Long Head Research Articles

Public Perceptions of Normal and Ideal Head Shape: A Crowdsourced Survey Analysis

Background: Cephalic index (CI) is an objective measure of head shape used by craniofacial surgeons to support a diagnosis of head shape abnormality. However, the consensus on what values correspond to a normal head shape are changing following the Back to Sleep campaign. Recent work has shown an increase in mean CI from 74 to 84. Following this shift, no study has been undertaken to evaluate whether the perception of normal head shape has changed as well. Methods: About 1020 subjects, 18 or older, were recruited through Amazon Turk crowdsourcing platform. Subjects were asked to select the head shapes they considered most normal in a series of questions identifying ideal head shape in children 6 months or younger. Demographic information was recorded for study participants to identify differing ethnic perceptions of head shape. Results: The mean cephalic index preferred by a crowdsourced population was 81.84 (SD 2.48). There was a difference in mean preferred CI between people who identified as black (CI = 82.875) and people who identified as white (CI = 81.500; P = .00062). There was no difference in mean preferred CI between males and females. Education level, age healthcare occupation status, medical literacy, and work involving children did not affect preference. Conclusions: The typical head shape has changed following the Back to Sleep campaign and the current perception of head shape aligns with the newly described norm as opposed to the historic population data. Criteria for intervention and outcome goals should be adjusted accordingly.

Endoscopic Strip Craniectomy and Helmet Therapy for Sagittal Craniosynostosis: An Analysis of Cranial Growth Changes in the Early Postoperative Period.

The purpose of this study is to analyze cranial width and length growth curves in the early postoperative period of patients by undergoing endoscopic sagittal strip craniectomy (ESC) to determine the timing of the maximal growth curve change. By analyzing the complex interplay of cephalic length and width measurements, we hope to better understand the cephalic index (CI) growth curve during this early period. This is the first of a multistep process to elucidate the ideal cranial remolding orthosis (CRO) treatment duration. Retrospective review. Tertiary academic institution. Children with isolated sagittal craniosynostosis. ESC and postoperative CRO treatment (2015-2019). One cranial orthotist obtained preoperative and postoperative measurements. The maximal rate of change of width, length, and CI were compared against the postoperative week these occurred. Thirteen children (mean age: 3.3 months, average preoperative CI: 73.4) underwent this intervention. CI reached its highest growth rate by 4.9 average weeks postoperatively, which correlated with the maximal width growth rate (5.2 weeks). Length curves reached their maximal growth rate by 15.5 weeks. CI peaked (81.3) by 22.7 weeks postoperatively, a significant increase from baseline. Following ESC, in the early postoperative period, the CI growth curve has 4 phases: initial rapid expansion, early and late slowed expansion, and plateau, followed by possible regression phases. This highlights the importance of early postoperative CRO initiation, CRO compliance, and properly fitting CROs, especially in the first 2 phases. This data sets the stage for investigating the ideal treatment length.

Craniofacial measurements of Malaysian Malays, Chinese and Indians based on the analyses of post-mortem computed tomographic images

ABSTRACT Considering that the Asian group is huge and consists of many sub-populations in terms of genetics and geographic locations, it is imperative to develop population-specific standards for forensic practice. However, baseline data for a Malaysian population are not readily available. We wish to apply the methodology of Gill et al. (1988) on linear measurements of the mid-facial skeleton observed in physical skulls of North Americans to post-mortem computed tomographic images of Malaysian individuals, together with cephalic and nasal indices. A total of 300 skull scans of equal distribution according to sex and ethnic groups were examined by an experienced observer. Mean values (±SD) in mm for maxillofacial breadth, mid-orbital breadth, alpha cord, naso-maxillofrontal subtense, naso-zygoorbital subtense, naso-alpha subtense, maximum cranial length, maximum cranial breadth, nasal height and nasal breadth in males are 24.98 ± 0.54; 54.84 ± 1.72; 25.20 ± 1.26; 12.52 ± 0.44; 19.70 ± 1.23; 21.33 ± 1.09; 180.36 ± 4.78; 143.02 ± 3.47; 51.76 ± 1.18; 24.99 ± 0.35; respectively. Findings for their female counterparts are 23.58 ± 0.69; 52.74 ± 2.36; 23.38 ± 1.21; 11.19 ± 0.5; 17.71 ± 1.36; 17.55 ± 1.19; 170.45 ± 24.18; 137.75 ± 16.95; 49.19 ± 0.99; 23.87 ± 0.39; respectively. Even though these craniofacial measurements are not able to confidently separate the three different ethnic groups, our study presented the preliminary measurements of Malaysian individuals comparatively to other global populations specifically in the Asian region.

