Anterior Surgery Research Articles

Mandibular pitching in management of severe open bite– A case report

This case report outlines the management of severe skeletal open bite with SFOA. Different treatment modalities are available to treat Class III Skeletal open bite. But the best treatment outcome can be achieved only when the treatment plan is individualized for every patient. A 18-year-old male patient with an Open bite and a class III skeletal base. Treated by Surgery first approach followed by Orthodontic treatment to transform the patient profile and smile.SFOA can be considered as a good option in patients with mandibular prognathism. Mandibular anterior pitch-up surgery offers an immediate solution in patients with severe skeletal open bite.

Sublingual hematoma as a complication of mandibular midline osteotomy: a case report and literature review.

Sublingual hematoma is a serious complication associated with anterior mandible surgery. It presents considerable risk due to the potential for airway obstruction, which can be life-threatening and necessitates prompt diagnosis and intervention. This case report describes the occurrence of sublingual hematoma following mandibular midline osteotomy and the subsequent management of this condition. Mandibular midline osteotomy is performed to correct skeletal or dental discrepancies in the transverse plane. Sublingual hematoma as a complication of a midline osteotomy has not been previously documented in the literature. This article provides a comprehensive review of the various etiologies associated with sublingual hematoma, along with its management modalities.

High Preoperative Expectations may not Need to be Feared.

Retrospective. Evaluate correlations between preoperative expectations for pain improvement and 12-month functional outcomes and satisfaction following 1-2 level primary anterior cervical surgery. Limited data exists evaluating correlations between patients' preoperative expectations for pain relief and subsequent functional and satisfaction outcomes following primary anterior cervical surgery. Understanding correlations between expectations and outcomes may help identify patients most likely to benefit from surgery. Patients who underwent 1-2 level primary ACDF or CDA for degenerative disease between 2016-2021 were included. All patients had 12-month NDI data. Preoperative expectations for pain relief were collected at the initial clinic visit using 5-point Likert scales. Preoperative and 12-month postoperative satisfaction were recorded using 7-point Likert scales. Covariates including age, gender, procedure type, smoking status, opioid use, worker's compensation/litigation, BMI, and indication (radiculopathy versus myelopathy). Linear regression models were constructed to assess 12-month NDI change score versus pain relief expectations. Additional regression models assessed expectations versus achievement of MCID at 3- and 12-months and satisfaction at 12-months. 198 ACDF (56.1% female, median age 57) and 52 CDR patients (55.8% female, median age 51) were included. Regression models found no significant correlations between pain relief expectations and degree of NDI score improvement at the 12-month postoperative timepoint or MCID achievement at the 3- and 12-month postoperative timepoints. There was no association between preoperative expectations and 12-month satisfaction. However, greater preoperative dissatisfaction was significantly associated with greater 12-month improvement in NDI score. Preoperative pain relief expectations were not associated with functional outcomes or satisfaction following 1-2 level primary ACDF or CDR at 12-month follow-up. Patients' dissatisfaction with their preoperative spinal condition was significantly associated with greater 12-month NDI improvement. Assessing preoperative satisfaction may help identify those most likely to benefit from surgery.

Review/Perspective: Incidence and treatment of CSF leaks/dural tears (DT) occurring during anterior cervical surgery

