Commissure Research Articles

Tessier cleft type 5 craniofacial anomaly – A rare oblique facial cleft

One of the rarest types of craniofacial malformations is Tessier cleft type 5. These are oblique facial clefts with bony defect representing an alveolar cleft in the premolar region. This extends to the lateral surface of the maxilla up to the infraorbital rim and orbital floor. The cleft begins in the upper lip, just medial to the commissure, and extends up to the eyelid. They may also show deficient maxillary growth on the side of the cleft, clinically represented as constriction in the maxilla and occlusal cant. It becomes very challenging to treat such cases and requires a team approach. The goals of such cases include surgical repair of the lower eyelid and outer canthus, expansion of the arch and alignment, Bone grafting for the alveolar cleft, zygomatic region, and orbital rim to restore the continuity. The following is a case report of Tessier type 5 facial cleft describing the clinical features, diagnosis, and treatment approach for the case.

Comparative study between surgical lateral internal sphincterotomy and botulinum toxin injection in the treatment of chronic anal fissure

Introduction Anal fissure is a longitudinal ulcer from below the dentate line to above the anocutaneous line. In 90% of cases, it is posterior. The second location is anterior commissure. In women, ∼80% are posteriorly, whereas 20% occur anteriorly. Botulinum toxin (BTX) action is mediated by its action on the autonomic nervous system. The treatment goal for BTX is the interruption of the internal sphincter spasm. Indeed, sphincter manometry after BTX injection has demonstrated a lowering of resting internal pressure. The aim is to compare effectiveness of surgical lateral internal sphincterotomy (LIS) versus BTX injection. Patients and methods A total of 60 patients were randomly allocated into two equal groups of 30 patients each: group I (lateral internal sphincterotomy group) and group II (BTX injection group). Results Chronic anal fissure can be successfully treated with surgical LIS with a 90% healing rate after 2 months, with no recurrence rate recorded, in comparison with a 70% healing rate in BTX injection, with a 20% incidence of recurrence. Conclusion LIS is a satisfactory treatment for chronic anal fissure, being quick and easy to be performed with minimal complications. Recurrence is uncommon. BTX is safe and easy, with rapid relief of pain, with no risk of anesthetic or operative complications. It is relatively less invasive than surgical, with negligible complications, but it has a higher recurrence rate. The risk of anal incontinence is higher in the surgical group especially in elderly patients than BTX injection; therefore, BTX injection is preferred in middle aged and elderly patients, risk factor for anal incontinence, or those of recent complaint of anal fissure.

Predictors of Complications During Percutaneous Multitrack Balloon Mitral Valvuloplasty

Introduction: Mitral Stenosis (MS) is characterized by a decrease in Mitral Valve (MV) orifice area leading to compromised left ventricular filling. The consequence is stagnation of blood proximal to the MV that results in elevated left atrial, pulmonary venous, and pulmonary artery pressure. Aim of the work: Trace the complication of mitral regurgitation during the procedure percutaneous Balloon Mitral Valvuloplasty (PMV) by using multitrack balloon. Subjects and methods: This interventional non-randomized cohort study was conducted on 121 patients who presented with moderate to severe MS and subjected to PMV using multitrack balloon technique and were divided into 2 groups, according to resultant mitral regurgitation: Group A: included patients with no or mild mitral regurgitation and Group B: included patients with severe mitral regurgitation. Results: Multivariate regression identified MV balloon sizing (OR 3.877, CI 95% 1.131-13.289, P value 0.031), MV commissural asymmetry (OR 67.48, CI 95% 5.759-790.72, P value 0.001). Conclusion: Mitral valve calcification, balloon sizing and MV asymmetry are significant factors that can predict the development of severe MR after balloon valvuloplasty.

Identification of cis -Regulatory Region Controlling Semaphorin-1a Expression in the Drosophila Embryonic Nervous System.

