Surgical Approach For Treatment Research Articles

Epidemiology and Management Paradigm of Head and Neck Infections, including COVID-19 Pandemic Period: A 10-Year Retrospective Study in a Maxillofacial Center of Cluj-Napoca

Background. The management of odontogenic infections varies across the globe. To shed light on the subject, this study delves into the practices of the Oral and Maxillofacial Department at Cluj-Napoca County Hospital. Material and Methods. This comprehensive retrospective analysis of 10 years of clinical experience covered a range of factors, including demographics, clinical and investigations factors, medical and surgical treatment approaches, and follow-up. Additionally, the study examined the change in trends over the course of the COVID-19 pandemic. Results. While head and neck infection occurrence had a decreasing trend before the COVID-19 pandemic, during the pandemic era the number of patients almost doubled. The infections were prevalent in the submandibular space, teeth being the prevalent cause. Young adults are prone to suffer from odontogenic infections. High levels of C reactive protein, ASA II-IV risk, and hepatic dysfunction indicated a longer time of hospitalization. The majority of antibiograms were negative, and the positive ones indicated Streptococcus and Staphylococcus species as prevalent pathogens. Extra- or intraoral surgical drainage and wide-spectrum antibiotics proved to be the workhorse for odontogenic infections. Conclusion. This study advances our understanding of oral and maxillofacial surgery and offers actionable strategies for improving patient outcomes in similar healthcare institutions worldwide.

Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient

Background: Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries. Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies. Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique. Case presentation: A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and who was a heavy smoker, was admitted to our hospital with symptoms of long time with bilateral claudication and became leg rest pain. He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access. Aortoiliac occlusive disease (TASC II Type D Class) diagnosis was made by lower extremity duplex ultrasound and CT angiography. The patient underwent urgent percutaneous transluminal angioplasty with kissing stent technique. The patient was discharged 4 days after the procedure without any significant complaints, received optimal medical treatment, and was educated about smoking cessation. Conclusion: Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.

Clinical characteristics and multimodal imaging can help diagnosing and treating mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy.

Mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE) is a recently described, histopathologically and molecularly defined (SLC35A2-mutated) type of cortical malformation. Although increasingly recognized, the diagnosis of MOGHE remains a challenge. We present the characteristics of the first six patients diagnosed in Bulgaria, with the aim to facilitate identification, proper presurgical evaluation, and surgical treatment approach in this disease. Revision of histopathological specimens of 202 patients operated on for drug-resistant focal epilepsy identified four cases with MOGHE. Another two were suggested, based on clinical characteristics and subsequently, were histologically confirmed. Sanger SLC35A2 sequencing on paraffin-embedded or fresh-frozen brain tissue was performed. Analysis of seizure types, neuropsychological profiles, electroencephalographic (EEG), imaging features and epilepsy surgery outcomes was done. Three out of the six cases (50%) harbored pathogenic SLC35A2 mutations. One patient had a heterozygous somatic variant with uncertain significance. Clinical characteristics included epilepsy onset in infancy (in 100% under 3 years of age), multiple seizure types, and moderate or severe intellectual/developmental delay. Epileptic spasms with hypsarrhythmia on EEG were the initial seizure type in five patients. The subsequent seizure types resembled those in Lennox-Gastaut syndrome. The majority of the patients (n = 4) presented prominent and persisting autistic features. Magnetic resonance imaging (MRI) showed multilobar (n = 6) and bilateral (n = 3) lesions, affecting the frontal lobes (n = 5; bilaterally in three) and characterized by increased signal on T2/fluid-attenuated inversion recovery (FLAIR). Voxel-based morphometric MRI post-processing and positron emission tomography helped determining the localization and extent of the lesions and presumed epileptogenic zones. After surgery, four patients (66.7%) were seizure-free ≥2 years. Interestingly, all seizure-free patients carried somatic SLC35A2-alterations. Epileptic spasms, early prominent neuropsychological disturbances, MRI-T2/FLAIR hyperintense lesions with cortico-subcortical blurring, frequently multilobar and especially frontal, can preoperatively help to suspect MOGHE. Epilepsy surgery is still the only successful treatment option in MOGHE.

