Contralateral Side Research Articles

Asymmetry and rehabilitation of the subjective visual vertical in unilateral vestibular hypofunction patients.

Patients with acute unilateral peripheral vestibular hypofunction (AUVP) show postural, ocular motor, and perceptive signs on the diseased side. The subjective visual vertical (SVV) test measures the perceived bias in earth-vertical orientation with a laser line in darkness. This study was aimed at (1) examining whether SVV bias could depend on preset line orientation and angles, and (2) investigating whether vestibular rehabilitation (VR) can improve SVV normalization. To our knowledge, SVV symmetry/asymmetry and impact of VR on SVV normalization have never been documented in the literature. We investigated the SVV bias in a retrospective study (Study 1: n = 42 AUVP patients) comparing the data recorded for line orientation to the ipsilateral and contralateral sides at preset angles of 15° and 30°. We investigated the effects of VR on SVV normalization in a prospective study (Study 2: n = 20 AUPV patients) in which patients were tilted in the roll plane using a support tilted to the hypofunction side with the same amplitude as the SVV bias. This VR protocol was performed twice a week for 4 weeks. Supplementary data on body weight distribution and medio-lateral position of the center of foot pressure (CoP) were obtained using posturography recordings. Study 1 showed asymmetrical values of the SVV bias. On average, the SVV errors were significantly higher for ipsilateral compared to contralateral line orientation (6.98° ± 3.7° vs. 4.95° ± 3.6°; p < 0.0001), and for 30° compared to 15° preset angle (6.76° ± 4.2° vs. 5.66° ± 3.3°; p < 0.0001). Study 2 showed a fast SVV normalization with VR. Non-pathological SVV bias (below ±2°) was found after only 3 to 5 VR sessions while pathological SVV values were still observed at the same time after symptoms onset in patients without VR (1.25° ± 1.46° vs. 4.32° ± 2.81°, respectively; p < 0.0001). A close temporal correlation was observed in the time course of body weight distribution, mediolateral CoP position, and SVV bias over time, suggesting beneficial effects of the VR protocol at both the perceptive and postural levels. We recommend routine assessment of the ipsilateral and contralateral SVV bias separately for a better evaluation of otolith organs imbalance that can trigger chronic instability and dizziness. The SVV bias and the postural impairment caused by the imbalanced otolith inputs after unilateral vestibular loss can be rapidly normalized by tilting the patients in the roll plane, an additional means in the physiotherapist's toolbox. The protocol likely reweights the visual and somatosensory cues involved in the perception of verticality.

Development of the humeral head offset index for control of humeral torsion

BackgroundControl of humeral torsion can present a challenge, especially intraoperatively during closed reduction and fixation of humeral shaft fractures or 2-part surgical neck fractures of the proximal humerus. The objective of this study is to develop and validate an indirect method for the assessment of humeral torsion using an index that is linearly correlated with rotational arm position and can be derived from only a single plain radiographic image of the proximal humerus.MethodsThe Humeral Head Offset Index (HHOI) is calculated as the ratio of the medial and lateral offset of the humeral head measured from the outer cortices of the shaft on a plain radiographic or fluoroscopic image. The relationship of HHOI with humeral torsion was first verified on a sawbone model with radiopaque characteristics under fluoroscopic control. Different degrees of retroversion were simulated through manual rotation of the humerus with a digital protractor in 5° increments until 40° internally rotated and then in 5° increments until 40° externally rotated from the neutral position. The same procedure was subsequently performed digitally on Digitally Reconstructed Radiographs (DRRs) from computed tomography (CT) dataset of the sawbone. Next, the HHOI index was applied to eight randomly selected patients with total humerus CT using the same method. Spearman’s rho was calculated for the bivariate analysis of correlation between the simulated degree of retroversion and the HHOI. Strength of correlation was classified according to Koo and Li. Interrater and intrarater reliability of three blinded observers with repetition of measurement after three months were analyzed by assessing the intraclass correlation coefficient (ICC).ResultsBoth in the sawbone model and in DRRs, we demonstrated a high to very high significant linear correlation between simulated retroversion and the HHOI. ICC values demonstrated excellent interrater reliability and excellent intrarater reliability for measurement of the HHOI.ConclusionsThe HHOI is a new, simple, reliable index that has a linear relationship to the rotation of the humerus and can therefore allow an indirect control of humeral torsion in comparison to the contralateral side.

A Survey of Preoperative, Perioperative, and Postoperative Management Practices for Testicular Torsion in Pediatric Patients among European Surgeons.

