Complete Patient Satisfaction Research Articles

HUBUNGAN KUALITAS PELAYANAN DOKTER GIGI MUDA DALAM PERAWATAN GIGI TIRUAN LENGKAP AKRILIK TERHADAP KEPUASAN PASIEN

Background: Dentures are dental prostheses that are used to replace lost teeth and tissues. Patients who believe that denture care services are frequently visited throughout treatment are the most likely to seek dental care. Objective: Analyzing the association between young dentists' service quality in the treatment of acrylic complete dentures and patient satisfaction at the Gusti Hasan Aman Oral Dental Hospital. Method: The study used an observational-analytic method with a cross-sectional research design and a simple random sampling technique. A sample of 38 people was obtained using a research instrument, namely a questionnaire. Results: According to the study's findings, the majority of complete denture users at the Gusti Hasan Aman Oral Dental Hospital were between the ages of 55 and 64 (55-64%). According to the gender of the study's findings, the majority of complete denture users at the Gusti Hasan Aman General Hospital (60.52%) were women. According to the study's findings based on education level, the majority of complete denture users at the Gusti Hasan Aman General Hospital were elementary school educated (50%). According to the findings of the study on the service quality of young dentists, the majority of patients (98.4%) believed they received satisfactory service. Patients were satisfied with the treatment (84.2%), according to the results based on patient satisfaction. The findings of the Somer's d test were 0.000. Conclusion: The service quality of RSGM is generally extremely good, and acrylic complete denture patients who are treated are highly delighted.Keywords: Dentures, Patient Satisfaction, Service Quality

Patient-Reported Outcome Measures in Cataract Surgery

Abstract Purpose: To assess the patient-reported outcome measures and health-related quality of life in cataract patients after their cataract surgery. Method: A prospective observational pilot study was conducted on 197 patients with cataract who underwent phacoemulsification cataract surgery in an urban-based eye care hospital. Result: Out of 197 patients, 110 patients fulfilled the inclusion criteria of the study. In our study, we chose Catquest-9SF as our parent questionnaire and made a few modifications in it based on the livelihood of our patients. The patient satisfaction percentage with reference to improvement in vision after cataract surgery with intraocular lens (IOL) implantation in our study was 87%. A total of 96% of the patients who had multifocal/trifocal IOL implantation were completely satisfied with the cataract surgery. Conclusion: Due to improvement in life expectancy of elderly patients and increased usage of gadgets by them, spectacle independence and functional improvement have become their requirements. With standardised techniques, expertise and experience with the right use of advanced equipment and appropriate IOLs, we were able to get excellent results and complete patient satisfaction by knowing their lifestyle and requirement. Patient-reported outcome measures helped us in improving the vision and health-related quality of life after cataract surgery.

Improving Quality Health Care Services by Implementing DMAIC Approach in Paediatric Cardiology Department of Public Hospital of Sindh, Pakistan: A Case Study

Objectives: The hospital industry has changed its dimension from diagnosis to complete total patient satisfaction. This study aims to identify the critical variables that can enhance overall patient satisfaction in the hospital industry. The study identified three critical factors for any hospital to provide quality service. Methodology: The study adopted the lean Six Sigma process improvement methodology to identify the critical service factors in hospitals. Lean Six Sigma is a flexible problem-solving tool that comprehensively solves any problem. DMAIC process improvement methodology is used to define, measure, analyze, improve, and control the overall experience in the hospital. CTQ (critical to quality) was defined and represented by Kano methodology. After filtration through cause and effect analysis, three core dimensions and 25 sub-dimensions of critical quality were identified. The impacts of these 25 sub-dimensions were evaluated and prioritized using the Kano Model of patient satisfaction. This identifies the most critical service requirement. This study is an initiative for service quality improvement in the hospital industry. In the future, this technique can be modified and adopted by different public and private hospitals to enhance the practical implementation. Results: Findings indicate that healthcare organizations demonstrate enhanced system-wide capabilities, optimizing resource utilization. Understanding patient needs propels satisfaction and delight. Three overarching factors, with 25 sub-factors, significantly impact patient satisfaction, predominantly yielding positive effects across the categories. Conclusion: This research concludes that providing quality service is critical in the hospital industry. Quality service is pivotal in the evolving hospital industry, transitioning from a focus on diagnosis to holistic patient satisfaction. This study aims to identify critical variables essential for enhancing overall patient satisfaction, pinpointing key factors crucial for delivering quality service in any hospital.

