Bone Window Research Articles

Abstract WMP39: Incorporation of Automated Robotic Transcranial Doppler to Screen for Patent Foramen Ovale and Quantify Right to Left Shunt Severity in the Evaluation of Ischemic Stroke Patients for Stroke Etiology at a Comprehensive Stroke Center

Background: Patent foramen ovale (PFO) as a source of right-left shunting (RLS) is a recognized risk factor for recurrent stroke in young patients. Current standard care for RLS diagnosis includes transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and manual transcranial Doppler (TCD) which have disadvantages. The purpose of this retrospective review is to evaluate incorporation of an automated robotic TCD (rTCD) into the standard evaluation for RLS as cause of stroke, as prior studies have indicated higher sensitivity and quantification of RLS size to direct cardiology referral for potential PFO closure. Methods: Between Dec 2021-Oct 2022, 200 stroke patients age <65 were included in this retrospective review. Average age was 55.7 ± 11.1 yrs. All patients had standard TTE and an rTCD (NovaSignal) with saline bubble injection at rest and Valsalva strain for assessment of RLS performed by echo and ultrasound technicians. Neurologists read results, including RLS shunt severity using the Spencer Shunt Grading scale (0-5), where Grade 3-5 is considered large. Results: The rate of positive RLS shunt using rTCD was 55.5% (n=111), of which 23.5% (n=47) were Spencer grade 3+ or higher. No bone window rate was 8.5% (n=17), which is lower than reported manual TCD rates. There were no rTCD RLS shunt negative patients who had a positive TTE or TEE. Of patients who had positive rTCD (n=14) and TTE with bubble, only 5 TTE’s were positive (35.7% sensitivity). Of rTCD positive patients (n=23) who also had TEE with bubble, only 11 were positive (48% sensitivity). And of 15 rTCD Grade 3+ RLS, only 11 TEE with bubble were positive (73% sensitivity). Conclusion: We successfully replaced rTCD for TTE with bubble to screen for RLS on patients who were admitted with a stroke or TIA, with the following advantages. Non-TCD technicians could be trained to perform the tests with accuracy. rTCD was more sensitive in detecting RLS than TTE with bubble. Quantification of RLS severity identified stroke patients with potentially higher risk of recurrence, prioritized to more aggressive medical management and cardiology referral for TEE and potential PFO closure.

Modified tibial cortex transverse transport for diabetic foot ulcers with Wagner grade ≥ II: a study of 98 patients.

Diabetic foot ulcers constitute a substantial healthcare burden on a global scale and present challenges in achieving healing. Our objective was to assess the efficacy of modified tibial cortex transverse transport surgery in managing refractory diabetic foot ulcers. We retrospectively analyzed clinical data from 98 patients suffering from diabetic foot ulcers classified as Wagner grade ≥II who were admitted to our medical facility between January 2020 and June 2022. All the patients were treated by modified tibial cortex transverse transport surgery, wherein the osteotomy scope was reduced to two rectangular bone windows measuring 1.5cm × 1.5cm each. Record the patient's general information and ulcer healing time; ulcer area, ankle-brachial index, WIFi classification, and visual analogue scale before and 3 months following the surgical intervention. The average duration of diabetes of 98 patients with diabetic foot ulcer was 20.22 ± 8.02 years, 52 patients had more than one toe gangrene on admission. The postoperative wound healing rate was 95.83% and the average healing time was 53.18 ± 20.18 days. The patients showed significant improvement in ankle-brachial index, WIFi classification, and visual analogue scale at 3 months postoperatively compared to preoperatively, with statistically significant differences (P< 0.05). Eight patients experienced complications, and the incidence of complications was 8.16%. Throughout the follow-up period, there were no instances of ulcer recurrence noted. Modified tibial cortex transverse transport surgery demonstrates effectiveness in the management of diabetic foot ulcers by enhancing lower limb microcirculation and facilitating the process of wound healing.

Ultrasound combined with urokinase under key-shaped bone window enhances blood clot lysis in an in vitro model of spontaneous intracerebral hemorrhage.