Background: The incidence of cerebrospinal fluid (CSF) leaks/dural tears (DT) occurring during anterior cervical diskectomy and fusion (ACDF) are typically relatively low. However, this frequency markedly increases when anterior corpectomy and fusion (ACF) are performed to address ossification of the posterior longitudinal ligament (OPLL). Methods: The reported frequencies of CSF leaks/DT occurring during elective ACDF (i.e. exclusive of trauma), ranges from 0.24% to 1.7%. Notably, this incidence substantially rises for multilevel ACF addressing anterior OPLL, markedly varying from 3.4 - 44.7%. Results: The classical risks of anterior cervical CSF leaks/DT with anterior cervical surgery may be minimized utilizing an operating microscope. For OPLL, careful evaluation of preoperative non-contrast CT studies is critical, especially to document whether any of the 3 signs of dural penetrance is present. Here, posterior operative choices should be strongly considered in the presence of sufficient lordosis and/or a Positive K Line (+ K Line) as this will avoid an anterior cervical CSF leak/dural fistula. Alternatively, for patients with kyphosis and a Negative K Line (- K Line), preoperative anticipation and planning to treat an intraoperative anterior CSF leak/DT (i.e. direct anterior primary dural graft repair with 7-0 Gore-Tex sutures, microdural staples, microfibrillar collagen, wound-peritoneal shunt, and lumbar drain or lumboperitneal shunt) are essential in the course of performing direct anterior OPLL resection. Conclusion: The incidence of anterior cervical CSF leaks/DT is relatively low (i.e. range 0.24 - 1.7%) where ACDF is performed for disc disease/spur/spondylosis exclusive of OPLL. However, where ACF is performed for multilevel OPLL, the risk of CSF Leaks/DT is substantially higher (i.e. range 4.3-44.7%).

Comparison of anterior vs. posterior surgery for cervical myelopathy due to OPLL: a systematic review and meta-analysis.

Systematic review and meta-analysis. To compare the effectiveness and safety between the anterior and posterior approach, and identify the more effective surgical approach for treating ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. This meta-analysis searched three electronic databases (PubMed, Embase, Cochrane library), including 17 randomized and non-randomized controlled studies published since 2000-2023 that compared the effectiveness and safety of anterior and posterior surgical approaches for the treatment of ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association (JOA) scores, functional recovery rates, excellent and good outcomes of the surgical approaches, Visual Analogue Scale (VAS), C2-C7 angle cobb and complication were analyzed. RevMan 5.3 was utilized for data analysis. This study suggested that there were no statistically differences between the anterior group and posterior group in terms of preoperative JOA score [WMD=0.23, 95% CI, (-0.22, 0.67), P=0.32], preoperative VAS [WMD=0.03, 95% CI, (-0.24, 0.30)], postoperative VAS [WMD=-0.16, 95% CI, (-0.47, 0.15) P=0.97] function recovery rate of patients with canal narrowing ratio less than 50-60% [WMD=-1.54, 95% CI, (-4.46, 1.38), P=0.30]. The anterior group showed higher postoperative JOA score [WMD=0.99, 95% CI, (036,1.63) P<0.05], post C2-C7 angle cobb [WMD=2.62, 95% CI, (0.36, 4.87), P=0.02] as well as function recovery rate (regardless of canal narrowing ratio) [WMD=16.05, 95% CI, (14.08, 18.03), P<0.05], especially a significant higher function recovery rate of patients with canal narrowing ratio greater than 50-60% [WMD=19.32, 95% CI, (17.25, 21.40), P<0.05]. There was a significant difference between anterior group and posterior group in complication. [OR=0.12, 95% CI, (0.01, 0.24), P<0.05]. Based on the study's finding, The study suggested that when the conservative treatment for OPLL is unsatisfied, the surgical approach of entering through the anterior approach is a better choice. Nevertheless, it is still necessary to consider the specific situation of the patient. One of the next research directions is how to reduce the complications of anterior surgery.

Artificial intelligence applications in cataract and refractive surgeries.

This review highlights the recent advancements in the applications of artificial intelligence within the field of cataract and refractive surgeries. Given the rapid evolution of artificial intelligence technologies, it is essential to provide an updated overview of the significant strides and emerging trends in this field. Key themes include artificial intelligence-assisted diagnostics and intraoperative support, image analysis for anterior segment surgeries, development of artificial intelligence-based diagnostic scores and calculators for early disease detection and treatment planning, and integration of generative artificial intelligence for patient education and postoperative monitoring. The impact of artificial intelligence on cataract and refractive surgeries is becoming increasingly evident through improved diagnostic accuracy, enhanced patient education, and streamlined clinical workflows. These advancements hold significant implications for clinical practice, promising more personalized patient care and facilitating early disease detection and intervention. Equally, the review also highlights the fact that only some of this work reaches the clinical stage, successful integration of which may benefit from our focus.

