Important Anatomical Structures Research Articles

EXODONTIA DE TERCEIROS MOLARES INFERIORES: DESAFIOS E COMPLEXIDADES CIRÚRGICAS

Third molar extraction is one of the procedures within the dental clinic that causes people the most fear, despite being performed frequently. The incidence of complications can still be considered high. The anatomical position of these dental elements is one of the main reasons for complications during their removal, due to the proximity of important anatomical structures. Therefore, the use of radiographic examinations to evaluate the positioning of third molars is essential so that it is possible to visualize ways to conduct the surgery safely. The aim of this work is to review, according to the bibliographic literature, the risks of complications during extraction of lower 3rd molars. For this, a search was carried out in the literature, in the following databases: Pubmed, Virtual Health Library (VHL), Scielo and Google Scholar, using the descriptors: “Nonerupted tooth”, “Third Molar” and “Oral Surgery ”. The established inclusion criteria include articles that address the defined theme and that are available for full reading, in Portuguese and English, published in the last 10 years. The exclusion criteria were articles that deviate from the proposed topic, repeated articles and incomplete research. The present work is expected to acquire information to better perform surgeries on third molars according to their clinical condition, presenting ideal approaches for diagnosis and surgical planning and emphasizing the care necessary to avoid surgical complications. Keywords: Tooth Unerupted. Third Molar. Oral Surgery.

Variability and clinical anatomy of the superior gluteal nerve-A systematic review and meta-analysis.

The superior gluteal nerve (SGN) is a mixed nerve of the sacral plexus that arises from the posterior divisions of the L4, L5, and S1 nerve roots. Its motor branch plays a crucial role in innervation of hip muscles, which allows for physiological gait or walk-pattern. As for its sensory branch, it provides innervation for the hip joint capsule, especially its superior part. The understanding of this nerve is crucial as it may be injured during many operations involving mostly pelvic surgery, both arthroscopic and open procedures. The risk of injury is especially high during total hip arthroplasty (THA). These lesions often result in the presentation of major walk-pattern abnormalities. The most classical and commonly known would be the Trendelenburg sign, which presents with pelvic instability characterized by having the patient standing on one leg whereby the pelvis on the contralateral side will be dropping, resulting in a positive sign. The aim of this meta-analysis was to obtain all relevant data on SGN and its variations, in order to emphasize its anatomical, physiological, as well as clinical implications. A large-scale search was conducted in all major databases (PubMed, Embase, Science Direct, Google Scholar, and Web of Science) in order to determine and pool all available and relevant SGN data. No restrictions were applied to date or language. The data collection was categorized by prevalence, branching, patterns, course, origin, and distance from anatomical landmarks. A total of 41 studies (n = 869 hemipelves) were included in our analysis. The most common branching pattern of SGN was a spray pattern, 70.4% (95% CI: 54.4-96.8; p < 0.001) of the general population. We found that the closest branch to the greater trochanter of the femur and concurrently the most at risk during surgery was a muscular branch to gluteus minimus muscle. As the trend of pelvic surgeries, especially THA continues to rise, SGN lesions are now more than ever at risk. Yet to the authors' knowledge, this does not seem to be reflected in the current literature thereby making this the first meta-analysis concerning this important anatomical structure. The authors believe it is paramount for surgeons, especially in the orthopedic specialty, to thoroughly understand the SGN with its anatomical variability and clinical tie-ins.

Accuracy of Outsourced Radiology Reports in Emergency Surgical Care: Do They Provide a High-Quality, Cost-Effective Service?