Minimally invasive surgery for spontaneous intracerebral hemorrhage is impeded by inadequate lysis of the target blood clot. Ultrasound is thought to expedite intravascular thrombolysis, thereby facilitating vascular recanalization. However, the impact of ultrasound on intracerebral blood clot lysis remains uncertain. This study aimed to explore the feasibility of combining ultrasound with urokinase to enhance blood clot lysis in an in vitro model of spontaneous intracerebral hemorrhage. The blood clots were divided into four groups: control group, ultrasound group, urokinase group, and ultrasound + urokinase group. Using our experimental setup, which included a key-shaped bone window, we simulated a minimally invasive puncture and drainage procedure for spontaneous intracerebral hemorrhage. The blood clot was then irradiated using ultrasound. Blood clot lysis was assessed by weighing the blood clot before and after the experiment. Potential adverse effects were evaluated by measuring the temperature variation around the blood clot in the ultrasound + urokinase group. A total of 40 blood clots were observed, with 10 in each experimental group. The blood clot lysis rate in the ultrasound group, urokinase group, and ultrasound + urokinase group (24.83 ± 4.67%, 47.85 ± 7.09%, 61.13 ± 4.06%) was significantly higher than that in the control group (16.11 ± 3.42%) (p = 0.02, p < 0.001, p < 0.001). The blood clot lysis rate in the ultrasound + urokinase group (61.13 ± 4.06%) was significantly higher than that in the ultrasound group (24.83 ± 4.67%) (p < 0.001) or urokinase group (47.85 ± 7.09%) (p < 0.001). In the ultrasound + urokinase group, the mean increase in temperature around the blood clot was 0.26 ± 0.15°C, with a maximum increase of 0.38 ± 0.09°C. There was no significant difference in the increase in temperature regarding the main effect of time interval (F = 0.705, p = 0.620), the main effect of distance (F = 0.788, p = 0.563), or the multiplication interaction between time interval and distance (F = 1.100, p = 0.342). Our study provides evidence supporting the enhancement of blood clot lysis in an in vitro model of spontaneous intracerebral hemorrhage through the combined use of ultrasound and urokinase. Further animal experiments are necessary to validate the experimental methods and results.

An Ultrasonic Transceiver for Non-Invasive Intracranial Pressure Sensing.

This paper presents a 9-mW ultrasonic through-transmission transceiver (TRX) for portable, non-invasive intracranial pressure (ICP) sensing. It employs two ultrasound transducers placed at the temporal bone windows to measure changes in the ultrasonic time-of-flight (ToF), based on which the skull expansion and the corresponding ICP waveform are derived. Key components include a high-efficiency Class-DE power amplifier (PA) with 95% efficiency and an output swing of 15.8 VPP, along with a successive approximation register (SAR) delay-locked loop (DLL)-based time-to-digital converter (TDC) with 29.8 ps resolution and 122 ns range. Other than electrical characterization, the sensor is validated through two demonstrations using a water tank setup and a human head phantom setup, respectively. It demonstrates a high correlation of R2 = 0.93 with a medical-grade invasive ICP sensor. The proposed system offers high accuracy, low power consumption, and reliable performance, making it a promising solution for real-time, portable, non-invasive ICP monitoring in various clinical settings.

Comparison of polymethyl methacrylate skull implant fixation by three types of titanium fasteners

To evaluate mechanical strength of three methods of polymethyl methacrylate skull implant fixation in two experimental models. The first experiment was performed on a plastic model that was as close as possible to bone in structural characteristics. The second experiment was performed on a biological specimen (a ram's head). We assessed the quality of implant fixation to bone window edges by craniofixes, ties and microscrews and lateral intercortical screws. Craniofixes are feasible for small flat flaps, but not advisable for wide highly curved implants. They are also the most expensive method of fixation. Implant fixation by ties and microscrews is a universal method comparable in price to craniofix. Lateral intercortical fixation is effective both for small flat implants and wide implants with large curvature. However, this method is not always applicable. Combined fixation by lateral intercortical screws and ties allows for the most effective fixation while reducing the overall price of consumables.

