Bone Removal Research Articles

Repeat discectomy for recurrent same level disc herniation: A literature review of the past 5 years.

Recurrent disc herniations remain a challenge in spinal surgery. Although some authors recommend a repeat discectomy, others offer more invasive secondary fusions. Here, we reviewed the literature (2017-2022) regarding the safety/efficacy of treating recurrent disc herniations with repeated discectomy alone. Our literature search of recurrent lumbar disc herniations included; Medline, PubMed, Google scholar, and the Cochrane database. We focused on the types of discectomy performed, perioperative morbidity, costs, length of surgery, pain scores, and incidence of secondary dural tears. We identified 769 cases that included 126 microdiscectomies, and 643 endoscopic discectomies. Rates of disc recurrence ranged from 1% to 25% with accompanying secondary durotomy varying from 2% to 15%. In addition, operative times were relatively short, ranging from 29.2 min to 125 min, with a relatively small average estimated blood loss (i.e., minimal to maximally 150 mls). Repeated discectomy was the most commonly performed treatment for same-level recurrent disc herniations. Despite minimal intraoperative blood loss and short operating times, there was a significant risk of durotomy. Notably, patients must be informed that more extensive bone removal for treating recurrent disc increases the risk for instability warranting subsequent fusion.

Transcanal Excision of Exostoses: Large Series Comparing Bone Removal Methods.

External auditory exostosis (EAE) is a condition of progressive temporal bone growth into the external auditory canal most commonly from repeat cold water and wind exposure. Several tools have been utilized for EAE excision with varying implications for intra- and postoperative complications. However, comparisons of osteotome and microdrill are made difficult due to the few published cases and intervariability between surgeons. Furthermore, evidence is needed to analyze the safety of novel supplemental tools such as the piezoelectric bone-cutting device. Retrospective chart review. Medical clinic and surgery center. A total of 413 subjects representing 472 earsmet the inclusion criteria. Of which 159 ears were operated on using osteotome alone (OA), 271 using osteotome with a drill (OD), and 42 with osteotome with piezoelectric (OP). Charts were analyzed for the most reported intraoperative complications and postoperative symptoms and complications. There were no significant differences in the rate of tympanic membrane perforations nor in total intraoperative complications between OA, OD, or OP. The OD group contained the only nonperforation intraoperative event. OA had the lowest or near lowest incidence of all symptoms analyzed. OA showed a significantly lower incidence of tinnitus when compared to OD and OP. We found that OA performed the best, though not statistically significant in most measures, with regard to mitigating rates of complications postsurgery. Our findings suggest OA provides lower risk intraoperatively and postoperatively for patients undergoing transcanal exostosis excision.

Manual Instruments as an Alternative to Drilling for Bony Exposure in Skull Base Surgery: Concept and Technique.

Background Drilling in neurosurgery is an integral part of surgical exposure, especially in skull base approaches and craniovertebral junction (CVJ) surgeries. Most of such drillings are done in close proximity to the neurovascular structures in skull base surgeries and cervical-medullary junction or facet/pedicle in CVJ surgeries. Reluctance to drilling among young neurosurgeons is due to less hands-on experience during training and also, in the early part of the career, due to fear of injury to neurovascular structures. Methods Five commonest bone removals for skull base region and CVJ surgeries that can be safely done using manual instruments were identified based on experiences of senior authors. The authors highlight key technical nuances to widen surgical corridors using manual instruments safely for skull base surgical approaches. Results Basic neuroanatomical concepts and basic physics help in using manual instruments safely for bone removals in various skull base surgical approaches. Conclusions Manual instruments may be used for bone removals in selected skull base surgical approaches, which help young neurosurgeons to perform these surgeries in limited-resource settings.

Dr Ahila's Endoscopic Ear Surgery Chisel and Mallet.

The online version contains supplementary material available at 10.1007/s12070-023-03629-0.