The Drosophila transmembrane semaphorin Sema-1a mediates forward and reverse signaling that plays an essential role in motor and central nervous system (CNS) axon pathfinding during embryonic neural development. Previous immunohistochemical analysis revealed that Sema-1a is expressed on most commissural and longitudinal axons in the CNS and five motor nerve branches in the peripheral nervous system (PNS). However, Sema-1a-mediated axon guidance function contributes significantly to both intersegmental nerve b (ISNb) and segmental nerve a (SNa), and slightly to ISNd and SNc, but not to ISN motor axon pathfinding. Here, we uncover three cis-regulatory elements (CREs), R34A03, R32H10, and R33F06, that robustly drove reporter expression in a large subset of neurons in the CNS. In the transgenic lines R34A03 and R32H10 reporter expression was consistently observed on both ISNb and SNa nerve branches, whereas in the line R33F06 reporter expression was irregularly detected on ISNb or SNa nerve branches in small subsets of abdominal hemisegments. Through complementation test with a Sema-1a loss-of-function allele, we found that neuronal expression of Sema-1a driven by each of R34A03 and R32H10 restores robustly the CNS and PNS motor axon guidance defects observed in Sema-1a homozygous mutants. However, when wild-type Sema-1a is expressed by R33F06 in Sema-1a mutants, the Sema-1a PNS axon guidance phenotypes are partially rescued while the Sema-1a CNS axon guidance defects are completely rescued. These results suggest that in a redundant manner, the CREs, R34A03, R32H10, and R33F06 govern the Sema-1a expression required for the axon guidance function of Sema-1a during embryonic neural development.

Outcomes of deep brain stimulation lead revision surgeries for Parkinson’s disease

Objective To study the outcomes of the revision surgeries correcting electrode malposition in deep brain stimulation (DBS) for Parkinson’s disease (PD). Methods A total of 18 PD patients were enrolled who underwent lead revision surgeries due to subthalamic nucleus (STN) DBS lead malposition at Neuromodulation Center, Department of Neurosurgery, Tsinghua University Yuquan Hospital between September 2013 and May 2018. Changes in UPDRS-III scores on and off medication were analyzed at 1 month and 6 months postoperatively compared to those before surgery. MR images were also collected to analyze the lead location change. Results Among the 18 patients, 14 had bilateral lead revision and 4 had unilateral revision. A total of 32 leads were revised, among which 25 were reimplanted and the other 7 were repositioned without reimplantation. Off medication, the average UPDRS-Ⅲ scores before and 1 month and 6 months after surgery were 44.0±10.5, 22.4±7.4 and 25.3±7.7 respectively. On medication, those were 27.3±9.1, 16.7±8.7 and 20.3±8.3 respectively. The analysis of variance and comparisons between groups showed that the on and off medication scores were significantly reduced after the revision surgery (P<0.05). The off medication score at 6 months was averagely improved by (40.7±4.7)%(5.9-79.5%). The average distance between pre-implantation and post-implantation lead locations on the plane 3.5 mm below AC (anterior commissure)-PC (posterior commissure) was (2.8±1.0) mm(1.2-4.5 mm). No adverse events such as hemorrhage or infection were observed after surgery. Conclusion Lead revision surgery could safely and effectively remedy the suboptimal outcomes due to electrode malposition in STN-DBS for PD patients. Key words: Parkinson disease; Deep brain stimulation; Subthalamic nucleus; Electrode malposition; Revision surgery

Torque Controlled True Intrusion and Retraction: A Novel Protocol for Altering the ‘Gull-Wing Lip’ Morphology:

The paradigm of orthodontics in the past century has been limited to the dentoalveolar segment and to some extent the jaws. The shift from hard tissue paradigm to soft-tissue has wide ned our focus on how we look at the face as a whole. Brin ging about changes in soft-tissue contours, once thought to be beyond the scope of orthodontics are now being addressed to. Once such example of atypical soft-tissue morphology is the ‘gull-wing’ lip pattern. This pattern is identified by an obvious increase in incisal exposure at rest and smile and an excessive difference between the philtrum and commissural length. The lip morphology is known to be dependent on the vestibular sulcular depth which in turn depends on the vertical anterior teeth root positioning. The vertical incisal show is merely a manifestation of improper sulcular morphology seen in the gull-wing lip pattern. The true intrusion of maxillary incisors and simultaneous torque controlled retraction tends to alter the sulcular morphology and in turn the gull-wing pattern.