Background Computed tomography (CT) scans play a crucial role in emergency surgical care, serving both diagnostic and prognostic functions. They significantly contribute to timely and effective patient care. This study aims to compare abdominal CT scan reports prepared by locally employed radiologists with those from outsourced radiology reporting services for patients presenting with acute surgical conditions. Additionally, the study evaluates how different reporting styles, such as free-text versus structured formats, influence the overall quality of the reports. Methods The study was conducted in the general surgery unit of North Manchester General Hospital, Manchester, a district general hospital in North West England. Patients admitted through the accident and emergency (A&E) under the general surgery team who underwent abdominal CT scans between August 2023 and October 2023 were included. Trauma patients and those who received non-abdominal CT scans were excluded. Local radiology reports were compared to outsourced reports using statistical analysis. The clarity and comprehensiveness of the reports were carefully evaluated, and the impact of free-text versus structured reporting formats was also considered. Results A total of 192 patients were included in the study, with a median age of 59 years. Compared to locally reported scans, outsourced radiology reports frequently omitted commentary on key anatomical structures, including the biliary system, spleen, kidneys, lymph nodes, mesentery and peritoneum, vasculature, bones and soft tissues, and lung bases. Reports using a structured format provided more thorough commentary on the spleen, adrenal glands, mesentery and peritoneum, and bones and soft tissues compared to free-text reports. Conclusion Outsourced radiology reports significantly underreported important abdominal anatomical structures. Free-text reporting was associated with significant omissions in abdominal anatomical structures, which could negatively affect clinical decision-making and management plans. Further studies are recommended to evaluate the comprehensiveness of outsourced radiology reporting and to ensure standardization in reporting, ultimately providing patients with high-quality emergency care.

Trans-Achilles percutaneous fixation technique for posterior malleolus fracture: a cadaveric study

BackgroundIt has been reported that 43.6% of ankle fractures are accompanied by posterior malleolus fractures. The aim of this study is to define a safe zone for posterior malleolus fractures by determining the locations of the important anatomical structures in this region. Additionally, it aims to identify the trans-Achilles passage line for Kirschner wire insertion through a posteroanterior approach for posterior malleolus fragments.MethodsSix below-knee amputee fresh-frozen leg cadavers were used in this study. A trans-Achilles Kirschner wire was applied to the cadavers in the posteroanterior direction under the guidance of fluoroscopy. The areas where the Kirschner wire passed were dissected, and their proximity to vital anatomical structures was measured.ResultsIn all cadavers, the transverse thickness of the Achilles tendon at the level of the trans-Achilles Kirschner wire was 15.5 mm and the trans-Achilles Kirschner wire application was 18.6 mm from the sural nerve, 16 mm from the posterior tibial tendon, and 12.16 mm from the flexor digitorum longus muscle. It was performed 15.16 and 14.6 mm from the posterior tibial artery and vein, 12.3 mm from the tibial nerve, 13.6 mm from the tibiofibular joint, and 55.5 mm from the insertion site of the Achilles tendon to the calcaneus and at a sufficient distance from vital anatomical structures.ConclusionsThe proposed trans-Achilles percutaneous surgical technique is safe from neurovascular structures for fixing posterior malleolar fractures. However, the long-term clinical outcomes of this technique need to be explored.Level of evidenceLevel III, A cadaveric study.

Functional and Aesthetic Lower Lip Reconstruction With Depressor Anguli Oris Muscle Flap and Reverse Superior Labial Artery Flap.

The lower lip is an important anatomical structure involved in daily activities such as eating, drinking, and speaking, as well as in facial expressions. Lower lip defects should be repaired to preserve lip function without disrupting the aesthetic harmony of the lips within the face. This goal is difficult for plastic surgeons because, for functional and aesthetic repair, it is necessary to replace the mucosa, muscle (especially contractile), and skin tissues present in the lip. Subtotal lower lip repair was performed using an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap in seven male patients with a mean age of 63 years. A depressor anguli oris muscle flap was used to repair the orbicularis oris muscle defect. The desepithelialized part of the reverse superior labial artery flap was used for mucosal defect repair, whereas the remaining part was used for skin defect repair. Patients were followed up for an average of 15 months. Patient lips, epithelialization, sensation, and sphincter function were clinically evaluated. Electromyography (EMG) was performed at 6 and 12 months to evaluate the function of the depressor anguli oris muscle flap. All the reverse superior labial artery flaps survived without any loss. Trapdoor deformity developed in the flaps of two patients. The desepithelialized parts of the flaps were completely epithelialized (covered with mucosa) by approximately 6th week. In the EMG controls of the patients at 6 months, the depressor anguli oris muscle was contractible. Sensation regained in the operated lip during the follow-up period. The combination of an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap is an important surgical option for the functional and aesthetic repair of subtotal lower lip defects.