Management of testicular torsion varies between specialties resulting in lack of standardization. The aim of this survey was to assess pre-, peri-, and postoperative differences. An online questionnaire was distributed in 2023 to general and pediatric surgeons, pediatric urologists, and urologists by the Trainees of European Pediatric Surgery. Among 88 respondents (92% tertiary referral hospital), 38% always or usually perform sonography in case of suspected torsion respectively. In addition, 15% always attempt manual detorsion and 44% depending on the clinical presentation. Most surgeons (93%) favor a scrotal approach. Interestingly, pediatric surgeons choose a transscrotal while other specialties opt for a midline incision (p = 0.002). The majority (57%) employ a three-point fixation, while 42% opt for a two-point fixation. In case of necrotic testis, 61% puncture the testis with 52% opting for surgical removal, while 33% perform orchiectomy and 6% leave it in situ. Regarding necrotic or borderline-appearing testis, 54% take a biopsy. Furthermore, 82% perform prophylactic orchidopexy of the contralateral side during the same session. Postoperative antibiotics are always administered by 12%, while 52% do so sometimes. Most perform sonographic (58%) or clinical (57%) follow-up 3 months postoperatively. Notably, pediatric surgeons and urologists perform follow-up more frequently themselves, while general surgeons/urologists recommend follow-up by pediatricians (p = 0.002). In addition, 76% of responders affirm adhering to European Association of Urology guidelines. Unawareness of guidelines and institutional practices are reasons most commonly cited for nonadherence. Our study reveals significant disparities in the pre-, peri-, and postoperative management of testicular torsion underscoring the need for establishing standardized practices.

The Light Switch and the Dimmer: Qualitative Observations to Improve Diagnostic Lacrimal Irrigation

ABSTRACT Purpose To emphasise the importance of “soft” observations during lacrimal irrigation in diagnosing lacrimal outflow dysfunction and reporting outcomes of soft factors post-DCR. Methods A retrospective study of patients with ≤ 20% of regurgitation on lacrimal irrigation who underwent DCR surgery. A comparative analysis of percentage reflux of saline (RFX), initial mucus in reflux (IMR), patient-reported transit time of saline (PR-TTS), and resistance encountered (RES) during LS was performed. Validated TEARS score was used. Subjective success was defined as ≥ 2-point improvement in T subscale of TEARS score. Objective success, as a decrease in RFX, RES, PR-TTS and absence of IMR, post-operatively. Results From a total of 253 patients who underwent DCR surgery, 8 patients met the inclusion criteria. All patients were T4 (wiping >10× daily) indoors and outdoors. TEARS score improved after surgery with a mean reduction of T = 2.62, E = 1.63 and A = 1.35 (p < .05) with no significant change in R scores (p = .10). A mean reduction in RFX of 11.75 ± 6.74% and a median improvement of 1 point in PR-TTS and 2 point in RES was observed (p < .05). No significant changes of these parameters occurred in the contralateral side during this period. Subjective and objective success of DCR was 75% and 100%, respectively. Conclusions This study is the first to attempt to combine qualitative “soft” observations during lacrimal irrigation such as IMR, RES and PR-TTS for identifying nasolacrimal outflow dysfunction and reporting outcomes using these parameters of DCR in patients with epiphora and ≤ 20% of fluid regurgitation. These parameters were greater in the more symptomatic side and successfully improved after DCR, making them a valuable tool to reach a provisional diagnosis.

Motor function is related to the lower phase angle than to muscle mass of the lower limbs in older females with hip osteoarthritis: a cross-sectional observational study

BackgroundMuscle mass and phase angle (PhA) can be measured using multi-frequency bioelectrical impedance analysis (BIA). Osteoarthritis of the hip (OAhip) causes decreased muscle mass and PhA in the deformed lower limb. However, previous studies have not accounted for the influence of sex, and thus, the relationship between muscle mass, PhA, and motor function remains unclear. This study aimed to elucidate the relationship between PhA, an index of muscle mass and quality measured using BIA, and motor function during gait and standing in female patients with OAhip.MethodsMuscle mass and PhA of patients with OAhip were measured using BIA. Motor function was evaluated using the Timed Up and Go test, ground reaction/weight, rate of force development/weight, and load ratio between the osteoarthritic (OA) and contralateral sides when standing up. The difference between the OA side and the contralateral lower limb was tested to clarify the characteristics of the deformed lower limb. The relationship between each motor function was determined using a partial correlation coefficient with age as a control variable and multiple regression analysis with each motor function as the dependent variable and age, OA-side muscle mass/body weight ratio, and PhA as independent variables.ResultsThis study involved 60 patients with OAhip (age 65.6 ± 7.6 years, height 154.2 ± 6.0 cm, weight 56.8 ± 10.5 kg) scheduled for unilateral total hip arthroplasty. Muscle mass, PhA, and lower limb load ratio were significantly decreased in the lower limbs on the OA side. Furthermore, using a partial correlation coefficient with age as a control variable, PhA showed significant correlations with motor functions related to standing up and walking, and multiple regression analysis revealed that PhA was independently related to each motor function. ConclusionsEvaluation and interventions that consider muscle quality rather than muscle mass are important.