Quantitative Anatomical Study of the Supratentorial and Infratentorial “Endoscopic Keyhole” Approach to the Peripineal Region

Background. The pineal region represents significant challenges in terms of neurosurgery. Currently, anatomical research that simulates surgery for the endoscopic keyhole approach to the pineal region is lacking. This study aims to summarize the exposure range and operational characteristics of total endoscopic surgery under the four supratentorial and infratentorial keyhole approaches, through rigorous quantitative anatomical research. We also aim to understand the surgical exposure characteristics and surgical feasibility under each approach. Method. Six wet cadaveric head specimens (a total of 12 sides) were subjected to simulated surgery with a keyhole bone window size of approximately 3 × 4 cm. The median endoscopic supracerebellar infratentorial approach (M‐ESCITA), the paramedian endoscopic supracerebellar infratentorial approach (PM‐ESCITA), the endoscopic occipital transtentorial approach (EOTA), and the endoscopic interhemispheric high occipital transtentorial approach (EHOTA) were used to measure the surgical path depth, maximum distance between the tentorial margins, maximum operable area, operable angle, and relative degree of freedom of each approach. Results. There was no difference in the exposure range of the surgical area. The surgical path of PM‐ESCITA was the longest (p &lt; 0.001), and its horizontal operating angle was the largest (p &lt; 0.001), whereas the anteroposterior operating angle of EHOTA was the largest (p &lt; 0.001). The maximum operational area of M‐ESCITA was the largest in the pineal region (p &lt; 0.01), whereas that of EHOTA was the largest in the tetrapod region (p &lt; 0.001). M‐ESCITA had the highest relative degree of freedom during surgery at the pineal gland level (p &lt; 0.001), PM‐ESCITA at the splenium of the corpus callosum (p &lt; 0.01), and EHOTA at the corpora quadrigemina (p &lt; 0.001). Conclusions. Each of the four endoscopic keyhole approaches has its own advantages. Through anatomical research, doctors can train themselves and master the differences in surgical procedures through different approaches. The choice of approach and surgical challenge are dependent on the microsurgical techniques employed by the surgeon. A balance between minimally invasive and safe endoscopic surgery should be pursued.

Contrast enhanced computed tomography of small ruminants: Caprine and ovine.

The use of small ruminants, mainly sheep and goats, is increasing in biomedical research. Small ruminants are a desirable animal model due to their human-like anatomy and physiology. However, the large variability between studies and lack of baseline data on these animals creates a barrier to further research. This knowledge gap includes a lack of computed tomography (CT) scans for healthy subjects. Full body, contrast enhanced CT scans of caprine and ovine subjects were acquired for subsequent modeling studies. Scans were acquired from an ovine specimen (male, Khatadin, 30-35 kg) and caprine specimen (female, Nubian 30-35 kg). Scans were acquired with and without contrast. Contrast enhanced scans utilized 1.7 mL/kg of contrast administered at 2 mL/s and scans were acquired 20 seconds, 80 seconds, and 5 minutes post-contrast. Scans were taken at 100 kV and 400 mA. Each scan was reconstructed using a bone window and a soft tissue window. Sixteen full body image data sets are presented (2 specimens by 4 contrast levels by 2 reconstruction windows) and are available for download through the form located at: https://redcap.link/COScanData. Scans showed that the post-contrast timing and scan reconstruction method affected structural visualization. The data are intended for further biomedical research on ruminants related to computational model development, device prototyping, comparative diagnostics, intervention planning, and other forms of translational research.

Depressed Skull Fracture Surgical Management and Outcome among Head Injury Patients: Experience at Tertiary Care Hospital

Objective: To evaluate outcomes in patients with managed depressed skull fractures operatively having head injuries. Methods: This study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro. We analyzed 76 patients who underwent operative management for skull fractures. Patient selection included both children and adults with skull fractures evident on CT brain scans using bone windows. Results: Our study included 76 patients, with 48 males and 28 females, and a mean age of 28.68 ± 10.33 years. Among them, 45 (59.21%) were under 30 years old, and the highest incidence of depressed skull fractures occurred in the 21 – 30 age group. Road traffic accidents were the leading cause, accounting for 42 (55.25%) cases, while falls from heights contributed to 24 (31.57%) cases, and 7 (9.21%) resulted from objects falling on the patients. Conclusion: Patients with head injuries can be fatal if not managed promptly. Neglecting the management of a depressed fracture can also impact the outcome in these cases and lead to a series of complications.