Physician awareness of patients’ preferred level of involvement in decision-making at the initial urogynecology visit: a randomized trial

BackgroundStudies have shown up to a 40% discordance between patients’ preferred roles in decision-making before and their perceived roles after their visit. This can negatively affect patients’ experiences; interventions to minimize this discordance may significantly improve patient satisfaction. ObjectivesWe aimed to determine whether physicians’ awareness of patients’ preferred involvement in decision-making before their initial urogynecology visit affects patients’ perceived level of involvement after their visit. Study designThis randomized controlled trial enrolled adult English-speaking women presenting for their initial visit at an academic urogynecology clinic from June 2022 to September 2022. Before the visit, participants completed the Control Preference Scale to determine the patient’s preferred level of decision-making: active, collaborative, or passive. The participants were randomized to either the physician team being aware of their decision-making preference prior to the visit or usual care. The participants were blinded. After the visit, participants again completed a Control Preference Scale and the Patient Global Impression of Improvement, CollaboRATE, patient satisfaction, and health literacy questionnaires. Fisher exact, logistic regression, and generalized estimating equations were used. Based on a 21% difference in preferred and perceived discordance, we calculated the sample size to be 50 patients in each arm to achieve 80% power ResultsWomen (n = 100) with a mean age of 52.9 years (SD = 15.8) participated in the study. Most participants identified as White (73%) and non-Hispanic (70%). Before the visit, most women preferred an active role (61%) and few preferred a passive role (7%). There was no significant difference between the two cohorts in the discordance between their pre-and-post Control Preference Scale responses (27% versus 37%; p = .39) or whether their symptoms were much better or very much better following the visit (18% versus 37%; p = .06). However, when asked whether they were completely satisfied with the visit, those assigned to the physician awareness cohort reported higher satisfaction than those in the treatment as usual cohort (100% versus 90%; p = .03). ConclusionAlthough there was no significant decrease in discordance between the patient's desired and perceived level of decision-making following physician awareness, it had a significant impact on patient satisfaction. In fact, all patients whose physicians were aware of their preferences reported complete satisfaction with their visit. While patient-centered care does not always entail meeting all of the patients' expectations, the mere understanding of their preferences in decision-making can lead to complete patient satisfaction.

Creation of pacemaker remote monitoring networks between hospital and pharmacies during Covid-19 outbreak

IntroductionRemote Monitoring (RM) of Cardiac Implantable Electronic Devices (CIEDs) is proven to be safe and efficient. It has been adopted in our center since years. At the time of the recent Covid-19 outbreak, we introduced and tested a collaborative organizational model, through a new RM device (Totem), creating a network with the surrounding territory and limiting CIED patients’ presence in hospital. MethodsWe involved 4 neighbor pharmacies where Totem devices were installed; we called and informed 64 patients with Totem compatible pacemaker (PM) about the possibility to perform their PM follow-up (FU) in-pharmacy; 58 gave their consent and their data were inserted into our RM database. ResultsDuring an 18-month FU period, a total of 70 RM transmissions have been received: one alert of high atrial burden triggering a pharmacological optimization, one alert of high ventricular impedance leading to a new ventricular lead implantation and four alerts of elective replacement indicator. Fulfilled questionnaires revealed complete patient satisfaction. ConclusionsA collaborative network between our hospital and the surrounding territory to perform RM FUs of CIEDs during Covid-19 pandemic was feasible, leading to patient compliance and satisfaction and revealing important technical and clinical alerts.

EFFECTIVENESS OF LIMBERG FLAP AND KARYDAKIS PROCEDURE IN PILONIDAL SINUS DISEASE – A COMPARATIVE INTERVENTIONAL STUDY IN A TERTIARY CARE CENTRE OF EASTERN INDIA.