The Predictive Value of Preoperative Measurements of Cochlear Nerve Diameters From MRT and Postoperative Speech Perception in Adult Patients With Cochlear Implant.

The current study aims to investigate whether objective measurements of the cochlear nerve (CN), derived from preoperative MRI images, correlate with postoperative speech perception in CI patients. Retrospective cohort study. University Medical Center, tertiary academic referral center. Patients undergoing a cochlear implant surgery including MED-EL (Synchrony 2, FLEX electrode series; MED-EL, Innsbruck, Austria) Cochlear (slim straight electrodes; Cochlear Ltd., Sydney, Australia), Advanced Bionics (HiRes Ultra 3D CI, HiFocus SlimJ electrodes; Sonova, Zürich, Switzerland), and Oticon (Neuro Zti EVO; Oticon A/S, Smørum, Denmark) between 2020 and 2023. Preoperative MRI images were utilized to measure the volume of the modiolus (VM), the cross-sectional areas of the CN (ACN), and for normalization, the area of the facial nerve (AFN) and the area of the internal ear canal (AIEC). Postoperative speech perceptions were assessed through word recognition scores (WRS) at several stages following the first fitting (FF) of the CI processor: immediately after FF, 1 month, 3 months, and 6 months after FF. Sixty-eight patients were enrolled in this study. A statistically significant positive correlation between the ratio between ACN and AFN (ACN/AFN) and WRSFF was identified (R = 0.36, p < 0.003). However, this correlation disappeared in subsequent follow-up tests. Moreover, upon grouping patients based on their degree of asymmetrical hearing loss, it was observed that the correlation was primarily driven by patients with moderate to severe asymmetrical hearing loss (AHLm) on the contralateral side (R = 0.62, p = 0.0003). The present results suggest that assessing the size of the CN through MRI has limited predictive utility for postoperative speech perceptions during CI consultations. This limitation seems to be particularly relevant for AHLm patients and is confined to the initial activation period.

Postoperative Orbital Morphology Observations Following Fronto-Orbital Advancement and Cranial Vault Remodeling in Patients With Unilateral Coronal Synostosis.

Observations of preoperative and postoperative orbital morphology following fronto-orbital advancement and cranial vault remodeling (FOA and CVR) in patients with unilateral coronal synostosis (UCS). This retrospective cohort included patients diagnosed with unilateral coronal synostosis and treated with fronto-orbital advancement and cranial vault remodeling at the Children's Hospital of Fudan University. The orbital height, orbital width, and orbital volume were obtained from head 3-dimensional computed tomography of preoperation and postoperation. The DICOM data of CT were then imported into mimics research version 21.0. The authors measured OH and OW according to the bony landmarks, then reset the parameters of the soft tissue window, and conducted a 3-dimensional reconstruction of the orbital soft tissue to get OV. The preoperative and postoperative measurements of the intact side were compared with the affected side, respectively. Statistical analysis was performed using SPSS version 25.0 (Ρ=0.05). Twelve patients with UCS (5 male, 7 female) meeting criteria were included in the study. There were 4 patients with UCS on the left and 8 on the right. The average age at initial surgery was 19.50 months. Before the operation, the data of the intact side and the affected side were compared, respectively, and the difference was found to be significant in OH (Ρ=0.005) and OW (Ρ=0.005), while the OV (Ρ=0.106) was not statistically significant. After procedures of FOA and CVR, the data of the intact side and the affected side were compared, respectively, the significant difference was found in OV (Ρ=0.002), while not in OH (Ρ=0.060) or OW (Ρ=0.066). After undergoing the operation of FOA and CVR, the OH and OW of the ipsilateral and contralateral sides of patients with UCS were basically symmetrical, while the volume of the affected orbit was still relatively smaller.

Choke Anastomosis: A Key Element Acting as a Shunt Converter Between Adjacent Angiosomes.