Predictive Factors of Outcomes in Helmet Therapy for Deformational Plagiocephaly and Brachycephaly.

Deformational plagiocephaly and brachycephaly, or abnormal flattening of the infant skull due to external forces, are often managed with orthotic helmet therapy. Although helmet therapy is widely used, the factors that predict poor outcomes are not well characterized. In this study of over 140,000 patients who received helmet therapy, older age and greater severity at presentation, and noncompliance with treatment were each independently associated with worse craniometric and provider-reported outcomes. Each additional point of cranial vault asymmetry index or cephalic index at a presentation is associated with an increased likelihood of residual brachycephaly at completion [odds ratio (OR): 1.067; 95% Cl: 1.058-1.075; P <0.0001 and OR: 2.043; 95% CI: 2.021-2.065; P <0.0001, respectively], whereas each additional point of cranial vault asymmetry index at a presentation associated with increased likelihood of residual asymmetry at completion (OR: 2.148; 95% Cl: 2.118-2.179; P <0.0001). Patients were more likely to have residual brachycephaly or asymmetry with increasing age at treatment initiation (OR: 1.562; 95% CI: 1.524-1.600; P <0.0001 and OR: 1.673; 95% Cl: 1.634-1.713; P <0.0001, respectively, for each additional month of age at initiation). These results highlight a need for prompt referral for helmeting, especially in cases with severe features or when patients present late to care. Potentially modifiable factors are age at helmeting and compliance with treatment protocols, and consideration of these factors may be important for achieving success in some cases.

Retrospective analysis of tracheal hypoplasia in brachycephalic and non-brachycephalic dogs: Inter- and intra-observer agreement of measurements.

This retrospective study was undertaken on the records of intraluminal diameter of the trachea in 185 dogs, in which hypoplasia of the trachea had been suspected. The relative size of the trachea was measured using the tracheal diameter (TD), thoracic inlet distance (TI), thoracic tracheal diameter (TT) and the width of the third rib (3R), expressed as ratios TD:TI and TT:3R. Thirty-five dogs were diagnosed as having tracheal hypoplasia. Bulldogs and non-bulldog brachycephalic dogs had significantly smaller measured trachea diameters compared to the predicted values calculated on the basis of their body weight. Radiographs of each dog were investigated by four observers. Inter- and intra-observer reliability (ICCinter, ICCintra) was based on the measurements taken by four observers to evaluate the reproducibility of the protocol. There was a good ICCinter (0.8) and ICCintra (0.89) agreement. Craniocaudal tangential radiographs, centred on the cranial thoracic aperture, did not show a significant difference in tracheal diameter measurements compared to the right lateral radiographs. In conclusion, our findings indicate that bulldogs and non-bulldog brachycephalic dogs have smaller tracheal diameters than non-brachycephalic dogs.

Congenital malformations in brachycephalic dogs: A retrospective study.

The popularity of brachycephalic dogs has increased in recent years due to their docile temperament and peculiar features. The historical inbreeding and consequent lack of genetic diversity involved in the development of these breeds led to an increase in the manifestation of deleterious genes that may lead to malformations. In addition, there are serious health issues intrinsic to the conformation, mainly attributed to these extreme characteristics. Therefore, this retrospective study aimed to observe the frequency of malformations in brachycephalic dogs compared to the pure and mixed breeds (MB). The medical records of pregnant bitches admitted at the Service of Obstetrics and Animal Reproduction (SORA) from January 2017 to December 2021 were retrieved from the hospital's computer system and analyzed one by one. Seven hundred sixty-eight neonates born from 168 litters were included in this study. Of these litters, 72.6% (122/168) were brachycephalic. Malformations were found in 52 puppies, with an incidence of 6.77% (52/768). Of the 32 litters that produced malformed puppies, 28 were brachycephalic (87.5%). In total, 23 types of malformations were registered, the most common being cleft palate (1.30%) and anasarca (1.17%). Ten of the puppies (10/52; 19.23%) presented two or more associated malformations. Bitches above 7 years were more prone to present malformed puppies in their litters. Brachycephalic breeds were 3.03 times more likely to present malformed neonates when compared to other breeds; the odds ratio increased to 5.07 when modern brachycephalic was compared to ancestral brachycephalic. Regarding the mode of delivery, elective cesarean sections accounted for 66.6% of births while 19.64% were eutocic vaginal deliveries, and 13.69% were dystocic. The presence of malformed puppies in a litter causes suffering for the owner, the bitch and for the puppy itself, therefore, the veterinarian plays a key role in this scenario. Knowledge about congenital abnormalities, their causes, diagnosis, and approach is essential to reduce the incidence of malformations and improve the quality of life of these animals.