The Application Effect of Craniotomy through Transsylvian Rolandic Point-Insular Approach on Hypertensive Intracerebral Hemorrhage in Posterior Basal Ganglia

Objective. To evaluate the hematoma clearance and safety of small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach for patients with hypertensive intracerebral hemorrhage (HICH) in posterior basal ganglia. Methods. This retrospective study enrolled a total of 86 patients with HICH in the posterior basal ganglia region who underwent surgery between January 2020 and December 2021. These patients were divided into two groups: the conventional group and the study group. The intraoperative information, postoperative hematoma clearance rate, increasing rate of cerebral edema and rebleeding occurrence rate, postoperative complication rate, and prognoses were compared between the two groups. Additionally, we observed and compared the rate of postoperative cerebral hematoma increase, as well as the neurological function and activities of daily living (ADL) at admission, 3 months, and 6 months after surgery in both groups. Univariate and multivariate logistic regression analyses were performed to explore factors affecting the prognosis of patients with HICH in the posterior basal ganglia region after small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach. Results. The study group exhibited significantly shorter automatic eye-opening times and hospital stays compared to the conventional group ( P &lt; 0.05 ). Furthermore, the study group demonstrated better hematoma clearance rates, lower rates of cerebral hematoma at postoperative 48 h and 72 h, and lower rates of rebleeding compared to the conventional group ( P &lt; 0.05 ). At 3 and 6 months postsurgery, the study group exhibited a significantly greater improvement in neurological function and ADL compared to the conventional group ( P &lt; 0.05 ). Additionally, the incidence of postoperative complications in the study group was lower than that in the conventional group ( P &lt; 0.05 ). Furthermore, the prognosis of the study group was significantly better than that of the conventional group at the 6-month follow-up ( P &lt; 0.05 ). Conclusion. A small bone window craniotomy via transsylvian Rolandic point-insular approach has been shown to improve the hematoma clearance rate in patients with HICH in the posterior basal ganglia region while also reducing the incidence of complications. This approach is highly safe and feasible for implementation in clinical practice.

Thoracic cavity of the Shirazi cats: New insights using computed tomography and magnetic resonance imaging.

Our study provided a comprehensive characterization of the thorax of Shirazi cats by comparing the relevant soft and bone windows of computed tomography (CT) and magnetic resonance imaging (MRI) with cross, sagittal and coronal sectional anatomy. We outlined the mediastinum and its anatomic relationships with the trachea, oesophagus, lungs, heart, cranial and caudal vena cavae, and other thoracic structures using the data series gathered from adult normal Shirazi cats. The cranial mediastinum extended from the thoracic inlet to the 4th intercostal space, the middle mediastinum extended from the 5th and 7th intercostal spaces and was occupied by the heart and large blood vessels and the caudal mediastinum extended as a short and narrow portion from the 8th intercostal space to the diaphragm. The contents of the mediastinum and its relationship with the lungs and diaphragm were clearly presented in coronal-sectional anatomy and CT slices. The diaphragm was clearly observed in the lung windows of the ventral thorax. Sagittal-sectional anatomy and CT clarified the thorax's architecture and its contents, with higher density in the soft windows. The distribution of thoracic vessels on cross- and coronal-contrast CT scans was clearly visible. In addition, MRI scans provided an excellent anatomic reference of the thorax with the help of cross, coronal and sagittal scans, especially in the heart and blood vessels. Our study provides a valuable atlas for the diagnosis of malformations of the thoracic structures and offers better assessments for helping veterinary radiologists and clinicians in diagnostic processes.

Diagnostic Yield of Bone Window Computed Tomography and Cerebral Angiography Testing Congenital Bilateral Hypoplasia of the Internal Carotid Artery.