Recent Advances in Understanding and Management of Arteriovenous Malformations of the Temporal Skin Area

Context: Arteriovenous malformations (AVMs) of the temporal skin area, though less common than cerebral AVMs, pose significant challenges in terms of cosmetic and functional outcomes. Over the past decade, substantial advancements have been made in the understanding and management of these lesions. This paper aims to review the latest developments in the pathophysiology, diagnosis, and treatment of temporal skin AVMs, and to explore ongoing challenges and emerging research directions. Evidence Acquisition: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar. The focus was on research published in the past ten years related to temporal skin AVMs, including reviews, clinical studies, and advancements in treatment techniques. Results: The review discusses the evolution in understanding the pathophysiology of temporal skin AVMs, improvements in diagnostic imaging techniques, and the refinement of surgical and non-surgical treatment approaches. The outcomes, including cosmetic and functional results, and complications associated with various treatments, are also presented. Conclusions: The management of temporal skin AVMs has benefited from multidisciplinary approaches, combining surgery, interventional radiology, and dermatology. However, challenges remain in achieving optimal cosmetic and functional outcomes, necessitating ongoing research and innovation.

ОЦЕНКА РЕЗУЛЬТАТОВ ПРИМЕНЕНИЯ АЛГОРИТМА ВЫБОРА ОПТИМАЛЬНОГО ХИРУРГИЧЕСКОГО ДОСТУПА К ЗАБРЮШИННОМУ ПРОСТРАНСТВУ У ПАЦИЕНТОВ С РАЗЛИЧНЫМИ ПАРАМЕТРАМИ КОНСТИТУЦИИ.

Relevance. Despite the rapid development and predominance of endovideosurgical techniques in the treatment of pathologies of organs and structures of the retroperitoneal space, the implementation of transperitoneal or retroperitoneal approaches for open surgical interventions remains a routine activity. Surgical treatment of various pathologies of retroperitoneal localization leads to the development of nonspecific life-threatening complications in 23.8% - 30% of clinical observations, and associated mortality - 7.2% - 11% of cases. Previously, our works presented the results of comparing the number of this type of complications when using laparotomy or retroperitoneal access, depending on the constitutional parameters of the patient. An assessment was made of the significance of the influence of constitutional parameters on the development of nonspecific life-threatening complications, on the basis of which an algorithm for choosing the optimal surgical access to the structures of the retroperitoneal space was developed [patent application No. 2024113445 dated May 17, 2024]. Purpose of the study. To evaluate the effectiveness of using an algorithm for selecting the optimal surgical approach in the surgical treatment of pathologies of organs and structures of retroperitoneal localization. Materials and methods. Comparative analysis of the results of surgical treatment of patients with various surgical pathologies of the retroperitoneal space. Group I (n = 167), where the choice of surgical approach was determined using the “optimal surgical approach selection algorithm.” Group II (n = 284), in which the choice of access to the structures of the retroperitoneal space was not unified and was chosen without taking into account the constitutional parameters of the patient. In the perioperative period, the duration of surgical intervention, the volume of intraoperative blood loss, the number of days of stay in the intensive care unit, the time of postoperative respiratory support, the duration of postoperative intestinal paresis and the number of postoperative bed days were assessed. Criteria assessed in the postoperative period: development of myocardial infarction, acute cardiovascular failure, ARDS with the development of respiratory failure, acute kidney injury; cases of development of ischemic colitis and small intestinal obstruction, requiring repeated interventions, as well as the phenomenon of multiple organ failure. Wound complications included failure of retroperitoneal and laparotomy wounds, including eventration. To calculate quantitative characteristics, the median (Me) and percentiles (Q0.25 - Q0.75) were determined. Calculation of statistical significance between groups was performed using the Mann-Whitney U test**, for comparison of qualitative indicators - the Chi-square test* in IBM SPSS Statistics 25 software. Results. In group I, compared with group II, there was a shorter surgical intervention time [140.8 vs 179.5] min, p = 0.031**, a smaller volume of intraoperative blood loss [280.4 vs 413.3] ml, p = 0.024* *; postoperative respiratory support [4.5 vs 8.5] hours, p = 0.041**; length of stay in the intensive care unit [1.8 vs 3.4] days, p = 0.021**; postoperative intestinal paresis [1.2 vs 4.8] days p = 0.024**; and duration of total postoperative hospital stay [9.1 vs 16.4] days p = 0.003**. The number of postoperative nonspecific life-threatening and wound complications in group I was 24 (14.4%), and in group II - 64 (22.5%) cases (p = 0.023*). The number of complications-related deaths in group I was 9 (5.4%); in group II - 32 (11.26%) cases (p = 0.037*). Conclusion. The use of an algorithm for selecting the optimal surgical approach for surgical treatment of pathologies of organs and structures of the retroperitoneal localization of the access leads to a reduction in the number of nonspecific life-threatening complications to 14.4%, and associated deaths to 5.4%.

Substitute or coexistence? mediastinoscopy-assisted versus thoracoscope-assisted esophagectomy in esophageal cancer - a meta-analysis of perioperative outcomes and long-term survival.

