Discussion Of Surgical Techniques Research Articles

Schwannomas of the greater superficial petrosal nerve – case series, discussion of surgical techniques, and review of literature

Facial nerve schwannomas account for about 0.8% of all petrous mass lesions. Schwannomas of the greater superficial petrosal nerve (GSPN) are a rare subtype with few case-reports up to date. A retrospective analysis of clinical outcomes, radiographic findings and postoperative complication between June 2007 and December 2020 was performed. Four cases of GSPN schwannomas were reported. The presenting symptoms were facial nerve palsy and hearing loss. Imaging studies showed a subtemporal mass on the anterosuperior aspect of the petrous bone, in one case with extraordinary petrous bone and mastoid infiltration and destruction. Three cases were removed through a subtemporal extra- or intradural approach, one case via a combined pre- and retrosigmoid approach. Improvement of facial nerve palsy occurred in one case; new hearing loss was observed in another case. Xeropthalmia was a short-term temporary deficit in three cases. Short- to mid-term follow-up of the patients has not shown any tumor recurrence. GSPN schwannomas are rare entities presenting with heterogenous symptoms. Our surgical findings emphasize safe resection. Complete remission is possible by GTR. Since the small data set limits the expressiveness of statements regarding standard of care and alternative therapy options, additional data is needed.

What Is the Accuracy of Bimaxillary Orthognathic Surgery Using Occlusally-Based Guides and Patient-Specific Fixation in Both Jaws? A Cohort Study and Discussion of Surgical Techniques

The development of advanced digital orthognathic surgical protocols requires investigation to determine the accuracy of surgical outcomes. This report's purpose is to quantify 3-dimensional linear discrepancies between simulated and actual results for double-jaw orthognathic surgery utilizing occlusally-based guides in conjunction with patient-specific fixation in both jaws. This retrospective cohort study assessed the accuracy of double-jaw orthognathic surgery, in all cases performed by 1 surgeon between May 2019 and January 2021, utilizing occlusally-based guides and patient-specific fixation plates in both maxillary and mandibular surgeries. The primary outcome was absolute linear discrepancy between virtually-planned and surgically-achieved maxillary and mandibular position in 3 dimensions. Secondary outcomes were relative (directional) discrepancy, to assess if protocols erred in 1 direction of each surgical axis. Sequencing of bimaxillary surgery, age, and sex were covariates. Absolute and relative linear differences at A-point, B-point, and pogonion were evaluated using t tests. Descriptive statistics were amassed, and results were analyzed to determine if discrepancies differed from a null hypothesis of 2-mm error. Forty-nine patients were enrolled, consisting of 25 males and 24 females with a mean age of 24.8years. Thirty-five single-piece and 14 multipiece LeFort I osteotomies, 49 bilateral sagittal splits, and 35 genioplasties were studied; there were 22 maxilla-first and 27 mandible-first surgeries. Mean A-point absolute discrepancies of 0.57 (95% confidence interval: 0.41-0.73), 0.37 (0.24-0.50), and 0.45 (0.33-0.57) mm were observed in horizontal, transverse, and vertical planes, respectively. B-point discrepancies were 1.15 (0.79-1.52), 0.62 (0.47-0.78), and 1.14 (0.91-1.38) mm. Pogonion discrepancies were 1.29 (0.86-1.73), 0.85 (0.64-1.06), and 1.24 (1.00-1.49) mm. All P values were <.001. Sequencing of bimaxillary surgery did not alter absolute differences (P=.2 to>.9) with A-point discrepancies consistently smaller than B-point and pogonion discrepancies regardless of sequencing. Mandible-first surgery was associated with posterior directional error; both sequences were associated with superior directional error at B-point and pogonion. Bimaxillary orthognathic surgery utilizing a patient-specific protocol in both jaws produces results highly reproducible to planned simulated surgery and accurate below a 2-mm hypothesis, with maxillary discrepancies approaching 0.5mm and mandibular discrepancies approaching 1mm.

Multimodality Imaging of Cholecystectomy Complications.