Comparing scissors and scalpels to a novel surgical instrument: a biomechanical sectioning study

BackgroundThis study introduces a novel surgical instrument to reduce iatrogenic nerve injuries during procedures such as carpal tunnel and ulnar nerve decompression surgery. These injuries often result from direct damage to surrounding tissues by surgical instruments, whose designs have remained largely unchanged over the past decades. The novel device is a modified surgical forceps that has a deployable surgical scalpel that runs along a groove on the forceps. This design protects important anatomical structures while allowing fast dissection and cutting of fascial layers.MethodsThe process used to develop a novel instrument included computer-aided design (CAD) modeling, 3D printing for prototyping, and the fabrication of an aluminum prototype. Biomechanical testing was performed with the novel device, iris scissors, bandage scissors, and a scalpel on an MTS Static Materials Test System. The peak force to slide-cut, number of cut attempts, and percentage cut on first attempt were compared between the prototype and traditional surgical tools. The materials cut in testing were Ace™ bandage, stockinette, and gauze. Statistical analyses were performed using Welch’s t-tests and Fisher’s exact tests.ResultsCompared to conventional bandage and iris scissors, the novel surgical instrument required significantly less force to cut through an Ace™ bandage, stockinette, and gauze (p < 0.01). The number of cuts required to transect those same materials with the novel device was comparable to that of the scalpel and bandage scissors. Additionally, while there were no differences between the novel device and the other devices for an Ace™ bandage and stockinette, the novel device tended to cut a greater percentage of gauze in one pass than did the iris scissors.ConclusionThe novel surgical instrument designed in this study required less force compared to conventional scissors, demonstrated cutting efficiency similar to that of a scalpel blade, and had more safety features than either instrument. This study highlights the value of collaboration between biomedical engineering and orthopedic surgery departments on innovation in medical technology, through which new technologies with improved design and functionality demonstrate the potential to reduce iatrogenic injuries.

Mixed reality combined with surgical navigation technology assisted in parapharyngeal space tumors surgery: a clinical study

Objective: To assess the feasibility and application of mixed reality combined with surgical navigation technology in parapharyngeal space tumor surgery, and to provide a reference for the development and promotion of this technology. Methods: In this study, retrospective data collection was conducted on 16 patients with parapharyngeal space tumors who were treated at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2020 to June 2023. The patient's age was (39.6±17.8) years, with 4 males and 12 females. Mixed reality combined with surgical navigation technology was utilized to assist physicians in the treatment of these patients. Mixed reality combined with surgical navigation technology was used to assist physicians in treatment of these patients. The application steps included acquisition of image data, processing of image data [three-dimensional (3D) reconstruction, image fusion, and virtual surgical design], development of surgical navigation plan, connection of mixed reality and navigation system, automatic registration and intraoperative guidance and validation. In the preoperative plan, landmark points were placed on the virtual tumor and surrounding important structures reconstructed using digital software, serving to guide the localization of crucial anatomical structures. Intraoperative positioning deviation, surgical time, intraoperative blood loss, and postoperative complications were recorded and analyzed to evaluate the clinical application effectiveness of mixed reality combined with surgical navigation technology. Results: With the assistance of mixed reality combined with surgical navigation technology, 16 patients successfully underwent tumor resection. All patients were accurately diagnosed preoperatively by 3D reconstruction and image fusion technology, and a comprehensive preoperative plan was formulated; intraoperatively, mixed reality combined with surgical navigation technology was utilized for the localization of important structures. The average localization deviation of 38 landmark points during the operation were (4.43±1.96) mm, with 62% (26/42) of the points having a deviation of ≥0 and<5 mm. The average duration of the operation was (149.6±53.9) min and the blood loss was 70 (45, 150) ml. The average postoperative follow-up was 16 months, and five patients experienced postoperative complications involving facial paralysis, hoarseness, and choking. Conclusions: Mixed reality combined with surgical navigation technology can achieve the three-dimensional visualization of oral and maxillofacial anatomical structures to achieve precise preoperative diagnosis. During surgery, the technology can real-time display the relationship between soft tissue tumors and the surrounding important anatomical structures, guide surgical operation, and enhance the safety of surgery.