Currently, mediastinoscopy-assisted esophagectomy (MAE) and thoracoscope-assisted esophagectomy (TAE) represent two prevalent forms of minimally invasive esophagectomy extensively employed in the management of esophageal cancer (EC). The aim of this meta-analysis is to assess and compare these two surgical approaches concerning perioperative outcomes and long-term survival, offering valuable insights for refining surgical strategies and enhancing patient outcomes in this field. Adhering to PRISMA guidelines, we systematically searched PubMed, Web of Science, Cochrane Library, Embase, and CNKI databases until March 1, 2024, for studies comparing MAE and TAE. Outcomes of interest included perioperative outcomes (intraoperative outcomes, postoperative recovery, postoperative complications) and survival rates. Statistical analyses were performed using RevMan 5.4, with heterogeneity dictating the use of fixed or random-effects models. Totally 21 relevant studies were finally included. MAE was associated with significantly shorter operation times ((MD=-59.58min, 95% CI: -82.90, -36.26) and less intraoperative blood loss (MD=-68.34mL, 95% CI: -130.45, -6.23). However, MAE resulted in fewer lymph nodes being dissected (MD=-3.50, 95% CI: -6.23, -0.78). Postoperative recovery was enhanced following MAE, as evidenced by reduced hospital stays and tube times. MAE significantly reduced pulmonary complications (OR=0.59, 95% CI: 0.44, 0.81) but increased the incidence of recurrent laryngeal nerve injury (OR=1.84, 95% CI: 1.30, 2.60). No significant differences were observed in anastomotic leakage, chylothorax, cardiac complications, wound infections, and gastric retention between MAE and TAE. The long-term survival outcomes showed no statistical difference (HR=1.05, 95% CI: 0.71-1.54). MAE offers advantages in reducing operation time, blood loss, and specific postoperative complications, particularly pulmonary complications, with a shorter recovery period compared to TAE. However, it poses a higher risk of recurrent laryngeal nerve injury and results in fewer lymph nodes being dissected. No difference in long-term survival was observed, indicating that both techniques have distinct benefits and limitations. These findings underscore the need for personalized surgical approaches in EC treatment, considering individual patient characteristics and tumor specifics.

Mucosal melanoma treatment patterns and outcomes in real clinical practice: Single institution experience.

e21571 Background: Mucosal melanoma (MM) is a challenging malignancy to diagnose and treat, even with the advent of modern drug therapies. There is a lack of established surgical, radiological, or pharmacological treatment approaches for locally advanced or metastatic mucosal melanoma. This study analyzes the treatment practices and clinical outcomes at a single institution over a five-year period to understand real-world clinical practices. Methods: A сomprehensive, continuous, retrospective study analyzed medical records of adults with histologically confirmed MM at the N.N. Blokhin Russian Cancer Research Center from January 2018 to December 2023. Data was digitized into an electronic questionnaire, with patient follow-up conducted via telephone. Results: A total of 87 patients were identified, comprising 72 females (82.8%) from 31 regions of Russia. The median age was 67.8 years (ranging from 29.5 to 90.1 years). The patient breakdown was as follows: 6 with head&neck MM (6.9%), 41 with vulvovaginal MM (47.1%), 5 with penile MM (5.7%), 27 with anorectal MM (31.0%), and 8 with gastrointestinal MM (9.2%). A significant portion of the patients presented with locally advanced (22.9%) or metastatic disease (67.8%), while 9.2% of the patients had undergone surgery and were being considered for adjuvant treatment. The most common sites of metastasis were regional lymph nodes (23%), liver (14%), and lungs (11.5%), with one patient having CNS metastasis. Mutational status was determined for 48 of the 87 patients, revealing driver mutations in 12 patients (Table). The majority of patients were initially treated with immunotherapy. The most frequently used therapies included monotherapy with anti-PD-1 agents (nivolumab or pembrolizumab, accounting for 41.6%) and a combination of ipilimumab and nivolumab (33.3%). After a median follow-up of 17.7 months, the median overall survival (OS) for the entire cohort was 18.1 months (with a 95% confidence interval ranging from 6.8 to 23.2 months), showing no significant statistical differences in outcomes based on the location of the mucosal melanoma or the type of treatment received. Conclusions: Mucosal melanoma remains an under-researched malignancy. There is a critical need for prospective, randomized trials to explore more effective treatment options for patients with this condition. [Table: see text]