We herein report a case of congenital bilateral hypoplasia of the internal carotid artery (ICA) that was diagnosed by bone window computed tomography (CT) and cerebral angiography. A 23-year-old woman presented with left dominant quadriplegia. Brain magnetic resonance imaging showed not only massive infarcts in the anterior circulation but also poor depiction of the bilateral ICAs. Bilateral carotid canals on bone window CT suggested hypoplasia. Cerebral angiography revealed narrowing of each ICA above its bifurcation, and the blood supply to the intercranial carotid systems developed from the vertebrobasilar system through the posterior communicating arteries and posterior cerebral arteries. We diagnosed the patient with congenital bilateral hypoplasia of the ICA based on bone CT and cerebral angiography findings. Performing both bone window CT and cerebral angiography can facilitate the diagnosis of congenital hypoplasia of the ICA.

Ultrasound biomicroscopy in the quantification of brain perfusion parameters of a rat stroke model: Analysis of contrast agent bolus kinetic dynamics

BackgroundIschemic stroke represents a significant global health concern, necessitating thorough investigations and the utilization of stroke animal models to explore novel treatment modalities and diagnostic imaging techniques. New methodUltrasound biomicroscopy (BMU), operating at a center frequency of 21 MHz, along with ultrasound contrast agents (UCAs), was used to quantify microcirculation cerebral blood flow in a rat model of ischemic stroke. The microcirculation parameters were derived from time intensity curve (TIC) plots obtained based on UCA-bolus kinetics. ResultsSemiquantitative perfusion-related parameters were assessed. The TIC curves showed differences in amplitude when compared intra-animal between the left and right sides, and three situations were observed: normal perfusion, hypoperfusion, and nonperfusion. ROC analysis of delays between the left and right time intensity peak (TIP) for regions of interest (ROIs) in the control and stroke-hypoperfusion groups revealed an optimal cutpoint of 0.39 s to indicate when hypoperfusion is occurring in rats, with a sensitivity of 93.33 % and a specificity of 80 %. Comparison with existing method(s)Ultrasound perfusion imaging through the temporal bone window has been clinically applied to stroke patients using a UCA bolus for TIC analysis. TIC parameters were correlated with MRI- and CT-based measurements. ConclusionsThis investigation quantified cerebral blood flow in a rat model of ischemic stroke by measuring microcirculation parameters. The study demonstrated the efficacy of this approach as a valuable tool for conducting preclinical studies.

Discrimination of invasive lung adenocarcinoma from Lung-RADS category 2 nonsolid nodules through visual assessment: a retrospective study.

Invasive adenocarcinomas (IADs) have been identified among nonsolid nodules (NSNs) assigned as Lung Imaging Reporting and Data System (Lung-RADS) category 2. This study used visual assessment for differentiating IADs from noninvasive lesions (NILs) in this category. This retrospective study included 222 patients with 242 NSNs, which were resected after preoperative computed tomography (CT)-guided dye localization. Visual assessment was performed by using the lung and bone window (BW) settings to classify NSNs into BW-visible (BWV) and BW-invisible (BWI) NSNs. In addition, nodule size, shape, border, CT attenuation, and location were evaluated and correlated with histopathological results. Logistic regression was performed for multivariate analysis. A p value of < 0.05 was considered statistically significant. A total of 242 NSNs (mean diameter, 7.6 ± 2.8mm), including 166 (68.6%) BWV and 76 (31.4%) BWI NSNs, were included. IADs accounted for 31% (75) of the nodules. Only 4 (5.3%) IADs were identified in the BWI group and belonged to the lepidic-predominant (n = 3) and acinar-predominant (n = 1) subtypes. In univariate analysis for differentiating IADs from NILs, the nodule size, shape, CT attenuation, and visual classification exhibited statistical significance. Nodule size and visual classification were the significant predictors for IAD in multivariate analysis with logistic regression (p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of visual classification in IAD prediction were 94.7%, 43.1%, 42.8%, and 94.7%, respectively. The window-based visual classification of NSNs is a simple and objective method to discriminate IADs from NILs. The present study shows that using the bone window to classify nonsolid nodules helps discriminate invasive adenocarcinoma from noninvasive lesions. • Evidence has shown the presence of lung adenocarcinoma in Lung-RADS category 2 nonsolid nodules. • Nonsolid nodules are classified into the bone window-visible and the bone window-invisible nonsolid nodules, and this classification differentiates invasive adenocarcinoma from noninvasive lesions. • The Lung-RADS category 2 nonsolid nodules are unlikely invasive adenocarcinoma if they show nonvisualization in the bone window.