Choke anastomosis is commonly recognized as a resistance factor that detrimentally affects the hemodynamics of the skin flap; however, its additional potential physiological roles in normal skin function are currently not fully understood. Ten cadaveric forehead flap specimens pedicled with unilateral STAs were perfused with lead oxide-gelatin mixture, and then dissected into 3 layers, including the super temporal fascia-frontalis-galea aponeurotica layer, the subcutaneous adipose tissue layer, and the "super-thin flap" layer. The forehead flap and stratified specimens underwent molybdenum target x-ray and subsequent transparent processing to effectively visualize the microscopic spatial architecture of arterial vessels across all levels. Based on the different anastomoses near the midline area of the flap, 2 types of arterial perfusion were identified: choke anastomosis type (8/10) and true anastomosis type (2/10). The former formed multiple choke anastomoses near the midline. In the "super-thin flap" layer, arterial perfusion density on the ipsilateral side was significantly higher compared to that on the contralateral side. The arterioles on the ipsilateral side exhibited a dense and uninterrupted distribution, whereas those on the contralateral side appeared sparse and dispersed. The latter exhibited an alternative perfusion pattern; the bilateral arterial vessels were connected with 3 to 5 true anastomoses near the midline. Furthermore, the microscopic architecture confirmed a uniform distribution of arterioles that remained continuous from ipsilateral to contralateral sides in the "super-thin flap" layer. This study demonstrated that choke anastomosis not only impairs blood perfusion in the adjacent angiosomes but also acts as a shunt converter to impact the blood supply of distal skin flaps at different levels through the "trans-territory diversion phenomenon." This results in necrosis of the superficial dermis while preserving survival of the deep subcutaneous adipose tissue.

Localization and Speech-in-Noise Performance in a Virtual Reality Test Environment: A Pilot Study of Adults With Single-Sided Deafness Using a Cochlear Implant.

The purpose of this exploratory study was to (a) construct a virtual reality (VR) test environment to measure speech recognition in noise (SIN) and localization, and (b) use the VR test environment to establish degree of binaural hearing benefit among a small number of adults with single-sided deafness (SSD) using a cochlear implant (CI). This pilot study included five adults implanted for SSD. The test environment was composed of an eight-speaker array that delivered restaurant noise and Institute of Electrical and Electronics Engineers sentences. VR head-mounted display goggles delivered a video recording of a busy restaurant. Participants completed SIN and localization in two conditions: (a) normal-hearing ear and a CI on the contralateral SSD side (CI-ON) and (b) normal-hearing ear and unaided on the contralateral SSD side (CI-OFF). Overall, CI benefits for SIN and localization within the VR test environment were improved for some participants, although not all. CI benefit for SIN and localization was dependent on speaker location. VR test environments present new opportunities for studying SIN and localization abilities in participants with CIs. This pilot study shows that, within a VR test environment, degree of CI benefit among SSD participants for SIN and localization varies across speaker location and across participants.

Differences in Somatosensory Function Related to Hand Dominance: Results of a Quantitative Sensory Testing Study in Healthy Volunteers.

Quantitative sensory testing commonly utilizes the unaffected, contralateral side as a control to detect somatosensory dysfunction. There is scant evidence that somatosensory function for the volar dominant and non-dominant hands is equivalent, therefore intra-patient comparisons are unwarranted. This study aimed to identify dominance-related differences in palmar hand somatosensation, thereby determining if the unaffected contralateral hand is a valid comparator in clinical populations. With ethical approval (IREC_13_1_10) and informed consent, 110 healthy adult volunteers' participated in this clinical measurement study. Somatosensory function was assessed with the German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) protocol. Half of the participants were tested on the dominant hand. Thirteen parameters of thermal and mechanical detection and pain threshold were evaluated at both the dorsal and volar hand (distal middle finger). Tests were performed in the same order and instructions were read from a standardized script. Results for dorsal hand tests were compared to DFNS normative data to confirm participants met study inclusion criteria. Between-group differences for age and sex were investigated with the independent samples t-test and Chi-square test of independence, respectively. Group differences for dominant and non-dominant hands for all 13 continuous QST parameters were investigated with the Mann-Whitney U-test. Data for 106 participants were included in statistical analysis. Fifty percent of participants were tested on the dominant hand [n=53]; there were no differences for age or sex between groups (dominant or non-dominant hand test group). The dominant volar hand was significantly more sensitive to vibration detection threshold than the non-dominant hand (P=0.001). There were no significant differences related to dominance for other DFNS QST measures. For quantitative sensory testing with the DFNS protocol in healthy cohorts, the contralateral, unaffected hand is a valid control, with the exception of vibration detection threshold.

Comparison of actual prognosis between unilateral and bilateral central neck dissection in modified radical neck dissection patients with no clinical central lymph node metastasis: a retrospective cohort study.

This study aimed to evaluate the long-term prognosis of contralateral central neck dissection (CND) in papillary thyroid cancer (PTC) patients with ipsilateral lateral neck metastasis. We compared the actual recurrence rate according to the extent of CND-ipsilateral and contralateral sides. A total of 708 PTC patients who underwent total thyroidectomy and concomitant ipsilateral or bilateral CND with ipsilateral lateral neck dissection between January 1997 and December 2022 at Samsung Medical Center were retrospectively analyzed. The median follow-up time was 118 months. Locoregional recurrence was observed in 26 patients (7.9%) and 30 patients (7.9%) in the ipsilateral and bilateral CND groups, respectively. There were 6 contralateral recurrence cases (1.8%) in the ipsilateral CND group and 6 cases (1.6%) in the bilateral CND group. There was only 1 contralateral central neck recurrence in the ipsilateral CND group. The incidence of hypocalcemia (P = 0.007) was higher in the bilateral CND group compared to the ipsilateral CND group. Surgeons may consider performing only unilateral CND-the side where tumor is for therapeutic purposes to reduce surgical complications.

