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Patel, Ankit, Hiren Shah, Aalok Shah, Sharvil Hetavbhai Gajjar, Ripple Shah, and Suril Shah. "To study surgical outcome of various surgical procedures of lateral release in valgus knee in total knee arthroplasty." International Journal of Research in Orthopaedics 3, no. 4 (June 23, 2017): 692. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20172091.
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<p class="abstract"><strong>Background:</strong> Fixed valgus deformity presents a major challenge in total knee arthroplasty (TKA), especially in moderate or severe cases. In knee arthritis, fixed-varus deformity (50 to 55%) is three times more frequent than fixed-valgus deformity (10 to 15%). Valgus deformity occurs more commonly in rheumatoid arthritis and also in osteoarthritis with hypoplasia of the lateral femoral condyle. Valgus deformity is often associated with flexion or external rotation contracture of the knee. In this study we aim to study the surgical outcome of total knee replacement in valgus deformity via standard medial parapatellar approach using various techniques like Pie –Crusting release of lateral structures or combined technique of pie crusting and standard release of lateral structures. Aim: To evaluate surgical outcome of various surgical techniques via standard medial parapatellar approach in fixed valgus deformity in Total Knee Arthroplasty.</p><p class="abstract"><strong>Methods:</strong> The present study involved both male and female patients with osteoarthritis of knee with valgus deformity. In present series, 26 consecutive patients of osteoarthritis with valgus deformity operated with total knee replacement were included. Previously operated cases of high tibial osteotomy and patients having contraindication for TKA were excluded from the study.<strong></strong></p><p class="abstract"><strong>Results:</strong> Valgus angle in this study was between 13 to 27 degree with average 17.84 degree. These results were comparable to many such similar studies. In our study, post operatively, knee society score was average 87.69 and function knee score was 82.5. Mean range of motion was 105 degree. In our study, mean tibiofemoral alignment improved from 17.84 valgus to 4.7 valgus.</p><p class="Default"><strong>Conclusions:</strong> Knee society score is excellent with both techniques and there is no difference in both techniques Iliotibial band and posterolateral capsule are most common structures that require release. Initial ligament balancing should be done with pie crusting and then sequential lateral release if require. </p>
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Dosen, L. K., and R. Haye. "Surgical closure of nasal septal perforation. Early and long term observations." Rhinology journal 49, no. 4 (October 1, 2011): 486–91. http://dx.doi.org/10.4193/rhino10.236.
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BACKGROUND: Results of surgical treatment of nasal septal perforation are usually evaluated using closure of the perforation as criterion of success. Patients, however, may still have symptoms. AIM: To assess the long-term results of surgical treatment of nasal septal perforation with bilateral, posterior based mucoperichondrial septal flaps using a four-point symptom score to ultimately improve treatment and selection criteria. METHODOLOGY: Patients were seen 6 months postoperatively. Questionnaires were sent to 116 surviving patients in 2008-2009. The response was 104. Patients reporting moderate or severe symptoms were seen as outpatients. RESULTS: Between 1987 and 2004, 126 patients were surgically treated using posterior based bilateral mucoperichondrial septal flaps. Sixteen patients had a reperforation during the first 3 months, and another 3 several years later. There was no correlation between early outcome and diagnosis, preoperative size of the perforation, gender or severity of preoperative crusting. There was an increased rate of reperforation with increasing age. Complications seen at the 6 months` follow-up of patients with closed perforations were lachrymal duct stenosis, partial vestibular stenosis, hypoesthesia, crusting and septal deviation, most of which were treatable. Long-term observation mean 10 years) of the same patients showed the following moderate or severe symptoms: crusting, obstruction and bleeding, mainly in men. Obstruction was often due to various forms of perennial rhinitis, sometimes to crusting and more rarely to septal deviation. Crusting was the only independent symptom. There was no correlation between crusting and diagnosis, preoperative size of the perforation, age or severity of preoperative crusting. CONCLUSIONS: Results of the surgical technique using posterior based bilateral mucoperichondrial septal flaps for treatment of nasal septal perforations were good, but depend on surgical expertise and age of the patient. Long-term results from other studies will be a guide to choose the proper surgical procedure to minimize the number of late symptoms. Prosthetic treatment cans be an alternative. Patients with return of symptoms should seek further advice.
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Dosen, L. K., and R. Haye. "Surgical closure of nasal septal perforation. Early and long term observations." Rhinology journal 49, no. 4 (October 1, 2011): 486–91. http://dx.doi.org/10.4193/rhino10.081.
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Background: Results of surgical treatment of nasal septal perforation are usually evaluated using closure of the perforation as criterion of success. Patients, however, may still have symptoms. Aim: To assess the long-term results of surgical treatment of nasal septal perforation with bilateral, posterior based mucoperichondrial septal flaps using a four-point symptom score to ultimately improve treatment and selection criteria. Methodology: Patients were seen 6 months postoperatively. Questionnaires were sent to 116 surviving patients in 2008-2009. The response was 104. Patients reporting moderate or severe symptoms were seen as outpatients. Results: Between 1987 and 2004, 126 patients were surgically treated using posterior based bilateral mucoperichondrial septal flaps. Sixteen patients had a reperforation during the first 3 months, and another 3 several years later. There was no correlation between early outcome and diagnosis, preoperative size of the perforation, gender or severity of preoperative crusting. There was an increased rate of reperforation with increasing age. Complications seen at the 6 months` follow-up of patients with closed perforations were lachrymal duct stenosis, partial vestibular stenosis, hypoesthesia, crusting and septal deviation, most of which were treatable. Long-term observation mean 10 years) of the same patients showed the following moderate or severe symptoms: crusting, obstruction and bleeding, mainly in men. Obstruction was often due to various forms of perennial rhinitis, sometimes to crusting and more rarely to septal deviation. Crusting was the only independent symptom. There was no correlation between crusting and diagnosis, preoperative size of the perforation, age or severity of preoperative crusting. Conclusions: Results of the surgical technique using posterior based bilateral mucoperichondrial septal flaps for treatment of nasal septal perforations were good, but depend on surgical expertise and age of the patient. Long-term results from other studies will be a guide to choose the proper surgical procedure to minimize the number of late symptoms. Prosthetic treatment cans be an alternative. Patients with return of symptoms should seek further advice.
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Iqbal, Zafer, Shahbaz Mujtaba Ghouri, Rehan Saleem, Aysha Nauman, Muhammad Nadeem, and M. Daood Saleem. "Inferior turbinate reduction by use of Diode Laser. A study on surgical outcome, post-operative crusting, and bleeding." Pakistan Journal of Medical and Health Sciences 15, no. 7 (July 26, 2021): 1739–41. http://dx.doi.org/10.53350/pjmhs211571739.
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Objectives: To assess the efficacy of the technique regarding the surgical outcome, post-operative crusting, and bleeding. Design: Single Blind interventional type of study. Study Place and period: This study was conducted at, Chaudhary Muhammad Akram Teaching and Research Hospital Lahore from July 2018 to June 2019. Material and methods: The study included 100 patients and the results of technique in respect to surgical outcome, the safety of technique regarding post-operative complications like crusting in the postoperative period and epistaxis were analyzed. Results: A total of 100 patients were included for research. Their ages were between 10-40 years. It was concluded that almost all the patients had felt improvement in their nasal blockage and postnasal discharge. The sneezing and headache in these patients also have been improved. Ten patients presented with nose crusting and 4 patient presented with mild epistaxis. No acitve intervention was not required in any patient. Conclusion: It was concluded that reduction of inferior turbinate by Diode laser is an excellent, and safe option, regarding the surgical outcome, and complications faced by patients registered for turbinate surgery. Keywords: Turbinates reduction, Diode laser, epistaxis.
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Omura, Kazuhiro, Kazuhiro Nomura, Teppei Takeda, Norihiro Yanagi, Hiroki Kuroyanagi, Taichi Yanagihara, Yasuhiro Tanaka, Hiromi Kojima, and Nobuyoshi Otori. "How I Do It: Inferior Turbinectomy: Modified Techniques for Submucosal Resection." Allergy & Rhinology 12 (January 2021): 215265672110347. http://dx.doi.org/10.1177/21526567211034736.
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Although inferior turbinectomy with submucosal resection effectively reduces the volume of the inferior turbinate, there is room for improvement in surgical procedures. Techniques have been developed to reduce crusting and bleeding while efficiently achieving volume reduction. State-of-the-art procedures pertaining to the local injection site, incision line, exposure of the periosteum, submucosal outfracture of the turbinate bone, trimming of redundant mucosa, and incision line suturing are described. Pre and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores and postoperative inferior turbinate bleeding and crusting were evaluated. For the 18 consecutive patients analyzed, the pre and postoperative NOSE scores were 67.8 ± 14.8 and 16.1 ± 13.0, respectively ( P = .0002). Postoperatively, bleeding was absent, and only minor suture thread crusting was observed in 13 patients. In conclusion, our novel technique improves the effectiveness of surgery as well as the postoperative quality of the inferior turbinate.