Diagnosis and treatment of corpus callosum lesion in children

Corpus callosum is an important constituent of central nervous system.It is located in the bottom of the fissurae longitudinalis cerebri, linking the cross the nerve fibers of left and right hemispheres.Corpus callosum is the largest commissural fibers.There are a variety of lesions in corpus callosum, presenting a variety of clinical symptoms, but most of them are not specific.Common corpus callosum lesions include corpus callosum hemorrhage, corpus callosum infarction, corpus callosum demyelinating, agenesis of the corpus callosum, corpus callosum tumor, corpus callosum injury, clinically mild encephalitis/encephalopathy with a reversible splenial lesion and so on.At present, there are few studies on corpus callosum lesions in children in China.This paper summarizes the current situation and the latest research progress of corpus callosum lesion in children. Key words: Corpus callosum; Lesion; Children; Clinical feature

A Case of a Subglottic Stone

A 50-year-old woman visited our clinic, complaining of a long-term foreign body sensation in her throat. Laryngeal examination revealed a subglottic nodular lesion posterior to the anterior commissure. Her laboratory data were within normal range and there was no particular abnormality in her history. A 2-mm sized stone was extracted after incising the nodule. The surrounding nodular tissue was removed carefully. The patient recovered completely after the surgery. This is the first case of a subglottic laryngeal stone reported in an English-language journal. J Med Cases. 2018;9(10):352-354 doi: https://doi.org/10.14740/jmc3171

Application and effect of electrocardiograhy on totally implantable venous access ports

Objective To investigate the accuracy and safety of using normal saline as a medium to guide the catheter lumen to assist the localization of the catheter tip. Methods This study included the patients with hematological malignancies in our fully implantable venous port. We enrolled 105 patients from January 2014 to December 2015 as control group, and 220 patients from January 2016 to June 2017 as the experimental group. The control group used the traditional fully implantable venous port after the chest X slice to determine the location of the catheter tip. The experimental group used the intracavitary electrocardiogram location technology to assist the complete implantable venous port catheter tip positioning catheter, then chest X film. Results No catheterization occurred in all the patients. The rate of catheter placement was 100%. In the experimental group, 179 patients (81.36%) had the best placement of catheter tip (i.e., superior vena cava right atrium junction, CAJ), and 35 patients (52.38%) in the control group had the best placement of catheter tip. The proportion of the catheter tip located in the best position (the superior vena cava auricular commissure and CAJ) in the experimental group was higher than that in the control group (χ2=29.615, P < 0.05). Conclusions By the injection of saline guided endocardial mapping real-time monitoring of totally implantable venous transfusion port catheter tip position, can guide the surgeon to grasp the real-time operational direction of totally implantable venous transfusion port catheter tip, accurately positioning the catheter tip position, improve the surgical success rate, worthy of clinical use. Key words: Totally implantable venous access ports; Tip positioning; Electrocardiograhy

Endoscopic anatomy of superior and inferior transtentorial approach to the posterior third ventricle

Objective To conduct anatomic study of structures and exposure of the posterior third ventricle by simulating superior and inferior transtentorial approach with endoscope and to provide anatomical basis for treatment involving this area with endoscope. Methods Five formalin-fixed cadaver heads (10 sides) were dissected bilaterally. To observe and measure anatomical structures of the posterior third ventricle by endoscopic infratentorial-supracerebellar (midline or paramedian) approach and occipital-tentorial approach with comparison of exposure using different surgical approaches. Results (1) Measurement of anatomical structures: Average number of bridging veins of the cerebellum was 3.6±0.6. The diameter of the vein of Galen was 5.6±0.6 mm. The distance from Habenular commissure to confluence of sinuses was 74.4±6.7 mm and the distance from anterior commissure to confluence of sinuses was 107.2±7.3 mm. (2) Comparison of different surgical approaches: The exposed area of pineal glands was 19.6±2.8 mm2, which was almost the same to that in operations through infratentorial-supracerebellar (midline or paramedian) approach and occipital-tentorial approach. The average of exposed area in splenium of corpus callosum was 55.2±7.9 mm2, 34.7±7.9 mm2 and 44.9±5.9 mm2 , respectively, and in ipsilateral superior colliculus was 153.8±13.4 mm2, 177.5±24.0 mm2 and 197.6±19.8 mm2 , respectively. Both had statistically significant difference (all P<0.05). Conclusions Endoscopic superior and inferior transtentorial approach seems feasible and safe for removal of tumors in the posterior third ventricle. Selection of surgical approaches should be based on the tumor type, size, location and its relationship to the surrounding structures. Key words: Natural orifice endoscopic surgery; Anatomy; Surgical approach; Posterior third ventricle tumor

