Case Of Protrusion Research Articles

A comparative study: Ultrasound-guided leverage reduction with internal fixation using Kirschner wires or elastic stable intramedullary nailing for severely displaced radial neck fractures in children.

Treatment of radial neck fractures (RNFs) in children, particularly those with severe displacement or angulation, remains controversial, largely due to the challenge of achieving optimal reduction without resorting to open reduction. This study aimed to assess the outcomes of ultrasonography (US)-guided percutaneous leverage reduction coupled with US-guided fixation using either elastic stable intramedullary nail (ESIN) or Kirschner wire (KW) for severely displaced Judet type III and IV RNFs in children. We hypothesized that both strategies would be effective and aimed to identify the superior approach. A total of 38 pediatric patients presenting with Judet type III and IV RNFs resulting from falls were treated surgically between January 2020 and January 2022. The cohort comprised 15 boys and 23 girls, aged on average 7.6 ± 2.3 (range: 2.8-11.3 years). The fractures were classified as type III (n = 28) and type IV (n = 10). The patients were divided into 2 treatment groups: ESIN group (n = 15; treated with US-guided percutaneous leverage reduction and ESIN fixation) and the KW group (n = 23; treated with US-guided percutaneous leverage reduction and KW fixation). Variables such as surgical time, frequency of intraoperative radiography, fracture healing time, hospitalization costs, radiographic outcomes, and functional elbow scores were analyzed. Most fractures demonstrated both clinical and radiographic evidence of complete healing within 7 weeks. Based on the Tibone and Stoltz classification (Tibone J, Stoltz M. Fractures of the radial head and neck in children. J Bone Joint Surg Am. 1981;63:100-6), almost all patients had excellent or good clinical outcomes, with only one exception in the ESIN group. The KW group exhibited significantly lower hospitalization costs compared to the ESIN group [(9562.6 vs 12,043.6 + 7694.0)¥, P < .05]. Both groups required notably few intraoperative radiographic exposures (KW: 5.4 ± 2.1 times, ESIN: 4.0 ± 1.9 times, P < .05). No major complications were reported. However, one case of ESIN displacement and joint protrusion was noted. Our study suggests that US-guided percutaneous leverage reduction, combined with either ESIN or KW fixation, is an effective treatment for severely displaced radial neck fractures in children. Both treatment modalities resulted in notably few intraoperative radiographic exposures and yielded favorable clinical and radiological outcomes. The integration of US-guided leverage reduction and KW fixation is both cost-effective and safe.

Modified Vaginal Mesh Procedure with DynaMesh®-PR4 for the Treatment of Anterior/Apical Vaginal Prolapse.

(1) Background: Treating female pelvic organ prolapse (POP) is challenging. Surgical meshes have been used in transvaginal surgeries since the 1990s, but complications such as mesh exposure and infection have been reported. Polyvinylidene fluoride (PVDF) mesh, known for its stability and non-reactive properties, has shown promise in urogynecological surgeries. (2) Methods: A retrospective analysis was conducted on 27 patients who underwent a modified PVDF vaginal mesh repair procedure using DynaMesh®-PR4 and combined trans-obturator and sacrospinous fixation techniques. Additional surgeries were performed as needed. (3) Results: The mean operation time was 56.7 min, and the mean blood loss was 66.7 mL. The average hospitalization period was 4.2 days with Foley catheter removal after 2 days. Patients experienced lower pain scores from the day of the operation to the following day. Postoperative follow-up revealed that 85.2% of patients achieved anatomic success, with 14.8% experiencing recurrent stage II cystocele. No recurrence of apical prolapse was observed. Complications were rare, with one case (3.7%) of asymptomatic mesh protrusion. (4) Conclusions: The modified vaginal mesh procedure using DynaMesh®-PR4 showed favorable outcomes with a short operation time, low recurrence rate, rare complications, and improved functional outcomes. This surgical option could be considered for anterior and apical pelvic organ prolapse in women.