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Rafique, Atif, Maqbool Raza, Shahid Farooq Khattak, Muhammad Ali, Khalid Azam, and Muhammad Zubair. "COMPARATIVE STUDY BETWEEN CONVENTIONAL INFERIOR TURBINECTOMY AND ENDOSCOPIC INFERIOR TURBINOPLASTY FOR TREATMENT OF INFERIOR TURBINATE HYPERTROPHY." PAFMJ 71, Suppl-3 (December 31, 2021): S617–21. http://dx.doi.org/10.51253/pafmj.v71isuppl-3.4738.
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Objective: To compare efficacy of endoscopic turbinoplasty versus conventional inferior turbinectomy for hypertrophy of inferior turbinate.
Study Design: Comparative prospective study.
Place and Duration of Study: Ear, Nose and Throat (ENT) Department Combined Military Hospital (CMH) Multan, from Jun 2019 to May 2020.
Methodology: This study comprised of 50 patients of various age groups and both genders. Patients were grouped into two groups A and B, each group having 25 patients through random sampling. Patients in group A had endoscopic turbinoplasty whereas patients in group B had partial turbinectomy through conventional surgical method. Patients were followed regularly in both groups and were inspected postoperatively at 2 weeks, after 1 month and after 3 months.
Results: Patients who underwent Endoscopic turbinoplasty experienced less pain (p˂0.05) postoperatively at 2 weeks compared to conventional surgical turbinectomy. In addition, these patients showed statistically significant healing and reduced crusting at 1 month postoperatively. At 3 months post operatively all patients had healed completely as opposed to only 72% with surgical turbinectomy.
Conclusion: Endoscopic turbinoplasty is more effective than conventional surgical technique for inferior turbinate hypertrophy as it leads to less post-operative pain, reduced nasal crusting and earlier healing.
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Wong, S., and U. Raghavan. "Outcome of surgical closure of nasal septal perforation." Journal of Laryngology & Otology 124, no. 8 (May 20, 2010): 868–74. http://dx.doi.org/10.1017/s0022215110000745.
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AbstractObjective:To assess success rates and symptom control after surgical treatment of nasal septal perforation.Method:A prospective study was undertaken of 28 consecutive patients with symptomatic nasal septal perforation treated surgically by one surgeon between 2005 and 2007. All patients underwent an open rhinoplasty approach with bilateral superior and inferior nasal mucosal advancement flaps and acellular porcine collagen placed in between. Symptom severity was assessed pre- and post-operatively using a validated visual analogue score. The nasal valve angle was assessed pre- and post-operatively by two independent assessors.Results:Patients comprised 12 women and 16 men, with a mean age of 45 years (range: 21–76). The mean follow up was 16 months (range: 6–24). The mean vertical and horizontal diameters of the perforations were 22 mm (range: 10–35) and 27 mm (range: 10–37), respectively. Twenty-seven (96 per cent) patients had complete closure of nasal septal perforation. There were statistically significant differences between the pre- and post-operative mean visual analogue scale scores for epistaxis (p < 0.001), crusting (p < 0.001), whistling (p < 0.001) and nasal obstruction (p < 0.001). Epistaxis, crusting and whistling resolved in all patients, and 92 per cent reported improvement in nasal blockage.Conclusion:Closure of nasal septal perforation using an open rhinoplasty approach with nasal mucosal advancement flaps and a porcine collagen sandwich is a pertinent and reliable technique for the management of nasal septal perforation.
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Lu, G. Nina, Danielle F. Eytan, and Shaun C. Desai. "Simultaneous Septal Perforation and Deviation Repair with a Chondromucosal Transposition Flap." OTO Open 4, no. 2 (January 2020): 2473974X2092433. http://dx.doi.org/10.1177/2473974x20924332.
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Nasal septal perforations can cause issues of epistaxis, whistling, crusting, saddle deformity, and obstruction, which motivate patients to seek surgical repair. Numerous methods of septal perforation repair have been described, with surgical success rates ranging from 52% to 100%, but few studies address situations with concomitant septal deviation. In treating patients with septal perforation and deviation, both issues should be addressed for optimal outcomes. While routine septoplasty involves the removal of septal cartilage, septal perforation repair involves the addition of interposition grafts. The composite chondromucosal septal rotation flap harmoniously combines these seemingly conflicting goals as an effective and efficient technique for septal perforation repair. We present 3 patients successfully treated for their septal perforation and septal deviation concurrently with this technique.
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Jaju, Rahul Gopikishan, Ansari Muqtadeer Abdul Aziz, Mahesh R. Kade, and Sharad K. Salokhe. "Sequential two stage release for genu valgum correction in total knee replacement." International Journal of Research in Orthopaedics 4, no. 2 (February 23, 2018): 254. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20180512.
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<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Valgus deformity presents a major challenge in total knee replacement, especially in moderate or severe cases. Many surgical techniques have been described to balance<sup> </sup>the soft tissues in correction of a severe valgus deformity<sup> </sup>during total knee replacement. The structures most commonlyreleased in a valgus knee include the posterolateralaspect of the capsule, iliotibial band (IT band), the lateral collateral ligament (LCL), the popliteustendon, and the lateral head of the gastrocnemius muscle.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">thirty two patients undergoing unilateral total knee replacement were followed for the evaluation of study. There were 22 female (68%) and 10 males (32%) with an age of 62.7±6.9 years (range 50-75) with valgus deformity of 18.59˚±8.32˚ (range 10-40˚). Preoperative diagnosis was rheumatoid arthritis in 23 patients (72%) and osteoarthritis in 9 patients (28%). Posterior stabilizing cemented implants were used</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Based on total knee score we achieved 21 (63.64%) excellent, 10 (31.82%) good and 1 (4%) fair results. With the total functional score we had 16 (50%) excellent, 15 (45.45%) good and 1 (4%) fair results. In patients with only step1 release (17 patients) we achieved 84% (15 pts) excellent, 8% (1 pt) good, 8% (1 pt) fair with knee score; and 67% (11pts) excellent, 33% (6pts) good with functional score. In step 2 release group (15 pt) we achieved 10% (1 pt) excellent, 90% (14 pts) good with knee score; and 10% (1pt) excellent, 80% (13 pts) good and 10% (1 pt) fair with functional score. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Good to excellent results can be achieved with two step sequential lateral release of posterolateral capsule and IT band pie-crusting which has direct correlation with severity of valgus deformity. The safety, simplicity, and high success rate of the two step sequential lateral release of posterolateral capsule and pie-crusting of IT band justify its routine use to correct every valgus deformity in total knee replacement.</span></p>
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Santana, Jéssyca Porto, Roberto Hyczy Ribeiro Filho, Cassio Wassano Iwamoto, Maria Fernanda de Aguiar Soares, and Johann G. G. Melcherts Hurtado. "INFERIOR TURBINOPLASTY: COMPARISON BETWEEN THE DIRECT VISION AND NASAL ENDOSCOPIC TECHNIQUES." Journal of Contemporary Diseases and Advanced Medicine 1, no. 1 (April 1, 2022): 10–19. http://dx.doi.org/10.14436/jcdam.1.1.010-019.oar.
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The hypertrophy of inferior turbinates is considered one of the main causes of nasal obstruction. There are clinical and surgical options for treatment. If clinical control fails, the volumetric reduction of those structures is usually recommended. Theendoscopic approach is considered safe, as it enables a comprehensive assessment of the extent of the turbinate anatomy and effective hemostasis. Turbinoplasty is a procedure that requires manual skill and has the advantages of non-exposure of raw area, less chance of bleeding and less crusting. This study aimed to compare the postoperative outcome of patients who underwent inferior turbinoplasty under direct vision and via nasal endoscopy, through a prospective randomized study conducted at the IPO hospital (Instituto Paranaense de Otorrinolaringologia, Curitiba/PR, Brazil). In this study, 17 patients were evaluated and divided into two groups according to the surgical technique used. Both groups underwent flexible nasofibroscopy on the 15th and 30th day postoperatively, were asked if they experienced cacosmia, and if there was any need for nasal packing during the period. Although the video technique offers a broad view of the nasal anatomy and of the inferior turbinates, it demands more adequate material and more experience from the surgeon, and its surgical time is longer. By considering these results, we can conclude that there are no statistical differences between the postoperative results of the two turbinoplasty techniques.
