group 2, and seven in Group 3. Fractures were primarily in the distal third of the tibia. On initial assessment, all wounds would have required free tissue transfer. Group 1 patients were reconstructed with free flaps. Among Group 2, closure was accomplished by skin grafting (N = 1), local flaps (N = 1), pedicled muscle flaps (N = 1), and free flaps (N = 2). In Group 3, five wounds were closed primarily and two were skin grafted. All limbs were shortened, averaging 25.1 mm; seven were intentionally deformed, most commonly varus (10-20°). After skeletal correction, residual leg length discrepancy averaged 5.7 mm. No patients required amputation. CONCLUSIONS: Acute skeletal shortening with or without intentional temporary deformation in select IIIB/IIIC open tibial fractures can facilitate soft tissue coverage and limb salvage in patients who might otherwise require amput ation. PMID:34049839 | DOI:10.1016/j.bjps.2021.03.105 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

xlomafota13 shared this article with you from Inoreader Multi-Disciplinary Skull Base Conference and its Effects on Patient Management Via otol rhinol Ann Otol Rhinol Laryngol. 2021 May 28:34894211021251. doi: 10.1177/00034894211021251. Online ahead of print. ABSTRACT OBJECTIVE: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. METHODS: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. RESULTS: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. CONCLUSIONS: For a significant proportion of patients with pathology of the lateral skull base, the management plan ch anged as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes. PMID:34049445 | DOI:10.1177/00034894211021251 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy

xlomafota13 shared this article with you from Inoreader A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy Via otol rhinol Ann Otol Rhinol Laryngol. 2021 May 28:34894211018926. doi: 10.1177/00034894211018926. Online ahead of print. ABSTRACT OBJECTIVE: The sialendoscopy era in the treatment of salivary gland stones has reduced the use of classical surgical methods. However, the miniature ducts and tools may cause difficulties in removing large sialoliths. Therefore, invasive combined oral surgeries or gland resection may be considered. We searched for the most suitable method in order to stay in line with the minimally invasive approach that preserves the ductus anatomy, and that can reduce the surgical fears of patients. MATERIALS AND METHODS: The study included 84 cases (23 parotid and 61 submandibular) in whom stones were fragmented by pneumatic lithotripsy and removed between January 2015 and January 2020. The parotid cases comprised 7 females and 16 males, and the submandibular cases comprised 25 females and 36 males. Intraductal lithotripsy was performed using pneumatic lithotripter. This study has fourth level of evidence. RESULTS: Based on total number of cases (n = 84), success rate was 67/84 (79.7%) immediately after sialendoscopy, and overall success rate was 77/84 (91.6%). Based on number of stones treated (n = 111), our immediate success rate was 94/111 (84.6%), and overall success rate was 104/111 (93.7%). The success criteria were complete removal of the stone and fragments in a single sialendoscopy procedure and resolution of symptoms. CONC LUSIONS: We successfully treated salivary gland stones, including L3b stones, in our patient cohort with sialendoscopy combined with pneumatic lithotripsy. The lithotripsy method that we have adapted seems to be more useful and cost-effective compared to its alternatives. We were also able to preserve the ductus anatomy and relieve patients' concerns.Level of Evidence: Level IV. PMID:34049458 | DOI:10.1177/00034894211018926 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anatomical study of the thoracic duct and its clinical implications in thoracic and pediatric surgery, a 70 cases cadaveric study

xlomafota13 shared this article with you from Inoreader Anatomical study of the thoracic duct and its clinical implications in thoracic and pediatric surgery, a 70 cases cadaveric study Via radiol anat Surg Radiol Anat. 2021 May 29. doi: 10.1007/s00276-021-02764-z. Online ahead of print. ABSTRACT INTRODUCTION: Given the high variability and fragility of the thoracic duct, good knowledge of its anatomy is essential for its repair or to prevent iatrogenic postoperative chylothorax. The objective of this study was to define a site where the thoracic duct is consistently found for its ligation. The second objective was to define an anatomically safe surgical pathway to prevent iatrogenic chylothorax in surgery for aortic arch anomalies with vascular ring, through better knowledge of the anatomical relationships of the thoracic duct. METHODS: Seventy adult formalin-fixed cadavers were dissected. The anatomical relationships of the thoracic duct were reported at the postero-inferior mediastinum, at levels T3 and T4. RESULTS: The thoracic duct was consistently situated between the left anterolateral border of the azygos vein and the right border of the aorta between levels T9 and T10, whether it was simple, double, or plexiform. It was located medially, anteromedially, or posteriorly to the left subclavian artery in 51%, 21%, and 28% of the cases, respectively, at the level of T3. At T4, it was posteromedial in 27% of the cases or had no direct relationship with the aortic arch. CONCLUSION: These results favor mass ligation of the thoracic duct at levels T9-T10 between the right border of the aorta and the azygos vein, eventually including the latter. To prevent iatrogenic postoperative chylothorax in aortic arch anomalies with vascular ring surgery, we recommend remaining strictly lateral to the left subclavian artery at the level of T3 to reach the aortic arch anomalies with vascular ring at T4. PMID:34050781 | DOI:10.1007/s00276-021-02764-z View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment Outcomes of Sinonasal Malignancies Involving the Orbit