Quantitative assessment of mitral apparatus in patients with acute myocardial infarction after percutaneous coronary intervention by real-time three-dimensional transthoracic echocardiography

Objective To assess the changes of structure and function of the moderate mitral valvular regurgitation before and after percutaneous coronary intervention (PCI) by real-time 3-dimensional transthoracic echocardiography(RT 3D-TTE). Methods Thirty-two patients with acute myocardial infarction(AMI) and moderate mitral regurgitation were enrolled in the study, while 30 healthy subjects were selected as the control group. All patients accepted RT 3D-TTE, the imaging was analyzed offline with TomTec 4D MV-Assessment software. The mitral valve structure and function parameters were measured. All AMI patients were performed RT 3D-TTE at 12 hours before PCI, 1 week and 3 months after PCI. According to whether improved at 3 months after PCI, patients with moderate mitral regurgitation were divided into two groups: improvement group and no improvement group. Results ①Compared with the control group, anterior-posterior(AP) diameter, anterolateral-posteromedial(AL-PM) diameter, annular circumference(AC), commissural diameter(CD), three-dimensional annular area(AA3D), tenting volume(TV), tenting height(TH), nonplanarity angle(NPA)of mitral regurgitation group were larger(P<0.05), annular height(AH)and maximum annular displacement(ADMax), and maximum annular displacement velocity(ADVMax) of mitral regurgitation group were smaller(P<0.05). ②At three months after PCI, 20 patients with moderate mitral regurgitation were improved(effective regurgitant orific area<0.2 cm2), twelve patients with moderate mitral regurgitation were not improved. Compared with mitral valve parameters before PCI and at one week after PCI, AP, AL-PM, AC, CD, AA3D, and TV in improvement group were discreased at three months after PCI(P<0.05), AH was increased (P<0.05). Compared with mitral valve parameters before PCI, mitral valve structure and function parameters after PCI were not improved, compared with those in no improvement group, AP, AL-PM, AC, CD, and AA3D in improvement group were smaller(P<0.05). ③By analysis of ROC curves AP, AL-PM, AC, and CD for diagnosing mitral regurgitation had good test effectiveness. Conclusions In patients with acute myocardial infarction and moderate mitral regurgitation, the mitral annular is not only presented as the size enlargement but also the flattening of its geometric shape and the decrease of its dynamic, while structure and function parameters of the mitral valve before PCI can predict improvement of mitral regurgitation and provide a reference for the development of clinical programs. Key words: Echocardiography, real-time three-dimensional; Myocardial infarction; Mitral valve insufficiency

Experience of surgical treatment of post-burn oral commissural contracture (Microstomia)

Introduction: One of the significant problems of facial burns is post burn oral commissural contracture (Microstomia) occurring as a result of circumferential scarring at the junction between the lips and cheek. It results in aesthetic disfigurement of face and functional impairments like feeding, speech and oral hygiene and difficulty of intubation. Objective: This study aims to share the experience of treatment of microstomia with various methods. Methods: This study comprised of 7 cases of microstomia of variable severity over a period of 10 years. Case number 1, 2 and 3, having severe microstomia, were treated with Converse method of commissuroplasty without waiting for scar maturation. Case number 4 and 5 had moderate severity microstomia, in these patients the correction of the neck contracture was considered as priority and were treated with release of neck contracture and split skin grafting. Case number 6 and 7 had pressing priority of treatment of ectropion which was treated first but unfortunately further the treatment of microstomia was given back seat by the patients. Results: Case number 1 to 5 treated operatively showed significant improvement in mouth opening while case number 6 and 7 who rejected treatment, showed no improvement.Conclusion: Post burn microstomia is infrequent yet important functional condition causing difficulty for feeding and for intubation during anesthesia and hence its correction falls under essential procedure to be done earliest without waiting for scar maturation. Cases which were treated operatively showed significant improvement in mouth opening. In cases that rejected treatment, hence considered as conservatively treated, the results were inferior.