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Mabry, Richard L. "Inferior Turbinoplasty: Patient Selection, Technique, and Long-Term Consequences." Otolaryngology–Head and Neck Surgery 98, no. 1 (January 1988): 60–66. http://dx.doi.org/10.1177/019459988809800111.
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When conservative medical management of symptomatically enlarged inferior turbinates is ineffective, the obstructing tissue may be reduced by an intramucosal or extramucosal destructive procedure (such as electrocautery, cryotherapy, or laser vaporization), or by conservative surgical resection. In the latter instance, enlarged conchal bones may be removed by the technique of turbinate submucous resection, while diffuse stromal hypertrophy necessitates partial resection of the inferior turbinates. A number of techniques of inferior turbinate surgery have been described. I have used the procedure of “inferior turbinoplasty” with increasing frequency for more than 9 years. Three to five years after such surgery, a detailed followup of 40 patients revealed none of the once-feared sequelae of turbinate resection, such as bleeding, crusting, foul nasal discharge, or bothersome postnasal drainage. Histologic examination of turbinates almost 5 years after turbinoplasty revealed fibrosis and scarring, with a marked decrease in mucous gland population, and normal mucosa. To obtain the best possible functional result inferior turbinate surgery is a necessary adjunct to most septal surgery. If conservatively done, it does not impair normal turbinate function. It must be stressed, however, that if the underlying cause of the turbinate hypertrophy is not addressed, recurrent obstruction can and probably will occur.
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Ohmori, Takaaki, Tamon Kabata, Yoshitomo Kajino, Tomoharu Takagi, and Hiroyuki Tsuchiya. "Effectiveness and Safety of Needle Medial Collateral Ligament Pie-Crusting in Total Knee Arthroplasty: A Cadaveric Study." Journal of Knee Surgery 31, no. 08 (September 5, 2017): 705–9. http://dx.doi.org/10.1055/s-0037-1606377.
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AbstractMedial collateral ligament (MCL) pie-crusting technique in total knee arthroplasty (TKA) is one of the methods of medial release. The effects and risks of blade pie-crusting have been reported in previous studies. However, only a few have reported the safety and efficacy of needle pie-crusting. In this cadaveric study, we quantitatively evaluated the amount of gap change by MCL needle pie-crusting. We investigated five knees of four fresh human cadavers and performed posterior-stabilized TKA. Only deep MCL release as the medial release was conducted. We punctured the MCL from the deep layer to the superficial layer using a 18 G needle in a 90-degree flexion position for 0, 10, 20, 50, 75, and 100 times. Medial and lateral gaps were measured accurately with a balancer at determined times in 0 and 90-degree flexion positions. Changes in medial and lateral gaps were not significant differences in flexion and extension position. However, in 90-degree flexion, medial gap changes were tended to be larger than lateral gap changes. A 0.6 mm additional medial release and a 0.2 mm additional lateral release were found per 10 times pie crust in flexion position (100 times, p: 0.08). However, large differences existed among the cases. Needle pie-crusting is safer than blade pie-crusting because of the small efficacy of one-time pie crust. MCL needle pie-crusting showed varied effects for each case. This result indicates the risk of relaxation of an unexpected gap. Caution should be taken when choosing between needle pie-crusting and blade pie-crusting.
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Claret-Garcia, Guillem, Jordi Montañana-Burillo, Eduard Tornero-Dacasa, Manel Llusá-Pérez, Dragos Popescu, Andreu Combalia-Aleu, and Sergi Sastre-Solsona. "Pie Crust Technique of the Deep Medial Collateral Ligament in Knee Arthroscopy: Ultrasound and Anatomic Study." Journal of Knee Surgery 32, no. 08 (August 15, 2018): 764–69. http://dx.doi.org/10.1055/s-0038-1668125.
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AbstractThis article determines compartment opening of the medial articular space of the knee after pie crust (PC) technique of the medial collateral ligament (MCL) by ultrasound measurements and anatomic dissection. This is a cadaveric study of 12 specimens. Four anatomic references were marked on the skin. Distances between the femur and tibia in the internal compartment at 30 degrees of flexion were obtained with ultrasound measurements in four situations: with and without applying valgus force both prior and after the PC technique. Ultrasound measurements of the medial articular compartment were made twice and mean value was calculated. An anatomical dissection was performed and distances between the puncture marks and the infrapatellar branch of the saphenous nerve was measured. Lilliefors test of normality was applied and variables were expressed as mean and standard deviation (SD). Qualitative variables were expressed by absolute frequencies and percentages. Statistical significance was a two-tailed p-value of < 0.05. Prior to the PC technique, mean (SD) distance between the femur and tibia in the medial compartment were 14.2 (4.0) mm in basal conditions and 17.1 (3.7) mm when applying valgus force (p = 0.003). PC technique increased the mean (SD) distance by 1.9 (1.9) mm under basal conditions (p < 0.01) and 2.9 (1.6) mm when applying valgus force (p < 0.01). The infrapatellar branches of the saphenous nerve were not damaged and the mean (SD) distance between the punctures and the nerve was 9.0 (3.3) mm. The PC is a reproducible, safe, and measurable surgical technique that opens controllably the medial compartment. PC as described avoided damage to the nerve branches.
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Pukhlik, Sergey, and Sergey Bezshapochny. "Management of patient after surgical interventions in nasal cavity and paranasal sinuses." OTORHINOLARYNGOLOGY, no. 1(2) 2019 (March 9, 2019): 54–65. http://dx.doi.org/10.37219/2528-8253-2019-1-54.
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Relevance: It was noted that after conducting еndonasal surgical interventions in the nasal cavity and paranasal sinuses, prolonged functional disorders were observed, accompanied by reactive edema, leading to sinus congestion, crusting and respiratory failure. Purpose: the aim of the study was to increase the effectiveness of treatment of patients with chronic rhinosinusitis by improving the technique of early postoperative rehabilitation. Materials and methods: the results were obtained from a comprehensive examination and treatment of 110 patients with chronic purulent and polypous sinusitis, aged 21 to 60 years, who were divided into two similar groups. Patients of the first group and second group received basic postoperative therapy, including systemic antibiotics. In addition, patients of the first group (main) instilled Sinuforte 1 time per day in both halves of the nose. Sinuforte began to be administered from the second day after surgery or the day after removal of tampons. Patients of the second group (control) washing the nose with saline 4-5 times a day and instilled Pinosol oil in the nose. Patients were evaluated for ten days after surgery. The subjective state of patients (complaints) was assessed, the clinical endoscopic picture, olfactometry were evaluated, rhinocytograms were performed. Results: a good clinical result was obtained, comparable or greater than the effect of treating patients without the inclusion of Sinuforte in complex therapy. In this case, the drug is administered once a day, while washing the nose and regular cleaning of the nasal cavity by a doctor is not required.
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Abdel-Aty, Yassmeen, Rachel B. Cain, Cullen Taylor, Michael J. Marino, Devyani Lal, and Stephen F. Bansberg. "Outcomes of Septal Perforation Repair With Concurrent Endoscopic Sinus Surgery." Otolaryngology–Head and Neck Surgery 165, no. 2 (January 26, 2021): 370–74. http://dx.doi.org/10.1177/0194599820982912.
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Objective This study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported. Study Design Case series. Setting Tertiary care center. Methods In this institutional review board–approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow-up. Results Fifty-six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3-41) mm in length by 9.3 (range, 2-23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow-up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs. Conclusion Patients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.
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Chahla, Jorge, Benjamin Sherman, Frank Wydra, and Michael B. Gerhardt. "The Pie-Crusting Technique for Capsular Management During Hip Arthroscopy." Arthroscopy Techniques 8, no. 1 (January 2019): e93-e96. http://dx.doi.org/10.1016/j.eats.2018.09.005.
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Polat, Barış, Deniz Aydın, Ayşe Esin Polat, Tahsin Gürpınar, Enes Sarı, Ramadan Özmanevra, Mehmet Yalçınozan, and Kaan Erler. "Objective Measurement of Medial Joint Space Widening with Percutaneous “Pie Crust” Release of Medial Collateral Ligament during Knee Arthroscopy." Journal of Knee Surgery 33, no. 01 (August 8, 2019): 094–98. http://dx.doi.org/10.1055/s-0039-1694711.