Polydatin protects against articular cartilage degeneration by regulating autophagy mediated by the AMPK/mTOR signaling pathway.

Knee osteoarthritis (KOA) is one of the leading causes of disability. Polydatin has a potential effect on KOA treatment but the therapeutic mechanism is not clear. This study aims to investigate the therapeutic action of polydatin in KOA and its mechanism in activating autophagy via the AMP-activated protein kinase (AMPK)/mTOR signaling pathway. After a KOA rat model was established by anterior cruciate ligament transection surgery, model rats were treated with polydatin 40 mg/kg for 30 days. Subsequently, cartilage tissues were collected, and hematoxylin-eosin (HE), Safranin-O, and TUNEL staining, and western blotting were performed to evaluate the pathological damage and autophagy-related protein expression. Then, human chondrocyte C28/I2 cells were stimulated with lipopolysaccharide (LPS), and the effects of polydatin on C28/I2 cell viability, apoptosis, and autophagy-related protein expression were detected by MTT, Flow Cytometry, and western blot. In addition, an AMPK inhibitor (Dorsomorphin 2HCl) was used to probe the cell proliferation and apoptosis of polydatin-administered C28/I2 cells. Polydatin ameliorated the pathological damage in rat cartilage tissues and inhibited cell apoptosis in KOA rats. Meanwhile, in C28/I2 cells, polydatin promoted viability and reduced apoptosis. In addition, the protein expression of collagen II, LC3II/LC3I, Beclin-1, and p-AMPK/AMPK were upregulated, and p62 and p-mTOR/mTOR were downregulated by polydatin treatment. Interestingly, relative results showed that the protective effect of polydatin in LPS-stimulated-C28/I2 cells was blocked by the AMPK/mTOR inhibitor, dorsomorphin 2HCl. Our research showed that polydatin reduced apoptosis and activated autophagy both in vivo and in vitro by the AMPK/mTOR signaling pathway to protect against KOA, which provided the basis for further investigation into the potential therapeutic impact of polydatin on KOA.

Establishment of Evidence-Based Nursing Indices for Dysphagia After Anterior Cervical Spine Surgery.

To select and obtain relevant evidence for the management of dysphagia after anterior cervical spine surgery both domestically and internationally, clinical quality evaluation indicators were developed based on evidence-based nursing practices, and obstacles and promoting factors in evidence-based nursing practices were analysed. This research was aimed to provide a basis for evidence-based nursing practices to promote standardized management of dysphagia after anterior cervical surgery. Dysphagia is the most common complication following anterior cervical surgery, but there is a lack of standard protocols and guidelines to direct clinical practice. Mixed methods were employed for the translational research to support evidence-based practice. This study was based on the JBI evidence-based health care model. According to the '6S Evidence Resource Pyramid Model', we searched from top to bottom. This study is guided by the knowledge to action (KTA) evidence-based practice model. Utilizing a comprehensive evidence-based approach and following the 6S evidence resource pyramid model, relevant evidence on the management of swallowing disorders after cervical anterior surgery was selected from both domestic and international sources. Based on the best available evidence, the Delphi expert consultation method was used to establish a management plan for swallowing disorders post-cervical anterior surgery. Semi-structured interviews were then conducted to identify barriers to clinical implementation, and clinical quality evaluation indicators, as well as promoting factors, were subsequently developed. Based on the 31 best evidence points, 12 evaluation indicators were developed. The baseline results of these indicators reveal that, apart from evaluation indicator 8, which has a compliance rate of 72.2%, the compliance rates for most of the other indicators are relatively low. Based on the results of the clinical quality review, the following main obstacles were analysed: negative behaviours and attributes, lack of professional knowledge, and lack of standardized management. Effective management of swallowing disorders after cervical spine surgery is crucial for enhancing treatment outcomes, reducing complications, shortening hospital stays and improving patient quality of life. This study identified the best evidence for managing dysphagia post-anterior cervical surgery and developed corresponding solutions. The next step involves applying these measures in clinical practice to improve patient prognosis and elevate the quality of care.