3-Dimensional Morphometric Outcomes After Endoscopic Strip Craniectomy for Unicoronal Synostosis.

Endoscopic strip craniectomy with postoperative helmeting (ESCH) for unicoronal synostosis has shown to be a less morbid procedure when compared with fronto-orbital remodeling (FOR). We aim in this pilot study to report objective methods and quantitative morphologic outcomes of endoscopically treated unicoronal synostosis using 3-dimensional surface scans. Our electronic records were reviewed for ophthalmological, neurodevelopmental outcomes, and helmet-related complications. For morphologic outcomes, the following parameters were used: Cranial Index, Cranial Vault Asymmetry Index, Anterior Symmetry Ratio (ASR), and Root Mean Square between the normal and synostotic sides of the head. Three-dimensional stereophotogrammetry scans were evaluated at 3 time points preoperative, 6 months post-op, and at the end of the treatment, which was compared with age-matched scans of normal controls and FOR patients. Nonparametric tests were used for statistical analysis. None of the ESCH cases developed strabismus, major neurodevelopmental delay, or helmet complications. All morphologic parameters improved significantly at 6 months post-op except for the Cranial Vault Asymmetry Index. The ASR was the only parameter to change significantly between 6 months post-op and final scans. At end of helmet treatment, ASR and Root Mean Square differed significantly between the ESCH and both FOR and control groups. Endoscopic strip craniectomy with postoperative helmeting for single unicoronal synostosis had excellent clinical outcomes. Most of the improvement in head morphology occurred in the first 6 months of treatment. Despite the normalization of the overall head shape, there was residual asymmetry in the frontal and temporal regions of the head.

Endoscopic strip craniectomy with molding helmet therapy versus spring-assisted cranioplasty for nonsyndromic single-suture sagittal craniosynostosis: a systematic review.

Endoscopic strip craniectomy with postoperative molding helmet therapy (ESC-H) and spring-assisted cranioplasty (SAC) are commonly used minimally invasive techniques for correction of nonsyndromic sagittal craniosynostosis, but it is unclear which, if either, is superior. Therefore, the authors undertook a systematic review to compare ESC-H with SAC for the surgical management of nonsyndromic single-suture sagittal craniosynostosis. Studies were identified through a systematic and comprehensive search of four databases (Embase, MEDLINE, and two databases in the Cochrane Library). Databases were searched from inception until February 19, 2021. Pediatric patients undergoing either ESC-H or SAC for the management of nonsyndromic single-suture sagittal craniosynostosis were included. Systematic reviews and meta-analyses, single-patient case reports, mixed cohorts of nonsyndromic and syndromic patients, mixed cohorts of different craniosynostosis types, and studies in which no outcomes of interest were reported were excluded. Outcomes of interest included reoperations, blood transfusion, complications, postoperative intensive care unit (ICU) admission, operative time, estimated blood loss, length of hospital stay, and cephalic index. Pooled summary cohort characteristics were calculated for each outcome of interest. Methodological quality was assessed using the Newcastle-Ottawa Scale. The study was reported in accordance with the 2020 PRISMA statement. Twenty-two studies were eligible for inclusion in the review, including 1094 patients, of whom 605 (55.3%) underwent ESC-H and 489 (44.7%) underwent SAC for nonsyndromic sagittal craniosynostosis. There was no difference between the pooled estimates of the ESC-H and SAC groups for operative time, length of stay, estimated blood loss, and cephalic index. There was no difference between the groups for reoperation rate and complication rate. However, ESC-H was associated with a higher blood transfusion rate and higher postoperative ICU admission. The available literature does not demonstrate superiority of either ESC-H or SAC, and outcomes are broadly similar for the treatment of nonsyndromic sagittal craniosynostosis. However, the evidence is limited by single-center retrospective studies with low methodological quality. There is a need for international multicenter randomized controlled trials comparing both techniques to gain definitive and generalizable data.