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AbstractKnee arthroscopy may be called the most commonly and increasingly performed orthopaedic procedure. Posterior medial compartment visualization may be quite challenging. The aim of the present study is to detect objective measurement of medial joint space widening with percutaneous “pie crust” release of medial collateral ligament (MCL) during knee arthroscopy. We used this technique for all knees that require any intervention in the posteromedial compartment and for tight knees in which adequate visualization of the posteromedial compartment cannot be obtained. Eighteen patients (18 knees) were included in this study. Patients were evaluated clinically with the Lysholm and Tegner scores at the final office visit. Joint balance, valgus instability, pain or tenderness on MCL region, and numbness over the medial side of the joint were also noted. Measurements of medial joint space (mm) were obtained at three different times with perioperative C-arm images: normal, controlled valgus force, and after pie crusting. The median follow-up time was 9 (6–12) months. Final follow-up Lysholm (p < 0.05) and Tegner scores (p < 0.05) increased significantly compared with preoperative scores. At the final follow-up, there was no pain or tenderness over MCL and there were no signs of saphenous nerve or vein injury. Medial joint space values in after pie crusting increased significantly (p < 0.05) compared with neutral position measurements and controlled valgus force application (p < 0.05). Controlled release of the MCL in knees provided ∼2.45 times wider visualization place. Furthermore, pie crusting of MCL is a safe and effective technique that provides enough space for visualization and instrumentation in knees. This is a Level IV study.
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Aglietti, Paolo, Domenico Lup, Pierluigi Cuomo, Andrea Baldini, and Lapo De Luca. "Total Knee Arthroplasty Using a Pie-crusting Technique for Valgus Deformity." Clinical Orthopaedics and Related Research 464 (November 2007): 73–77. http://dx.doi.org/10.1097/blo.0b013e3181591c48.
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Dubois de Mont-Marin, G., D. Babusiaux, and J. Brilhault. "Medial collateral ligament lengthening by standardized pie-crusting technique: A cadaver study." Orthopaedics & Traumatology: Surgery & Research 102, no. 4 (June 2016): S209—S212. http://dx.doi.org/10.1016/j.otsr.2016.03.002.
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Dubois De Mont-Marin, G., D. Babusiaux, and J. Brilhault. "Allongement du ligament collatéral médial par une technique standardisée de pie-crusting : étude cadavérique." Revue de Chirurgie Orthopédique et Traumatologique 102, no. 4 (June 2016): S6—S10. http://dx.doi.org/10.1016/j.rcot.2016.03.002.
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Dunbar, Robert P., Lisa A. Taitsman, Bruce J. Sangeorzan, and Sigvord T. Hansen. "Technique Tip: Use of “Pie Crusting” of the Dorsal Skin in Severe Foot Injury." Foot & Ankle International 28, no. 7 (July 2007): 851–53. http://dx.doi.org/10.3113/fai.2007.0851.
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Akgun, Ulas, Umut Canbek, Cem Yalin Kilinc, Ahmet Emrah Acan, Nazim Karalezli, and Nevres Hurriyet Aydogan. "Efficacy of Pie-Crusting Technique on Soft Tissues in Distal Tibia and Fibula Fractures." Journal of Foot and Ankle Surgery 58, no. 3 (May 2019): 497–501. http://dx.doi.org/10.1053/j.jfas.2018.09.027.
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Martin, Thomas J., and Tareq Kheirbek. "Application of pie-crusting technique to facilitate closure of open abdomen after decompressive laparotomy." BMJ Case Reports 14, no. 8 (August 2021): e244219. http://dx.doi.org/10.1136/bcr-2021-244219.
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We present the case of a 23-year-old man who developed abdominal compartment syndrome secondary to severe pancreatitis and required decompressive laparotomy and pancreatic necrosectomy. Despite application of a temporary abdominal closure system (ABThera Open Abdomen Negative Pressure Therapy), extensive retroperitoneal oedema and inflammation continued to contribute to loss of domain and prevented primary closure of the skin and fascia. The usual course of action would have involved reapplication of ABThera system until primary closure could be achieved or sufficient granulation tissue permitted split-thickness skin grafting. Though a safe option for abdominal closure, application of a skin graft would delay return to baseline functional status and require eventual graft excision with abdominal wall reconstruction for this active labourer. Thus, we achieved primary closure of the skin through the novel application of abdominal wall ‘pie-crusting’, or tension-releasing multiple skin incisions, technique.
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Choi, Keun Young, In Jun Koh, Man Soo Kim, and Yong In. "Medial Meniscal Ramp Lesion Repair Through Anterior Portals Using a Medial Collateral Ligament Pie-Crusting Technique." Arthroscopy Techniques 10, no. 4 (April 2021): e1073-e1077. http://dx.doi.org/10.1016/j.eats.2020.12.010.
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He, Xuan, Hong Cai, and Ke Zhang. "Pie-crusting technique is effective and safe to release superficial medial collateral ligament for total knee arthroplasty." Journal of Orthopaedic Translation 13 (April 2018): 33–40. http://dx.doi.org/10.1016/j.jot.2018.01.001.
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Meneghini, R. Michael, Andrew T. Daluga, Lindsey A. Sturgis, and Jay R. Lieberman. "Is the Pie-Crusting Technique Safe for MCL Release in Varus Deformity Correction in Total Knee Arthroplasty?" Journal of Arthroplasty 28, no. 8 (September 2013): 1306–9. http://dx.doi.org/10.1016/j.arth.2013.04.002.
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Ha, Chul-Won, Yong-Beom Park, Choong-Hee Lee, Soo-Ik Awe, and Yong-Geun Park. "Selective Medial Release Technique Using the Pie-Crusting Method for Medial Tightness During Primary Total Knee Arthroplasty." Journal of Arthroplasty 31, no. 5 (May 2016): 1005–10. http://dx.doi.org/10.1016/j.arth.2015.11.019.
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Jinliang, Wang, and Wei Xuan. "Limited release medial collateral ligament technique." Orthopaedic Journal of Sports Medicine 8, no. 9_suppl7 (September 1, 2020): 2325967120S0052. http://dx.doi.org/10.1177/2325967120s00526.
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Introduction: To explore the outcome of selective releasing medial collateral ligament in total knee arthroplasty. Hypotheses: Selective releasing technique work for knee balance and clinical results. Methods: Sixty cases of total knee arthroplasty were studied retrospectively from May,2016 to May 2017.The cases traits were as follows:22 male,38 female,age between 55 years and 83 years,the diagnosis totally OA,pre-operative and varus angle was (13.8±2.5)°,preoperative HSS score 36.5±2.9.All the cases were performed with new technique in which anterior parts of MCL was released limitedly ,posterior-lateral was released about one centimeter beneath joint line,and pie-crusting was used when it was still unbalanced.This was different from the conventional one in which a regular medial soft tissue envelope was performed. Results: Post-operation wound was I stage union.The average follou-up was nine months(6-12 months).The resudial varus angle was (0.8±1.5)°,HSS score was (86.0±3.5),which had significant statistically difference compared with the pre-op one. Conclusion: The selectively releasing MCL technique was minimally invasive and easy to learn. Good function was achieved.
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Ahn, Jin Hwan, Yong Seuk Lee, Moon Jong Chang, and Ka Hyun Kim. "Arthroscopic partial meniscectomy of the medial meniscus posterior horn using a "pie-crusting" technique in a tight knee." Arthroscopy and Orthopedic Sports Medicine 2, no. 1 (January 1, 2015): 30–33. http://dx.doi.org/10.14517/aosm14017.
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Moore, Ryan E., Michael A. Conditt, Martin W. Roche, and Matthias A. Verstraete. "How to Quantitatively Balance a Total Knee? A Surgical Algorithm to Assure Balance and Control Alignment." Sensors 21, no. 3 (January 20, 2021): 700. http://dx.doi.org/10.3390/s21030700.
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To achieve a balanced total knee, various surgical corrections can be performed, while intra-operative sensors and surgical navigation provide quantitative, patient-specific feedback. To understand the impact of these corrections, this paper evaluates the quantitative impact of both soft tissue releases and bone recuts on knee balance and overall limb alignment. This was achieved by statistically analyzing the alignment and load readings before and after each surgical correction performed on 479 consecutive primary total knees. An average of three surgical corrections were required following the initial bone cuts to achieve a well aligned, balanced total knee. Various surgical corrections, such as an arcuate release or increasing the tibial polyethylene insert thickness, significantly affected the maximum terminal extension. The coronal alignment was significantly impacted by pie-crusting the MCL, adding varus to the tibia, or releasing the arcuate ligament or popliteus tendon. Each surgical correction also had a specific impact on the intra-articular loads in flexion and/or extension. A surgical algorithm is presented that helps achieve a well-balanced knee while maintaining the sagittal and coronal alignment within the desired boundaries. This analysis additionally indicated the significant effect that soft tissue adjustments can have on the limb alignment in both anatomical planes.
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Sednieva, Y., K. Bruyère-Garnier, A. Naaim, A. Viste, and L. L. Gras. "Strain release assessment of the iliotibial band (ITB) when using a pie-crusting technique: a preliminary ex vivo study." Computer Methods in Biomechanics and Biomedical Engineering 23, sup1 (October 19, 2020): S276—S278. http://dx.doi.org/10.1080/10255842.2020.1816291.