Reconsideration of hot topics on laparoscopic radical gastrectomy

Laparoscopic radical gastrectomy(LRG) has been popularized with the development of laparoscopic surgical techniques. As a result of the requirement of surgical skill of LRG, the evidence is always highly demanded. The surgical safety and radical resection of tumor is one of the most important principles. Based on published studies and authors' own experience, this article discusses the following topics on laparoscopic gastrectomy: (1)Indications of surgery: Laparoscopic gastrectomy for early gastric cancer is accepted all over the world. For locally advanced gastric cancer, laparoscopic gastrectomy with D2 dissection is considered to be safe and feasible based on domestic studies, especially the CLASS research. (2)Positions and approaches: Classic approaches of laparoscopic gastrectomy include left-side approach, right-side approach, anterior approach and posterior approach. Left-side position is the first choice in China, which is suitable for most laparoscopic gastrectomy. Meanwhile, right-side position is most recommended in Japan and Korea. The selection of approach could be varied by the feature of the tumor, the anatomy of the tumor and the habit of surgeons. (3) Lymphadenectomy of the superior area of pancreas: Based on Japanese Classification of Gastric Carcinoma (14th edition), Chinese Expert Consensus on Quality Control of Laparoscopic Radical Gastrectomy for Gastric Cancer (2017 edition) and authors' own experience, we define the lymph node dissection margin of the superior area of pancreas in laparoscopic distal gastrectomy with D2 dissection as follows: right side is the left wall of portal vein; left side is the posterior gastric artery; upper side is the commissure of diaphragmatic crura; lower side is the anterosuperior side of common hepatic artery and splenic artery; posterior side (on the right side of coeliac trunk) is the plane composed of portal vein, common hepatic artery and the root of coeliac trunk; posterior side (on the left side of coeliac trunk) is the Gerota's fascia. (4) Bursectomy or not: Bursectomy is not recommended as standard procedure in cT3 or cT4a gastric cancer based on the results of JCOG1001. However, to achieve a better surgical plane, dissection of anterior lobe of transverse mesocolon and pancreatic capsule in some area is accepted. (5) Totally laparoscopic reconstruction of digestive tract: along with the development of equipment and modification of anastomosis, the totally laparoscopic reconstruction of digestive tract becomes more and more welcome in laparoscopic gastrectomy as it provides a better and larger surgical scene compared to small incision assisted surgery. The whole procedure of anastomosis is overlooked by laparoscopy, without any over traction of tissue.

ANTICOMMISSURAL BARRIERS IN ABDOMINAL SURGERY: UP-TO-DATE STATE OF PROBLEM

Widening of the spectrum and volume of surgical interventions causes rise in frequency of peritoneal commissures. Development of commissural process in the abdominal cavity is connected with chronic abdominal pain syndrome, reducing the quality of patients’ life, disturbance of female reproductive function as well as acute commissural bowel obstruction. The only technique for elimination of already existing abdominal commissures is mechanical adhesiotomy. Surgery is considered to be justified in case of acute bowel obstruction, it is connected with technical difficulties and high risk for organ and tissue traumatization; it provokes formation of additional commissures. Especially significant are pathogenetically grounded methods for prevention of commissure formation. During the recent decades, one of the main places in prevention of peritoneal commissures is occupied by specialized medicinal preparations - anticommissural barriers. Their use is pathogenetically grounded and most promising. The information on present-day anticommissural barriers and prospects of their use for prevention of peritoneal commissures is presented in this review.