A comparison of harmonic and traditional sharp staphylectomy techniques in 15 brachycephalic dogs.

The objective was to compare sharp staphylectomy and staphylectomy using harmonic focus shears, assess surgical time, intraoperative haemorrhage and outcome. Our hypothesis was that harmonic staphylectomy would result in reduced surgical time, decreased intraoperative haemorrhage and greater relative improvement. Dogs that were presented to Highcroft Veterinary Referrals between July 2020 and September 2021 with brachycephalic obstructive airway syndrome and underwent surgical correction were prospectively enrolled. Surgical technique was randomised, and surgical time, staphylectomy time, intraoperative haemorrhage, hospitalisation and change in patients' Cambridge BOAS Grade at a 14-day recheck were recorded. Fifteen dogs were enrolled: seven dogs underwent sharp and eight underwent harmonic staphylectomy. Nine patients returned for follow-up, four of seven and five of eight, respectively. Harmonic staphylectomy was associated with less haemorrhage (0 versus 9 cotton buds) and a shorter average staphylectomy time (3minutes 36 seconds versus 14 minutes 50 seconds). No statistically significant differences were observed in total surgery time, number of nights hospitalised, or change in Cambridge BOAS Grade. An average of 0.68 mm of thermal necrosis was seen at the cut edges of soft palates removed by harmonic staphylectomy. Harmonic staphylectomy can result in a reduction in staphylectomy time and degree of intraoperative haemorrhage compared to sharp staphylectomy, with no deleterious impact on postoperative recovery or the long-term outcome of patients.

Syringohydromyelia in Dogs: The Genomic Component Underlying a Complex Neurological Disease.

Simple SummarySyringohydromyelia is a neurological disorder which is characterized by the appearance of fluid-containing cavities within the spinal cord and is common in brachycephalic dogs. Although syringohydromyelia is believed to be under multigene control, the molecular basis of this disease remains poorly defined. In this study, seven candidate genes were identified. Of these, five genes were determined to be involved in bone development (PLXNA2, HHAT, MBOAT2, ITGAV) and calcium homeostasis (HPCAL1). Considering previous studies in dogs showing syringohydromyelia associated with craniocervical junction malformations, these genes may be considered good candidates for the development of this disease. This report dissects the genomic component of syringohydromyelia in dogs, paving the way for further research into this complex disease found in both canine and human species.Syringohydromyelia (SHM) is a neurological disorder characterized by the appearance of fluid-containing cavities within the spinal cord. Although SHM is thought to be under multigenic control, the molecular basis of this disease remains poorly defined. A genome-wide association study (GWAS) was carried out comparing the whole genome sequences (WGS) from 12 dogs with SHM and 2 panels of 26 dogs (either older than 5 years and showing the absence of SHM or belonging to breeds not susceptible to SHM) to identify candidate genes associated with the development of SHM. Seven candidate genes were identified. Of these, five genes were determined to be involved in bone development (PLXNA2, HHAT, MBOAT2, ITGAV) and calcium homeostasis (HPCAL1). Although further validation is needed at the transcript level, it is worth highlighting the association of a possible pathogenic variant which generated a new intronic branch-site sequence in PLXNA2 (T/C, CFA7:7043294). Considering previous studies in dogs that show SHM related to craniocervical junction (CCJ) malformations, these genes can be considered good candidates for the development of this disease. This report dissects the genomic component of SHM in dogs, which paves the way for further research on this complex disease found both in canine and human species.