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Krouse, John H., and Dewey A. Christmas. "Powered Instrumentation in Functional Endoscopic Sinus Surgery II: A Comparative Study." Ear, Nose & Throat Journal 75, no. 1 (January 1996): 42–44. http://dx.doi.org/10.1177/014556139607500110.
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The present paper compares the use of the microdebrider as a form of powered instrumentation for endoscopic sinus surgery with traditional endoscopic surgical techniques. A group of 250 patients undergoing surgery with the microdebrider was compared with a group of 225 patients undergoing traditional procedures in order to evaluate their postoperative recovery, healing, and incidence of complications. The use of the microdebrider demonstrated faster healing with less crusting than standard techniques, as well as decreased bleeding, synechia formation, lateralization of the middle turbinate, and ostial reocclusion. The microdebrider offers excellent surgical results with fewer complications and faster healing than traditional techniques in functional endoscopic sinus surgery.
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Kwak, Dai-Soon, Yong In, Tae Kyun Kim, Han Suk Cho, and In Jun Koh. "The pie-crusting technique using a blade knife for medial collateral ligament release is unreliable in varus total knee arthroplasty." Knee Surgery, Sports Traumatology, Arthroscopy 24, no. 1 (October 7, 2014): 188–94. http://dx.doi.org/10.1007/s00167-014-3362-1.
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Abdullah, Baharudin, and Sharanjeet Singh. "Surgical Interventions for Inferior Turbinate Hypertrophy: A Comprehensive Review of Current Techniques and Technologies." International Journal of Environmental Research and Public Health 18, no. 7 (March 26, 2021): 3441. http://dx.doi.org/10.3390/ijerph18073441.
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Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of the inferior turbinate is to relieve the obstruction while preserving the function of the turbinate. There have been a variety of surgical techniques described and performed over the years. Irrespective of the techniques and technologies employed, the surgical techniques are classified into two types, the mucosal-sparing and non-mucosal-sparing, based on the preservation of the medial mucosa of the inferior turbinates. Although effective in relieving nasal block, the non-mucosal-sparing techniques have been associated with postoperative complications such as excessive bleeding, crusting, pain, and prolonged recovery period. These complications are avoided in the mucosal-sparing approach, rendering it the preferred option. Although widely performed, there is significant confusion and detachment between current practices and their basic objectives. This conflict may be explained by misperception over the myriad of available surgical techniques and misconception of the rationale in performing the turbinate reduction. A comprehensive review of each surgical intervention is crucial to better define each procedure and improve understanding of the principle and mechanism involved.
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Rifat, Mahmud Asif, Mostafa Kamal Arefin, Abu Yusuf Fakir, SK Nurul Fattah Rumi, Husne Qumer Osmany, Hashim Reza Roctim, Tanvir Mostafa, Mohammad Zaid Hossain, and Partha Pratim Chowdhury. "Pattern of Lymph Node Metastasis in Oral Cancer." Journal of Dhaka Medical College 29, no. 1 (January 5, 2021): 41–46. http://dx.doi.org/10.3329/jdmc.v29i1.51170.
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Background: Oral cancer is a common neoplasm worldwide which has a increased incidence and mortality rate over the past decades. In spite of skilled surgical and radio therapeutic modalities it is characterized by poor prognosis and a low survival rate. Lymph node metastasis is an important negative prognostic factor in oral cancer. In this study, pattern of cervical lymph node metastasis in oral carcinoma has been described. Such information may contribute to the understanding of oral cancer management plan.
Methods: This cross-sectional observational study was conducted in the Otolaryngology and Head-Neck surgery department of Dhaka Medical College Hospital. The study period was from January 2018 to June 2018. A total of 50 patients were selected by purposive sampling technique. Data were collected by study physician himself. Then these collected data were recorded in structured case report forms. Clinical examination and relevant investigations were done. After planned surgical procedure post operative histopathological reports were collected. All collected questionnaire were checked very carefully. Data were processed and analyzed with the help of computer program SPSS and Microsoft excel. Quantitative data were expressed as mean and standard deviation and qualitative data as frequency and percentage. Comparison were done by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram & charts etc.
Result: Overall demographic features of 50 patients revealed that, the maximum incidence was seen in the age group 31-50 years (54.0%), mean age of the patient was 49.6 ±9.2 year. Male and female ratio was 4.5:1. In this study most of the tumors were well and moderately differentiated, 34.0% and 62.0% respectively. Aetiology and predisposing factors revealed that the most common were cigarette smoking, betal quid and alcohol consumption, present in 52.0%, 28.0% and 22.0% of patients respectively. Post operative histopathology reports showed that 24 patients (48.0%) had neck node metastasis among which 59.4% were with tumor size >1 cm. Tumors with the depth of invasion >3 mm had a very high risk of metastasis (P<0.0001), as compared to tumor less than 3 mm in thickness. Out of the 24 patients with nodal metastasis 17(34.0%) patients had a single node metastasis (N1). Level I and Level II were the commonest site to be involved (14 patients). Nodal metastasis predominantly occurred from primary tumour site of tongue (22.0%) and floor of the mouth (14.0%). It was seen that patients with higher grade had a higher risk of metastasis (grade 1:–29.4%, grade 2:- 54.8%, grade 3:– 100.0%).
Conclusion: Oral carcinoma may appear at any sub site, although there are certain areas in which it is found more frequently, such as the oral tongue, cheek and floor of the mouth. Lymph node metastasis is more common in oral carcinoma mostly level I & II, which is one of the most relevant prognostic factors. Elective neck dissection can be considered in all patients with tumors more than 3 mm in thickness.
J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 41-46
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Nedelcu, T., and O. Courage. "Évaluation de l’apport et de la morbidité du « pie-crusting » technique pour les lésions du ménisque interne sur genou serré à propos d’une série de 19 patients." Revue de Chirurgie Orthopédique et Traumatologique 97, no. 8 (December 2011): S488. http://dx.doi.org/10.1016/j.rcot.2011.09.044.
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Thorp, Brian D., Satyan B. Sreenath, Charles S. Ebert, and Adam M. Zanation. "Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak." Neurosurgical Focus 37, no. 4 (October 2014): E4. http://dx.doi.org/10.3171/2014.7.focus14350.
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Endoscopic skull base surgery continues to rapidly evolve, requiring comparable advances in reconstructive techniques. While smaller skull base defects with low intraoperative CSF flow have been successfully managed with a variety of avascular and/or noncellular techniques, larger defects with high CSF flow require more robust repairs often in the form of vascularized flaps, which confer excellent success rates in this setting. Despite these successful outcomes, a paucity of data describing specific patient and operative characteristics and their effects on repair exist. Therefore, a retrospective, consecutive chart review was performed on patients who underwent endoscopic skull base reconstruction with a vascularized flap in the setting of intraoperative CSF leaks. In this series, 151 patients with a mean age of 51 years underwent 152 vascularized flap skull base reconstructions for an array of benign and malignant pathologies. These vascularized flaps included 144 nasoseptal flaps, 6 endoscopic-assisted pericranial flaps, 1 facial artery buccinator flap, and 1 inferior turbinate flap that were used throughout all regions of the skull base. Perioperative (< 3 months) and postoperative (> 3 months) flap complications were assessed and revealed 3 perioperative flap defects (2.0%) defined as a visualized defect within the substrate of the flap and a total of 5 perioperative CSF leaks (3.3%). No patient experienced flap death/complete flap loss in the cohort. Assessed postoperative flap complications included 1 case (0.7%) of mucocele formation, 8 cases (5.3%) of prolonged skull base crusting, and 2 cases (1.3%) of donor-site complication, specifically septal perforation secondary to nasoseptal flap harvest. Among the 152 cases identified, 37 patients received radiation therapy while 114 patients did not undergo radiation therapy as part of the treatment profile. No significant association was found between perioperative complication rates and radiation therapy (p = 0.634). However, a significant association was found between postoperative complication rates and radiation therapy, primarily accounted for by an increased risk for prolonged (> 6 months) skull base crusting (p = 0.025). It is clear that larger skull base defects with high intraoperative CSF flow require thoughtful approach and strong consideration for vascularized repair.
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Gamarra, G., A. Gallegos, E. Alvarado, M. Asparrin, and W. Vivanco. "159 TECHNIQUES FOR OVUM PICK-UP IN GONADOTROPIN-TREATED ALPACAS." Reproduction, Fertility and Development 20, no. 1 (2008): 159. http://dx.doi.org/10.1071/rdv20n1ab159.