Cholecystectomy is one of the most common surgeries performed in the United States. Although complications are uncommon, the high incidence of this surgery means that a radiologist will likely encounter these complications in practice. Complications may arise in the immediate postoperative period or can be delayed for weeks, months, or years after surgery. Vague and nonspecific symptoms make clinical diagnosis challenging. As a result, multimodality imaging is important in postoperative evaluation. US and multidetector CT are the usual first-line imaging modalities. Hepatobiliary scintigraphy, SPECT/CT, and MRI with conventional or gadoxetate hepatobiliary contrast material are important and complementary modalities that are used for workup. The authors begin with a brief discussion of surgical technique and expected postoperative findings and then describe complications organized into four groups: (a) biliary complications, (b) stone-related complications, (c) iatrogenic complications, and (d) gallbladder complications. Biliary complications include bile leaks and bilomas, acute biliary obstruction, and biliary stricture. Stone-related complications include retained and recurrent stones and spillage of stones into the peritoneum. Iatrogenic complications include hemorrhage, vasculobiliary injury, arterial pseudoaneurysms, duodenal injury, and migration of clips. Gallbladder complications include recurrent cholecystitis after subtotal reconstituting cholecystectomy and unexpected gallbladder cancer. An invited commentary by Mullens and Ibrahim is available online. Online supplemental material is available for this article. ©RSNA, 2022.

Neck Bypass Modification for Inferior Trapezius Flaps: A Discussion of Surgical Technique and Experience

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Complete Laryngotracheal Separation from Blunt Trauma: A Case Series and Discussion of Surgical Techniques

Objectives: (1) Recognize the often subtle clinical presentation of complete laryngotracheal separation. (2) Address immediate course of action in the event of a total separation. (3) Describe components of a successful surgical repair. Methods: Over 3 years at a tertiary care center in Las Vegas, Nevada, 3 cases of complete laryngotracheal separation secondary to blunt trauma were successfully treated with prompt surgical intervention. Various surgical techniques were employed, given the complexity and different characteristics of each patient’s presentation, with cartilaginous reduction and fixation favored over soft tissue apposition, along with fenestration tracheostomy procedures to prevent infection of the repair sites. Successful long-term outcome was defined by tracheostomy tube decannulation and lack of multiple tracheal dilations or other tracheoplasty procedures to maintain a patent airway. Results: All 3 patients initially required a tracheostomy due to airway edema, but each made an uneventful recovery with early capping and tracheostomy tube decannulation. None of the patients necessitated further tracheal procedures, and all had serviceable voice and good swallowing function. Conclusions: Because of the relative rarity of complete laryngotracheal separations due to blunt trauma, surgical methods for repair are not widely published. We present our experience with the hope that it will assist other surgeons when faced with the challenge of diagnosing and repairing this life-threatening injury.

A midfacial degloving approach to the nasopharynx: Case presentation and discussion of surgical technique

A midfacial degloving approach to the nasopharynx: Case presentation and discussion of surgical technique

Migrated XLIF Cage: Case Report and Discussion of Surgical Technique

Extreme lateral interbody fusion (XLIF; NuVasive, Inc, San Diego, California) is a minimally invasive technique developed to avoid complications associated with traditional or minimally invasive anterior or posterior approaches to lumbar interbody fusion. It uses a direct lateral, retroperitoneal, transpsoas approach for placement of an interbody cage. To date, no reports of cage-related complications or procedures for revising an XLIF have been published. This article describes a case of a complication unique to this procedure and the surgical technique used to treat it. A 49-year-old woman underwent XLIF at L3-4 with supplemental posterior pedicle fixation for treatment of a pseudarthrosis of a previous fusion performed for junctional degeneration below an old scoliosis construct. One month postoperatively, she reported increasing leg pain, and imaging studies demonstrated the cage to have extruded laterally. The cage was revised using a mini-open lateral approach. The presence of neurologic symptoms (leg pain) necessitated the cage to first be reimpacted before it could be safely extracted. A new cage was placed with the addition of a lateral plate. The patient's leg pain resolved shortly after the revision, and at 1-year follow-up, she appeared to have a solid fusion with no further complications. If required, XLIF may be safely and effectively revised through a minimally invasive or mini-open lateral approach. Use of a lateral plate as a buttress should be considered in cases associated with significant coronal deformity or lateral listhesis, even when planning use of supplemental posterior instrumentation.