Study on the mitral valve geometry of the healthy subjects assessed by real-time three-dimensional transthoracic echocardiography and real-time three-dimensional transesophageal echocardiography

Objective To assess the correlation and agreement of the mitral valve geometry parameters obtained by real-time three-dimensional transthoracic echocardiography (RT-3D-TTE) and real-time three-dimensional transesophageal echocardiography (RT-3D-TEE). Methods RT-3D-TTE and RT-3D-TEE were performed on 29 healthy volunteers under conscious state and general anesthesia respectively. The mid-systole mitral valve parameters were analyzed by TomTec Imaging Systems. The repeatability test of the mitral valve parameters obtained by RT-3D-TTE was performed. The correlation and agreement of the mitral valve parameters obtained by RT-3D-TTE and RT-3D-TEE were assessed,and then the differences of mitral valve parameters between the two methods were compared. The study was approved by the Shanxi Dayi Hospital Ethics Committee (Approval no.YXLL-2015-040). Results ①The mitral valve parameters obtained by RT-3D-TTE showed excellent intra- and interobserver reproducibility,in intra-observer and inter-observer with ICC>0.8 for all the parameters,and the Bland-Altman plots displayed the average differences of anterior-posterior (AP),anterolateral-posteromedial (ALPM),annular circumference (AC),three-dimensional annular area (AA3D) for intra- and interobserver were 0.009±0.11,-0.008±0.10,-0.036±0.32,0.030±0.36 in intra-observer and -0.018±0.09,0.087±0.20,-0.037±0.44,-0.016±0.62 in inter-observers,respectively. ②There were close correlations (r=0.566-0.870,P 0.05). The rest of parameters including ALPM,sphericity (SPI),commissural diameter (CD),AC,AA3D,nonplanarity angle (NPA),tenting height (TH),maximum annular displacement (ADmax) and maximum annular displacement velocity (ADVmax) had significant differences (P<0.05). Conclusions The mitral valve parameters obtained by RT-3D-TTE are highly reproducible and similar to those obtained by RT-3D-TEE,and the two methods have close correlations and good agreement. Therefore,RT-3D-TTE has higher potential clinical application value in the evaluation of mitral valve geometry. Key words: Echocardiography,real-time three-dimensional; Mitral valve

Methodology study for the anatomic structure of aortic root using three-dimensional transesophageal echocardiography

Objective To establish a quantitative analysis method for the anatomic structure of aortic root by real-time three-dimensional transesophageal echocardiography, and to explore the reliability and repeatability of this method. Methods Ninety five adult patients underwent RT-3DTEE were included in this study.Full-volume 3D images of aortic root were acquired and analyzed offline with QLab-3DQ (iE33, Philips). The three mutually perpendicular plane were determined. Results 1) Aortic root: At the end of diastole, the diameter and area of coronary artery sinus bottoms level was 1.84 cm and 3.45 cm2; the diameter and area of top commissural level was 2.97 cm and 7.77 cm2; the diameter and area of sino-tubular junction level was 2.72 cm and 5.44 cm2. 2) Aortic sinus: right coronary sinus was widest, left coronary sinus was the most stenosis(P 0.50). The measurement of each parameter, which analysis among different angles showed that 0° region were more accurate than others. Conclusions 3D quantitative analysis to aortic root can be established by full-volume RT-3DTEE images and has better reliability and repeatability. Key words: Echocardiography, transesophageal; Echocardiography, real-time three-dimensional; Aortic root; Methodology; Quantitative analysis

HUBUNGAN BERAT BADAN BAYI BARU LAHIR DENGAN KEJADIAN RUPTUR PERINEUM PADA PERSALINAN NORMAL DI RSI IBNU SINA BUKITTINGGI TAHUN 2014

The main cause of postpartum is hemorrhage 40% of maternal mortality include haemorrhage caused by a ruptured perineum. Rupture of the perineum is torn birth canal accidentally due to incorrect position of labor and the weight of the baby is too big. The purpose of this research is to reduce the maternal mortality rate by 2014. The research method is analytical survey with cross sectional design. The population in this study are all normal birth mothers for 33 people. The sampling method used is accidental sampling technique univariate analysis to describe the characteristics of respondents, bivariate analysis to determine the relationship of weight newborns with perineal rupture in normal delivery using a statistical test Chi square. Most respondents weight babies with normal birth weights (2500-4000 grams) of 27 (81.8%) and in getting the majority of mothers who suffered 2nd degree perineal rupture is a tear with extension into the vaginal mucosa, posterior commissure, the skin of the perineum and perineal muscles for 20 (60.6%) normal birth mothers. The result showed a significant value of p = 0,00 of the known value of p <0.05 only in so there is a significant relationship between weight newborns with perineal rupture in normal labor. This research is expected to be developed and implemented further as researching on primigravida added elastician maternal perineum.