The Effect of the COVID-19 Pandemic on the Decision-making Process of Mandibular Impacted Third Molar Extraction

Objectives: In this study, we investigated the impact of the COVID-19 pandemic on the decision-making process for impacted mandibular third molar removal and related clinical teaching. Methods: From April 21 to April 28, 2020, we distributed a self-constructed survey via the Wenjuanxing software platform to oral clinicians engaged in the extraction of mandibular third molars. Results: We received 321 valid responses. Overall, 22.4% of clinicians were temporarily not performing tooth extractions in outpatient clinics and 50.2% of clinicians were temporarily not performing impacted tooth extractions. The main reason cited was that aerosol-generating high-speed handpieces were not recommended for use during the pandemic, opting instead for the surgical handpiece with copious saline irrigation as the main method for bone removal; the hammer-and-chisel method was considered to be too traumatic and posed too high of a risk for iatrogenic injury. Conclusions: The implementation of disease control measures during the COVID-19 pandemic significantly affected clinical decision-making regarding impacted mandibular third molar extractions; the main reason cited was the contraindication of using aerosol-generating high-speed handpieces. The hammer-and-chisel method may represent a valuable surgical application under the requirements for epidemic prevention and control. We provide a new idea for the extraction of interrupted permanent molars in the context of epidemic prevention and control is provided.

Using acoustic feedback and analyses for removal of bone cement during revision knee replacement surgeries.

The purpose of this study was to analyze the scraping sounds generated during revision knee replacement surgeries to discriminate between the inner cortical bone and the cement, with the goal of minimizing bone removal and increasing the structural integrity of the revision. We prepared seven porcine femurs by partially filling them with bone cement, and recorded scraping sounds produced by a surgical scraping tool. We used a hierarchical machine learning approach to first detect a contact and then classify it as either bone or cement. This approach was based on a Support Vector Machine learning algorithm that was fed with temporal and spectral features of the sounds. A Leave-One-Bone-Out validation method was used to assess the performance of the proposed method. The average recall for the noncontact, bone, and cement classes was 98%, 75%, and 72%, respectively. The corresponding precision for the respective classes was 99%, 67%, and 61%. The scraping sound that is generated during revision replacement surgeries carries significant information about the material that is being scraped. Such information can be extracted using a supervised machine learning algorithm. The scraping sound produced during revision replacement procedures can potentially be used to enhance cement removal during knee revision surgery. Future work will assess whether such monitoring can increase the structural integrity of the revision.

Bone cutting processes and removal behaviors in orthopedic surgery with an ultrasonic orthopedic scalpel

Bone cutting is a common and important procedure in surgery. As a type of orthopedic instrument, ultrasonic orthopedic scalpels (UOSs) have been widely used due to their safety and convenience. Therefore, it is very important to have a deep understanding of the cutting process and the bone removal behavior of a UOS, to improve cutter design and complement the basic theory of the bone-cutting mechanism. However, few studies have focused on the characteristics of ultrasonic cutting. In this work, based on bone structure, the bone-cutting processes of a UOS were defined and the bone removal behavior in ultrasonic bone cutting was studied. In this study, it was believed that a direction of ultrasonic vibration different from that of the lamellar arrangement and collagen fibers would lead to different cutting characteristics. Based on this, the cutting modes were divided into four typical types. After examining and analyzing the crack propagation and chip formation of compact bone for the four cutting modes, the removal behaviors of ultrasonic bone cutting were defined. At the same time, the surface morphology indicated that there were significant differences in the surface damage for different cutting modes, which supported the idea that the bone removal behaviors were different for different modes. In addition, the force signals were analyzed and the results showed that there were differences in the cutting forces for different cutting modes. The static and dynamic components of the cutting forces were also analyzed. The study demonstrated the correlation between bone removal and the microscopic and submicroscopic structure of bone in ultrasonic cutting. These conclusions provided guidelines for analyzing bone tissue injuries caused by UOSs, improving the surgical process of bone cutting, optimizing the design of orthopedic instruments, and further complementing the basic theory of bone cutting.

Effect of closing material on hearing rehabilitation in stapedectomy and stapedotomy: A finite element analysis.