MR diffusion-weighted imaging precision in BIRADS downstaging

BackgroundBreast cancer is a major cause of both morbidity and mortality. Therefore, it is essential to promptly identify breast cancer in order to implement a more cautious surgical approach for disease treatment. Breast ultrasonography examination has long been used as a supplementary technique to mammography to evaluate palpable or mammographically detectable breast masses. Presently, Breast MRI has become an essential instrument for the detection and analysis of breast cancer. Diffusion-weighted imaging (DWI) is MRI technique that quantifies the movement of water molecules within tissue. It can provide valuable information about the density, viscosity, integrity of membranes, and microstructure of tissues. This study included sixty patients with Equivocal/high BIRADS lesions, underwent Mammography and /or U/S, CEMRI with DWI.Aim of the workThe aim of this study was to disclose MRDWI potency in depiction and assessment of different breast lesions unaccompanied by contrast-enhanced MRI with a view to avoid the high cost of the MRI contrast, lessen the number of needless biopsies and probably reclassify breast lesions of high BIRADS categories.ResultsThis prospective study included 58 patients (with 60 breast lesions), who came with sono-mammography breast lesions of BIRADS lesions > 2, comparison between sono-mammographic BIRADS and MRI BIRADS was done, where 40 cases were downgraded by MRBIRADS. On paralleling MRDWI unescorted by contrast-enhanced MRI with sono-mammographic BIRADS, 36 cases were downgraded. Correlation between pathology of the biopsied lesions with sono-mammography, MR BIRADS and MRDWI was done as well. Sono–mammography shows 88.9% sensitivity and 61.9% specificity with accuracy of 77.7%. Combined CE –MRI and DWI shows 94% sensitivity and 97.6% specificity with accuracy of 96%. While DWI solely shows 88.9% sensitivity and 90.5% specificity with accuracy of 96%. The cutoff value of ADC for prediction of malignancy was 0.9 with 94% sensitivity, 87% specificity and 83.3 accuracy.ConclusionsCEMRI is un-debatably effective in depicting and discriminating indeterminate breast lesions chiefly when combined with DWI. Yet, with the high expense of the contrast and in the event of contrast contraindications or unavailability, DWI has proven to be a convenient substitute for CE-MRI aiding in rendering the breast lesion BIRADS downgraded with diminishing the unneeded biopsies.

The management of goal-directed fluid therapy during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Cytoreductive surgery is a surgical treatment approach that has been applied over the last 3 decades in patients with peritoneal metastases originating from intraabdominal organs. Goal-directed fluid therapy (GDFT) is an approach in which a patient fluid therapy during a medical procedure or surgery is carefully managed based on a specific goal. In this study, we aimed to present the results of GDFT in patients who underwent cytoreductive surgery for peritoneal carcinomatosis (PC) during the perioperative period. This retrospective study included 398 patients patient who underwent cytoreductive surgery + hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) due to PC originating from intraabdominal malignancies. Of the cases, 233 (58.6%) were female, and 165 (41.4%) were male patients. The mean age was 58.9. Perioperative findings revealed an average PC score of 12 (3-24), average lactate levels of 3 (2-7) mmol/L, Pao2/fio2 of 3.3 (2.4-4.1) mm Hg, mean arterial pressure (MAP) of 60 (55-70), average surgery duration of 6.5 hours (3-14), and average blood loss of 400 (200-4000) cc. The mean intraoperative fluid rate was 6.4 mL/kg/h (IQR 5.8-7.1). Sixteen (16.3%) patients experienced Clavien-Dindo Grade 3-4 adverse events. Within 30 days, 25 patients (6.3%) died. CRS + HIPEC procedures utilizing perioperative GDFT along with advanced anesthesia monitoring devices have shown successful application, offering an alternative to traditional and restrictive fluid management approaches.

SAGES guideline for the diagnosis and treatment of appendicitis.

Appendicitis is an extremely common disease with a variety of medical and surgical treatment approaches. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians and patients in decisions regarding the diagnosis and treatment of appendicitis. A systematic review was conducted from 2010 to 2022 to answer 8 key questions relating to the diagnosis of appendicitis, operative or nonoperative management, and specific technical and post-operative issues for appendectomy. The results of this systematic review were then presented to a panel of adult and pediatric surgeons. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Conditional recommendations were made in favor of uncomplicated and complicated appendicitis being managed operatively, either delayed (>12h) or immediate operation (<12h), either suction and lavage or suction alone, no routine drain placement, treatment with short-term antibiotics postoperatively for complicated appendicitis, and complicated appendicitis previously treated nonoperatively undergoing interval appendectomy. A conditional recommendation signals that the benefits of adhering to a recommendation probably outweigh the harms although it does also indicate uncertainty. These recommendations should provide guidance with regard to current controversies in appendicitis. The panel also highlighted future research opportunities where the evidence base can be strengthened.