Levator anguli oris: a cadaver study implicating its role in perioral rejuvenation.

The purpose of this study was to investigate the role of the levator anguli oris in perioral rejuvenation by delineating the detailed anatomy of this muscle and illustrating a new technique to elevate the oral commissure using this muscle. Fresh cadaver dissection was carried out in 9 facial halves specifically examining the anatomy of and surrounding the levator anguli oris. This muscle was identified in each cadaver to coalesce with the zygomaticus major muscle at the modiolus, thus elevating the oral commissure. In 3 facial halves, an intraoral incision from the canine to the modiolus was performed. This allowed easy access to the levator anguli oris muscle for plication and successful elevation of the oral commissure. This procedure could be applied in combination with traditional face lifts to enhance facial rejuvenation or potentially used to reanimate the partially paralyzed face.

Transoral CO2 laser surgery for early glottic carcinoma with anterior commissure involvement

To explore the feasibility and effect of CO2 laser surgery for early glottic carcinoma with anterior commissure involvement. Twenty-seven patients with T1b glottic squamous cell carcinoma who underwent transoral CO2 laser surgery as the primary modality of treatment from January 2008 to August 2013 were reviewed. All patients were males and the age ranged from 46 to 81 years old. The patients did not receive any other treatments. Preoperative enhanced CT scan was performed to assess the status of the tumors and the lamina of thyroid cartilage. All the patients without the lamina of thyroid cartilage involved underwent transoral CO2 laser surgery. Among 27 cases, aside from 1 patient converted to open operation due to inadequate exposure, 26 patients were successfully implemented operation. All the patients were followed-up for 12 to 60 months (median 26 months) and no recurrence. Granulation occurred four to six weeks after operation in all patients. Among them, granulation disappeared automatically three to six months in 22 patients and was resected with local anesthesia in other 4 patients, which the pathological results were inflammatory lesion. All patients did not undergo tracheotomy and nasogastric feeding, with an average stay of three days in hospital after surgery, and had different degree of vocal cord adhesion 6 months later. Transoral CO2 laser surgery is an ideal procedure for early glottic carcinoma with anterior commissure involvement. Better preoperative evaluation, endoscopic technique and satisfied exposure are keys to the success of operation.

Advances from probabilistic tractography in connections of the limbic system with the cerebellum

The limbic system is a complex set of brain structures located on both sides of the thalamus, right under the cerebrum. It is not a separate system but a collection of structures from the telencephalon, diencephalon, and mesencephalon, including the hippocampus, amygdala, anterior thalamic nuclei, fornix, columns of fornix, mammillary body, septum pellucidum, habenular commissure, cingulate gyrus, parahippocampal gyrus, limbic cortex, pars of olfactory system and limbic midbrain areas. Nevertheless, recent studies showed that the definition of anatomical structures considered part of the limbic system is a controversial subject. Although the role of the cerebellum was traditionally considered mainly associated to motion control, it has been recently suggested a cerebellar involvement in emotions control, cognitive processes and social behavior. In this regard, we have previously demonstrated that the cerebellum is interconnected with the hippocampus [1]. In this work, a wider sample of normal subjects was examined by using probabilistic Constrained Spherical Deconvolution (CSD) tractography, which represents a method able to overcome many limitations of other Diffusion Tensor Imaging (DTI) techniques, providing more accurate data [2]. We found evidences in the human brain that the cerebellum is widely linked with limbic-related structures and provided a more reliable demonstration of direct cerebello-limbic pathways. In addition, we further extendend our analysis to the other limbic connections including uncinated fasciculus, cingulate fasciculus, inferior longitudinal fasciculus, anterior thalamic connections and fornix. Although these pathways have been already described in the tractographic literature we provided reconstruction and quantitative analysis, which could be potentially useful to explore pathological conditions damaging this system. Finally, the demonstration of the existence of cerebello-limbic connections could constitute an important step in the knowledge of the anatomic substrate of non-motor cerebellar functions.