Stapedotomy or stapedectomy operations are often performed to treat otosclerosis. During the operation, the space created by bone removal is usually filled with a closing material such as fat or fascia. In this study, the effect of the Young's modulus of the closing material on the hearing level was investigated through the 3D finite element model of a human head including auditory periphery. The Young's moduli of the closing material used to implement stapedotomy and stapedectomy conditions in the model were varied from 1 kPa to 24 MPa. The results showed that the hearing level improved when the closing material was more compliant after stapedotomy. Therefore, when the stapedotomy was performed using fat whose Young's modulus is lowest among the potential closing materials, the hearing level recovered the best among all simulated cases. On the other hand, in stapedectomy, the Young's modulus did not have the linear relationship between the hearing level and the compliance of the closing material. Hence, the Young's modulus causing the best hearing rehabilitation in stapedectomy was found not at the end of the investigated range of Young's modulus but somewhere in the middle of the given range.

A Deep Learning Approach for Automated Bone Removal from Computed Tomography Angiography of the Brain.

Advanced visualization techniques such as maximum intensity projection (MIP) and volume rendering (VR) are useful for evaluating neurovascular anatomy on CT angiography (CTA) of the brain; however, interference from surrounding osseous anatomy is common. Existing methods for removing bone from CTA images are limited in scope and/or accuracy, particularly at the skull base. We present a new brain CTA bone removal tool, which addresses many of these limitations.A deep convolutional neural network was designed and trained for bone removal using 72 brain CTAs. The model was tested on 15 CTAs from the same data source and 17 CTAs from an independent external dataset. Bone removal accuracy was assessed quantitatively, by comparing automated segmentation results to manual segmentations, and qualitatively by evaluating VR visualization of the carotid siphons compared to an existing method for automated bone removal.Average Dice overlap between automated and manual segmentations from the internal and external test datasets were 0.986 and 0.979 respectively. This was superior compared to a publicly available noncontrast head CT bone removal algorithm which had a Dice overlap of 0.947 (internal dataset) and 0.938 (external dataset). Our algorithm yielded better VR visualization of the carotid siphons than the publicly available bone removal tool in 14 out of 15 CTAs (93%, chi-square statistic of 22.5, p-value of < 0.00001) from the internal test dataset and 15 out of 17 CTAs (88%, chi-square statistic of 23.1, p-value of < 0.00001) from the external test dataset. Bone removal allowed subjectively superior MIP and VR visualization of vascular anatomy/pathology.The proposed brain CTA bone removal algorithm is rapid, accurate, and allows superior visualization of vascular anatomy and pathology compared to other available techniques and was validated on an independent external dataset.

A human, allogeneic cortical bone screw for distal interphalangeal joint (DIP) arthrodesis: a retrospective cohort study with at least 10 months follow-up

IntroductionThe prime requisites of a good digital arthrodesis are a painless and stable union in a proper position. Arthrodesis of the distal interphalangeal joint of the fingers is not without potential complications including nonunion, malunion, and deep tissue infections. The Shark Screw® is a human, cortical bone allograft for osteosynthesis and an alternative to metal or bioabsorbable devices in orthopedics and trauma surgery. The primary hypothesis is that the fusion and complication rate, using the Shark Screw®, is at least similar to those reported in the literature, using metal or bioabsorbable screws.Material and methodsThis retrospective cohort study analyzes the fusion and complication rate and the patient satisfaction of distal interphalangeal joint arthrodesis of 27 fingers with the human allogeneic cortical bone screw. Complications, Disabilities of Arm, Shoulder, and Hand Questionnaire (Quick-DASH) score and Michigan Hand Outcomes Questionnaire (MHQ) score, grip and pinch strength and fusion angle were investigated.ResultsThe mean follow-up was 23 months. At 6 weeks after surgery, fusion was obtained for all fingers. There was no surgical complication that required revision surgery. An average fusion angle of 13.6° ± 10.7° was measured. VAS pain score decreased significantly from 6.9 before surgery to 0.14 after surgery. The Quick-DASH score decreased from 10.7 to 7.8. The MHQ score improved in all sub-scores.ConclusionThe complication rates, using the Shark Screw® for DIP joint arthrodesis, are lower compared to the results reported in the literature for other surgical techniques. Complications related to the human allograft cortical bone screw itself were not observed. The bone screw is completely remodeled into the host bone and further hardware removal is not necessary.Level of evidenceIV.