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The objective of the present study was to evaluate the quantity and quality of oocytes collected when using 2 methods for ovum pick-up and 2 different regimens for ovarian stimulation in live alpaca donors. Thirty-four non-pregnant female alpacas of 3 to 5 years of age maintained at 4100 m elevation in southern Peru were randomly distributed into 4 experimental groups. Groups 1 (n = 8) and 3 (n = 9) received an intravaginal device containing 0.78 mg of progesterone (Cue-Mate�, Bioniche Animal Health, Belleville, Ontario, Canada) plus an i.m. injection of 1 mg of estradiol benzoate on Day 0; the intravaginal device was removed on Day 7. Groups 2 (n = 7) and 4 (n = 10) received an i.m. injection of 3.1 mg of LH (Lutropin�, Bioniche Animal Health) on Day 0. Females received 700 IU of eCG (Pregnecol�, Bioniche Animal Health) i.m. on Day 7 (Groups 1 and 3) or Day 2 (Groups 2 and 4). In all groups, oocyte collection was done 2 days after the injection of eCG. Groups 1 and 2 were subjected to ventral laparotomy aspirating the oocytes from follicles >3 mm in diameter using a 10-mL hypodermic syringe containing 1 mL of aspiration media (Ringer's lactate solution plus 10% bovine serum) and connected to an 18 G � 1 inch aspiration needle. After collection, the follicular fluid was searched and the COC were graded. Groups 3 and 4 were subjected to ovum pick-up by transvaginal recovery using an ultrasound scanner (Parus 240�, Pie Medical, Maastricht, the Netherlands) equipped with a vaginal probe of 7.5 MHz (MEVA�, Pie Medical) and a 17G � 55 cm aspiration needle introduced through a needle guide. Follicles >3 mm in diameter were aspirated into 50-mL centrifuge tubes containing 5 mL of aspiration media with 75 IU mL–1 of heparin. The aspirated fluid was filtered and rinsed using an embryo filter (EmCon�, Immunosystems, Menomonie, WI), and COC were searched and graded under a microscope based on the intactness of the cumulus cell layers. Data were analyzed by ANOVA. There were no differences (P > 0.05) between groups in the mean number of follicles aspirated per donor (11.0, 13.8, 9.4, and 9.1 for Groups 1 to 4 respectively), and in the mean number of COC recovered per donor (7.6, 7.0, 6.0, and 6.1 respectively for Groups 1 to 4). The proportions of good quality COC were significantly (P < 0.01) different between surgical (81.0 and 79.5% for Groups 1 and 2) and transvaginal/ultrasound-guided (7.4% for Group 3) methods of collection; however, they were similar to the proportion in Group 4 (64.9%) retrievals. The results show that in the absence of an intravaginal device, a similar quantity and quality of alpaca oocytes can be collected when using a surgical approach or minimally invasive ultrasound-guided transvaginal follicular aspiration.
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Bellad, Shama A., N. Manjunath, and Shilpa Ravi. "Comparison between microdebrider assisted surgery and the conventional methods in the surgical treatment of nasal polyps." International Journal of Otorhinolaryngology and Head and Neck Surgery 5, no. 1 (December 25, 2018): 154. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20185305.
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<p class="abstract"><strong>Background:</strong> Microdebrider is emerging as a convenient tool for various ENT surgeries that helps in easier disease clearance and reduced morbidity. Though it requires some surgical expertise initially to master the skill of handling it, it is worth procuring and using in endoscopic sinus surgery. The present study was conducted to compare the microdebrider assisted endoscopic surgery and conventional methods using sinus endoscopes in the surgical management of nasal polyps.</p><p class="abstract"><strong>Methods:</strong> 30 patients diagnosed with nasal polyposis between the age group of 5 to 60 were equally randomized into 2 surgical groups- powered endoscopic sinus surgery group and conventional endoscopic sinus surgery group with 15 patients in each group. The study aimed at comparing the intra operative (blood loss, duration of surgery) and post operative results (crusting, scarring, discharge, symptoms, recurrence) between the two groups using Lund–Mackay scoring system and visual analogue scale. The data was statistically analysed. </p><p class="abstract"><strong>Results:</strong> A significant statistical evidence for a shorter operative time, dryness of the field, better surgical conditions and improved VAS scoring at 3 and 6 months postoperatively was observed in the powered endoscopy group than using conventional techniques.</p><p class="abstract"><strong>Conclusions:</strong> The use of microdebrider in endoscopic sinus surgery has the advantage of complete clearance of disease, smoother intra operative course and better post operative healing when compared to conventional instruments in the treatment of nasal polyps.</p><p> </p>
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Marks, Steven C., and Dana G. Kissner. "Management of Sinusitis in Adult Cystic Fibrosis." American Journal of Rhinology 11, no. 1 (January 1997): 11–14. http://dx.doi.org/10.2500/105065897781446810.
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Until recently, cystic fibrosis was frequently fatal during childhood. However, with current medical management, many patients are living into adulthood. This has created a new population of patients with chronic sinusitis and severe medical problems. In this report, experience with 22 patients, eight of whom have undergone sinus surgery, is presented, and recommendations for management are proposed. Presenting symptoms are typical of sinusitis, but in a few patients, severe debilitating headaches predominate. Oral antibiotics are often of little use due to the numerous courses of high dose intravenous antibiotics used for resistant pulmonary infections. Topical nasal steroids and mucolytics have been of some benefit. Fourteen operative procedures were performed on eight patients. These procedures included 12 endoscopic sphenoethmoidectomies, four Caldwell-Luc procedures, two frontal sinus obliterations, and one transseptal sphenoidotomy (many of these were in combination.) Results from this experience indicate 1) Failure of endoscopic surgery to control frontal and maxillary sinus disease; 2) Delayed healing of the ethmoid cavity with persistent crusting; and 3) Significant, albeit short term, symptomatic relief following surgical intervention. Based on this limited series, we conclude that surgery should be delayed until absolutely necessary and that an aggressive approach should be adopted when surgery is performed. In our hands this included initial endoscopic sphenoethmoidectomy with open surgical techniques used for removal of trapped inspissated secretions. We recommend long term intravenous antibiotics postoperatively and frequent cleaning of the ethmoid cavity after surgery, continuing indefinitely, to optimize the benefit of surgery.
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Viladot-Pericé, Ramón, and Antonio Viladot Voegeli. "What is new about hallux rigidus?" Journal of the Foot & Ankle 15, no. 3 (December 20, 2021): 191–92. http://dx.doi.org/10.30795/jfootankle.2021.v15.1587.
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Hallux rigidus (HR) represents one of the most frequent forefoot disorders, together with hallux valgus and lateral toe deformities, being the most frequent degenerative process in the foot and ankle.This publication is the result of the collaboration of colleagues of the Spanish Society of Medicine and Foot and Ankle Surgery (Sociedad Española de Medicina y Cirugía del Pie y Tobillo, SEMCPT) and the Argentinean Society of Medicine and Foot and Leg Surgery (Sociedad Argentina de Medicina y Cirugía de Pie y Pierna, SAMCPP). It is an honor for us to have this work edited in the Journal of the Foot & Ankle, a journal with a marked Latin identity. We really thank Alexandre Leme Godoy-Santos, Chairman of the Editorial Board, for his help and contribution. This update topic has been coordinated by R. Viladot Pericé and A. Viladot Voegeli, together with M. Herrera and M. Núñez-Samper.Considering the interest and the extent of this topic and, according to the coordinators, we have divided the publication into two parts. The first one describes general aspects (definition, etiology, classification, treatment algorithm, etc.) and the conservative treatment of HR, whereas the second one addresses the different surgical techniques described to treat this disease.The aim of this work is to review our knowledge on HR and to perform an update on the innovations that have emerged during the last years.
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Kedarnath, Ratkal, and Syed Mushtaq. "Descriptive study of endoscope assisted creation of neoturbinate by antral mucosal inversion in atrophic rhinitis." International Journal of Otorhinolaryngology and Head and Neck Surgery 3, no. 3 (June 24, 2017): 539. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20171581.