Head injury patients at a tertiary health care center

Background: Head injury is a significant reason for high dreariness and mortality, especially in youthful and useful age bunch patients. As per the World Health Organization report on street security, road traffic accidents (RTAs) would be the fifth driving reason for death worldwide constantly 2030. Larger part of the head wounds are ramifications of street auto collisions (RTAs), falls, attacks, or wounds, happening either in the work environment, during sport, and so forth. Present study was aimed to study patients with head injury coming to our tertiary care center.Methods: Present study was a prospective, observational type, conducted in patients with head injury who were admitted under the department of surgery during study period.Results: After applying inclusion and exclusion criteria, total 230 patients were considered for present study. 57% patients were from 21-50 years age group. Male to female ratio was 2.6:1. RTAs (63%) was most common cause of head injury in present study followed by assaults (20%) and fall from height (10%). 63% patients had mild head injury, while 21% and 16% patients had moderate and severe head injury respectively. Total 17% deaths were noted in present study. Outcome worsens with worsening of severity of head injury.Conclusions: Trauma remains leading cause of head injury in present study. Necessary preventive measures and vigorous training of all medico and para-medico staff for early management of head injury can definitively reduce mortality and morbidity due to head injury.

Parental care and early development of the labrisomid blenny Labrisomus philippii (Labrisomidae) from northern Chile

The parental care of the nests and the embryonic and larval development of the labrisomid blenny Labrisomus philippii (Teleostei: Labrisomidae) were described for the first time. In situ underwater recordings were done on nests deposited at 2-m depth at Pisagua and Sarmenia, northern Chile. The nests were composed by a mass of adhered eggs, exclusively on red algae covers (Rhodophyta) outside the crevices used by the adult and guarded by the male. Males utilized ~90% of the time taking care of the nest, defending it from predators (other fish and crustaceans), and keeping it clean. For the observation of larvae, egg masses were extracted from the nests and incubated in the laboratory. Eggs are spheroid, 1.09–1.23 mm in size, with filaments originating from a central thallus in the basal pole, small perivitelline space and granular yolk, with numerous small oil droplets. Larvae hatched at an average size of 5.06 ± 0.10 mm body length (BL), with a functional mouth, and a round yolk-sac of 0.09 mm3. Larvae are elongated, slightly laterally compressed, with a round and moderate head and a short snout. They have preopercular spines and 35 myomeres; melanophores are located on the cleithrum symphysis, over the head, along the base of the anal fin, between pterygiophores of the dorsal ray fin, and in the ventral margin of the gut. During development, larvae grew at 0.28 mm d−1. Finally, this research helped to increase knowledge on early-life history traits of this coastal fish inhabiting rocky shores along the south Pacific Ocean.

Evaluation of VEGF-A and CCL2 in dogs with brachycephalic obstructive airway syndrome or canine idiopathic pulmonary fibrosis and in normocephalic dogs

Brachycephalic obstructive airway syndrome (BOAS) and canine idiopathic pulmonary fibrosis (CIPF) of West Highland White Terriers (WHWTs) often cause intermittent or chronic hypoxemia. Our objective was to evaluate serum and bronchoalveolar lavage fluid (BALF) concentrations of hypoxemia-related proinflammatory mediators vascular endothelial growth factor A (VEGF-A) and chemokine (CC motif) ligand 2 (CCL2) in brachycephalic dogs (BDs) and WHWTs with and without CIPF. Additionally, effects of BOAS severity and ageing on these mediators were assessed.114 BDs (28 English Bulldogs (EBs), 37 French Bulldogs, 49 Pugs), 16 WHWTs with CIPF, 26 healthy WHWTs, and 39 normocephalic control dogs were included. Fifty-four BDs were re-examined after two to three years. Bead-based immunoassay was used for proinflammatory mediator measurements.Compared with controls, significantly higher serum concentrations of VEGF-A were seen in EBs (P = 0.009) and of CCL2 in CIPF and healthy WHWTs (P < 0.001; P = 0.002). BALF samples were available from controls, EBs, and WHWTs. VEGF-A was significantly lower in EBs (P < 0.001) and in CIPF and healthy WHWTs (P = 0.006; P = 0.007) and CCL2 was higher in CIPF WHWTs (P = 0.01) compared with controls. Between visits, only serum VEGF-A significantly decreased in BDs (P < 0.001), but breed, BOAS severity, or its change had no significant effect.In conclusion, in EBs with BOAS proinflammatory changes in VEGF-A were detected in both serum and BALF. Ageing reduced serum VEGF-A in BDs. In WHWTs, our results confirmed earlier findings of CCL2 as an important biomarker for CIPF.