Bone cutting efficiency and heat generation using a traditional fluted Burr and a novel fluteless resurfacing tool

BackgroundPowered instrumentation is often used for bone preparation and/or removal in many orthopaedic procedures but does risk thermogenesis. This study compares biomechanical properties of a fluted burr and a novel fluteless resurfacing tool. MethodsTwenty cadaveric metatarsals were tested with four predetermined cutting forces to evaluate heat generation and cutting rate for the fluted burr and fluteless resurfacing tool over 40 s or until a depth of 4 mm was reached. Cutting rate was calculated from displacement transducer data. Heat generation was measured by thermocouples placed in the bone adjacent to the burring site. Assuming a body temperature of 37 °C, a 10 °C increase in heat was used as the threshold of inducing osteonecrosis. FindingsAt 1.0 N and 1.7 N, the thermal osteonecrosis threshold was reached at comparable times between burrs, while the bone removed by the resurfacing tool was on average five times greater than fluted burr at 1.0 N and over twice as great at 1.7 N. Statistical analysis of these common cutting forces showed the resurfacing tool had significantly higher cutting rates (P < 0.01). As a result, the fluted burr produced higher temperatures for the same amount of bone removal (P < 0.01). InterpretationIn a cadaveric study, the fluteless resurfacing tool demonstrated higher bone cutting rates and lower heat generation for the same amount of bone removed than a traditional fluted burr.

Can a Computational Model Predict the Effect of Lesion Location on Cam-type Hip Impingement?

The Warwick consensus defined femoroacetabular impingement syndrome as a motion-related clinical disorder of the hip with a triad of symptoms, clinical signs, and imaging findings representing symptomatic premature contact between the proximal femur and acetabulum. Several factors appear to cause labral and cartilage damage, including joint shape and orientation and patient activities. There is a lack of tools to predict impingement patterns in a patient across activities. Current computational modeling tools either measure pure ROM of the joint or include complexity that reduces reliability and increases time to achieve a solution. The purpose of this study was to examine the efficacy of a low computational cost approach to combining cam-type hip shape and multiple hip motions for predicting impingement. Specifically, we sought to determine (1) the potential to distinguish impingement in individual hip shapes by analyzing the difference between a cam lesion at the anterior femoral neck and one located at the superior femoral neck; (2) sensitivity to three aspects of hip alignment, namely femoral neck-shaft angle, femoral version angle, and pelvic tilt; and (3) the difference in impingement measures between the individual activities in our hip motion dataset. A model of the shape and alignment of a cam-type impinging hip was created and used to describe two locations of a cam lesion on the femoral head-neck junction (superior and anterior) based on joint shape information available in prior studies. Sensitivity to hip alignment was assessed by varying three aspects from a baseline (typical alignment described in prior studies), namely, femoral neck-shaft angle, femoral version, and pelvic tilt. Hip movements were selected from an existing database of 18 volunteers performing 13 activities (10 male, eight female; mean age 44 ± 19 years). A subset was selected to maximize variation in the range of joint angles and maintain a consistent number of people performing each activity, which resulted in nine people per activity, including at least three of each sex. Activities included pivoting during walking, squatting, and golf swing. All selected hip motion cases were applied to each hip shape model. For the first part of the study, the number of motion cases in which impingement was predicted was recorded. Quantitative analyses of the depth of penetration of the cam lesion into the acetabular socket and qualitative observations of impingement location were made for each lesion location (anterior and superior). In the second part of the study, in which we aimed to test the sensitivity of the findings to hip joint orientation, full analysis of both cam lesion locations was repeated for three modified joint orientations. Finally, the results from the first part of the analysis were divided by activity to understand how the composition of the activity dataset affected the results. The two locations of cam lesion generated impingement in a different percentage of motion cases (anterior cam: 56% of motion cases; superior cam: 13% of motion cases) and different areas of impingement in the acetabulum, but there were qualitatively similar penetration depths (anterior cam: 6.8° ± 5.4°; superior cam: 7.9° ± 5.8°). The most substantial effects of changing the joint orientation were a lower femoral version angle for the anterior cam, which increased the percentage of motion cases generating impingement to 67%, and lower neck-shaft angle for the superior cam, which increased the percentage of motion cases generating impingement to 37%. Flexion-dominated activities (for example, squatting) only generated impingement with the anterior cam. The superior cam generated impingement during activities with high internal-external rotation of the joint (for example, the golf swing). This work demonstrated the capability of a simple, rapid computational tool to assess impingement of a specific cam-type hip shape (under 5 minutes for more than 100 motion cases). To our knowledge, this study is the first to do so for a large set of motion cases representing a range of activities affecting the hip, and could be used in planning surgical bone removal. The results of this study imply that patients with femoroacetabular impingement syndrome with cam lesions on the superior femoral head-neck junction may experience impinging during motions that are not strongly represented by current physical diagnostic tests. The use of this tool for surgical planning will require streamlined patient-specific hip shape extraction from imaging, model sensitivity testing, evaluation of the hip activity database, and validation of impingement predictions at an individual patient level.