N6-methyladenosine-modified circCDK14 promotes ossification of the ligamentum flavum via epigenetic modulation by targeting AFF4

BackgroundThe ligamentum flavum (LF) is an important anatomical structure of the spine. Ossification of the LF (OLF) has become the leading cause of thoracic spinal stenosis. Circular RNAs (circRNAs) and N6-methyladenosine (m6A) modification are reported to be associated with several human diseases. However, the role of circRNAs and m6A modification in the pathogenesis of OLF has not been fully investigated. Here, we aimed to explore the vital function of circRNAs and m6A modification in OLF.Materials and methodsWe analysed the circRNA expression of 4 OLF tissues and 4 normal LF tissues using bioinformatic analysis and identified circCDK14 for further analysis. We investigated the effects of circCDK14 on the osteogenic differentiation of LF cells. We observed that circCDK14 regulated its target genes by binding to miRNAs as a miRNA sponge. Moreover, the circRNA pull-down assay indicated that RNA-binding proteins might regulate the expression of circCDK14 via m6A modification.ResultsCircCDK14 was significantly upregulated in OLF tissues compared to normal LF tissues. Overexpression of circCDK14 promoted the osteogenic differentiation of LF cells. Mechanistically, CircCDK14 promoted the expression of ALF transcription elongation Factor 4 (AFF4) by serving as a sponge for miR-93-5p. Moreover, Wilms tumour 1-associated protein (WTAP) increased the stability of circCDK14 via N6-methyladenosine modification.ConclusionThe m6A-modified CircCDK14 binding to miR-93-5p played an important role in the osteogenesis of LF cells by targeting AFF4, providing a promising therapeutic target for OLF.

Strategies for prevention and treatment of vascular and nerve injuries in mandibular anterior implant surgery

Important anatomical structures such as mandibular incisive canal, tongue foramen, and mouth floor vessels may be damaged during implant surgery in the mandibular anterior region, which may lead to mouth floor hematoma, asphyxia, pain, paresthesia and other symptoms. In severe cases, this can be life-threatening. The insufficient alveolar bone space and the anatomical variation of blood vessels and nerves in the mandibular anterior region increase the risk of blood vessel and nerve injury during implant surgery. In case of vascular injury, airway control and hemostasis should be performed, and in case of nerve injury, implant removal and early medical treatment should be performed. To avoid vascular and nerve injury during implant surgery in the mandibular anterior region, it is necessary to be familiar with the anatomical structure, take cone-beam computed tomography, design properly before surgery, and use digital technology during surgery to achieve accurate implant placement. This article summarizes the anatomical structure of the mandibular anterior region, discusses the prevention strategies of vascular and nerve injuries in this region, and discusses the treatment methods after the occurrence of vascular and nerve injuries, to provide clinical reference.

Ear concha carcinoma: excision and repair with an innovative revision of Masson’s post-auricular revolving-door flap (flip-flop flap)

Carcinomas of the concha are difficult to treat due to the difficulty in accessing the site and the surrounding important anatomical structures. In this article, we describe the reparative procedure of an auricular concha defect using the Masson1 revolving door island flap revisited according to Mauro Giordani, MD.

The Application of Mask Region-Based Convolutional Neural Networks in the Detection of Nasal Septal Deviation Using Cone Beam Computed Tomography Images: Proof-of-Concept Study.