An illustrated look at brachycephalic dogs

An illustrated look at brachycephalic dogs

Intragroup analysis of new craniometric data from the ancient Panjakent nauses

The article discusses new cranial materials excavated at the ancient Panjakent necropolis in 2003–2004. The crania were found in ossuary burials in nauses (small separate crypts) dating from the late VII to the early VIII centuries AD. The materials of the study include 19 crania of various preservation statuses (7 males, 11 females and one non-adult individual). The present study aims to compare the newly obtained cranial data with the al-ready published samples to see whether they are consistent with the current knowledge about the specifics of the crania from ancient Panjakent nauses. Furthermore, the new materials increase the sample size, which allows for an intragroup statistical analysis to be applied — the maximum overall number of observations in the pooled sam-ple has increased to 42 (data published by Ginzburg in 1950-s included). Besides from the craniometric part, we also recorded non-metric traits and visible pathological conditions, which are not discussed separately in the pa-per. The intragroup analysis of variability included both univariate (standard deviations, the F-test of equality of variances, correlation analysis) and multivariate statistical methods (Principal component analysis). In general, the increase in the sample size has not changed its anthropological characteristics described almost 70 years ago. This was a sub-brachycranial Caucasoid population with average-sized neuro- and facial cranium, moderate horizontal profiling, and moderate nasal bones protrusion. Statistical analyses seem to support the previous typo-logy-based assumptions about the presence of at least two morphological variants within the sample that differ mainly in the cranial index. The Principal component analysis results reveal that the crania from particular nauses cluster closely to each other, which is consistent with the hypothesis of these nauses possibly being family burials.

Prevalence and characterization of middle ear effusion in 55 brachycephalic dogs.

Multiple, breeding-related malformations of the skull of brachycephalic dogs are well-known. Whereas the eye-catching deformities of the nose that lead to dramatic respiratory problems are obvious, changes of the middle ear are often an incidental finding on CT examinations and usually clinically inapparent. The objectives of this work were to investigate the prevalence and characteristics of middle ear effusion in brachycephalic dog breeds presented for multilevel surgery of upper airway obstructions. Brachycephalic dogs with incidental middle ear effusion detected on CT scans obtained prior to surgical treatment of brachycephalic airway syndrome were prospectively enrolled. A perendoscopic tympanocentesis followed by macroscopic description, microscopic cytology and bacteriological analysis of the fluid was performed. Prevalence of middle ear effusion in all dogs presented to the department during the study period was 55/170 (32 %) in 86 middle ears. The only breeds suffering from MEE were French Bulldogs (FB) with a prevalence of 35/66 (53 %) and Pugs with a prevalence of 20/79 (25 %). Tympanocentesis was performed in 80 ears. In the majority of cases the effusion was either mucoid or serous, with a honey-like or ochre colour.Bacteriology was available for 76 ears and tested positive in 34 (45 %) cases. Cytology was performed in 73 ears and revealed all effusions to contain inflammatory cells with a high concentration in 23 (31.5 %) cases. Brachycephalic dogs presented for surgical treatment of brachycephalic airway syndrome have a high prevalence of incidental middle ear effusions. Cytological findings differ from previously reported analyses of effusions in Cavalier King Charles spaniels with clinical symptoms of primary secretory otitis media, where usually cell-free effusions are found. A study comparing effusions of brachycephalic dogs with vestibular disease to those found as an incidental condition is warranted.

Outcomes and Predictors of Outcome with Cisternostomy in the Management of Traumatic Brain Injury—A Prospective Observational Study at a Tertiary Centre

Abstract Background Traumatic brain injury (TBI) is a major cause of morbidity and mortality in young individuals. Goal of management in TBI patients is mainly focused on the secondary injury. Since the cisterns and the brain communicate, it would be possible to decrease the pressure in both these compartments by opening the cisterns to the atmospheric pressure. Objective To study the outcomes and predictors of outcome with cisternostomy in the management of TBI. Methods A single tertiary care center's prospective observational study of outcomes with cisternostomy with intraoperative intracranial pressure (ICP) monitoring. Patients were evaluated clinically and radiologically with Marshall CT score. They were categorized into mild, moderate, and severe head injury groups based on Glasgow coma scale (GCS) score. Outcomes were evaluated with Glasgow outcome scale (GOS) score. Results A total of 25 patients with TBI were enrolled in this study. They underwent cisternostomy with intraoperative ICP monitoring. They were categorized into 4 groups based on the age. In our study, mortality rate was 32%. As much as 48% had good recovery at 3 months follow-up with GOS 4 and 5. Mean ICP after cisternostomy was 6.36 ± 1.91 mm Hg. In our study, there was decrease in ICP after cisternostomy. Conclusion Age, time interval from trauma to surgery, and ICP showed prognostic importance on outcomes. Cisternostomy can efficiently decrease the ICP in the TBI patients and reduce postoperative complications.