Direct anterior decompression in patients with ossification of the posterior longitudinal ligament significantly relieves short-segment spinal cord high signal

BackgroundIn patients with ossification of the posterior longitudinal ligament of the cervical spine (OPLL), high spinal cord signal (HCS) is frequently observed in the spinal cord of the corresponding segment. However, studies on the differences in the improvement of high spinal cord signal due to different surgical approaches are limited. The aim of this study was to investigate the improvement of high spinal cord signal in long and short segments with different choices of surgical approaches.MethodsIn this study, we conducted a meticulous review of medical records for patients diagnosed with ossification of the posterior longitudinal ligament (OPLL). Demographic variables, including gender, age, and body mass index (BMI), were systematically recorded. We evaluated the severity of neurological impairment using the Japanese Orthopaedic Association (JOA) scores both preoperatively and at multiple postoperative follow-up points. Neurological assessments were complemented by serial magnetic resonance imaging (MRI) T2-weighted imaging (T2WI) to measure the extent of high-signal changes (HCS) in the spinal cord, and the alteration of the HCS was quantified by the SCR (the ratio between the signal intensity value of the HCS region and the signal intensity value of the normal spinal cord region at C7-T1).ResultsIn the short-segment high signal change (HCS) group, comparisons of JOA score improvement (Recovery1) and HCS improvement (CR1) at 6 months postoperatively did not demonstrate significant differences between the surgical approaches (P > 0.05; Table 1). However, at the 2-year follow-up, patients who underwent anterior surgery exhibited significantly greater improvements in both JOA scores (Recovery2) and HCS (CR2), with statistical significance achieved (P < 0.05; Table 1). In contrast, in the long-segment HCS group, there was no significant difference between the anterior and posterior surgical approaches in terms of JOA improvement and HCS improvement at 6 months and 2 years postoperatively (P > 0.05; Table 2).ConclusionsIn patients with OPLL who present with spinal cord high signal, anterior surgery by resection of the ossified posterior longitudinal ligament and direct decompression is more conducive to regression of small spinal cord high signal and improvement of clinical neurological function if the extent of spinal cord high signal is small.

Is the Ossification of the Posterior Longitudinal Ligament a Positive Factor for the Fusion after Posterior Cervical Fusion and Decompression?

Objective: Multilevel posterior cervical fusion (PCF) and decompression surgery is a viable treatment option for multilevel ossification of posterior longitudinal ligament (OPLL) and spondylotic myelopathy. Since OPLL is known to affect bone formation, this study aimed to examine the effect of OPLL on the incidence of pseudarthrosis following PCF in a cohort study. Methods: We conducted a retrospective cohort study of patients with PCF and laminectomy at our institution. This study included patients who underwent C3 to C6 posterior fusion surgery involving lateral mass screw fixation without anterior surgery for OPLL or spondylotic myelopathy. Fusion status was evaluated 1 year postoperatively with computed tomography. Bone mineral density (BMD) and sagittal parameters were also evaluated as potential contributing factors to the fusion rate.Results: Eighty patients were included. Pseudarthrosis was observed in 22.5% (n=18) of patients. Pseudarthrosis incidence was lower in patients with OPLL (spondylosis vs. OPLL, 33.3% vs. 12.2%; p=0.003), and a higher BMD T-score (pseudarthrosis vs. fusion, -1.9 ± 0.7 vs. -0.6 ± 1.3; p&lt;0.01), a larger preoperative range of motion (ROM) (26.7 ± 13.3 vs. 17.6 ± 10.9; p=0.01), and a greater preoperative-to-postoperative decrease in cervical lordosis (-8.1 ± 7.9 vs. -2.7 ± 7.9; p&lt;0.01). Pseudarthrosis was associated with worsening neck pain after surgery. Conclusion: The absence of OPLL, lower BMD, larger preoperative ROM, and a greater decrease in postoperative cervical lordosis were identified as risk factors for pseudarthrosis after multiple PCF.