xlomafota13 shared this article with you from Inoreader Treatment Outcomes of Sinonasal Malignancies Involving the Orbit Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1730353 Objective Orbital invasion is associated with a poor prognosis in cases of sinonasal malignancy. This study aimed to analyze the oncological outcomes of sinonasal malignancies involving the orbit. Patients and Methods We reviewed the medical records of 116 patients with a sinonasal malignancy who had orbital invasion at initial diagnosis and followed up at least 6 months between June 1991 and October 2017 at a single institute. The overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) rates according to the clinicopathological factors, extent to orbit, and treatment modality were compared. Results Patients were mainly treated with surgery and postoperative radiation (n = 39, 33.6%) and concurrent chemoradiation (n = 72, 62.1%). Only five patients (5.1%) underwent orbital exenteration. The OS, DSS, and PFS rates significantly decreased in patients older than 60 years of age and in patients with a higher Charlson Comorbidity Index Score (each p < 0.001). The OS and DSS rates were higher in patients at clinical T3 and N0 stage than in patients at clinical T4 and N1–2 stage (each p < 0.05). There were no significant differences in survival and local control rates according to the extent of orbital invasion, treatment modalities, and orbital preservation. However, neoadjuvant chemotherapy and adjuvant radiation or concurrent chemoradiation increased survival rates in the patients treated with surgery. Conclusion Orbit preservation and relatively successful oncological outcome could be obtained with surgery and adjuvant radiation or concurrent chemoradiation. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparative Outcomes by Surgical Approach in Patients with Malignant Sinonasal Disease

xlomafota13 shared this article with you from Inoreader Comparative Outcomes by Surgical Approach in Patients with Malignant Sinonasal Disease Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729978 Objective There is a paucity of data on comparative outcomes for open versus endoscopic surgery for patients with malignant sinonasal pathology. Most of the available studies are limited by a sample size <100 patients. Design This is a retrospective cohort study. Setting The findings of this study come from a single-institution tertiary care center from 2008 to 2019. Participants In total, 199 patients who underwent surgery for malignant sinonasal disease participated in this study. Main Outcome Measures The main outcome measures were perioperative complications and reoperation. Results Patients in our sample had a mean age of 59.7 years (SD, 20.4). In total, 62% were male and 72% were white. An endoscopic-only approach was used in 41% of patients and an open or combined approach in 59% of patients. Squamous cell carcinoma was the most common pathology (43.0%), followed by sarcoma (9.5%), skin cancer (6.5%), sinonasal undifferentiated carcinoma (6.5%), and adenocarcinoma (5.5%). The all-cause complication rate was 14.6%. Patients with an open resection had a higher rate of intraoperative complications (5.9 vs. 0%; p = 0.043), postoperative complications (19.5 vs. 3.7%; p = 0.001), and all-cause complications (21.0 vs. 3.7%; p < 0.001). The likelihood of early reoperation (<6 months) or late reoperation (>6 months) did not significantly differ by surgical approach (p = 1.000 and 0.741, respectively). Conclusion The endoscopic approach for resection of malignant sinonasal disease is viable for select patients and may be associated with a favorable complication rate compared with the open approach. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic Endonasal versus Transcranial Optic Canal Decompression: A Morphometric, Cadaveric Study