Management of Chronic Fissure in Ano: A Case Study on Conservative vs. Surgical Treatment Approaches

The conservative treatment arm includes dietary modifications, stool softeners, topical analgesics, and sitz baths. This approach focuses on symptom relief, promoting healing, and preventing recurrence. In contrast, the surgical intervention arm involves procedures like lateral internal sphincterotomy (LIS) or advancement flap repair. These techniques aim to address the underlying sphincter hypertonicity or poor blood supply to the fissure site. The case study will present two patient profiles: one managed conservatively and the other surgically. Parameters such as pain scores, healing rates, time to symptom resolution, and recurrence rates will be compared between the two groups. Additionally, quality of life metrics and patient satisfaction will be assessed. Insights from this case study can aid clinicians in selecting the most appropriate treatment modality for chronic anal fissures, considering factors such as severity, patient preference, and potential risks. Ultimately, the study seeks to contribute valuable evidence to the ongoing debate surrounding the optimal management strategy for this prevalent colorectal condition. Furthermore, the impact on the patient's quality of life and satisfaction with the chosen treatment approach is examined. Through a multidisciplinary approach involving gastroenterologists, colorectal surgeons, and the patient, this case study highlights the importance of individualized care and shared decision-making in managing chronic fissure in ano.

Staged bilateral total shoulder arthroplasty: a single institutional experience with mid-term follow-up

BackgroundThe preferred surgical approach for surgical treatment of advanced glenohumeral arthritis is shoulder arthroplasty (SA). Considering the growing volume and success of SA, patients with bilateral shoulder disease are likely to undergo surgery on both shoulders. There are numerous studies evaluating the outcomes of bilateral hip and knee arthroplasty, but a paucity of information examining bilateral SA. This study intends to evaluate the clinical outcomes of patients undergoing staged bilateral anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA). MethodsInstitutional records were queried for patients who underwent staged bilateral aTSA or rTSA from 2009 to 2020. Patient records were retrospectively reviewed to assess preoperative and postoperative range of motion (ROM) and strength measurements, demographic information, and complications. Mean ± standard deviation was reported for all continuous variables. Mean functional measurements were compared using a 2-Sample t-Test, ordinal variables via Wilcoxon-Mann Whitney test, and categorical variables via Chi-squared test. Patients were included in the outcome analysis if they had a bilateral TSA with the same procedure (i.e. aTSA on both sides, or rTSA on both sides). Results43 patients (15 male, 28 female) were included. There was an average time of 1.8 years between surgeries. Of the 43 patients, 26 patients had staged bilateral aTSAs and 14 had staged bilateral rTSAs with three patients who had different surgeries on each shoulder. The three patients with different surgeries on each shoulder were excluded from outcome analysis. Patients who had staged aTSA operations demonstrated significant improvement in external rotation (P = .0191, P < .001), forward elevation (FE) (P = .0004, P < .001), and internal rotation (IR) (P = .0183, P = .0166) after the first and second surgeries. Staged rTSA patients showed significant improvement in FE after the first (P = .0043) and second surgeries (P = .016). Patients demonstrated significant increase in strength of external rotation (P = .0136), FE (P = .0088), and IR (P = .0206) after the first rTSA. There was no corresponding increase in strength testing after the second bilateral rTSA surgery. The average Single Assessment Numeric Evaluation, Contralateral Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores for all surgeries were 84 ± 10, 83 ± 13, 75 ± 20, and 9 ± 2, respectively for the first surgery and 82 ± 13, 83 ± 13, 71 ± 21, and 8 ± 3 for the second surgery. ConclusionIndividuals that undergo staged aTSA procedures gain a better ROM and IR strength after both operations. However, individuals that undergo staged rTSA procedures have an improved ROM and strength after the first surgery but limited improvement after the second.

Pecial features of surgical approach for patients with Dupuytren's contracture (our experience)