Artificial intelligence (AI) models are being increasingly studied for the detection of variations and pathologies in different imaging modalities. Nasal septal deviation (NSD) is an important anatomical structure with clinical implications. However, AI-based radiographic detection of NSD has not yet been studied. This research aimed to develop and evaluate a real-time model that can detect probable NSD using cone beam computed tomography (CBCT) images. Coronal section images were obtained from 204 full-volume CBCT scans. The scans were classified as normal and deviated by 2 maxillofacial radiologists. The images were then used to train and test the AI model. Mask region-based convolutional neural networks (Mask R-CNNs) comprising 3 different backbones-ResNet50, ResNet101, and MobileNet-were used to detect deviated nasal septum in 204 CBCT images. To further improve the detection, an image preprocessing technique (contrast enhancement [CEH]) was added. The best-performing model-CEH-ResNet101-achieved a mean average precision of 0.911, with an area under the curve of 0.921. The performance of the model shows that the model is capable of detecting nasal septal deviation. Future research in this field should focus on additional preprocessing of images and detection of NSD based on multiple planes using 3D images.

Importance of an unclear fascial layer, stylopharyngeal fascia: an anatomical study

Objectives: The stylopharyngeal fascia is an important anatomical structure; however, its exact location and relationship with other neighboring structures have not been clearly demonstrated. Therefore, our aim was to reveal the stylopharyngeal fascia to demonstrate its course and neurovascular relationship in the parapharyngeal space. Methods: Ten fresh frozen cadaveric necks were dissected through a transparotideal and transcervical approach extending to the parapharyngeal region. All the neurovascular structures and muscles were preserved to demonstrate the stylopharyngeal fascia. Results: The stylopharyngeal fascia was mostly found on the lateral aspect of the internal carotid artery and could be found by advancing into the plane between the posterior belly of the digastric and stylohyoid muscles at the parapharyngeal space borders. The stylopharyngeal fascia covered not only the parapharyngeal segment of the internal carotid artery but also the cranial nerves X–XII at the parapharyngeal space. The cranial nerve IX coursed laterally to this fascial structure, posterior to the stylopharyngeus muscle in the parapharyngeal space. Conclusion: Although the stylopharyngeal fascia was previously shown to be related to other neurovascular structures, its anatomical course and histology remain unclear. Moreover, the stylopharyngeal fascia was defined using different nomenclatures in different studies. In this study, the stylopharyngeal fascia was shown to be an important anatomical landmark for dissection at the border of the parapharyngeal space. Further studies investigating its histological structure and defining its proper nomenclature are required. Therefore, we propose the term “parapharyngeal fascia”.

RARE ANATOMIC VARIATIONS: AGENESIS OF LEFT MENTAL FORAMEN COEXISTING WITH TWO RIGHT MENTAL FORAMINA

Knowledge about the proximity of important anatomical structures is crucial for all surgical interventions, including those in the lower jaw region. One of these important structures is the mental foramen, which transmits the mental nerve, whose branches provide sensory innervation to the chin, lower lip, and gingiva. The mental foramen variations can influence the effectiveness of the mental nerve anesthesia and can also be related to complications during surgical procedures such as implant placement, apicoectomy, vestibuloplasty, etc. We present a very rare case of agenesis of left mental foramen coexisting with two right mental foramina incidentally found in a patient examined by cone-beam computed tomography.

Evaluation of the benefit of indocyanine green as an educational and practical tool for ureteral identification in laparoscopic pelvic surgery: a cross-sectional study

Background Indocyanine green (ICG) is a visible near-infrared fluorescent dye. Several studies have reported its benefit in identifying important anatomical structures, tissue vascularization, and sentinel lymph nodes in the case of tumors. Studies have shown that ICG is critical and safe in gynecologic surgeries. However, research on how ICG dye can help surgeons in laparoscopic surgeries correctly identify the course of the ureter has yet to be further investigated. Method This cross-sectional study enrolled 62 gynecology attending and resident surgeons who were asked to identify the course of the ureter on images of laparoscopic surgeries. The results were then compared with images in which ICG dye highlighted the course of the ureter. The purpose of this study was to detect the ability of surgical assistants and residents to adequately identify the course of the ureter in laparoscopic pelvic surgeries. Results No statistically significant differences were found in terms of year of residency, years of experience, number of laparoscopic procedures attended, and correct identification of ureter course. ICG proved useful in identifying the correct ureteral trajectory. Conclusions ICG can be a valuable tool to improve the correct identification of ureters and improve surgical outcomes.