Three-dimensional computed tomography analysis of the atlanto-dental interval in a healthy Karachi population: a single-center retrospective cross-sectional study

Background: The atlantoaxial joint has a complex anatomical configuration and has a wide range of mobility. Traumatic, inflammatory, and neoplastic joint pathologies frequently affect this joint. The aim of this retrospective cross-sectional study was to evaluate the atlanto-dental intervals (ADI) in patients who underwent computed tomography (CT) scans of the neck and cervical spine in at a Tertiary Care Hospital in Karachi, Pakistan. Methods: This was a retrospective cross-sectional study conducted at a tertiary care hospital in Karachi between 1 January 2021 and 31 December 2021, following approval from the hospital ethical review committee. Patients above the age of 15 who underwent CT scans were included, while individuals with a history of cervical trauma, infection, rheumatoid arthritis, or congenital anomalies, as well as those younger than 15 years old, were excluded. CT scans were performed using a multidetector scanner utilizing a standardized protocol. Sagittal and coronal images were reconstructed. ADI measurements, including anterior ADI (AADI), posterior ADI (PADI), and lateral ADI (LADI) on both sides, were determined using appropriate bone window settings. A radiologist with a minimum of 3 years of experience analyzed the CT scans. Results: The mean age of the patients was 49.3±17.7 years (age range: 16–85 years). The mean AADI was 1.4±0.4 mm, with a range of 0.0–2.1 mm. The mean PADI was 19.1±1.9 mm, with a range of 13.8–24.6 mm. The mean left LADI measurement was 3.3±1.2 mm with a range of 1.2–10.0 mm, and the mean right LADI measurement was 3.2±1.1 mm with a range of 1.2–6.3 mm. Conclusion: Our study examined the ADI in patients who underwent CT scans of the neck and cervical spine in Karachi. The findings provide valuable insights into the relationship between ADI measurements, age, and sex. These results contribute to our understanding of the anatomical variations in this region, which may aid in the diagnosis and management of cervical spine disorders.

Hemorrhage Evaluation and Detector System for Underserved Populations: HEADS-UP

ObjectiveTo create a rapid, cloud-based, and deployable machine learning (ML) method named hemorrhage evaluation and detector system for underserved populations, potentially across the Mayo Clinic enterprise, then expand to involve underserved areas and detect the 5 subtypes of intracranial hemorrhage (IH). MethodsWe used Radiological Society of North America dataset for IH detection. We made 4 total iterations using Google Cloud Vertex AutoML. We trained an AutoML model with 2000 images, followed by 6000 images from both IH positive and negative classes. Pixel values were measured by the Hounsfield units, presenting a width of 80 Hounsfield and a level of 40 Hounsfield as the bone window. This was followed by a more detailed image preprocessing approach by combining the pixel values from each of the brain, subdural, and soft tissue window-based gray-scale images into R(red)-channel, G(green)-channel, and B(blue)-channel images to boost the binary IH classification performance. Four experiments with AutoML were applied to study the effects of training sample size and image preprocessing on model performance. ResultsOut of the 4 AutoML experiments, the best-performing model was the fourth experiment, where 95.80% average precision, 91.40% precision, and 91.40% recall were achieved. On the basis of this analysis, our binary IH classifier hemorrhage evaluation and detector system for underserved populations appeared both accurate and performed well. ConclusionHemorrhage evaluation and detector system for underserved populations is a rapid, cloud-based, deployable ML method to detect IH. This tool can help expedite the care of patients with IH in resource-limited hospitals.

