Innervation Area Research Articles

Low-intensity laser radiation effect on young sheep growth and development

Sheep breeding is very well developed in many countries such as Australia, New Zealand, England, China, Russia, and several others. The main concern of all producers of products is to profit from this livestock industry, and they do it but often do not pay attention to environmental aspects. In this work, proposed, along with the usual zootechnical and veterinary measures, to introduce into the production process the stimulation of the biological capabilities of animals inherent in nature itself. For this purpose, we used low-intensity laser radiation, which was applied to young sheep in the thymus’ innervation area. So at four months of age were obtained increases in the live weight of rams. The experimental groups’ animals exceeded the control group’s animals by an average of 0.5 and 1.1 kg, and at seven months of age - by 0.8 and 1.3 kg, respectively, which indicates the positive effect of non-invasive laser radiation on animal organisms.

A case of Nevus of Ota treated with laser picosecond Alexandrite 755 nm: A case-report

Background: Nevus of Ota is a well-defined dermal melanocytosis characterized by bilateral multiple small, bluish-brown macules in the area innervated by the first and second branches of the trigeminal nerve. Currently, the therapeutic modalities for this condition are still limited and complete resolution is difficult to achieve.Case Description: A 23-year-old woman complained a brown spot on the right cheek since the patient was born. It looked like the skin but slightly darker than its surroundings. Four years ago the patient had received 6 sessions of QS: Nd-YAG laser therapy, but the spot is still clearly visible. Dermatological status of the orbital, infraorbital, zygomatic, and right buccal regions showed multiple hyperpigmented patches, gray-brown, well-defined, geographically in shape with size 0.2 x 0.3cm – 5 x 7cm. The lesion was unilateral and distributed within the innervation area of the second and third trigeminal nerve. Miravex® skin analysis showed that the average level of melanin was 0.464 with a melanin variation of 45%. Therefore, patient was diagnosed with Nevus of Ota. The proposed treatment was picosecond alexandrite 755nm laser, with a frequency of 2.5 Hz, pulse duration 550-750 ps, spot size 4 mm, and fluence 1.59 J/cm2. A marked improvement was observed after the treatment and after 21 days, a good grade of improvement was reported.Conclusion: Nevus of Ota can effectively treated with 755nm picosecond alexandrite laser therapy and results in a good grade of improvement.

Extracranial Non-Gasserian Ganglion Application of Radiofrequency Thermocoagulation on the Mandibular Branch of the Trigeminal through the Foramen Ovale for Trigeminal Neuralgia

Percutaneous radiofrequency ablation (RFA) of the trigeminal Gasserian ganglion via the foramen ovale is still one of the classic treatments for primary trigeminal neuralgia. However, the Gasserian ganglion is deep in the middle cranial fossa. Although it is a structure outside the brain tissue, the puncture needle must enter the encephalic to reach the Gasserian ganglion and so it is difficult to completely avoid the risk of intracranial hemorrhage and infection caused by puncture damage to intracranial blood vessels. It is not clear whether if it is possible for RFA at the extracranial non-gasserian-ganglion site via the exit of the cranial channel (foramen ovale) for patients with V3 trigeminal neuralgia (TN). Prospective, clinical research study. Department of Anesthesiology and Pain Medical Center, Jiaxing, China. One hundred and seven patients with isolated mandibular branch trigeminal neuralgia were included. Radiofrequency thermocoagulation was performed by CT-guided percutaneous puncture through the foramen ovale. The puncture target was the midpoint of the horizontal transverse diameter of the oval foramen. If the tingling sensation in the mandibular nerve innervation area could be detected, the radiofrequency thermocoagulation (90°C, 120 sec) under intravenous anesthesia would be performed. We investigated the inclination angle, puncture angle and depth, puncture operation time, intraoperative complications and short-term and long-term results after operation. After radiofrequency thermocoagulation, the pain in the mandibular branch dominant area was completely diminished in 104 patients. Two patients were cured after the second radiofrequency treatment. No intracranial hemorrhage not infection complications occurred, except for facial hematoma during operation in 21 cases. After 12-24 months of follow-up, 9 patients had recurrence and were still effective after receiving additional extracranial radiofrequency treatment. A control group should be established and more clinical data should be collected in future work. Extracranial non-Gasserian-ganglion RF can achieve satisfactory results and improve the safety of radiofrequency treatment for trigeminal neuralgia.