xlomafota13 shared this article with you from Inoreader Endoscopic Endonasal versus Transcranial Optic Canal Decompression: A Morphometric, Cadaveric Study Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729909 Introduction Decompression of the optic nerve within the optic canal is indicated for compressive visual decline. The two most common approaches utilized for optic canal decompression are a medial approach with an endoscopic endonasal approach and a lateral approach with a craniotomy. Our study is a cadaveric anatomical study comparing the length and circumference of the orbit decompressed via an endoscopic endonasal approach versus a frontotemporal craniotomy. Methods Five cadaveric specimens were utilized. Predissection computed tomography (CT) scans were performed on each specimen. On each specimen, a standard frontotemporal craniotomy with anterior clinoidectomy and superolateral orbital decompression was performed on one side and an endoscopic endonasal approach with medial wall decompression was performed on the contralateral side. Post-dissection CT scans were performed. An independent radiologist provided measurements of the length (mm) and circumference (degrees) of optic canal decompression bilaterally. Results The mean length of optic canal decompression for open and endoscopic approach was 13 mm (range 12–15 mm) and 12.4 mm (range 10–16 mm), respectively. The mean circumference of decompression for open and endoscopic approaches was 252.8 degrees (range 205–280 degrees) and 124.6 degrees (range 100–163 degrees), respectively. Conclusion The endoscopic endonasal and the transcranial approaches provide a similar length of optic canal decompression, but the transcranial approach leads to greater circumferential decompression. The endoscopic endonasal approach has the benefit of being minimally invasive, though. Ultimately, the surgical approach decision should be based on the location of the pathology and the surgeon's comfort. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Headache Before and After Endoscopic Transsphenoidal Pituitary Tumor Surgery: A Prospective Study

xlomafota13 shared this article with you from Inoreader Headache Before and After Endoscopic Transsphenoidal Pituitary Tumor Surgery: A Prospective Study Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729180 Objective Headache is a common symptom among patients with pituitary tumors, as it is in the general population. The aim of the study was to investigate headache as a symptom in patients with pituitary tumors before and 6 months after endoscopic transsphenoidal surgery (TSS). Design This is a prospective observational cohort study. Setting This study was conducted at university tertiary referral hospital. Participants A total of 110 adult patients underwent endoscopic TSS for pituitary tumors. Main Outcome Measures The Migraine Disability Assessment (MIDAS) questionnaire was used before and 6 months after surgery for the assessment of headache. Clinical variables with potential influence on headache were analyzed. Results Sixty-eight (62%) patients experienced headaches at least once during the 3 months before surgery. Thirty (27%) patients reported disabling headache before surgery, with younger age being an independent associated factor (p < 0.001). In patients with disabling headache before surgery, the median (interquartile range) MIDAS score improved from 78 (27–168) to 16 (2–145; p = 0.049), headache frequency decreased from 45 (20–81) to 14 (4–35) days (p = 0.009), and headache intensity decreased from 6 (5–8) to 5 (4–7) (p = 0.011) after surgery. In total, 16 of the 30 (53%) patients reported a clinically relevant improvement and five (17%) a clinically relevant worsening. Four (5%) patients developed new disabling headache. No predictor for postoperative improvement of headache was identified. Conclusion In this prospective study, the results show that disabling headache improves following endoscopic TSS in a subset of patients with pituitary tumors. However, no predictive factors for improvement could be identified. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Prospective Evaluation of Quality of Life in Patients Undergoing Extended Endoscopic Endonasal Surgery for Benign Pituitary Gland Lesion

xlomafota13 shared this article with you from Inoreader A Prospective Evaluation of Quality of Life in Patients Undergoing Extended Endoscopic Endonasal Surgery for Benign Pituitary Gland Lesion Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1730322 Introduction Endoscopic endonasal surgery (EES) has become the preferred approach for pituitary tumor resection. Nevertheless, research on quality of life related to pituitary adenoma surgery is scarce. Objective The aim of the study is to evaluate short-term quality of life in patients after endoscopic endonasal resection of pituitary tumors and to find predictors for poor quality of life (QOL) outcome. Materials and Methods A prospective cohort study was conducted, including all patients who underwent EES for pituitary tumors in a tertiary medical referral center. Recruited patients completed the Anterior Skull Base Disease-Specific QOL (ASBS-Q) questionnaire and the Sinonasal Outcome Test 22 (SNOT-22) questionnaire before surgery, 2 and 4 to 6 months after surgery. Demographic and clinical data was collected. Results Our study included 49 patients. The overall ASBS-Q scores significantly improved 4 to 6 months after surgery (4.46 vs. 4.2, p < 0.05). We found a significant improvement in QOL related to emotional state 2 months post surgery (4.41 vs. 3.87, p < 0.05), which became borderline significant 4 to 6 months post surgery. There was a significant improvement in pain (4.5 vs. 4.08, p < 0.05) and vitality (4.43 vs. 4.16, p < 0.05) domains 4 to 6 months post surgery. SNOT-22 scores did not change significantly postoperatively. Factors such as secreting and non-secreting tumors, tumor size, intraoperative cerebrospinal fluid leak, gross tumor resection, endocrine remission, and the use of nasoseptal flap reconstruction did not have a significant effect on QOL. Conclusion We found that patients after EES reported improved QOL 4 to 6 months post surgery. Specific improvement was noted in the QOL related to pain and vitality. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.