341. EXCISION OF EPIPHRENIC DIVERTICULUM WITH CARDIOMYOTOMY AND FUNDOPLICATION

Abstract Background Epiphrenic diverticulum, a type of pulsion diverticulum, is a rare esophageal diverticulum that occurs in up to 2% of the population. It is commonly located in the distal esophagus, 4 to 8 centimeters (cm) above the gastric cardia. Etiology includes raised intraluminal esophageal pressure and is often associated with an underlying esophageal motility disorder. Indications for surgical intervention depends on presence of symptomatic disease including worsening dysphagia, food retention, regurgitation and complications such as aspiration pneumonia. This video illustrates the surgical management of epiphrenic diverticulum and associated surgical outcomes. Methods 60-year-old male initially presented with symptoms of dysphagia, food regurgitation and reflux. Gastroscopy performed identified a large esophageal diverticulum, 3cm from cardioesophageal junction (CEJ) and barium swallow study as well as high resolution manometry verified normal esophageal motility. Biopsies did not show any dysplasia. Patient subsequently underwent laparoscopic excision of epiphrenic diverticulum, cardiomyotomy and anterior 180 degrees fundoplication. Intra-operatively, epiphrenic diverticulum was noted on right lateral aspect of esophagus with a 3cm wide neck, 3cm from CEJ. Diverticulum was resected using a linear stapler and cardiomyotomy was perfomed on the contralateral side along with a partial fundoplication. Results Patient had an uneventful post-operative recovery with no post-operative complications. Histology confirmed esophageal diverticulum with no dysplasia or malignancy seen. Water soluble contrast study performed on post-operative day 1 and 1 year later demonstrated smooth passage of contrast with no hold up. There was also complete resolution of presenting symptoms on follow-up reviews. Conclusion Epiphrenic diverticulum is a rare entity but may present with debilitating symptoms that can affect patient’s quality of life and function. Management of symptomatic patients involves resection of the diverticulum as well as a myotomy and fundoplication to address any underlying motility disorder. This case aims to illustrate the efficacy and positive surgical outcomes that can be achieved with this combined surgical approach. https://www.dropbox.com/scl/fi/v6ow104q16lgfjhdqajix/Diverticulum-excision-v6.mp4?rlkey=nlmta6y835myqzf2rdf9mqocm&amp;dl=0

Asymmetrical primary vesicoureteral reflux: Which is the best surgical strategy?

No report has been published regarding the recommended surgical treatment in patients presenting with symptomatic primary asymmetrical vesicoureteral reflux (VUR): high grade on one side and low grade on the contralateral side. The aim of this study was to evaluate the effectiveness and outcome of combined Lich-Gregoir extravesical reimplantation and subureteric Deflux® injection, of high grade and low grade VUR respectively. Non-inferiority to bilateral cross-trigonal reimplantation was investigated in terms of surgical complications, number of post-operative fUTIs and need for re-intervention. A monocentric retrospective study was undertaken of all consecutive children with primary asymmetrical VUR on MCUG treated over an 18-year period (2004-2022). Surgery was indicated following an episode of febrile urinary tract infection despite appropriate non-operative management. Demographic and clinical such as length of hospital stay for pain management, use of urinary Foley catheter and complications were analyzed. A total of 80 children met the study criteria: 40 patients underwent bilateral cross-trigonal re-implantation (Group 1) and 40 patients the combined Lich-Gregoir extra vesical reimplantation and Deflux® sub ureteric injection (Group 2). Complication and success rates were comparable in the two groups. The median hospital stay was significantly shorter for Group 2, with 50% of patients who were discharged on day 1. Moreover, the data showed a significant lesser need in number and length of bladder catheter and ureteral stents in Group 2. The technique proposed overcome the inconveniences of the other procedures that are commonly used in bilateral RVU: difficulty in retrograde catheterization or ureteroscopy after bilateral cross-trigonal reimplantation, the risk of transient bladder dysfunction after bilateral extravesical reimplantation and the low rate of success for high grade reflux of the sub ureteric Deflux® injection. The main limitation of the study lies in its retrospective nature and in the relatively short median follow-up. The combined Lich-Gregoir extra-vesical ureteral reimplantation and sub-ureteric Deflux® injection for the treatment of primary asymmetrical VUR is an effective alternative to the gold standard cross-trigonal ureteral reimplantation. Moreover, the position of the ureteric orifice is not modified in the eventuality of endourological procedures into adulthood.