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<p class="abstract"><strong>Background:</strong> As the exact etiology is not known, treatment is directed towards symptomatic relief. Medical treatment leads only to temporary remission of symptoms. Over the years, surgeons have attempted various techniques for long term relief of symptoms. Most of the techniques have been directed to the narrowing of the nasal cavity<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> All the cases diagnosed as primary atrophic rhinitis and who were willing to undergo this surgery were taken for the study. The cases diagnosed as primary atrophic rhinitis were subjected to detailed history and examination. Clinically following conditions were ruled out – tuberculosis, syphilis, rhinoscleroma, leprosy. A routine haemogram (Hb%, TC, DC, BT, CT), urine examination (albumin, sugar, microscopy), ESR serum VDRL was done for the patients<span lang="EN-IN">. </span></p><p class="abstract"><strong>Results:</strong> We were successful in creating a neoturbinate in 12 patients in our study. Of these, majority of the patients (6 patients) had their duration of symptoms between 2-4 years, the outcome in them are excellent in 4 patients, good in 2 patients<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The results are encouraging with reduced crusting, healthier mucosa and some patients even regaining their sense of smell. All these above, with no nasal obstruction or pinched nostrils as may occur in young’s closure. But the effort involved is more in this surgical procedure<span lang="EN-IN">.</span></p>
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Moon, Ju Hyung, Eui Hyun Kim, and Sun Ho Kim. "Various modifications of a vascularized nasoseptal flap for repair of extensive skull base dural defects." Journal of Neurosurgery 132, no. 2 (February 2020): 371–79. http://dx.doi.org/10.3171/2018.10.jns181556.
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OBJECTIVEEndonasal surgery of the skull base requires watertight reconstruction of the skull base that can seal the dural defect to prevent postoperative CSF rhinorrhea and consequent intracranial complications. Although the incidence of CSF leakage has decreased significantly since the introduction in 2006 of the vascularized nasoseptal flap (the Hadad-Bassagasteguy flap), reconstruction of extensive skull base dural defects remains challenging. The authors describe a new, modified vascularized nasoseptal flap for reconstruction of extensive skull base dural defects.METHODSA retrospective review was conducted on 39 cases from 2010 to 2017 that involved reconstruction of the skull base with an endonasal vascularized flap. Extended nasoseptal flaps were generated by adding the nasal floor and inferior meatus mucosa, inferior turbinate mucosa, or entire lateral nasal wall mucosa. The authors specifically highlight the surgical techniques for flap design and harvesting of these various modifications of the vascularized nasoseptal flap.RESULTSThirty-nine endonasal vascularized flaps were used to reconstruct skull base defects in 37 patients with nonsurgical or postoperative CSF rhinorrhea. Of the 39 procedures, extended nasoseptal flaps were used in 5 cases (13%). These included 2 extended nasoseptal flaps including the inferior turbinate mucosa and 3 extended nasoseptal flaps including the entire lateral nasal wall mucosa. These 5 extended nasoseptal flaps were used in patients who had nonsurgical CSF rhinorrhea due to extensive skull base destruction by invasive pituitary tumors. All flaps healed completely and sealed off the CSF leaks. Olfactory function slightly decreased in the 3 patients with extended nasoseptal flaps including the entire lateral nasal wall mucosa. One patient experienced nasolacrimal duct obstruction, which was treated by dacryocystorhinostomy. The authors encountered no wound complication in this series, while crusting at the donor site required daily nasal toilette and frequent debridement until the completion of mucosalization, which usually takes 8 to 12 weeks after surgery.CONCLUSIONSExtended nasoseptal flaps are a reliable and versatile option that can be used to reconstruct extensive skull base dural defects resulting from destruction by large invasive tumors or complex endoscopic endonasal surgery. An extended nasoseptal flap that includes the entire lateral nasal wall mucosa (360° flap) is the largest endonasal vascularized flap reported to date and may be an alternative for the reconstruction of extensive skull base defects while avoiding the need for additional external approaches.
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Saquian, Florence Yul N. "Basal Cell Carcinoma of the Lip and Mentum." Philippine Journal of Otolaryngology-Head and Neck Surgery 21, no. 1-2 (November 29, 2005): 52–54. http://dx.doi.org/10.32412/pjohns.v21i1-2.841.
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CASE
A 52-year-old non-diabetic female presented with a 20-year history of hyperpigmented lower lip ulcer which gradually involved the mentum, and on punch biopsy revealed basal cell carcinoma. As a housewife, she had no excessive exposure to sunlight or radiation, and no family history of cancer. On examination, a non-healing ulcer with hyperpigmented rolled-up borders had eroded the lower lip and mentum, extending into the alveolus and mandible. Wide excision with segmental mandibulectomy, bilateral supraomohyoid neck dissection and pectoralis major myocutaneous flap reconstruction were performed and radiotherapy scheduled 6 weeks after surgery.
Basal cell carcinoma (BCC) is the most common skin malignancy with estimated annual incidences of 1 million, over 500,000 and 190,000 in the USA, Europe and Australia, respectively1. More than 60% of all skin cancers in the Philippines are basal cell carcinoma2.
A slow-growing, locally invasive malignant epidermal tumor, it infiltrates tissues in a three-dimensional contiguous fashion through the irregular growth of sub-clinical fingerlike outgrowths3. It rarely metastasizes, with morbidity related to local tissue invasion and destruction4. Most can be treated easily with a high cure rate; however, there are some lesions that are much more aggressive. Advanced basal cell cancers may be arbitrarily defined as tumors > 2cm; that invade bone, muscle, or nerves; that have lymph node metastasis; or that require removal of a cosmetic or functional unit5. Complications are highlighted when lesions occur in the face, particularly near orifices of the eyes, nose, ears and mouth. As with lesions close to vital structures, these pose a greater clinical challenge4.
BCCs develop from pluripotential cells in the basal layer of the epidermis. Ultraviolet induced mutations in the TP53 tumor-suppressor gene, which resides on chromosome arm 17p, have been implicated in some cases of BCC. Furthermore, the loss of inhibition of the patched/hedgehog pathway also appears to play a role in development of BCCs and influences differentiation of a variety of tissues during fetal development6.
Recognizing the various histological subtypes of BCC is important because aggressive therapy is often necessary for some variants3. Nodular BCC appear as waxy or pearly papules with central depression, erosion or ulceration, bleeding or crusting, and rolled (raised) borders. Tumor cells typically have large, hyperchromatic, oval nuclei and little cytoplasm. Cells appear uniform, with few mitotic figures. Pigmented BCC contain increased brown or black pigment and are most common in individuals with dark skin. Superficial BCC appears as scaly patches or papules that are pink to red-brown, often with central clearing, commonly with a threadlike border, may mimic psoriasis or eczema, but they are slowly progressive. Micronodular BCC, an aggressive subtype, is not prone to ulceration, it may appear yellow-white when stretched, firm to touch, and may have a seemingly well-defined border. Morpheaform and infiltrating BCC present with sclerotic (scarlike) plaques or papules with ill defined borders extending beyond clinical margins. Ulceration, bleeding, and crusting are uncommon. It may be mistaken for scar tissue7.
Treatment is based on clinical diagnosis and a pre-operative biopsy3. A complete history relating the onset and rate of growth of the lesion as well as sun and radiation exposure should be taken. It is also necessary to examine and palpate the extent of lesion, with special attention given to high risk areas. Large extensive lesions may require radiographic examinations such as MRI or CT to assess soft tissue or bony involvement, respectively8. The most appropriate treatment options should be discussed with the patient. Co-morbidities may influence the choice between surgical and non-surgical treatment. Elderly patients with symptomatic and high-risk tumors may opt for less aggressive treatment options, which are palliative in intent3.
Various surgical and non-surgical treatments are currently available. Non-surgical techniques include thrice-weekly intralesional injection of human recombinant interferon -2 for three weeks for low-risk BCCs. This option is still investigational, unlikely to benefit high-risk tumor patients, and may be expensive and time-consuming3. Photodynamic and oral retinoid therapies are other options undergoing investigation and are not yet widely available3. Radiotherapy is an extremely useful form of treatment, but faces the same problem of accurately identifying tumor margins as standard excisional surgery9. It has been used to treat many types of BCC, including those with bony and cartilaginous involvement, but is less suitable for treating large tumors in critical sites, as these are often resistant and require radiation doses that closely approach tissue tolerance3.
Topical treatment options have been used in patients with contraindications for surgery and with lesions not entirely amenable to extirpative excision. 5-flourouracil (5FU) has been used for lowrisk, extrafacial BCC with unexciting results2,3. Imiquimod (an immune response modifier) 5% cream has been used alone and as adjunct to Mohs’ microsurgery for the treatment of BCC, with reported regression but not complete eradication of the tumor. Topical neomycin was also reported to cause regression in one case3. A prospective study involving topical application of Cashew nut extract (DeBCC®) on 14 patients with BCC in different parts of the face had no detected recurrences on follow – up periods of 11 – 49 months (28.7 months)2.
Excisional surgery removes the tumor entirely with a peripheral margin of normal tissue. For small lesions in the face, wide excision with adequate margins is sufficient, and various reconstructive methods can be used depending on the location of the lesion. Larger lesions which involve deeper structures such as bone, warrant more radical approaches to ensure adequate margins10. In our patient, infiltration of skin, mucosa, muscle, alveolus and mandible led to a segmental mandibulectomy and subsequent reconstruction.