Objective: Pilonidal sinus disease (PSD) is a common disease of natal cleft in Sacro- coccygeal region. It is more common in young male and may recur over time with surgery. We compared the effectiveness, outcomes and recurrence rates of Limberg ap and Karydakis procedure techniques in PSD. This is a comparative interventional study among 32 enrolled patients Materials And Methods: with pilonidal sinus disease. Patients were divided into two groups 16 patients (group KD) were treated with Karydakis procedure and 16 patients (group LF) were treated with Limberg ap technique. Seroma collection, wound infection, ap edema, hematoma, partial wound separation, pain score, return to normal activities, complete healing time, painless seating and patient satisfaction were compared between 2 groups (group KD and LF). the development rates of Results: seroma collection, wound infection, ap edema, hematoma, partial wound separation were 12.5%,18.75%,6.25%, 18.75%,18.75% in KD group as compared to 25%, 12.5%,12.5%, 0%, 0% in LF group respectively. Total ap necrosis was not observed in any patient (p<0.001). During the average follow up period of 12months, 2 (12.5%) of KD pts developed recurrence. In this study, the u Conclusion: se of Limberg ap was associated with lower complication rates, shorter length of hospital stays, early return to work, low pain score, high patient satisfaction, better complete healing. Therefore, we recommend Limberg ap for treatment of pilonidal sinus

Quality Standards in Upper Gastrointestinal Endoscopy: Can Deep Sedation Influence It?

Introduction: According to the guideline published by ESGE/UEG, a high-quality esophagogastroduodenoscopy (EGD) implies the application of some criteria that enable better healthcare outcomes. Although intra-procedural performance measures are dependent on patient factors, there is no reference to sedation practices in the guideline mentioned above. Objective: This study aimed to evaluate whether deep sedation influences EGD performance measures established by ESGE/UEG. Methods: This was a cross-sectional study, with a prospective enrollment, that considered for inclusion consecutive patients referred for EGD. Two questionnaires were used to assess performance measures and patient satisfaction after EGD. Results: Sedation had a statistically significant impact on most quality indicators, including complete examination (77.2% without sedation vs. 97.8% with sedation), inspection time (6.17 ± 3.45 vs. 8.39 ± 2.67 min), photodocumentation (78% vs. 97.8%), biopsies (39.3% vs. 60.7%), and patient satisfaction (5.42 ± 2.93 vs. 9.1 ± 1.19). The main reason for an incomplete procedure was patient intolerance (82.6%). Discussion: Deep sedation of patients submitted to EGD proved to be a determinant in the applicability of the ESGE/UEG quality indicators. Patient intolerance was eliminated in the group with sedation, enhancing procedure completeness, adequate pathology identification, management, and consequently, the effectiveness of the exam. Conclusion: Sedation administration should be considered in patients undergoing EGD since it ensures a high-quality procedure.

Fentanyl as an adjuvant to the local anesthetic in the peribulbar block for vitrectomy operations

ABSTRACT Background Adding certain drugs to the local anesthetics (LA) in peribulbar block (PBB) increases its intensity and duration of action, so we did this research to assess the impact of fentanyl addition to the LA in PBB for vitrectomy. Methods Forty patients were divided into: Control group: They got 9.5 ml of 0.5% bupivacaine (6 ml), 2% lidocaine (1.5 ml), 45 IU hyaluronidase (in 1.5 ml lidocaine), and 0.5 ml saline. Fentanyl group: They got the same medications plus 0.5 ml (25 mcg) of fentanyl instead of the saline. Our primary outcome was the duration of the block, and our secondary outcomes were the start of the motor block, scores for globe and lid akinesia, the quality of the block, scores for patient and surgeon satisfaction, postoperative VAPS, and the first request for analgesia and complications from the drugs used or the technique. Results The start of the motor block was significantly rapid in the fentanyl group. Additionally, there were notable variations in the length and intensity of the block between the two groups. The postoperative pain score was lower in the fentanyl group. While it was acceptable in the control group, the block quality was perfect in the fentanyl group. Complete patient satisfaction happens more often in the fentanyl group. There were no complications reported. Conclusion Fentanyl, when added to LA mixtures in PBB in vitrectomy, decreased the onset, increased the duration of lid and globe akinesia, and improved the quality of analgesia without causing any complications.