Carotid-cavernous fistula due to contralateral orbital trauma

Abstract: Direct carotid cavernous fistula is an abnormal arterio-venous connection from the carotid artery to the cavernous sinus (CS), resulting in high-pressure arterial blood entering the low-pressure venous CS. Most often, it occurs posttrauma and presents with ipsilateral orbital signs. In this report, we describe the case of a 54-year-old man, who presented with a late-onset right-sided red eye and diplopia following contralateral (left sided) orbital trauma (road traffic accident 7 months ago). Ocular examination revealed signs of Lateral rectus palsy, axial proptosis, and elevated intraocular pressure with dilated episcleral vessels in the right eye. Clinical findings were consistent with the diagnosis of right-sided direct CCF. To our surprise, digital subtraction angiogram revealed a left CCF with prominence of signs on the contralateral side. He underwent near-total endovascular coiling of the fistula, with initial aggravation of symptoms followed by near-total resolution.

The Arthroscopically Guided Bristow-Latarjet Procedure With Cortical Button Fixation: A Minimum 10-Year Follow-up

Background: Despite improved visualization, the use of arthroscopic surgery to perform the Latarjet procedure has not decreased the rates of complications and glenohumeral osteoarthritis (OA) in the long term. Many of the reported complications are related to the use of screws for bone block fixation with freehand drilling. Purpose: To evaluate the long-term (at a minimum 10-year follow-up) clinical and radiological outcomes of the arthroscopic Bristow-Latarjet procedure using a posterior guided drilling technique and suture button for coracoid bone graft fixation. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent the arthroscopic Bristow-Latarjet procedure with suture button fixation between 2011 and 2013 were reviewed by 2 independent evaluators. Complications and revision surgery were recorded, and we evaluated patient-reported outcomes including subjective scores, recurrence of shoulder instability (dislocation or subluxation), range of motion limitations, and return to sports. Patients had radiographs taken at least 10 years after surgery to assess glenohumeral OA according to the Samilson-Prieto classification system and computed tomography scans to assess bone block positioning and healing. Results: A total of 65 consecutive patients (68 shoulders) with a mean follow-up of 135 months (range, 120-156 months) were included. The mean age at the time of surgery was 25 ± 8 years; 7 patients had previous failed Bankart repair. At follow-up, 94% (64/68) of the shoulders had no recurrence of instability. The 4 cases of instability recurrence were traumatic and occurred at 3 weeks (a fall), 4 months, 2 years, and 7 years after surgery. No hardware failures, coracoid fractures, or neurological complications were observed. Overall, 61 patients (94%) were still participating in sports, with 44 (68%) at the same or higher level. Range of motion showed nonsignificant restrictions in external rotation with the arm at the side (7° ± 9°) and with the arm at 90° of abduction (9° ± 10°) compared with the contralateral side. Additionally, 11 shoulders (16%) had some residual anterior apprehension on clinical examination. At last follow-up, 77% (47/61) of the shoulders had no OA development or progression. Previous failed Bankart repair was a risk factor for the development of OA. Patients with OA had significantly lower Subjective Shoulder Value scores (79% vs 91%, respectively; P = .01) and decreased external rotation with the arm at the side (40° vs 65°, respectively; P = .001) compared with patients with no or little OA. Conclusion: The arthroscopically guided Bristow-Latarjet procedure with suture button fixation is a safe and durable surgical treatment method for recurrent anterior shoulder instability, allowing a high rate of return to sports without significant motion restrictions and no or little OA in the long term.

Reliability of the Sundsvall Method for Femoral Offset Evaluation.

Acetabular and femoral offset (FO) play an important role in total hip arthroplasty (THA). The Sundsvall method has been proposed to account for both FO and cup offset in one global hip offset measurement. In this study, we examine the agreement and inter-observer reliability of the Sundsvall method of hip offset measurement. Four hundred and ninety-nine THA patients at a single tertiary academic institution were retrospectively reviewed. Preoperative hip offset was measured on anteroposterior radiographs of the pelvis on the operative and contralateral side. Hip offset was also measured postoperatively on the operative side. Hip offset was measured using the Sundsvall method as the distance between the femoral axis and midline of the pelvis at the height of the lateral most point of the greater trochanter. All measurements were completed by two raters. Intra-class correlation coefficients (ICC) and Pearson's correlation coefficients were used to evaluate agreement and inter-observer reliability between two raters. There was excellent agreement between raters for preoperative hip offset measurement with an ICC of 0.91 (confidence interval [CI] 0.90-0.93, P<0.01) and R=0.92. There was excellent agreement between raters for postoperative hip offset with an ICC of 0.93 (CI 0.92-0.94, P<0.01) and R=0.93. This study confirms the inter-observer agreement and reliability of the Sundsvall method of hip offset measurement. With its high agreement and reliability, the Sundsvall method is an easy and reliable way to measure hip offset that can be applied in future clinical and research settings.