Transanal protrusion ventriculoperitoneal shunt migration in hydrocephalus patients

Perforation of the abdominal visceraand protrusionofthe distal end of the ventricul operitonealshunt are uncommon but serious complications of pediatric surgery. We report a case of distal ventriculoperitonealshunt protrusion into the appendix by transanal access in a patient who did not exhibit typical appendicitis symptoms. We report the case of a 2-year-old male with anal extrusion and assess his condition.

Temporary internal distraction for severe scoliosis: two-year minimum follow-up.

Temporary internal distraction (TID) is a surgical technique used to correct severe scoliosis. We sought to evaluate the long-term outcomes associated with temporary internal distraction (TID) for severe scoliosis. Scoliosis patients who underwent TID from 2006 to 2019 at a single institution were identified. Patients with coronal Cobb angles ≥ 90° or congenital scoliosis, and ≥ 2-year follow-up were included. Clinical and imaging data were reviewed for patient and operative characteristics and complications. Patient-reported outcomes were also analyzed. 51 patients (37 female) were included. Mean age at surgery was 14.3 ± 3.5years. Mean follow-up was 5.8 ± 3.0years. Eighteen (35%) curves were idiopathic, 24 (47%) were cerebral palsy (CP) related, and 9 (18%) were congenital. Mean Cobb angle was 103° preoperatively and 20° at final follow-up, with an intermediate angle of 55º in staged procedures. Intraoperative neuromonitoring changes occurred in 13 (25.4%) cases, but all returned to baseline with immediate lessening of distraction. Overall, three (5.8%) cases of wound dehiscence, five (9.7%) cases of deep infections, one (2%) case of screw protrusion, and one (2%) case of delayed extremity weakness occurred. Patient-reported outcomes significantly improved at final follow-up. Our findings suggest that TID is a valuable adjunct for correcting severe scoliosis. The mean Cobb reduction achieved (81%) was higher than that reported for halo-traction and was sustained over long-term follow-up. TID also allowed a shorter a hospital stay. While intraoperative neuromonitoring changes were not uncommon, they were reversible. However, care must always be exercised as major corrections may rarely result in delayed neurologic deficits despite intact neuromonitoring. Therapeutic-Level III.

A case of maxillary protrusion and excessive overjet treated successfully by implantation of a temporary anchorage device

This case report describes the treatment of a 15-year-old girl showing Angle’s Class II Division 1 malocclusion with maxillary prognathism and marked labial inclination of the maxillary anterior teeth, which was characterized by a large overjet, overjet occlusion, and mild crowding in the lower jaw. Our treatment completed without root resorption as a result of the combined use of a wire mechanism and anchors has rarely been reported before. The left and right maxillary first premolars were extracted, a temporary anchorage device (TAD) was used for space closure, and oral hygiene maintenance guidance was provided. The total treatment time was approximately 2 years and 7 months. Ideal overjet and overbite relationships were established, and the facial profile improved substantially. The 2-year follow-up assessment showed a morphologically and functionally stable result. For patients with marked maxillary prognathism, orthodontic treatment using TADs enables simultaneous and efficient maxillary anterior tooth retraction and reduction of overjet. Moreover, this treatment has the potential to shorten the treatment duration and contribute to the long-term stability of excessive overjet correction.

Long-Term Outcomes of Secondary Nasal Tip Plasty After Degradation of a Polycaprolactone (PCL) Mesh.

In secondary nasal tip plasty, it is often difficult to harvest appropriate septal extension grafts for sufficient tip projection. Therefore, studies using numerous alloplastic materials in rhinoplasty have been reported. This study aimed to evaluate the nasal tip change over time after tip plasty using a PCL mesh. We conducted a retrospective study of 86 Asian patients who received secondary tip plasty by septal extension grafting with a PCL mesh as a batten graft. Patient demographics and surgical outcomes were examined. The outcome variables were nasolabial angle, nasofrontal angle and Goode ratio. Measurements were performed with photographs obtained at short-term (postoperative 4-6 months) and long-term (more than postoperative 24 months) follow-ups. Aesthetic outcomes and safety were assessed using the Global Aesthetic Improvement Scale. Among 86 patients, 56 had a long-term follow-up. The mean age was 33.33 years, and the male-to-female ratio was 17.44:82.56. The nasolabial and nasofrontal angles did not change significantly between the short-term and long-term follow-ups. The Goode ratio, which is a useful tool to evaluate nasal projection, was decreased by 5.00%. Nevertheless, all patients were satisfied, and the long-term aesthetic outcomes were improved in 54 (96.4%) patients. There were two cases (2.33%) of complications, including one infection and one case of PCL-mesh protrusion. The present study demonstrated the usefulness and safety of PCL meshes when used in septal extension grafts as batten grafts. Although biodegradation seems to affect the nasal projection, PCL is still useful in secondary tip plasty along with other alloplastic materials. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pancreatic morphological abnormality that was challenging to differentiate from an ectopic pancreas: a case report