Ultrasound-guided microwave ablation of soft tissue venous malformations

ObjectiveTo assess the feasibility, safety, and effectiveness of microwave ablation (MWA) for soft tissue venous malformations (VMs). MethodsWe retrospectively analyzed 20 patients with symptomatic VMs in the lower extremities and trunk. MWA was performed in all 20 patients. Contrast-enhanced ultrasound (CEUS) was performed immediately and 1 month after ablation. The data on the complete ablation rate, symptom improvement, and patient satisfaction were collected. Follow-up examinations began 1 month after ablation and continued for 2 to 19 months. ResultsMWA was performed on 20 patients. The overall complete ablation rate was 75% (15/20). The complete ablation rate for the 11 patients with lesions <5 cm and the 9 patients with lesions >5 cm were 100% (11/11) and 44% (4/9), respectively. The complete ablation rate for the 14 patients with localized and 6 patients with extensive lesions was 93% (13/14) and 33% (2/6), respectively. Five patients had experienced incomplete ablation; 1 had a lesion >5 cm with ectopic drainage vessels, one had multiple lesions adherent to blood vessels and nerves, and three had large and extensive lesions. Thirteen patients had experienced significant improvements in clinical symptoms; 6 showed slight improvement; and 1 showed no change in symptoms. No complications or recurrences were observed. All 20 patients were satisfied with the therapeutic effect (100%). Twelve patients were significantly satisfied and 8 were slightly satisfied. ConclusionsMWA with ultrasound guidance is a safe, effective, and minimally invasive therapy for symptomatic soft tissue VMs and may be a promising approach in the future.

Evaluation of Denture Adhesive versus Single Implant on Complete Denture Retention and Patient Satisfaction

Evaluation of Denture Adhesive versus Single Implant on Complete Denture Retention and Patient Satisfaction

Hospital at Home for Intrathecal Pump Refills: A Prospective Effectiveness, Safety and Feasibility Study.

Continuous Intrathecal Drug Delivery through an implanted pump is a well-known therapeutic option for the management of chronic pain and severe disabling spasticity. To have a successful therapy, pump refills need to be performed at regular time intervals after implantation. In line with the increased applications of Hospital at Home, these refill procedures might be performed at the patient’s home. The aim of this pilot study is to evaluate the feasibility, safety, and effectiveness of intrathecal pump refill procedures at home. Twenty patients were included whereby pump refill procedures were conducted at the patient’s home. To enable contact with the hospital, a video connection was set-up. Tele-ultrasound was used as post-refill verification. All procedures were successfully performed with complete patient satisfaction. Ninety-five percent of the patients felt safe during the procedure, and 95% of the procedures felt safe according to the physician. All patients indicated that they preferred their next refill at home. The median time consumption for the physician/nurse at the patient’s home was 26 min and for the researcher at the hospital 15 min. In light of quality enhancement programs and personalized care, it is important to continue urgent pain management procedures in a safe way, even during a pandemic.

Which PASI Outcome Is Most Relevant to the Patients in Real-World Care?

In psoriasis treatment, there is a high need to define meaningful endpoints and differences from the patient perspective to analyze patient-relevant differences of frequently used outcome methods for psoriasis under real-world conditions. A sample of 3116 patients from the German Psoriasis-Registry PsoBest was analyzed for clinical as well as patient-reported outcomes (PRO) after 3- and 6-month treatment. The parameters PASI, DLQI, and PBI were intercorrelated and related to two anchoring variables: (1) patient satisfaction with treatment and (2) perceived complete clearance. Baseline data were as follows: PASI 10.5 ± 9.1, DLQI 12.4 ± 3.4, and PBI 2.7 ± 0.3. There was an almost linear relationship between “complete patient satisfaction” and the relative differences in PASI in the range from PASI 25 to PASI 90. However, there was no additional benefit between PASI 90 and PASI 100. The same finding resulted from the anchoring variable “perception of complete healing”. When related to DLQI outcomes, relative PASI changes as well as absolute changes and PASI at 3 and 6 months showed relevant differences between the PASI classes 25 to 90 but not between PASI 90 and PASI 100. Under real-world conditions, changes in PASI and DLQI reflect patient-relevant benefits.