Results of combined all-arthroscopic Latarjet with Hill-Sachs remplissage for significant bipolar glenohumeral bone loss

BACKGROUNDArthroscopic Latarjet using suture-button fixation has shown good clinical results and low recurrent instability in patients with significant glenoid bone loss (18). However, the presence of an associated Hill-Sachs lesion (HSL) is a risk factor for recurrent instability after isolated Latarjet (8,35,36). The aim of the study is to report clinical and radiological results following all-arthroscopic Latarjet combined with Hill-Sachs Remplissage (HSR). METHODSMonocentric prospective study including 41 patients (mean age 28 ± 7 years) who underwent the combined procedure between 2014-2019 with minimum 2 years follow-up (mean 40 ± 13 months). Indications were glenoid bone loss >10% (mean 23.9% ± 7.5%) and large, deep HSL (Calandra 3). Five (13%) patients had signs of osteoarthrosis stage I preoperatively, four (10%) had previous stabilization surgery (3 cases isolated Bankart and 1 case Bankart combined with HSR), and five (13%) were epileptic. The HSR was performed first followed by guided Latarjet procedure. Primary outcome measures included shoulder stability and function represented by Walch-Duplay and Rowe scores, and subjective shoulder value (SSV) for daily life/sports. Secondary outcome measures included coracoid graft position and union, and glenohumeral osteoarthritis using X-rays and computer tomography (CT). RESULTSThree patients (7%) had recurrent instability: one due to seizure, one following fall, and one related to graft osteolysis. Two patients were revised because of recurrence with arthroscopic distal clavicle autograft. There were no infections, neurologic complications, or hardware failures. The Walch-Duplay score was 90 (95% CI 76.8-93.2) and the Rowe score 95 (95% CI 77.2-92.2). The Median SSV averaged 96% (95% CI 87.5-97.0) for daily life and 90% (95% CI 75.7-90.2) for sports. Mean external rotation with the arm at side was 60˚ (95%CI 59-70) with a median loss 10° (95%CI 3-17) compared to contralateral side. Among patients playing sport preoperatively, 36 (95%) were able to return to sport: 25 (67%) at same level and 7 (18%) at lower level. The coracoid graft was flush with the glenoid surface in 96% of cases and subequatorial in 89%. The graft developed nonunion in 11% and fractured in 5%. Seven patients (18%) had radiographical signs of grade I osteoarthritis. CONCLUSIONCombined arthroscopic Latarjet and HSR is an efficient solution for dealing with significant bipolar glenohumeral bone loss. The combined procedure deserves consideration in high-risk patients including combined bone loss, recurrent anterior instability after failed stabilization procedures and/or seizure.

Comparison of the effects of submucosal hyaluronidase and dexamethasone on postoperative edema, pain, trismus, and infection following impacted third molar surgery

BackgroundLimiting postoperative edema, pain, trismus, and infection is crucial for smooth healing. This prospective, controlled clinical trial investigated and compared the effectiveness of dexamethasone and hyaluronidase in relieving these complications.MethodsIn groups Ia and IIa, 8 mg of dexamethasone and 150 IU of hyaluronidase were administered following the removal of impacted teeth, respectively. The contralateral sides (groups Ib and IIb) were determined as control groups. Edema, pain, trismus, and infection were clinically evaluated on the 1st, 2nd, 3rd, and 7th postoperative days.Results60 patients were enrolled in the study. Hyaluronidase provided significantly more edema relief than dexamethasone on the 1st, 2nd, 3rd, and 7th postoperative days (P = 0.031, 0.002, 0.000, and 0.009, respectively). No statistical difference was found between dexamethasone and hyaluronidase in VAS and rescue analgesic intake amount values for all time points. Hyaluronidase was more effective in reducing trismus than dexamethasone on the 2nd and 3rd postoperative days (P = 0.029, 0.024, respectively). Neither of the agents significantly increased the postoperative infection rate.ConclusionsHyaluronidase can be selected when postoperative excessive edema and trismus are anticipated. Dexamethasone may be a cost–effective option if postoperative pain control is merely targeted.Trial registrationThis trial was registered in the Clinical Trials Protocol Registration and Results System (ClinicalTrials.gov identifier number: NCT05466604) on 20/07/2022.