Carbon Dioxide Laser Sequestrectomy for Osteoradionecrosis: A Case Series.

Objective: To demonstrate a new approach to sequestrectomy using a carbon dioxide (CO2) laser for a clinic-based technique. Background: Osteoradionecrosis (ORN) of the jaw is a debilitating complication of radiotherapy for head and neck malignancies. Often refractory to medical therapy, surgical intervention for early staged disease with curettage and mechanical bone removal has mixed success, making this disease extremely difficult to treat. Therefore, new approaches to treat ORN of the jaw is needed. Methods: We describe five cases of early-to-intermediate-staged ORN illustrating a novel clinic-based sequestrectomy technique using a CO2 laser. Results: The exposed bone lesions involved the mandibular fixed gingiva, maxillary fixed gingiva, and hard palate. None of the patients had diabetes. Four patients required a total of two laser treatments and one patient needed only one treatment. All five patients demonstrated an excellent response with complete resolution of their ORN-related pain and complete mucosal coverage of the exposed bone with durable results (follow-up range, 7-19 months). Conclusions: This small series demonstrates encouraging results for CO2 laser sequestrectomy for ORN. This novel office-based intervention merits further study in larger prospective series and exploration in other disease populations, such as medication-related osteonecrosis of the jaws.

Management and Follow-up of Orthodontic Forced Extrusion: A Case Report. [English translation-Original in Spanish

This clinical case focuses on the diagnosis and treatment of forced eruption in a patient with dental trauma. Objective To propose a multidisciplinary treatment alternative which allows to increase dental structure through forced extrusion and subsequently rehabilitate it in function and aesthetics. Methods: The case of a 78-year-old male adult patient, healthy and without pathological history, attended the clinic of the Orthodontics and Dentomaxillofacial Orthopedics Specialty, referred by an Endodontics specialist, is described due to canine crown-radicular fracture. upper right, fixed bridge abutment with three units. In the intraoral examination, he presented a cervical fracture of the crown of the upper right canine. As a first step, endodontic treatment was performed on the tooth and placement of an intracanal support abutment (emptied endopost), in order to improve orthodontic traction. This adjunct consisted of a cast post with perforations. We proceed to place fixed appliances in the upper arch with the MBT technique (slot 0.022), from the right molar to the left canine with indirect and passive cementation (with the slots of the brackets aligned). Immediately afterwards, a 0.019 x 0.025 stainless steel rectangular archwire was placed with an extrusion bend at the level of the upper right canine. In the same fold, a helix-type loop was adapted that functioned as a support to place the passive ligature (lace back). Results: The treatment carried out on this patient is satisfactory, contributing to his general state of health, improving his self-esteem. Conclusion: Here, all the advantages offered by forced orthodontic extrusion were taken advantage of, even in an elderly patient, achieving a traction of four millimeters, which was achieved thanks to the use of light and controlled extrusive forces on the affected dental organ. With the described treatment modality, crown lengthening can be achieved without the need for bone resection, which allows for correct prosthetic rehabilitation, restoring function and aesthetics to the injured tooth and providing comprehensive benefit to the patient.