PO-1099 To plan and deliver adjuvant breast radiotherapy over 1 week: 1-week breast workflow implementation

Purpose or Objective To limit hospital visits and transportation of the patients with early breast cancer (BC) especially during the covid-19 pandemic, we aimed to implement a workflow of treatment to prepare and deliver adjuvant breast radiotherapy (RT) within 1 week. Materials and Methods Based on the Fast Forward RT schedule of 5 fractions of 5.2 Gy over 5 days for adjuvant BC, we designed a workflow to perform BC RT over 1 week from the first RT consultation to the end of treatment (figure 1). Patients were seen in consultation on Monday morning. The planning CT was carried out immediately after the consultation. A deep inspiration breath-hold technique was systematically offered to all patients. Automatic delineation using an artificial Intelligence (AI) based model with ART-PlanTM software was first corrected by a junior radiation oncologist (RO) then, independently by a senior RO. As 3D conformal RT failed to achieve dose constraints of the fast forward trial in many cases (due to breast hotspots), we developed a restricted IMRT (rIMRT) technique based on 2 tangential beams (internal and external) using inverse planning restricted optimization parameters to improve the dose homogeneity. Treatment planning was semi-automated by scripting the creation and optimization steps of rIMRT plans. After validation of the reliability of rIMRT treatment delivery by patient-specific quality assurance (PSQA) with gamma index evaluation on 20 patients, we decided to abandon systematic PSQAs. In-vivo dosimetry was validated by end-to-end controls and performed for each patient during the first fraction on Monday afternoon. Daily repositioning was controlled by portal images of the largest segment of each beam. Structured baseline, end of treatment and follow up evaluation forms were used to prospectively collect toxicities and oncological outcomes at each consultation. Patient agreement for data collection and analysis was prospectively obtained. $Φg Results From February 2021 to March 2021, the 1-week breast procedure was proposed to up to 3 patients/week, >65 years, in complete resection after conservative surgery, with pT1-T3 N0 BC, without tumor bed boost or regional lymph nodes irradiation. Six out of seven patients (85.7%) accepted the 1-week breast procedure. All procedures were successfully conducted over 5 days with complete patient and RT team satisfaction. A followup of acute toxicities by online consultation on day 10, structured evaluation forms and management decision trees has been implemented for these patients. No grade >2 acute toxicities (CTACE V4.0) have been reported so far. Conclusion The successful implementation of this comprehensive 1-week breast workflow with AI based delineation and semi-automated rIMRT without PSQA demonstrates the practical feasibility of the whole procedure over 5 days reducing drastically the coming-and-going to the hospital and the overall RT management time per patient. Our work opens the way for further development of comprehensive compact workflows in various settings.

Educational Informed Consent Video Equivalent to Standard Verbal Consent for Rhinologic Surgery: A Randomized Controlled Trial.

Informed consent is an integral part of pre-operative counseling. However, information discussed can be variable. Recent studies have explored the use of multimedia in providing informed consent for rhinologic surgery. To measure impact of an educational video (Video) compared to verbal informed consent (Verbal) on knowledge gained, alleviation of concerns, and efficiency. Patients undergoing endoscopic sinus surgery (ESS), septoplasty, or ESS+septoplasty were prospectively enrolled and randomized to receive Video or Verbal consent. The Video group watched an educational video; the Verbal group received standard verbal consent from an Otolaryngology resident per institutional protocol. Both groups had the opportunity to discuss questions or concerns with their attending surgeon. Prior to, and after, consent was signed, both groups completed surveys regarding knowledge of purpose, risks, and benefits of surgery as well as surgical concerns. Decision regret and patient satisfaction were also assessed post-operatively. 77 patients were enrolled (39 Video, 38 Verbal). Demographics were not significantly different between groups. Overall knowledge significantly improved (p < 0.005) and concerns significantly decreased (p < 0.001) following consent in both groups. Improvements in these metrics were equivalent between groups (p < 0.02). Furthermore, resident time to complete consent, patient satisfaction, and decision regret were not significantly different between groups. Use of an educational video was equivalent to standard verbal informed consent for patients undergoing rhinologic surgery. Otolaryngologists can consider developing procedure-specific videos to allow allocation of time to other tasks, standardized education of patients, and streamlining of the informed consent process.

Hybrid treatment of fibroadipose vascular anomaly: A case report.