BackgroundProtrusion of the lateral contour of the pancreatic head is a pancreatic morphological abnormality, which is known as rare shape atypia. We present a rare case of protrusion of the lateral contour of the pancreatic head, which was challenging to distinguish from an ectopic pancreas.Case presentationThe patient was a 40-year-old man with a history of acute pancreatitis that occurred twice in the past. He complained of epigastric pain since the day before the visit; his blood workup showed high serum amylase level and a CT scan revealed a 25-mm-large mass with contrast effect from the anterior wall of the gastric pylorus to the duodenum and increased surrounding fatty tissue density. Endoscopic ultrasonography revealed a mass lesion in the gastric pylorus with continuity with the gastric wall and suspected partial continuity with the pancreatic head. Thus, the possibility of pancreatic morphological abnormality or an ectopic pancreas was considered. Following which, resection was attempted and intraoperative findings showed a wide extension of the pancreatic parenchyma from the pancreatic head to the anterior wall of the gastric pylorus to the duodenal bulb. Since the patient only had mild pancreatitis, the resection was judged to be too invasive and was completed by exploratory laparoscopy.ConclusionsEven if the findings on preoperative CT are suspicious for an ectopic pancreas or tumor, a pancreatic morphological abnormality, such as a protrusion of the lateral contour of the pancreatic head, should be included in the differential diagnosis.

A case of adult skeletal maxillary protrusion corrected by the Wassmund and Wunderer osteotomy methods and orthodontic treatment

A case of adult skeletal maxillary protrusion corrected by the Wassmund and Wunderer osteotomy methods and orthodontic treatment

A case of mandibular protrusion with dermatomyositis treated with orthognathic surgery

A case of mandibular protrusion with dermatomyositis treated with orthognathic surgery

Protrusion of ventriculoperitoneal shunt catheter tip through anus with silence abdomen

Introduction: Ventriculoperitoneal shunt (VPS) is most commonly performed surgical treatment for hydrocephalus by draining excessive cerebrospinal fluid (CSF) in ventricles to peritoneal cavity. Despite significant improvement in shunt procedure and being a relatively simple procedure, shunt complications remain common. Aim: The aim of this paper is to report a case of perforated bowel presented with silence abdomen following VPS insertion. Case study: We report a case of protrusion of distal VPS catheter through anus with silent abdomen, managed successfully with minimal intervention. Patient, 11-months-old male infant, diagnosed with congenital communicating hydrocephalus and VPS placement was done at 6 months of life, presented with tip of VPS protruding from anus after 4 months of VPS insertion. Patient was scheduled for removal of VPS, where shunt was disconnected through superficial abdominal incision, distal portion removed through anus without resistance. Postoperative patient recovers well without abdominal complication. Results and discussion: Perforation of bowel by distal peritoneal catheter is rare and only accounts for 0.1%–0.7% of complication. The exact pathogenesis for spontaneous bowel perforation is unclear. Management of bowel perforation secondary to VPS is highly individualized, mainly depending on its clinical symptoms and signs. Conclusions: Although bowel perforation following VPS insertion is rare, it carries high mortality up to 15% especially if unrecognized and delayed in treatment. Early detection and appropriate management are key in reducing VPS related morbidity and mortality.