Objective. Although many years history of study, the issue of treating patients with Dupuytren's contracture keeps on being relevant. It is due to high incidence of this pathological condition among the population (up to 8.2%), the lack of a unified surgical treatment approach, and a high risk of postoperative complications (up to 40%). Existing approaches to the treatment do not ensure the absence of condition recurrence and are related to a long recovery period (up to 12 months).Purpose of the study: to improve the outcomes and reduce the treatment period of the patients with Dupuytren's contracture by creating and integrating algorithm for choosing the optimal surgical intervention in clinical practice.Material and methods. The study involved two parts. In the first part data of surgical treatment performed for 8962 patients with Dupuytren's contracture (10213 surgeries) operated during the period of 2007–2022 were analyzed. 6632 male (74%) and 2330 female (26%) were enrolled in the study. The patients’ mean age was (57 ± 6) years old (from 24 to 92 years old). 9396 needle fasciotomies (92%), 562 subtotal fasciectomies (5.5%), and 255 inspection interventions for recurrence after subtotal fasciectomy (2.5%) were performed.In the second part of the study, we suggested a universal algorithm for choosing the optimal technique of surgical treatment of patients with Dupuytren's contracture, depending on the severity, the presence of concomitant skin problems in the operation site (tightening scars or trophic lesions), the number of recurrences, and the method having caused them.Results and discussion. The follow-up period ranged from 3 to 15 years. Treatment outcomes were assessed using the qDASH scale and the treatment satisfaction subjective scale. Perfect treatment outcomes were obtained in 56.8% of cases, good – in 28.2%, satisfactory – in 11.1%, and unsatisfactory – in 3.9% of cases. Complications (iatrogenic damage to the dactylar nerves and arteries, flexor tendons, ruptures and deep skin cracks, and superficial infectious complications) occurred in less than 8% of patients. Contracture recurrences were noted in 5370 cases (52.6%).The analysis of our own 15-year experience (more than 10000 surgeries) as well as the study of colleagues’ experience (according to the literature) allowed us to formulate the guidance for choosing the approach of treating the patients with various forms of Dupuytren's contracture.In primary Dupuytren's contracture, we recommend needle fasciotomy (or collagenase injections) as a quick, minimally invasive surgical procedure causing minimal complications and contraindications (less than 8%). In severe cases, rehabilitation under the monitoring of a hand physician is recommended after the surgery.If the recurrence takes place after needle fasciotomy, a repeated minimally invasive procedure may be conducted. The condition recurring three or more times, we recommend considering the open surgery – subtotal fasciectomy accompanying by obligatory epidermic grafting (not palmar skin): cross-finger flap, dorsal metacarpal artery bond flap (Quaba/Maruyama), or full-thickness free skin graft taken from the forearm.The recurrence after subtotal fasciectomy occuring, the presence of tightening scars and trophic lesions should be assessed. In some cases, the tightening scars lack, a needle fasciotomy may be conducted by specialists having mastered the technique. In other cases, trophic lesions absent, we consider the inspection subtotal fasciectomy accompanied by the obligatory closure of the soft tissue defect using a full-thickness skin autograft or bond flap (not palmar skin) must be performed.Obligatory patients’ follow-up for two years (medical examinations every six months) after the surgery to identify the early signs of recurrence, collagenase or steroids injections into the palmar aponeurosis nodes (and/or physiotherapy with Fermencol) in case of disease progression, or prophylactic radiotherapy immediately after the surgery virtually allow to eliminate the risk of the condition recurrence.Conclusions. Analysis of the treatment outcomes of patients with Dupuytren's contracture of varying severity allowed us to work out a universal algorithm for choosing the optimal tactics of surgical treatment of the condition enabling improving the outcomes, reducing the recovery period, and decreasing the risk of recurrence.

Supraciliary Approach in Surgical Treatment of Zygomaticomaxillary Complex Fractures

Objective: To demonstrate the effectiveness of a supraciliary approach in zygomaticomaxillary complex fractures treatment.Case report: Patient A. (33-year-old man) was admitted to the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) with a diagnosis of traumatic fractures of the right and left zygomaticomaxillary complexes. According to the medical history, the injury was caused by a car accident. The patient underwent computed tomography of the facial skeleton. Computed tomography findings: fractures of lateral and medial orbital walls, supraorbital and infraorbital rims, glabella, and nasal septum. The patient underwent repositioning of the bone fragments and internal fixation with metal implants. The glabella fracture was reduced through a supraciliary approach. The function of the mimic muscles was fully preserved. The configuration of the face and soft tissues was restored. No soft tissue edema was observed. The postoperative scar is visualized after the unfolding of the orbito-palpebral fold of the upper eyelid.Conclusions: The systematic use of esthetic approaches by surgeons completely changes the rooted traditional way of managing patients with various maxillofacial pathologies. In addition to outstanding esthetic results, it increases the surgeons’ expertise level and the range of tasks a comprehensively developed specialist is capable of dealing with. One of the most crucial aspects is improvement of patients’ quality of life.