BackgroundFirst identified in 2014, fibroadipose vascular anomaly (FAVA) is a very rare type of venous and lymphatic malformation. Marked by tough fibrofatty tissue in the extremities overtaking portions of the muscles, it is associated with constant pain and contracture of the affected extremity. There is a paucity of literature, and no guidelines on treatment procedure are available. This case highlights the role of hybrid treatment with primary ethanol percutaneous ethanol embolization and additional surgery for radicality in excision of FAVA lesions.Case summaryA 9-year-old girl with FAVA underwent the hybrid treatment. The achievements of complete excision, clinical response, and patient satisfaction in long-term follow-up were assessed. Following the hybrid treatment, the patient experienced significant improvement in pain. Concurrent symptoms of physical limitation, leg swelling, and skin hyperesthesia also improved. The clinical benefit, supported by postoperative physiotherapy, was well stabilized at 6-month follow-up, resulting in complete patient satisfaction at 12- and 36-month follow-ups. No major complications were encountered.ConclusionEthanol embolization plus surgery is a safe, effective, and long-term hybrid treatment of symptomatic FAVA lesions.

NTNT Methods – Efficacy and Safety Issue

AbstractThe management of elimination of the pathological reflux in the saphenous vein has been developed recently by introducing the endovenous thermal techniques (EVTA), which have become the first line treatment. However, thermal techniques require tumescent infiltration, what may be the cause of discomfort. Furthermore, the use of EVTA has a potential risk of thermal damage of superficial nerves and requires to wear stocking after the procedure.Non-thermal non-tumescent techniques (NTNT) were proposed as a valid, safe and effective alternative to EVTA with significant clinical improvement, high complete occlusion rate and high posttreatment patient satisfaction. The most common novel NTNT are catheter-directed cyanoacrylate adhesive closure (CAC) and mechanochemical ablation.In the paper an overview of the currently available data regarding the NTNT efficacy and safety are presented.Based on the literature, NTNT has a high efficacy, comparable with the EVTA techniques, with an acceptable risk increase. However further studies with long-term results are needed also with regard to safety aspects.

Surgical management of iatrogenic anal stenosis

Aim Anal stenosis is an uncommon but troublesome complication of some anorectal operations, most often seen after surgical hemorrhoidectomy. Several methods are used to control this problem, ranging from medical to various surgical procedures, depending on the severity and extent of the stenosis. This study aims to evaluate diamond-shaped flap anoplasty with partial lateral internal sphincterotomy as a treatment option of iatrogenic severe anal stenosis. Study design A prospective study was conducted, which was approved by the ethics committee of the faculty, and the patients were consented before being included in this study. Place and duration of study The study was performed at the General Surgery Department, Al-Hussein Hospital, Faculty of Medicine, Al-Azhar University, from January 2017 to December 2019. Patients and methods A total of 14 patients with post-surgical severe anal stenosis were included in this study. All patients were treated by diamond-shaped flap anoplasty with partial lateral internal sphincterotomy. After the procedure, every patient was evaluated in the first week, second week, first month, third month, sixth month, and the first year regarding pain, bleeding, wound infection, wound healing, and incontinence. Results A total of 14 patients (10 females and four males) with severe anal stenosis, with a mean age of 43.65 years, were included. Post-hemorroidectomy anal stenosis represented the main etiology in 13 (93%) patients, with post-defecation pain being the major complaint in all patients. Unilateral diamond-shaped flap anoplasty with partial lateral internal sphincterotomy was done in all patients. Post-operative pain ranged from moderate to mild over the first week, and anal spotting, which occurred in only two patients, stopped spontaneously in the first few days, and no flap loss occurred, but wound infection occurred in four (28%) patients, who were treated conservatively. Gas incontinence occurred in seven (50%) patients but improved over the first month. Complete satisfaction was achieved in 12 (86%) patients, and in the other two patients with recurrent symptoms, complete satisfaction was reached at the end of the follow-up period by having the same operation on the other side. Conclusion Diamond-shaped flap anoplasty with partial lateral internal sphincterotomy is a good treatment option for severe anal stenosis, being simple with low complication rate and high success rate and an easy way to perform the same operation on the other side to obtain complete patient satisfaction in failed cases with recurrent symptoms.

Treating Morton's neuroma by injection, neurolysis, or neurectomy: a systematic review and meta-analysis of pain and satisfaction outcomes.