Intralimb Coordination Pattern of the Lower Limbs in Male Athletes With Allograft and Autograft Anterior Cruciate Ligament Reconstruction During Landing

Background and Objectives: Two common choices exist for anterior cruciate ligament (ACL) reconstruction, autograft and allograft. Hamstring tendon autografts and soft-tissue allografts are commonly used for ACL reconstruction. The outcomes between these two grafts are controversial. This research aims to quantify and compare lower limb joint coordination between two ACL reconstruction graft options and healthy individuals. Methods: Sixty-one athletes were enrolled after ACL reconstruction surgery (allograft, n=22; autograft, n=18). Furthermore, twenty-one healthy athletes were considered in the control group. The inclusion criteria included unilateral anterior cruciate ligament reconstruction surgery with allograft and autograft methods, male athletes with a minimum of 9 months and a maximum of two years since their surgery, successfully passing a series of quadriceps and hamstring strength tests and distance jumping before entering sports-specific activities under the supervision of a sports physiotherapist, and returning to pre-injury sports activities. Results: Autograft was not statistically different from matched healthy limbs in terms of joint coordination variability and magnitude (P&gt;0.05). However, the magnitude of joint coordination was superior to the allograft group compared to the autograft reconstructed ACL (P&lt;0.05). Conclusion: Although our result reported no significant difference between groups in joint coordination variability, having an insight into coordinative function after ACL reconstruction will help develop postoperative rehabilitation programs as well as minimize the re-injury risk among patients. We also suggest that scholars should conduct more robust trials with valid research designs to control the results of ACL reconstruction comparison with autograft and allograft.

Clinical significance of upper arm motor nerve conduction velocity in cubital tunnel syndrome.

Retrograde denervation occurs in severe entrapment neuropathy. This study aimed to investigate changes in motor nerve conduction velocity (MNCV) at the upper arm, specifically proximal to the elbow, in cubital tunnel syndrome (CuTS) and to correlate these changes with preoperative severity and postoperative outcomes. We retrospectively reviewed 95 elbows with 81 patients with CuTS for preoperative severity, and then 67 elbows with 60 of these patients who underwent anterior subcutaneous transposition surgery for postoperative outcome, classified into favorable and unfavorable groups according to Messina grade. The reduction of upper arm MNCV was correlated with aging, decreased compound muscle action potentials of abductor digiti minimi muscle, loss of sensory nerve action potentials, and modified McGowan grade. Postoperative assessment revealed lower MNCV values in the "unfavorable" group compared to the "favorable" group at 1 month, 6 months, and the last follow up. At each time point, the optimal cut-off value of upper arm MNCV for predicting postoperative outcomes was 54.1 m/s. Upper arm MNCV might be a useful predictor of poor surgical outcome. Ulnar nerve MNCV at the upper arm should be measured alongside routine assessment of MNCV at the elbow and forearm, especially in clinically severe cases considering surgery.

Micro-XCT analysis of anatomical features and dimensions of the incisive canal: implications for dental implant treatment in the anterior maxilla