LARYNGEAL CANCER SURGICAL RESULTS; 10 YEARS OF EXPERIENCE

OBJECTIVE: In this study, it was aimed to present the patients who underwent open laryngectomy in a tertiary otolaryngology clinic with current literature information in terms of age, gender, first symptom and duration, histopathological diagnosis, localization of the primary disease, neck condition, and our surgical treatment approach and results. MATERIAL AND METHODS: In this study, the retrospective analysis of the files of 70 patients who underwent open surgical treatment for laryngeal cancer between 2011 and 2021 in a tertiary otorhinolaryngology clinic is discussed. RESULTS: Of our laryngeal cancer cases, 68 (97.1%) were male, 2 (2.9%) were female, and their mean age was 64.9 (48-89 years). Thirty-four (48.57%) of our cases were glottic, 23 (32.9%) supraglottic, and 11 (15.7%) transglottic. There were 2 (2.85%) cases with isolated subglottic locations. Total laryngectomy was performed in 38 (54.3%) cases and partial laryngectomy was performed in 32 (45.7%) cases. Vertical laryngectomy in 1 (1.42%) of patients, subtotal laryngectomy in 1 (1.42%), frontolateral laryngectomy in 6 (8.57%), supraglottic horizontal laryngectomy in 10 (14.28%), supracricoid in 14 (20%) patients laryngectomy was performed. As a histopathological diagnosis; 3 (4.2%) cases of baso-squamous carcinoma, and the remaining 67 (95.8%) cases were squamous cell carcinoma. CONCLUSIONS: Surgery has an important place in the treatment of laryngeal cancers and neck dissection is complementary to regional control. Occult metastases in the cervical region cannot be determined using noninvasive methods, neck dissection is required to identify them. Detailed histopathological evaluation of lymph nodes removed during neck dissection is currently the most reliable method available for accurate diagnosis of lymph nodes.

A novel surgical treatment approach for the vertical root fracture of posterior teeth: a case report with 24-month review

Background Up to 25% of the tooth extraction after root canal treatment could be attributed to the vertical root fracture (VRF). The treatment choice for teeth with VRF would mostly be the extraction despite some repairing methods were also reported. The repairing treatment result of VRF would mostly depend on the fixation strength and the bioactivity of the repairing materials, especially for the posterior teeth with high masticating stresses. This case report designed a novel surgical treatment approach for the VRF of posterior teeth.Methodsa maxillary premolar with buccal-palatal complete VRF was treated with a new dual-layered repairing approach using adhesive resin + iRoot BP Plus bioceramic cement to fill the modified fracture line with retention forms through the intentional replantation.ResultsAt the 24-month review, the tooth showed desirable periodontal healing and normal function.ConclusionsThis case report indicated that the dual-layered repairing approach might be effective for saving the posterior teeth with VRF. Nevertheless, further clinical trials are needed for its long-term result.

Instrumental Tracheal Rupture

Abstract Tracheal rupture is an urgent life-threatening complication that relates to complex and poorly understood areas of trauma surgery. The article presents a review of modern world and domestic literature on instrumental tracheal ruptures, the Relevance of early diagnosis and various treatment methods. Based on an analysis of modern literature data, the article describes the issues of conservative and surgical treatment methods, as well as an assessment of their results. The problem of the diagnostic algorithm and the choice of conservative, surgical treatment has not been solved and remains relevant. The issues of treating patients with a defect in the membranous wall of the trachea in intensive care and in need of artificial ventilation in clinical practice remain unresolved. All of the above indicates the Relevance of the study.Aim of the study To present data from domestic and foreign literature on the diagnosis and treatment of instrumental tracheal ruptures.Material and methods A review of the literature was carried out for the period from 1993 to 2024 in Russian and English, available on the databases Pubmed, Medline, UpTodate, Scopus, E-library, on topics such as post-intubation tracheal rupture, iatrogenic tracheal rupture, diagnosis and treatment of instrumental tracheal ruptures, closed tracheal injury.Results The concept of the classification system, risk factors, etiopathogenesis is outlined. Information is provided on the diagnostic significance of computed tomography and tracheobronchoscopy. Close attention is paid to the methods and choice of treatment tactics, the principles of intraoperative tactics, and the strategy of conservative treatment. A comparative assessment of treatment Results and their complications with a conservative or surgical treatment approach is given.Conclusion Thus, an analysis of domestic and foreign literature indicates that the issues of diagnosis and treatment of iatrogenic tracheal injuries remain largely unresolved. There is no generally accepted algorithm for instrumental diagnosis of tracheal ruptures. There are no uniform approaches to determining indications and contraindications for conservative and surgical treatment of tracheal injuries. There are diametrically opposed opinions regarding the choice of treatment tactics. These contradictions create significant difficulties in assessing the Results of treatment of this complex category of patients.