Intrathecal Pumps

Direct neuroaxis drug delivery has expanded the physician's armamentarium to provide treatment options to those who have failed more conservative interventions. Starting from Bier's 'cocainization of the spinal cord' in 1898, direct nervous system pharmacy delivery has long been recognized as an effective means to treat pain. Intrathecal pump systems are now commonplace in the management of numerous pain states, as well as of neuromuscular sequelae of central nervous system injury. There has been much advancement in the physiologic and pharmacologic understanding of direct neuromodulation, providing a growing number of treatment options depending on the specific disease state. As well, surgical techniques and catheter systems have undergone refinements providing improved long-term safety and efficacy. We present a review of the historical evolution to current intrathecal therapies, as well as a dialog regarding patient selection, drug options, and side effects. Also, included is a discussion of surgical techniques, current delivery options and complications concerning pump placement.

Acute Odontoid Fractures: Anterior Odontoid Fixation

Fractures of the dens are common injuries. The classification of these fractures remains controversial. Anterior odontoid fixation is a safe and effective means of stabilizing some of these injuries. We review classification of these injuries, treatment options, and surgical indications. Anterior odontoid fixation is reviewed in further detail, with an emphasis on surgical indications and a discussion of surgical technique.

Use of the Levator Scapulae Muscle Flap in Head and Neck Reconstruction

There are numerous techniques available for reconstruction of defects following composite resection of oral cavity and oropharyngeal tumors. No single technique is applicable in all situations. The levator scapulae muscle flap is well known for its application in carotid protection. Little attention is paid to its usefulness in other aspects of head and neck reconstruction. We have been using the levator scapulae muscle flap for a variety of reconstructive problems. The flap is useful for buttressing intraoral suture lines, closing intraoral defects, and providing soft tissue to fill in dead spaces and bulk out lateral and anterior oral defects. The levator flap was found to be easy to elevate, safe, and reliable with a minimum of wound complications. A review of 18 patients, representative case studies, and a discussion of surgical technique and relevant anatomy and blood supply is presented.

Operative mobilization of stiff metacarpophalangeal joints: dorsal versus volar approach.

The effectiveness and merits of the dorsal and volar approaches for release of structures contributing to metacarpophalangeal joint stiffness were studied in 61 joints in 23 patients. Seventy-six percent of the joints in the volar group gained greater than 50 degrees passive motion compared to 29% in the dorsal group. Forty-four percent of the joints in the volar group gained greater than 50 degrees active motion compared to 16% in the dorsal group. Discussion of surgical technique and postoperative management reveals that the advantages of the volar approach are most evident during postoperative management, while the main advantage of the dorsal approach is better operative exposure.

Emergency Myocardial Revascularization: Cleveland Clinic Experience

Approximately 500,000 to 600,000 people die annually from acute myocardial infarction. The authors have pursued an aggressive surgical approach in patients with impending myocardial infarction and early acute myocardial infarction. A brief summary of their experience and a discussion of surgical technique is provided.

Surgery in Infancy and Childhood: A Handbook For Medical Students, Junior Hospital Staff and General Practitioners.

This fact-filled, well-written book of 597 pages and 340 illustrations includes a brief discussion of practically every problem encountered in pediatric surgery. Even related subjects such as hemophilia, Ehlers-Danlos syndrome, and ammoniacal diaper rash are included. Many of the photographs are in color. Each subject is discussed only briefly, but the information presented is pertinent. Some statements impress one as being dogmatic and present only the author's point of view. Undoubtedly, this is the price of conciseness and the necessity to include a great deal of material into a few pages. There is no discussion of surgical technique or of results of surgery. The book is recommended—as it was intended—as a handbook for medical students, junior house staff, and general practitioners. It cannot be recommended as a reference book for the trained pediatric surgeon, although he may find it useful and it should be included in his library. It can