The effect of single versus multiple piezocisions on the rate of canine retraction: a randomized controlled trial

BackgroundPiezocision is a minimally invasive surgical method aiming to accelerate tooth movement. However, its effect was found to be transient, appertaining to the regional acceleratory phenomenon (RAP). Hence, the aim of the study was to evaluate the effect of single and multiple piezocisions on the rate of orthodontic tooth movement (OTM). Moreover, the impact of both protocols on canine tipping and orthodontically induced inflammatory root resorption (OIIRR) has been assessed.MethodsThirty indicated patients for the therapeutic extraction of maxillary first premolars were enlisted in this split-mouth study, and they were randomly split into two equal groups, each including 15 subjects. In the Single Application Group (SAG), one side of the maxillary arch arbitrarily received a single piezocision before the onset of canine retraction, whereas in the Multiple Application Group (MAG), piezocisions were randomly performed on one side, three times on a monthly basis, over the 12-week study period. The contralateral sides of both groups served as the controls. Canine retraction was carried out bilaterally using nickel-titanium closed-coil springs, delivering 150 g of force, and the rate of tooth movement, as well as canine tipping were evaluated on a monthly basis, over a 3-month period. Cone-bean computed tomography scans were also conducted pre- and post- canine retraction, and OIIRR was assessed using Malmgren Index.ResultsThe reported outcomes revealed a significant increase in the amount of canine retraction, canine tipping, as well as root resorption scores on the experimental sides in both groups SAG and MAG post-retraction (p < 0.001). However, upon comparing the experimental sides in both groups, non-significant differences have been observed between them regarding all the assessed outcomes (p > 0.05).ConclusionsSingle and multiple piezocisions effectively accelerate OTM in comparison to conventional orthodontic treatment, with relative outcomes reported by both intervention frequencies. Accordingly, single piezocision is recommended as an adjunct to OTM. Furthermore, significant tooth tipping as well as a significantly higher root resorption risk accompanies both single and multiple piezocision applications in conjunction with OTM.Name of the RegistryClinicaltrials.govTrial Registration NumberNCT05782088Date of Registration23/03/2023 “Retrospectively registered”.URLhttps://clinicaltrials.gov/ct2/show/NCT05782088

Cancer in Patients With Incidental Asymmetric Oropharynx Positron Emission Tomography Uptake

Asymmetric oropharynx uptake on positron emission tomography (PET)/computed tomography (CT) is a common incidental finding and often prompts otolaryngology referral to rule out malignancy; however, the true risk of malignancy based on this finding is unknown. To identify the incidence of oropharynx cancer in patients with incidental asymmetric oropharynx PET uptake. In this retrospective cohort study, patients 18 years and older undergoing PET/CT scans at Mayo Clinic between January 2001 and December 2018 were included. Patients with a history or pretest suspicion of oropharynx cancer were excluded. Data were analyzed from March 2021 to December 2023. Blinded radiologic review of imaging studies, including measurement of maximum standardized uptake values (SUVmax) of the ipsilateral side of concern and contralateral side. Retrospective medical record review for associated clinical data. The primary study outcome was the incidence of oropharynx cancer diagnosis in patients with asymmetric oropharynx PET uptake. The primary outcome was formulated before data collection. Of the 1854 patients identified with asymmetric oropharynx PET uptake, 327 (17.6%) met inclusion criteria. Of these, 173 (52.9%) were male, and the median (range) age was 65.0 (24.8-90.7) years. The mean (SD) follow-up interval was 52.1 (43.4) months. A total of 18 of 327 patients (5.5%) were newly diagnosed with oropharynx cancer. The most common diagnosis was squamous cell carcinoma (n = 9), followed by lymphoma (n = 8), and sarcoma (n = 1). Patients with an incidental diagnosis of oropharynx cancer had higher mean (SD) ipsilateral SUVmax (8.7 [3.7] vs 5.3 [1.9]) and SUVmax ratio (3.0 [1.6] vs 1.6 [0.6]) compared with patients with normal examination findings. SUVmax ratio and difference were found to be good discriminators of oropharynx cancer, with areas under the receiver operating characteristic curve of 86.3% (95% CI, 76.4-94.6) and 85.8% (95% CI, 74.8-94.6), respectively. Patients with a new diagnosis of oropharynx cancer were more likely to have a corresponding CT abnormality than those with normal examination findings (6 of 18 [33%] vs 24 of 295 [8.1%]). Patients with concerning lesions on oropharynx palpation by an otolaryngology health care professional were significantly more likely to be diagnosed with oropharynx cancer compared with patients with normal examination findings (odds ratio, 28.4; 95% CI, 6.6-145.8). In this cohort study, while incidental asymmetric oropharynx PET uptake was common, a new diagnosis of oropharynx cancer was not and potentially results in a large volume of unnecessary referrals and work-up. Using SUVmax ratio, SUVmax difference, and CT correlation may increase the benefit of referral. Patients with a palpable oropharynx lesion and asymmetric oropharynx PET uptake should undergo confirmatory biopsy.