Delayed Diagnosis of a Ligamentous Lisfranc Injury on a Bomber Task Force Member.

The tarsometatarsal joint, or Lisfranc joint, is an extremely important anatomical structure and injury to it has been shown to cause long-term disabling ramifications. With a wide spectrum of injury involvement, from fracture dislocations to sprains, it is important to establish a diagnosis early to guide management. Although the more extreme higher energy fracture dislocations are more widely studied, there remains a paucity of literature on lower energy purely ligamentous injuries, especially among military service members.1 The deployed setting provides an extra layer of complexity in determining a musculoskeletal injury etiology for the provider, especially in resource-limited areas. When a high level of suspicion for Lisfranc injury exists based upon clinical presentation and in the setting of negative X-rays, more prudence should be placed on additional workup. This will guide decision-making for possible expedited stateside return for the patient and better odds of follow-up care. The following case demonstrates a unique scenario of an undiagnosed, purely ligamentous Lisfranc tear in a 23-year-old woman in a deployed environment with late presentation to an orthopedic surgeon stateside. Furthermore, emphasis is placed on factors that led to her delayed diagnosis and how advocating for advanced imaging modalities up-front can expedite care.

Examination of 3D sella turcica models in three species of ruminants.

Sella turcica is an important anatomical structure that contains the pituitary gland. Changes observed on the sella turcica facilitate the identification of diseases such as Down syndrome, Seckel syndrome and tuberculum sellae meningioma in humans. Therefore, studies in this region are critical for a better understanding of sella turcica. The crania of six adult male tuj sheep, five adult male hair goats and five adult male gazelles were used in the study. Cross-sectional images of the cranium were captured using computed tomography. Cross-sectional images were used to model the sella turcica region in 3D, and the region was analysed morphologically and morphometrically. It was observed in the study that fossa hypophysialis, dorsum sella and processus clinoideus caudalis were clearly observed on the sella turcica. The processus clinoideus caudalis in some animals was not split into two. In morphometric analysis, the sella turcica length and sella turcica height (rostral border) parameters were statistically significant between the groups (p < 0.05). Consequently, this study morphological and morphometric examinations were carried out on the sella turcica of different ruminant species, and the differences between the groups were discussed. This study is expected to contribute to the very limited number of related studies, taxonomy and clinical studies in this field.

Placement of ilio-sacral screws in fusionless technique for pediatric neuromuscular scoliosis utilizing planning software, in conjunction with intraoperative navigation, results in a safer optimal screw: a CT-based study.

The insertion of ilio-sacral (IS) screws for distal anchoring in the instrumentation of pediatric neuromuscular scoliosis (NS) presents a significant challenge, often leading to elevated rates of complications. Utilizing computed tomography (CT) navigation and preoperative planning technology is proposed as a potential solution to mitigate these challenges. This study aims to assess the precision of IS screw placement through CT-graphic measurements, both with and without preoperative planning, followed by navigated IS screw insertion, in pediatric neuromuscular scoliosis. Thirty-two treated patients were grouped based on surgical procedure: planned (P): 19 patients (n=38 screws) and non-planned (NP): 13 patients (n=26 screws). All screw placements (P and NP) took place under CT navigation. IS screw trajectories of P-group were drawn preoperatively on CT images with the cranial trajectory planning program and fused with the intraoperative CT images. There are several important anatomical structures that should be avoided when placing the IS screw (L5 root, spinal canal, L5S1 facet, SI joint, neurovascular structures anteriorly to the sacrum, S1 root in the S1 foramen and the intestines). Each trajectory was evaluated based on seven radiographical parameters whom we have enlisted partially based on the essentials of a good trajectory described by Miladi et al. (1: Ilium; 2: SI joint; 3: Promontorium; 4: Sacral plate; 5: Anterior sacral cortex; 6: S1 foramen; 7: Spinal canal). An independent sample T test was executed to compare both groups. The trajectories in the P group showed a significantly (P<0.05) higher overall similarity and optimality (12.1±2.1 vs 9.1±2.2 points) compared to the non-planned trajectory. Preoperative planning and navigated placement of IS screws on fusion images with intraoperative CT, results in a better trajectory of the ilio-sacral screws.