Wound healing complications following folded flap palatoplasty in brachycephalic dogs.

To determine the incidence and characteristics of wound healing complications after folded flap palatoplasty (FFP). Prospective study of 25 dogs that underwent FFP as a component of corrective multilevel surgery for brachycephalic obstructive airway syndrome. Oropharyngeal re-examination was conducted after a minimum of 28 days post-operatively, unless indicated earlier by the onset of clinical signs. Wound healing complications occurred in nine dogs (36%). Minor and major wound complications were diagnosed at a median of 36 days (1.5-51 days) post-operatively. Eight dogs had major wound complications, four of which showed no associated clinical signs. Two patterns of major wound complications were observed: incisional dehiscence (ID) with caudal retraction of the soft palate mucosa and development of a full-thickness defect (FTD) in the centre of the soft palate. Revision of the soft palate surgery was performed in five dogs, failing again in one dog with ID. Clinical signs resolved in symptomatic dogs after revision surgery to close FTD. In this study, wound healing complications were common after FFP and were not associated with significant clinical deterioration. Further research is necessary to determine the value and timing of routine post-operative oropharyngeal examination for assessment of soft palate healing after FFP as well as the indication for and success of approaches to the management of wound healing complications. The two distinct patterns of FFP failure recognised may provide insight into the underlying causes and lead to refinements in folded flap palatoplasty technique.

Talar Allograft Preparation for Treatment of Reverse Hill-Sachs Defect in Recurrent Posterior Shoulder Instability

Reverse Hill-Sachs lesions (rHSLs) after chronic posterior shoulder instability are important to recognize and treat appropriately. Treatment options for posterior instability with rHSL in the current literature are primarily based on percentage of humeral bone loss. In cases of moderate (25% to 50%) anterolateral humeral head bone loss, fresh osteochondral allografts are preferred. Recent literature has indicated that the talus serves as a robust grafting alternative site for the humeral head, as the talar dome shows high congruency and offers variable sizes. The purpose of this Technical Note is, therefore, to describe our technique for talus allograft preparation for the treatment of a large rHSL that highlights precise cutting anatomy, sizing options, and use of orthobiologics to ensure excellent talus union to the native humeral head surface.

Tear film breakup time and Schirmer tear test in normal dogs: Effects of age, sex, reproductive status, skull type, and nasolacrimal duct patency.

The present study aimed to determine the effects of age, sex, reproductive status, skull type, and nasolacrimal duct (NLD) patency on tear production and tear film breakup time (TBUT) in normal dogs. The ophthalmic data of 82 healthy adult dogs were evaluated in this study. Age, sex, breed, and reproductive status were recorded. Schirmer tear test (STT) and TBUT were assessed in all dogs, and interferometry was available for the selected dogs. The Jones test was used to evaluate NLD patency. The cephalic index (CI) was calculated for each dog (skull width/skull length ×100). Mean (SD) values for the STT results for the right (OD) and left (OS) eyes were 20.6 (2.7) and 20.2 (2.7) mm/min, respectively. Mean (SD) TBUT values for OD and OS were 6.5 (2.5) and 6.1 (2.3) mm/min in all dogs, respectively. Sex and reproductive status had no significant effect on STT and TBUT (P[OU] > 0.05). Skull type significantly affected TBUT in both eyes (P(OD) =0.01, P(OS) =0.003), but had no effect on STT (P[OU] > 0.3). Age had no correlation with STT and TBUT in either eye (P[OU] > 0.05). STT and TBUT had no correlation in either eye (P[OU] > 0.2). NLD patency had no significant effect on STT or TBUT (P[OU] > 0.1). The results of this study showed lower TBUT values in brachycephalic breeds than in non-brachycephalic breeds. A compensatory increase in STT values was observed in dogs with low TBUT values.