Surgical Orthodontic Treatment of Skeletal Mandibular Protrusion with Multiple Impacted Ankylosed Teeth Treated with Alveolar Corticotomy

To present a case of skeletal mandibular protrusion with multiple impacted ankylosed teeth, which were treated with conventional orthognathic surgery and alveolar corticotomy, respectively. Tooth ankylosis is characterized by the fusion of a root surface with the surrounding alveolar bone. Various treatment modalities for tooth ankylosis have been developed and are used commonly in the clinic. Corticotomy is defined as the application of intentional surgical injury to the cortical bone to mobilize a tooth with the adjacent bone and soft tissues. The corticotomy technique has been improved in recent years to avoid possible risks such as periodontal damage, tooth devitalization, and osseous necrosis due to an inadequate blood supply. A female patient aged 16 years and 3 months was diagnosed with anterior crossbite and the impaction and ankylosis of multiple canines. After the confirmation of ankylosis, alveolar corticotomy was performed on the maxillary left and mandibular right canines. After 6 months of traction (patient age, 19 years and 7 months), both canines had extruded successfully. After the completion of preoperative treatment, bilateral intraoral vertical ramus osteotomy was performed to correct the anterior crossbite involving a skeletal mandibular protrusion. The amounts of mandibular setback on the right and left sides were approximately 7 and 5 mm, respectively. The total treatment period was 55 months. Acceptable occlusion with a balanced profile was maintained over a 5-year retention period, indicating the long-term stability and success of the treatment. Our results indicate that alveolar corticotomy should be considered to facilitate the treatment of multiple impacted ankylosed teeth. This report proposes an efficacy of alveolar corticotomy for extrusion of impacted ankylosed teeth.

NEUROIMAGING DATA OF THE STUDY OF THE CHIASMAL-SELLAR REGION STRUCTURES

NEUROIMAGING DATA OF THE STUDY OF THE CHIASMAL-SELLAR REGION STRUCTURES

Morphological changes in rabbit cornea after implantation of a new keratoprosthesis supporting plate

To evaluate biocompatibility of the new keratoprosthesis supporting plates (KSP) in rabbits in vivo. The study included 15 chinchilla rabbits. In the first group (5 rabbit eyes) KSP made of hydrophobic acryl with square penetrating holes of 220×220 micron (model 1) were inserted into rabbits' corneas. In the second group (5 eyes), KSP made of hydrophobic acryl were used that had trapezoidal fenestrations with size (from 170×130 micron to 180×70 microns) gradually changing from periphery to the center of KSP (model 2). The control group rabbits (5 eyes) had 1/2 of Fyodorov-Zuev KSP made of titanium implanted. All animals were observed for up to 3 months with biomicroscopy and optical coherence tomography of the anterior segment. The animals were then euthanized and had their corneo-scleral discs excised and then examined with optical microscopy and scanning electron microscopy (SEM). After 3 months, there was only one case of KSP protrusion in the first group. In the second group, thinning of the corneal layers above the central part of KSP occurred in one case. The presence of polymer KSP (of both models) in the corneal stroma was found not to cause formation of rough fibrotic tissue. At the same time, adhered cellular and fibrous elements were discovered on the surface and inside the holes of the polymer KSP, while on the surface of the titanium plate cellular elements were absent. Supporting plates made of hydrophobic acrylic material can potentially serve as a foundation for the new keratoprosthesis design.

A case of bi-maxillary protrusion with ankylosed incisors treated with a multidisciplinary approach

A case of bi-maxillary protrusion with ankylosed incisors treated with a multidisciplinary approach

Elastic Stable Intramedullary Nailing for Treatment ofPediatric Femoral Fractures; A 15-Year Single Centre Experience.