Piezoelectric Device and Dynamic Navigation System Integration for Bone Window-Guided Surgery

IntroductionThis study investigates the feasibility of integrating a piezoelectric device (PIEZO) into a dynamic navigation system (DNS) for bone-window guided surgery. It compares the accuracy and efficiency of PIEZO + DNS to PIEZO + Freehand (FH) procedure for bone-window cutting and root-end resection (RER). MethodsForty-eight mandibular molars of 3D-printed surgical jaw models were divided into two groups: PIEZO + DNS (n = 24) and PIEZO + FH (n = 24). Cone-beam computed tomography scans were taken before and after the procedure. The procedure was virtually planned on X-guide software. The bone-window cutting and RER were conducted with a PIEZO under dynamic navigation in the PIEZO + DNS group and using the dental operating microscope in the PIEZO + FH group. The 2D- and 3D-accuracy deviations and angular deflection were measured for the bone window cut. The root length resected and resection angle were calculated. The bone window cut, RER, total operating time, and number of mishaps were recorded. ResultsPIEZO + DNS was more accurate than PIEZO + FH for bone-window cutting, showing fewer 2D and 3D deviations and less angular deflection (P < .05). The resection angle was lower in the PIEZO + DNS (P < .05). The bone-window cut and total operating time were significantly reduced using a DNS (P < .05). There was no difference in the number of mishaps (P > .05). ConclusionsWithin the limitations of this in vitro study, the integration of a PIEZO into a DNS is feasible for bone-window guided surgery. The DNS improved the accuracy and efficiency of bone-window cutting.

Modified Low-Flow Arthroscopic Sandwich Technique for Complex Osteochondral Lesions of the Talus

Treatment of osteochondral lesions of the talus proves to be challenging given the unique anatomy of the intra-articular surface and associated complexity of larger lesions. Simple bone marrow–stimulating procedures for large complex lesions often lead to poor results with increased risk of lesion progression, refractory pain, and associated functional limitations. Other methods of osteochondral autografts or allografts often require osteotomies, bone windows, or fibrin glue, which are associated with donor pain and nonunion. Thus, for larger and cystic lesions, we report our experience using a modified low-flow arthroscopic sandwich technique consisting of autologous cancellous bone graft, followed by a viable cryopreserved cartilage fiber, cartilage allograft matrix putty.

Lateral and crestal sinus lift complications: a retrospective comparative study

Background: To explore the relationship between the operative methods for sinus lifting and related intra-and postoperative complications. Methods: 47 cases of sinus lift were traced, with 118 implants placed. 83 of them after lateral sinus lifting and 35 with a crestal approach. Presence of bone septum, thickness of the sinus membrane, bone density, and the height of residual bone were tracked out preoperatively, as prerequisites of complications during and after implant placement in the distal parts of the maxilla. Results: In eight cases (17.02%), sinus membrane perforations occurred. The most common location of the tearing was close to the lower medial edge of the bone window. After fixing perforation, a total of 37 implants were placed under these conditions. In three of them (5.41%), poor osseointegration was found after six mounts. Statistically significant impact of the thickness of the sinus membrane in cases of membrane tearing was found. Conclusions: Increasing the height of the available bone in the distal areas of the maxilla by elevating the maxillary sinus floor is a safe and predictable procedure. Both the crestal and lateral approaches have a high success rate. All possible complications during the operation need to be analyzed in advance, and when they occur, it is mandatory to fix them adequately. Therefore, a careful consideration of the local and systemic conditions affecting implant survival is essential for successful implant treatment.

Retracted: Analysis of Influencing Factors of Serum Stress Index and Prognosis of HICH Patients by Different Anesthesia Methods Combined with Small Bone Window Microsurgery.

[This retracts the article DOI: 10.1155/2022/6971092.].

Piezoelectric Endodontic Microsurgery with Modified Cortical Window Technique: A Case Report

Osteotomy in endodontic microsurgery for teeth with periapical lesions which have not perforated the cortical plate can be a complex procedure especially if anatomical structures such as the mental nerve are close to the area of ​​surgical intervention. For such cases, the cortical bone window technique is an excellent option to access the operating field, preserving the cortical bone and avoiding the use of other bone regeneration materials. The present case documented the use of the cortical bone window technique with a modification, due to the proximity of the mental nerve to approach a persistent periapical lesion of a mandibular second premolar with previous endodontic treatment. Cone beam tomography (CBCT) and intraoral scanning were used for planning and elaboration of a navigation guide for surgical procedure. The clinical and radiographic 5-month follow-up with periapical radiography and CBCT revealed a favorable outcome, with an asymptomatic patient and an advanced healing process at the previous periapical lesion site.