Individual evidence suggests that multiple modalities can be used to treat entrapment pathology by Morton's neuroma, including injection, neurolysis, and neurectomy. However, their impacts on patient pain and satisfaction have yet to be fully defined or elucidated. Correspondingly, our aim was to pool systematically identified metadata and substantiate the impact of these different modalities in treating Morton's neuroma with respect to these outcomes. Searches of 7 electronic databases from inception to October 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidences of outcomes were extracted and pooled by random-effects meta-analysis of proportions. A total of 35 articles satisfied all criteria, reporting a total of 2998 patients with Morton's neuroma managed by one of the three modalities. Incidence of complete pain relief after injection (43%; 95% CI, 23-64%) was significantly lower than neurolysis (68%; 95% CI, 51-84%) and neurectomy (74%; 95% CI, 66-82%) (P = 0.02). Incidence of complete satisfaction after injection (35%; 95% CI, 21-50%) was significantly lower than neurolysis (63%; 95% CI, 50-74%) and neurectomy (57%; 95% CI, 47-67%) (P < 0.01). The need to proceed to further surgery was significantly greater following injection (15%; 95% CI, 9-23%) versus neurolysis (2%; 95% CI, 0-4%) or neurectomy (5%; 95% CI, 3-7%) (P < 0.01). Incidence of procedural complications did not differ between modalities (P = 0.30). Although all interventions demonstrated favorable procedural complication incidences, surgical interventions by either neurolysis or neurectomy appear to trend towards greater incidences of complete pain relief and complete patient satisfaction outcomes compared to injection treatment. The optimal decision-making algorithm for treatment for Morton's neuroma should incorporate these findings to better form and meet the expectations of patients.

Management of orthodontically induced mucogingival fenestration: A rare case report

Gingival fenestrations are of uncertain etiotogy having rarely been reported in the dental literature. It seems to have multifactorial origin and is commonly associated with the anterior region of the arch especially the incisors. The etiology of such defects can be due to decreased thickness of the alveolar housing, contour of the root apex, orthodontic tooth movement and endodontic pathology. To established an accurate diagnosis and proper institution of multidisciplinary comprehensive treatment protocol for salvaging teeth with complex orthodontic –periodontal problem. A 24- year old female patient reported to the department of Periodontics with exposed root in relation to maxillary right central incisor. History revealed previous orthodontic treatment 2-3 years back. On intra oral examination tooth exhibited grade 1 mobility and midline diastema. Apical portion of the root was seen perforating the buccal cortical plate and the mucosa. An interdisciplinary treatment was instituted which included root canal treatment followed by root end resection and soft tissue management. This case report resulted in an uneventful healing with coverage of the complete root apex and diastema closure with complete patient satisfaction. Combined orthodontic-periodontal problems offer great challenges to a clinician, therefore, an accurate diagnosis and treatment planning should be made accordingly for optimum outcome.

Three-dimensional computed tomography evaluation of craniofacial characteristics according to lateral deviation of chin

BackgroundThe relationship between the lateral deviation of chin and the upper and middle facial third asymmetry is still controversial. The purpose of this study is to evaluate the correlation of upper and middle facial third asymmetry with lateral deviation of chin using 3-dimensional computed tomography. The study was conducted on patients who underwent orthognathic surgery from January 2016 to August 2017. A total of 40 patients were included in this retrospective study. A spiral scanner was used to obtain the 3-dimensional computed tomography scans. The landmarks were assigned on the reconstructed 3-dimensional images, and their locations were verified on the axial, midsagittal, and coronal slices. The Pearson correlation analysis was performed to evaluate the correlation between chin deviation and difference between the measurements of distances in paired craniofacial structures. Statistical analysis was performed at a significance level of 5%.ResultsIn mandible, the degree of chin deviation was correlated with the mandibular length and mandibular body length. Mandibular length and mandibular body length are shorter on the deviated-chin side compared to that on the non-deviated side (mandibular length, r = −0.897, p value < 0.001; mandibular body length, r = −0.318, p value = 0.045). In the upper and middle facial thirds, the degree of chin deviation was correlated with the vertical asymmetry of the glenoid fossa and zygonion. Glenoid fossa and zygonion are superior on the deviated-chin side than on the non-deviated side (glenoid fossa, r = 0.317, p value = 0.046; zygonion, r = 0.357, p value = 0.024).ConclusionLateral deviation of chin is correlated with upper and middle facial third asymmetry as well as lower facial third asymmetry. As a result, treatment planning in patients with chin deviation should involve a careful evaluation of the asymmetry of the upper and middle facial thirds to ensure complete patient satisfaction.