Objective:To analyze outcomes of treatment and complications in children treated with elastic stable intramedullary nailing (ESIN) due to femoral fracture.Methods:From May 2002 until May 2018 case records of 103 patients (76 male and 27 female), with median age of 9 (range, 3-17) and follow-up of 92 months, who underwent ESIN because of displaced femoral fracture were retrospectively reviewed. The patient’s information including age, sex, side involved, trauma mechanism, type of fracture, associated injuries, neurovascular status, complications, operation time, duration of hospital stay, time to implant removal were analyzed. The surgical procedure implied a reposition of bone fragments and osteosynthesis with titanium elastic nails introduced through an incision over the lateral and medial border of the distal femoral metaphysis. Results:All patients achieved complete radiographic healing at a mean of 8.5 (range, 5-15) weeks. Nine (8.49%) postoperative complications were recorded: three entry site skin irritation, two cases of valgus angulation and one case of nail protrusion, re-fracture, Varus angulation and delayed union. All complications, except case of re-fracture and one valgus angulation, were treated conservatively, with no long term consequences for the patients. Two patients were re-operated. After removal of nails all patients recovered complete function of the extremity, without long term consequences.Conclusion:The ESIN for treatment of femoral fractures shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction. Because of the excellent objective and subjective results, the operative stabilization of femoral fractures with ESIN should be recommended to all pediatrics patients

A Case of Skeletal Maxillary Protrusion with Open Bite and Hypoplasia of the Condyle Treated Using Maxillary Surgery Alone

A Case of Skeletal Maxillary Protrusion with Open Bite and Hypoplasia of the Condyle Treated Using Maxillary Surgery Alone

Trans-anal protrusion of intussusception (TAPI) revisited: managed successfully in a resource limited hospital setting

Intussusception is the most common cause of Acute bowel obstruction in infants and toddlers. However, a Trans-anal protrusion of an intussusception (TAPI) is relatively rare and is not well reported in literature. A high index of suspicion is essential as the diagnosis is purely clinical, and often confused with rectal prolapse. Most patients present late due to neglect on the part of the parents or the primary treating physician. A late presentation usually results in a poor outcome and increased morbidity and mortality. Uncommonly these children may present early, where a prompt surgical management is desirable. The author reports a single case of a Trans anal protrusion of intussusception (TAPI) in a 1-½ -year old female child who was successfully managed in the author's resource-limited teaching institution without a dedicated pediatric surgery unit.

A Case of Protrusion of False Vocal Fold Resulting from the Deformed Thyroid Cartilage

A Case of Protrusion of False Vocal Fold Resulting from the Deformed Thyroid Cartilage

Transanal protrusion of subdural peritoneal shunt in the setting of appendicitis

Abstract Complications from shunts placed in the peritoneum, either ventriculoperitoneal or subdural, are varied. Perforation of hollow organs and subsequent natural orifice protrusion is a rare but well known complication. We report a case of a transanal protrusion of a subdural peritoneal shunt in the setting of previous abdominal pain possibly consistent with acute appendicitis. While a report of transanal protrusion of a ventriculoperitoneal shunt via the appendix has been reported this is the first report where abdominal inflammation was also present. While patients with hollow organ perforation have been described as being managed conservatively after externalization of the proximal shunt and removal of the distal shunt, we managed our patient with an operation given our concern for appendicitis.

Pediatric humeral fracture fixed by a single retrograde titanium elastic nail

Introduction: Almost all pediatric humerus fractures are well managed with conservative treatment with higher percentage of union rate. However there are certain conditions where surgical intervention will be inevitable like humerus fracture associated with polytrauma compound fractures, those with head and unacceptable alignment. It is not only the stable fixation but also the alignment which is important and can be maintained even by a single pre-bent elastic or flexible intramedullary nailing. Methods: This was a retrospective study of 28 pediatric humeral fractures fixed with a single retrograde titanium elastic nail from 2012 to 2016. Time to unite the fracture along with other complications was noted. The functional outcomes were assessed according to Broberg and Morrey for elbow function and Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder function. Results: Average age of patients was 8.85 1.84 (range 6 to 12 years). Time to unite the fracture was 8.28 2.43 weeks (range 6 to 12 weeks). There were 1 case of malunion around 10 degrees, 1 case of nail migration, one case of superficial infection at the site of nail entry, one case of transient radial nerve palsy and one case of nail protrusion in our study. There were 24 (85.71%) cases of excellent and 4 (14.29%) cases of good results according to Broberg and Morrey functional scores. Conclusion: Fixation of pediatric humerus fractures with a single flexible nail reduces operative time, radiation exposure, cost of treatment, chances of iatrogenic supracondylar fracture and ulnar nerve injury without compromising the final outcomes.