BackgroundThis study used micro-focus X-ray Computed Tomography (micro-XCT) to examine the anatomical differences and dimensions of the maxillary incisive canal (MIC) in a South African population. The accurate imaging yielded dependable results that support earlier research and enhance anterior maxilla surgery planning. Furthermore, these anatomical features are compared between various racial and gender groupings in the study.MethodsUsing a micro-XCT scanner, 108 human cadaver skulls from the Pretoria Bone Collection were scanned and included in the study. Advanced volume rendering software was employed for measuring the MIC length, diameter, shape, and the buccal bone wall measurements in relation to the MIC.ResultsSignificant anatomical variation in the size and shape of the MIC was identified in the population, with variations seen between racial and gender groups. The incisive foramen (ICO) mean diameter was 6.61 mm, and the MIC length varied from 4.96 to 20.10 mm. There were significant differences in the buccal alveolar bone height between different ethnic groups and gender. Regarding morphological patterns in coronal and sagittal views, single canals were more common in the black population while Y-shaped canals were more common in the white population. The study also introduced a new metric by measuring the mean distances between teeth #11 and #21 and the ICO (1.83 mm and 1.88 mm respectively).ConclusionsThe complex anatomical differences of the MIC in a South African population were clarified. Clinicians should be aware of tooth sockets in near proximity to the MIC and perform accurate preoperative assessment using sophisticated 3-D imaging and preferable guided implant placement in the anterior maxilla.

Cervical Lordosis Correction and Segmental Height in Anterior Cervical Surgeries; The Role of Implant Choice

This study aims to compare the impact of three surgical techniques-stand-alone cage placement (SAC), anterior cervical plate (ACP) fixation, and total disc replacement (TDR)-on cervical lordosis restoration and segmental height after anterior cervical discectomy at C5-6 level. To eliminate the effect of lordosis between different levels, patients operated on at the same level were included in the study. Restoring cervical lordosis is crucial for improving patient outcomes, including pain reduction and preventing mechanical complications. A retrospective screening of 89 patients who underwent single-level C5-6 surgery between 2011 and 2021 was analyzed. Patients were categorized into three groups based on the surgical technique used: SAC, ACP, or TDR. Lordotic angles and segmental heights were measured preoperatively, first-month follow-up, and at the 24-month follow-up. Statistical analysis was conducted using the Wilcoxon Signed Rank test and ANOVA, with a significance threshold set at P<.05. All three techniques resulted in significant early and late postoperative increases in both global and segmental lordosis. The early postoperative height gain was most pronounced in the ACP group. However, no significant differences in lordosis or height preservation were observed among the groups at the 24-month follow-up. These findings align with previous studies, indicating comparable long-term outcomes across these surgical approaches. Stand-alone cage placement, anterior cervical plate fixation, and total disc replacement all effectively restore cervical lordosis and segmental height after anterior cervical discectomy at the C5-6 level. Despite early differences, the long-term results were similar, suggesting that the choice of technique should be based on individual patient needs and specific surgical considerations.

Impact of Age on the Occurrence of Vascular Complications in Patients Undergoing Anterior Lumbar Approach Surgery.

Retrospective cohort study. To investigate the impact of age on the incidence of vascular complications in patients undergoing anterior lumbar approach surgery. Anterior approach lumbar spinal surgery may facilitate the use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of this approach, risks related to vascular injury in older patients have been described in the literature. In total, 751 consecutive patients with degenerative spinal pathology who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation (360), total disc replacement, or hybrid procedures (ALIF and total disc replacement) were included. Data collected included general patient descriptive data, surgery details, intraoperative vascular injury, and postoperative vascular complications (deep vein thrombosis and/or pulmonary embolism). Rates of vascular complications were compared across age groups. In addition, the mean age of patients was compared between those with versus without vascular complications. Overall mean age was 50.4 years (range: 20-83 yr). The mean estimated blood loss was 91.3mL (range: 10-2800mL). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins (mean blood loss was 721mL, and all were repaired intraoperatively). Postoperatively, 6 patients (0.8%) developed deep vein thrombosis and/or pulmonary embolism (one patient had both). With respect to age, there were no significant differences in rates of intraoperative, postoperative, or combined vascular complication rates across the age group ( P > 0.38). In addition, there were no statistically significant differences in the mean ages of patients with versus those without vascular complications ( P > 0.17). Overall incidence of vascular complications was 2.0%. No relationship between vascular complications and age was demonstrated. These data suggest that increased age may not necessarily be an absolute contraindication for anterior lumbar approach surgery. Level III.