Decompressive Craniectomy in Severe Traumatic Brain Injury: The Intensivist’s Point of View

Traumatic brain injury (TBI) represents a severe pathology with important social and economic concerns, decompressive craniectomy (DC) represents a life-saving surgical option to treat elevated intracranial hypertension (ICP). The rationale underlying DC is to remove part of the cranial bones and open the dura mater to create space, avoiding secondary parenchymal damage and brain herniations. The scope of this narrative review is to summarize the most relevant literature and to discuss main issues about indication, timing, surgical procedure, outcome, and complications in adult patients involved in severe traumatic brain injury, underwent to the DC. The literature research is made with Medical Subject Headings (MeSH) terms on PubMed/MEDLINE from 2003 to 2022 and we reviewed the most recent and relevant articles using the following keywords alone or matched with each other: decompressive craniectomy; traumatic brain injury; intracranial hypertension; acute subdural hematoma; cranioplasty; cerebral herniation, neuro-critical care, neuro-anesthesiology. The pathogenesis of TBI involves both primary injuries that correlate directly to the external impact of the brain and skull, and secondary injuries due to molecular, chemical, and inflammatory cascade inducing further cerebral damage. The DC can be classified into primary, defined as bone flap removing without its replacement for the treatment of intracerebral mass, and secondary, which indicates for the treatment of elevated intracranial pressure (ICP), refractory to intensive medical management. Briefly, the increased brain compliance following bone removal reflects on CBF and autoregulation inducing an alteration in CSF dynamics and so, eventual complications. The risk of complications is estimated around 40%. The main cause of mortality in DC patients is due to brain swelling. In traumatic brain injury, primary or secondary decompressive craniectomy is a life-saving surgery, and the right indication should be mandatory in multidisciplinary medical-surgical consultation.

Revision Distal Biceps Tendon Repair Using Original Intramedullary Buttons

There are several techniques used for tendon fixation in distal biceps tendon repair. Intramedullary unicortical button fixation has the advantage of high biomechanical strength, minimal proximal radial bone removal, and low risk of injury to the posterior interosseous nerve. One disadvantage in revision surgery is retained implants in the medullary canal. This article describes a novel technique for revision distal biceps repair initially fixed with intramedullary unicortical buttons, using the original implants.

A sagittal split osteotomy approach for removal of a large cementoblastoma at the mandibular angle

Benign lesions at the angle of mandible are frequently removed by a conventional intra oral approach to gain access and achieve complete visualisation. This method is quick and effective when dealing with small benign lesions that are superficially located at the angle of mandible. The removal of large and deeply located lesions with a conventional intra oral approach however, bring about a unique set of challenges particularly when the third molar is displaced towards the inferior border of mandible including lack of complete visualisation of the lesion, difficulty in identification and protection of the inferior alveolar nerve and necessitating removal of a considerable amount of osseous structure thus increasing the risk of a mandibular fracture. Alternative techniques for such lesions include an extra oral approach but one which could potentially create a cosmetic defect from cutaneous scarring and can result in facial nerve injury. This case report describes the use of a unilateral sagittal split osteotomy (SSO) in the removal of a mandibular cementoblastoma. This is a safe and effective technique allowing optimal access to the tumor with complete visualisation, identification and protection of the inferior alveolar nerve with minimal bone removal while maintaining mandibular integrity, strength and facial aesthetics.

Reconstruction using a facial artery musculomucosal flap technique after removal of necrotic bone in the anterior areas in medication-related osteonecrosis of the jaw: A technical note

The purpose of this study was to evaluate the outcomes of 7 patients with stage 2 or 3 medication-related osteonecrosis of the jaw (MRONJ) in an anterior area who were treated using a facial artery musculomucosal (FAMM) flap after necrotic-bone removal. Superiorly based FAMM flaps were used for maxillary defects in 4 patients while inferiorly based FAMM flaps were used for mandibular defects in 3 patients. Successful wound healing was defined as maintenance of full mucosal coverage without signs of infection at 6 months postoperatively. The follow-up periods ranged from 7 to 27 months (average: 16.8 months). Wound healing during the follow-up period was successful in all patients (100 % success rate). Despite the limited number of cases, our experience shows that a FAMM flap is an effective surgical option for well-vascularized wound-healing of exposed bone in patients with stage 2 or stage 3 MRONJ in anterior areas of the jaw.