Mandibular reconstruction aims to reconstitute the mandibular arch. Anterior defects result in the worst functional defects with the so-called “Andy Gump” deformity11. The preferred method for reconstructing anterior mandibular defects uses osseocutaneous free flaps, with the fibular free flap being most popular. The peroneal vessels act as the major blood supply to the periosteum in a segmental fashion allowing for multiple osteotomies, which are required for bone shaping with anterior defects. For reconstruction of the intra-oral structures, a large soft tissue paddle based on septal and intramuscular perforators can be used, and osteointegrated implants can be placed in the bone graft12.
Another option for reconstruction is a pedicled flap, and the more commonly used is the pectoralis major osteomyocutaneous flap. Its dominant pedicle is the thoracoacromial artery and vein that runs on the undersurface of the muscle. The underlying rib is also harvested to reconstitute the mandible13. The advantages of pedicled flaps include less morbidity, shorter operative time, and a more definitve blood supply, which ensures the survival of the skin flap and bone11. However, these flaps tend to be difficult to harvest and have limited arcs of rotation and limited bone graft mobility relative to the soft tissue portion of the flap. The blood supply of the bony portion is often tenuous following transfer, and the lack of bony bulk limits dental rehabilitation12.
Postoperative management of flap reconstruction includes gentle cleansing and application of topical antibiotics. Diligent oral hygiene offsets potential complications from post operative drooling. Partial or total flap failure is a common postoperative concern. Partial distal flap necrosis can be managed expectantly. Cyanosis may be due to excessive wound tension or vascular pedicle compromise, and should be explored as necessary15.
Acknowledgement :
We thank Dr. Camille Sidonie A. Espina for providing the case for discussion.
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RODRIGUEZ-COLLELL, JUAN RAMON, ARANTXA BLASCO-SERRA, LUIS RODRIGUEZ-PINO, and DAMIAN MIFSUT-MIEDES. "Deformidad tipo Checkrein del Hállux y dedos menores del pie sin fractura previa asociada." Revista Española de Cirugía Osteoarticular, April 1, 2020, 44–47. http://dx.doi.org/10.37315/sotocav20202825544.
Full textAbstract:
We present a bibliographic review and a description of the surgical technique in checkrein deformity of the hallux and lesser toes. This dynamic deformity causes a significant difficulty in walking and prevents patients from practicing any sport, since in the stance phase of gait toes are forced into maximum plantar flexion and end up trapped under the foot. In cases in which this is not associated with a bone fracture, the clinical suspicion causing the injury is a subclinical compartment syndrome. Treatment described in this work consists of a Z-plasty and the application of a pulvertaft suture in the flexor hallux longus. In the rest of the toes, any additional surgical procedure is not needed, as the deformity is corrected at the retromalleolar level.
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Hunter, Benjamin G. "Cartilage Sparing Septal Perforation Repair using Rotation Flaps and a Collagen Interposition Graft: A Case Series." Annals of Otology, Rhinology & Laryngology, November 6, 2020, 000348942097059. http://dx.doi.org/10.1177/0003489420970592.
Full textAbstract:
Objective: Septal Perforations may be asymptomatic or can cause significant problems including nasal obstruction, crusting, bleeding, whistling and in severe cases a change in nasal shape and even pain. Method: The author would like to present a single surgeon case series of septal perforation repairs, managed using an endo-nasal technique, with no external scars. There were 54 consecutive cases between 2011 and 2017. The repair was carried out using mucosal rotation flaps with an interposition graft of porcine collagen matrix. Patients were grouped according to the size of the perforation as measured at the time of the surgery. The patients were then clinically followed up for 1 year, and the recorded outcome measures were: the success of the surgical repair and the patient reported symptoms. Results: Surgical success was 70% up to 1 cm diameter, 77% from 1 to 2 cm and 82% in perforations from 2 to 3 cm in diameter. No perforation over 3 cm in diameter was successfully closed. Patients were rendered asymptomatic even if the perforation was not closed in between 81% and 91% of patients up to perforations 3 cm in size. Over 3 cm in size 50% of patients reported being asymptomatic. Conclusions: This technique is an effective and low morbidity option for patients with small to medium sized septal perforations. For perforations over 3 cm in diameter other options may be more suitable.
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Kanike, N., K. G. Hospattankar, G. Marotta, and D. Kumar. "Management of severe right lung cystic pulmonary interstitial emphysema in an infant at 24 weeks gestation with bedside selective left main stem bronchial intubation: Case report and review of the literature." Journal of Neonatal-Perinatal Medicine, September 25, 2020, 1–7. http://dx.doi.org/10.3233/npm-180178.
Full textAbstract:
Pulmonary interstitial emphysema (PIE) is a severe complication of mechanical ventilation in preterm infants. Selective bronchial intubation is a rarely used treatment strategy, as it is challenging, especially left main stem bronchial intubation. We report our experience in an infant at 24 weeks gestation with bedside left main stem bronchial intubation using flexible fiberoptic bronchoscopy. We also describe in detail the procedural details involved in the selective left main stem bronchial intubation including the helpful technique of gently bending the tip of the endotracheal tube to create “memory” to better direct the tube into the left main-stem bronchus while using the flexible fiberoptic bronchoscope. A review of the literature regarding selective bronchial intubation in newborn infants is presented. This case report and literature review suggest that bedside left main stem bronchial intubation using a flexible fiberoptic bronchoscope is a viable option to successfully manage even the most unstable extreme premature infant with unilateral right lung cystic PIE. This may potentially prevent a rare but necessary invasive surgical procedure like lobectomy or even death.
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Cornwell, Ethan, Evan R. Deckard, Kevin A. Sonn, and R. Michael Meneghini. "The Influence of Medial Collateral Ligament and Lateral Collateral Ligament Pie Crusting in Primary Total Knee Arthroplasty on Patient Reported Outcomes." Proceedings of IMPRS 4, no. 1 (December 10, 2021). http://dx.doi.org/10.18060/25905.
Full textAbstract:
Background and Hypothesis: Pie-crusting of the collateral ligaments can help achieve balanced gaps in total knee arthroplasty (TKA) in knees with varus or valgus deformity. However, the effect of this technique on patient-reported outcome measures (PROMs) is unknown. The purpose of this study was to compare PROMs following primary TKA for patients with and without medial collateral ligament (MCL) or lateral collateral ligament (LCL) pie-crusting.
Experimental Design or Project Methods: We retrospectively reviewed 1,305 primary TKAs. Intraoperative MCL or LCL pie-crusting was documented in all operative reports and recorded. Prospectively collected preoperative, 4-month postoperative, and minimum 1-year postoperative PROMs related to overall knee health, pain during functional activities, activity level, and overall satisfaction were compiled and compared between patients with and without MCL or LCL pie-crusting. Medians were evaluated with Kruskal-Wallis test adjusted for ties.
Results: The cohort was 67% female with mean age 66 years and BMI 34.0 kg/m2. MCL or LCL pie-crusting was performed in 13.0% of the cohort. There were no intraoperative or postoperative ruptures of the MCL or LCL. 6.3% of conforming bearing TKAs required a collateral ligament pie crusting versus 21.5% of standard bearing TKA (p<0.001). No significant differences were found in preoperative, 4-month, minimum 1-year, or change from preoperative baseline to minimum 1-year PROMs with and without pie-crusting of the collateral ligaments (p≥0.095). However, the LCL pie-crusting group had slightly better PROMs at minimum 1-year.
Conclusion and Potential Impact: These study results corroborate existing literature that pie-crusting of collateral ligaments is safe and effective to achieve a balanced TKA. Additionally, no significant outcome differences were found between groups with and without MCL or LCL pie-crusting. However, LCL pie-crusting for valgus knee correction had slightly better PROMs. Interestingly, conforming bearings may impart enhanced stability and mitigate the need for pie-crusting ligament releases in TKA.
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Han, Xu, Peizhao Wang, Jinyang Yu, Xiao Wang, and Honglue Tan. "Arthroscopic pie-crusting release of the posteromedial complex of the knee for surgical treatment of medial meniscus injury." BMC Musculoskeletal Disorders 21, no. 1 (May 14, 2020). http://dx.doi.org/10.1186/s12891-020-03336-9.
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Piri Ardakani, Mohammadreza, Mehdi Motififard, and Erfan Sheikhbahaei. "Primary Repair of Intraoperative Medial Collateral Ligament Tear during Medial Pie-Crusting Technique in Total Knee Arthroplasty with Varus Deformity." Journal of Orthopedic and Spine Trauma, April 11, 2021. http://dx.doi.org/10.18502/jost.v7i1.5967.
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