Comparison between early and late weight bearing after anterior cruciate ligament reconstruction surgery.

The anterior cruciate ligament (ACL) is a strip of dense connective tissue that runs from the femur to the tibia with a relatively poor blood supply. It prevents the femoral condyles from rolling posteriorly. ACL is commonly injured in any knee trauma, ranging from a little sprain to a total rupture. The arthroscope is the gold standard approach for identifying ACL tears, which may be treated conservatively or surgically. To assess the efficiency of immediate and delayed weight bearing after arthroscopic ACL reconstruction. Cohort longitudinal study carried through 6years from 2017 to 2023 et al.-kindy Teaching, Ulamaa, and Almuktar hospitals 186 patients, the patients were divided randomly into 2 groups, group A (n = 93) with immediate (after 10days) weight bearing and group B (n = 93) with delayed (after 1month) weight bearing following ACL reconstruction. any patients with chondral lesions, aged less than 19 or more than 40years, knee osteoarthritis, ligament damage, and deformity in lower extremities were excluded. Patients from both groups A and B had complete ACL tears and underwent arthroscopic ACL reconstruction follow-up for 6months duration regarding stiffness, infection, giving up pain, swelling, and quadriceps muscle atrophy. In group A, there were 93 patients,70 male and 23 female, and meniscal injury was 89 patients. While in group B (93 patients) 57 male and 36 female, meniscal injury in group B was 91. There is a statistically significant difference regarding knee swelling. (80.6% in group A, and 10.8% in group B), and knee pain in which (79.6% in group A patients and only 7.5% in group B). There is no significant value between the two groups about the knee getting given up, infection, stiffness, and quadriceps muscle atrophy. Delay weight bearing after ACL reconstruction makes the patients less prone to knee pain and effusion but more prone to quadriceps muscle atrophy.

8115 Evaluation Of The Incidence Of Hypoparathyroidism In Patients Undergoing Anterior Cervical Surgery

Abstract Disclosure: L.D. Santos: None. G. Oliveira Martins: None. J.V. Lima: None. L.A. Alvares: None. M.N. Lemos: None. L. Costa Figueiredo: None. E.N. Sakane: None. N. Scalissi: None. Introduction: The consensus published in 2022 suggests that a parathyroid hormone (PTH) level below 10 pg/mL may predict permanent hypoparathyroidism. However, these data have not yet been tested in the Brazilian population.Objective: To assess the clinical and laboratory characteristics of patients undergoing anterior cervical surgery, aiming to identify whether a postoperative PTH level below 10 pg/mL is associated with permanent hypoparathyroidism in a tertiary center in Brazil. Methods: We conducted a retrospective study with a chart review analysis. Results: We analyzed 59 patients who underwent anterior cervical surgery, with a mean age of 53 years (SD= +/- 17). 81% of the patients were alcohol consumers, and 76% were smokers. Regarding the surgical indication, 60.34% were for thyroid cancer, 17.24% for thyroid goiter, 13.79% for Graves' disease, 5.17% for glottic cancer, and 3.45% for primary hyperparathyroidism. Of the total operated patients, 49.15% were diagnosed with permanent hypoparathyroidism. The distribution of patients with permanent hypoparathyroidism was as follows: thyroid cancer 34.5%, Graves' disease 24.1%, goiter 24.1%, glottic cancer 10.3%, and primary hyperparathyroidism 7%. There was no significant difference in the occurrence of post-surgical hypoparathyroidism concerning the type of surgical indication (p&amp;gt;0.05). Regarding PTH 24 hours after surgery, a significant difference was observed between the group with permanent hypoparathyroidism and the group without the disease, with a mean PTH of 5.0 pg/mL and 10 pg/mL, respectively (p&amp;lt;0.05). As for serum calcium collected 24 hours post-surgery, there was no significant difference between the groups with and without permanent hypoparathyroidism (7.5 x 8.0 mg/dL; p&amp;gt;0.05). Conclusion: The PTH measurement in the first 24 hours postoperatively has proven to be more discriminative than the serum calcium measurement during the same period in identifying patients with permanent hypoparathyroidism. Presentation: 6/2/2024

Serotonergic Antidepressants are Associated With Higher Rates of Hematoma After Anterior Cervical Spine Surgery: A Large Propensity-matched Cohort Analysis.