Does the Tooth Sectioning Method Impact Surgical Removal of the Distoangular Impacted Mandibular Third Molar?

Distoangular impacted teeth are considered challenging to remove due to their anatomic position. Proper tooth sectioning ensures the removal with minimal bone removal. This study is aimed to compare the outcome of 2 different tooth sectioning methods. Patients with distoangular-impacted mandibular third molar were included in this single-blinded randomized controlled trial. Patients with Class III-impacted, grossly decayed teeth and who were ASA III and above were excluded. The subjects were randomly allocated into Group-A conventional method, where tooth sectioning at the cementoenamel junction, and Group B, the modified method, where tooth sectioning removes only the distal portion of the crown. The primary predictor variable was the tooth sectioning method. The primary outcome variable was the operative time and the secondary outcomes included postoperative pain, trismus, and edema assessed on postoperative days 3 and 7. The effect of treatment on operative time was assessed using a t-test and Chi-squared test was used to compare the categorical data. Thirty eight patients were included in this study. With a 1:1 allocation ratio, 18 (50%) patients were included in each group. No statistically significant differences were observed in the 2 groups for gender allocation (P=.32), age (P=.34), tooth classification (P=.97), and side of extraction (P=.32). The mean operative time was 31.61±14.13minutes for group A and 22.72±10.79minutes for group B, at the 95% confidence interval had a P value of .04 (P<.05), favoring group B. Secondary outcomes of pain measured by visual analogue scale 3.83±3.06 for group A and 3.88±3.06 for group B (P=.95), facial edema 22.79±2.08 and 22.88±1.32, respectively (P=.88), and the maximal interincisal opening of 33±8.59 and 31.33±7.42 on day 3 (P=.54) and 36.16±11.62 and 39.05±6.08 on day 7(P=.36). However, the difference in need for rescue analgesia 2.05±2.15 and 0.44±0.85 (P<.01) was statistically significant, suggesting the superiority of the conventional sectioning method. The results show that both methods of tooth sectioning yield comparably acceptable results. However, the tooth removal was faster by the modified sectioning and the need for rescue analgesia was minimal in this group, suggesting it to be a preferred technique over the conventional method.

Comparison of the effects of orbital decompression in Graves' ophthalmopathy

Abstract Introduction Graves' disease is an autoimmune disorder. One of the symptoms is an overgrowth of the soft tissues of the orbit. Orbital involvement can cause exophthalmos, diplopia, or vision loss. Treatment strategies include a surgical approach that limits the ailments mentioned above. Decompression can be achieved by reducing the amount of enlarged tissues (fat removal) or increasing the space for enlarged tissues (bone removal). Numerous authors discuss the advantages and disadvantages of various techniques in terms of reducing the exophthalmos, the number and persistence of complications, and the long-term prognosis. Materials and Methods A literature search of PubMed and the Poznan University of Medical Sciences Main Medical Library resources from 1993–2022 was performed. Thirty articles were reviewed with attention to the surgical treatment of Graves' ophthalmopathy. Results The main surgical techniques include fat decompression and bone wall decompression. The results of exophthalmos fat removal are characterized by a significant decrease in proptosis (5.45mm) with a small percentage of newly formed diplopia (9%). Bone reduction in the lateral wall of the orbit shows similar effects: reducing exophthalmos (4.33mm) and the newly formed diplopia, as with fat removal (3.7%). Bone reduction in the medial- lateral wall, medial- inferior- lateral wall, and medial–inferior wall shows a decrease in proptosis ( 4.9 mm, 4.6 mm, 3.77 mm) and a higher percentage of new-onset diplopia (18%, 15%, 28%). Conclusion The smallest amount of newly formed diplopia at the highest proptosis reduction occurs with the self-removal of fat or resection of the lateral orbital wall.