Retrospective evaluation and descriptive analysis of the prevalence of anatomical structures and variations in CBCT images before dental implant planning in a group Turkish population, part I.

The aim of this study is to emphasize the importance of using cone-beam computed-tomography in order to determine the anatomical structures and their variations before the treatment in patients who apply to the dentist clinic for implant treatment. In the study, CBCT images of 500 adult patients (240 female and 260 male), aged between 21 and 82 years, who applied for implant treatment due to missing teeth, were retrospectively analyzed. Anatomical structures and variations such as nasopalatine canal(NPC), canalis sinuosus(CS), antral alveolar artery(AAA), were evaluated in multiplanar reformation(MPR) sections which are axial, sagittal and coronal can be viewed in consistence with each other. The incidence of anatomical variation of CS in the right region was similar according to gender. The "Funnel" appearance of the NPC shape was found most common shape in both female and male patients (n = 89; 37.1% for females and n = 71; 27.3% for males). CBCT has become the most popular 3D imaging method in dental practice especially for planning dental implants. Understanding the relationship with important anatomical structures before implant applications is crucial in dealing with potential complications that may arise afterward. Assessing significant anatomical structures by CBCT and taking precautions against possible risks facilitate the work of dentists during and after procedures.

Feasibility study of a novel digital template-guided flapless extraction for maxillary palatal impacted teeth.

With the increasing maturity of 3D printing technology, the application of digital guide template in the extraction of impacted teeth has become more sophisticated. However, for maxillary palatal deeply impacted teeth, there still exist significant clinical challenges. This experiment introduces a novel digital guide template and innovatively employs a flapless technique to explore a minimally invasive approach for the extraction of palatal deeply impacted teeth. This experiment included 40 patients diagnosed with palatal completely impacted teeth, randomly divided into an experimental group and a control group. The experimental group used the new digital guide template for flapless extraction, while the control group employed the traditional freehand flap technique. The experimental group can significantly reduce the localization time of palatally impacted teeth (P < 0.001), with total surgery times of 18.15 ± 4.88min and 22.00 ± 7.71min for the experimental and control groups, respectively (P = 0.067). Although there were no significant statistical differences between the two groups in terms of intraoperative bleeding, adjacent tooth damage, infection, or damage to nearby important anatomical structures, the experimental group showed significant improvements in postoperative pain (P < 0.05), swelling (P < 0.001), and patient satisfaction (P < 0.001) compared to the control group. Compared to traditional freehand flap surgery, flapless extraction of palatally impacted teeth guided by digital templates significantly reduces the localization time of impacted teeth and demonstrates notable advantages in some postoperative complications. Future studies with larger sample sizes are needed to substantiate the feasibility of this technique.

Reconstruction of a Wrist Defect with a Distally-Based Radial Artery Perforator Flap: A Case Report

Introduction: Because of the important anatomical structures situated superficially, reconstruction of wrist soft tissue defects is challenging for the plastic surgeon. Depending on the characteristics of the defect, various reconstruction methods are commonly performed. A pedicled perforator flap stands as a valuable option providing reliable coverage of the defect while preserving the vascularity. Case report: A 35-year-old male presented with a post traumatic wrist soft tissue defect with exposure of underlying structures. Surgical debridement was performed, and the resulting defect was reconstructed with a distally-based radial artery pedicled perforator flap. Postoperative recovery was uncomplicated. Conclusion: Radial artery perforator flap proved to be a workhorse flap for soft tissue reconstruction of the wrist. It has many of the benefits of the radial forearm flap but minimizes the disadvantages.