Management of ossifying fibroma of the bone of the maxilla: a case report and review of the literature

Abstract Ossifying fibroma (OF) is a slow-growing benign fibro-osseous neoplasm. It is mostly odontogenic in origin, and it arises in the jaws, particularly the mandible. OF is characterized by the production of bone and cementum-like calcifications in a fibrous stroma. OF reports of the bone of the maxilla are uncommon. Diagnosing OF can be challenging due to the considerable overlap of clinico-pathological characteristics with those of other neoplasms. Herein, the authors describe a case report OF in a 26-year-old male who presented with a huge fibro-osseous tumor of the maxilla. Histopathology established the diagnosis of maxillary OF. The tumor was surgically removed via a Weber–erguson approach with satisfactory functional and cosmetic results. No recurrence has been found after one year of follow-up. Clinical, radiological, and pathological characteristics, as well as surgical treatment approaches, are further discussed. This is one of a few documented cases of maxillary OF in our setting.

Surgical treatment of invasive fungal infection in pediatric oncology.

Invasive fungal disease (IFD) is typically aggressive and related with high mortality in children with a hematological malignancy. The association of medical and surgical treatment may ameliorate the outcome. The aim of this study was to analyze the surgical treatment of fungal infections in pediatric oncological populations. Retrospective study (2000-2022) of a single-center experience. We reviewed the medical record of all patients with hematologic malignancies and IFD, analyzing the outcome. From the 70 pediatric cases of hematologic malignancies with the diagnosis IFD over 22 years, we included in the present study 44 cases who required surgical approaches for either diagnosis or treatment. Twenty-one patients were males and the mean age was 11 (range 1-23) years. The main indications for surgery were lack of improvement following medical treatment and/or progression of fungal infection (80%) and diagnosis confirmation (20%). Only five patients needed an emergency operation for rapid worsening of symptoms. The most common site of infection was the lung (80%) and the most frequently identified pathogen was Aspergillus (75%). The most common surgical procedures were lobectomy (performed in 17 patients) and atypical lung resection (10). Complications of surgery were mostly treated by medical approach. The mean time of resumption of oncological treatment was 40 (range 0-150) days. Surgery is an important step in the multimodal treatment of invasive fungal infection with excellent resolution rate. Overall mortality depends on the underlying malignancy.

DIFFERENTIAL APPROACH IN THE COMBINED SURGICAL TREATMENT OF VARICOSE VEINS OF THE LOWER EXTREMITIES ACCORDING TO THE RESULTS OF ULTRASOUND DOPPLER ULTRASOUND

The most common pathology of the lower extremity veins is varicose veins, which is an urgent medical and social problem. The number of patients with trophic disorders is not decreasing, despite the improvement of treatment methods, which leads to a deterioration in the quality of life. Therefore, the topic of introducing new and improving existing minimally invasive treatment methods is relevant and requires further research. According to international studies, the combined laser method of treatment is superior in terms of therapeutic and cosmetic results to all known methods of surgical treatment of varicose veins and can be used in most cases.Aim. To demonstrate the eff ectiveness of individual diff erentiated combined surgical techniques for the treatment of varicose veins of the lower extremities, taking into account the data of ultrasound preoperative and intraoperative navigation.Material and methods. The study included 246 patients with varicose veins of the lower extremities of class C2-C5, who had various variants of varicose veins of the lower extremities – saphenous varicose veins in the system of small and/or large saphenous veins, which in some patients was combined with varicose veins in the basin of non-saphenous veins and reticular varicose veins. Patients were divided into clinical groups due to the diff erence in surgical and tactical treatment approach. All patients underwent preoperative ultrasound Doppler ultrasonography (USG) of the lower extremity veins in horizontal and vertical positions. The patency of deep and saphenous veins, the presence of unable varicose dilated saphenous venous tributaries with an assessment of the aff ected basin (saphenous, non-saphenous varicose veins and combined forms) were assessed. Horizontal and vertical pathological venous refl uxes were detected. All patients underwent combined surgical intervention – EVLC and miniphlebectomy under ultrasound Doppler monitoring, and sclerotherapy as indicated. The observation period lasted 1.5 years for each patient.Research results and discussion. The assessment of the treatment results was based on the presence of patient complaints, analysis of the clinical picture, the presence or absence of complications during the observation period, recurrence of the disease during the observation period, and analysis of the ultrasound assessment of the veins by an ultrasound diagnostician during a dynamic examination. USG was mandatorily performed in patients of all groups before surgical treatment, during surgical correction and as a control within 1-3 days after surgery. Dynamic follow-up was performed in all patients at 1, 3, 6 and 12-18 months after surgical treatment.Conclusions. Most patients have a complete recovery after surgical treatment. Careful history taking in patients of this group and performance of ultrasound Doppler ultrasonography of the veins of the lower extremities allowed to choose an eff ective individual surgical treatment. Specialists’ understanding of the capabilities of ultrasound Doppler ultrasound of the veins of the lower extremities, as well as compliance with the full examination protocol for ultrasound Doppler veins, allows us to provide detailed information to determine the most eff ective treatment tactics and prevent complications of the disease.