Large database propensity-matched retrospective cohort analysis. This study aimed to investigate the potential effects of serotonergic antidepressants on outcomes after anterior cervical spine surgery (ACSS). It was hypothesized that the perioperative use of serotonergic antidepressants would be associated with higher rates of hematoma formation and worse outcomes after ACSS. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been associated with worse outcomes after orthopaedic procedures. A retrospective cohort analysis was performed using TriNetX, an aggregated and de-identified electronic health record platform. Patients who underwent anterior cervical surgery were included via Current Procedural Terminology (CPT) codes and the International Classification of Disease (ICD-10) encounter diagnosis codes. Cohorts were 1:1 propensity matched across seven demographic and medical comorbidity parameters, and outcomes were compared. The incidence of adverse outcomes, as well as healthcare utilization, within 14 days, 30 days, 90 days and 2-years post-operatively was evaluated. Following propensity matching, each cohort consisted of 9,249 patients, for a total of 18,498 patients included in final statistical analysis. SSRI/SNRI's were associated with higher odds of hematoma formation within 7-days (0.69% vs. 0.46%, OR 1.5 [95% CI 1.02-2.2], P=0.04) and within 14-days postoperatively (0.81% vs. 0.52%, OR 1.6 [95% CI 1.1-2.3], P=0.01. Within 30- and 90-days, SSRI/SNRI's were associated with higher risk of emergency department utilization (30-day OR 1.30 [1.1-1.4]; 90-day OR 1.3 [1.2-1.4]) and irrigation & debridement (I&D) (30-day OR 1.9 [1.2-3.0]). SSRIs/SNRIs were also associated with significantly higher risk of I&D within 2-years (OR 1.3 [1.1-1.6]). The use of serotonergic antidepressants perioperatively was associated with higher odds and risk of numerous outcomes, including hematoma formation, emergency department utilization and the need for irrigation & debridement. Future prospective studies are required to confirm these results. III; retrospective cohort analysis.

Successful Treatment of Nasopalatine Duct Cyst After Maxillary Anterior Implant Surgery: A Case Report.

Sporadic studies have reported the occurrence of nasopalatine duct cysts after maxillary anterior implant surgery, and the treatment methods still have clinical uncertainty. We report a potential therapy method that successfully treated a nasopalatine duct cyst that developed and expanded 1 year after maxillary anterior implant placement following periodontally hopeless teeth extraction. The nasopalatine cyst was treated surgically without removing implants. During flap surgery, the cyst was removed intact, and the exposed implant's surface was debrided thoroughly by hydrogen peroxide (H2O2) rinsing, glycine air polishing, and saline rinsing. To deal with the significant bone defect caused by the cyst, a bovine porous bone mineral injected platelet-rich fibrin (BPBM-i-PRF) complex was applied to fill the defect, following a resorbable collagen membrane to cover. Seven years after surgery, no cyst recurrence was observed, and bone regeneration in the bone graft area was stable. The implants functioned well without mobility. For nasopalatine duct cysts associated with dental implant placement, complete surgical debridement and longitudinal stable bone regeneration are possibly accessible by regenerative surgery without implant removal.

Efficacy of High Speed Drill for Safe and Adequate Neural Decompression in Anterior Cervical Discectomy and Fusion Surgeries.

Efficacy of High Speed Drill for Safe and Adequate Neural Decompression in Anterior Cervical Discectomy and Fusion Surgeries.