Chirurgická léčba benigních nádorů příušní žlázy na ORL oddělení Nemocnice České Budějovice, a.s., v letech 2014–2018

ntroduction: Salivary tumors represent a heterogeneous group of tumors of diverse location, histological structure and bio logical behavior. The purpose of this study was a retrospective evaluation of surgical treatment of a group of patients with newly dia gnosed benign tumors of the parotid salivary gland operated in the years 2014–2018 at the ENT department of Hospital České Budějovice, a.s. Material and methods: A type of surgery, defi nitive histology, postoperative complications and a number of recurrences were monitored. The data were evaluated by descriptive statistical methods. Results: A total of 190 surgeries with benign histological fi ndings in 182 patients were performed. The most common benign result was Warthin‘s tumor (90 cases, 47.4%), followed by pleomorphic adenoma (66 cases, 34.7%). Uncommon histological types of tumors were dia gnosed in 14 patients (7.4%). Non-tumorous fi ndings were found in 20 cases (10.5%). The most frequently performed procedure in 84 cases (44.2%) was extracapsular extirpation. Transient lesion in the area of innervation of the temporofacial and / or cervicofacial branch of the facial nerve was present in 34 (17.9%) patients. Permanent paresis of some of the branches of the facial nerve was reported in 2 (1.1%) patients. In 12 patients, the postoperative course was complicated by the development of salivary fi stula (6.3%). Pleomorphic adenoma relapsed after extracapsular extirpation in 5 cases (20.0%). After partial parotidectomy, one recurrence of pleomorphic adenoma (3.6%) was recorded. Warthin‘s tumor relapsed after simple extirpation in 4 cases (20.0%). Conclusion: Our evaluation results of the surgical treatment of benign parotid gland tumors lead us to make further eff orts improve the care of our patients. We see reserves mainly in the routine use of ultrasonographic examination with performance FNAC and thus planning a safe and suffi ciently radical operational solution. Keywords: parotid gland – pleomorphic adenoma – Warthin‘s tumor – parotidectomy – recurrence – facial nerve paresis – FNAC

Short-term effectiveness of free radial head reconstruction of coronoid process combined with artificial radial head replacement in treatment of complex terrible triad of elbow

To investigate the short-term effectiveness of free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation in the treatment of the complex terrible triad of the elbow. Retrospective analysis was made on the clinical data of 12 patients with complex terrible triad of the elbow treated with free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation between April 2011 and April 2018. There were 8 males and 4 females with an average age of 44.5 years (range, 26-62 years). The causes of injury included 5 cases of traffic accident, 7 cases of falling from hight. The Regan-Morrey classification of ulnar coronoid process fractures was type Ⅲ; Mason classification of radial head fractures was type Ⅲ in 7 cases and type Ⅳ in 5 cases. The time from injury to operation was 5-14 days, with an average of 6.0 days. The operation time, intraoperative blood loss, and complications were recorded. After operation, X-ray film of elbow joint was reexamined, fracture healing condition was observed, and fracture healing time was recorded. The flexion, extension, and rotation of the elbow joints on the healthy and affected sides were recorded and measured. The elbow function was evaluated according to Mayo elbow function score. The operation time was 90-140 minutes (mean, 110 minutes); the intraoperative blood loss was 100-300 mL (mean, 150 mL). None of the patients had vascular injury during the operation. One patient developed numbness in the ulnar nerve innervation area and recovered completely after symptomatic treatment for 1 week. All the 12 patients were followed up 12-22 months, with an average of 16 months. At last follow-up, the fracture healed completely, 1 patient developed ectopic ossification of elbow joint, and 2 patients developed traumatic arthritis of elbow joint. No internal fixation-related complications occurred. There was no significant difference in the range of motion of elbow flexion, extension, pronation, and supination between the affected and healthy sides ( P>0.05). The median Mayo elbow function score was 96, and the interquartile range was (94, 97), and the excellent and good rate was 91.7%. For patients with complex terrible triad of the elbow with ulna coronoid process fractures of Regan-Morrey type Ⅲ and radial head fractures of Mason type Ⅲ, Ⅳ combined with ulna olecranon fractures, the free radial head reconstruction, artificial radial head replacement, and ulna olecranon internal fixation, through active rehabilitation function exercise after operation, can achieve more satisfactory short-term effectiveness.

Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature.

The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the hip joint and the distribution of sensory receptors within its capsule. Five electronic databases were queried, with the search encompassing articles published between January 1945 and June 2019. Twenty-one original articles providing a detailed description of sensory receptors around the hip joint capsule (n=13) and its articular branches (n=8) were reviewed. The superior portions of the anterior capsule and the labrum were found to be the area of densest nociceptive innervation. Similar to the distribution of nociceptors, mechanoreceptor density was found to be higher anteriorly than posteriorly. Hip joint capsular innervation was found to consistently involve the femoral and obturator nerves, which supply the anterior capsule, and the nerve to the quadratus femoris, which supplies the posterior capsule. The femoral, obturator, and superior gluteal nerves supply articular branches to the most nociceptor-rich region of the hip capsule. The femoral and obturator nerves and the nerve to the quadratus femoris were found to consistently supply articular branches to both the anterior and posterior capsule of the hip joint. The anterior capsule, primarily supplied by the femoral and obturator nerves, and the superior labrum appear to be the primary pain generators of the hip joint, given their higher density of nociceptors and mechanoreceptors. Anatomy study, literature review.

The lumbosacral Plexus of the Barn Owl (tyto alba): Formation, branches and distribution.

The aim of the present study is to reveal the anatomical structure of lumbosacral plexus of barn owl. Six barn owls were included in the study. Nerves originating from plexus were dissected individually, and findings of innervation areas of nerves were determined. Lumbosacral plexus of barn owl was observed to be formed by ventral rami of ten synsacral spinal nerves. It was found that while the r. cutaneus femoris lateralis, the n. obturatorius, the n. coxalis cranialis, the r. cutaneus femoris medialis, the n. cutaneus femoris cranialis and the n. femoralis originated from the lumbar plexus, the n. isciofemoralis, the n. cutaneus femoris caudalis, the n. coxalis caudalis and the n. ischiadicus originated from the sacral plexus. Consequently, when the results of the study were compared with information of different avian species, it was observed that differences focused on the formation of the lumbar and sacral plexuses and innervation level of digits.

Balloon microcompression of gasserian ganglion in treatment of patients with trigeminal neuralgia

AIM: To determine the group of patients with trigeminal neuralgia for whom the balloon microcompression is the optimal treatment modality. To evaluate the effectiveness of balloon microcompression in the treatment of patients with trigeminal neuralgia.
 
 MATERIALS AND METHODS: The study included 52 patients (18 men and 34 women) with trigeminal neuralgia who were operated with the use of balloon microcompression in neurosurgical department of the Samara Regional Clinical Hospital named after V.D. Seredavin over the period from February 2012 to June 2017. The evaluation of effectiveness was carried by Visual Analogue Scale, Macnub scale, the dose tapering of anti-epileptic medicines was also taken into account.
 RESULTS: In postoperative period the decrease in pain syndrome was noticed by 48 patients (92.3%) from 90 10 to 30 10 points by Visual Analogue Scale. According to Macnub scale 29 patients (55.7%) estimated the level of treatment as good. 19 patients (36.5%) had negative emotional response due to the hypoesthesia, so the result was estimated as satisfactory. 39 patients (75%) managed to decrease the dosage of Finlepsin from 1000-1200 mg to 300-400 mg. Among them there were 8 patients (15%) who subsequently discontinued taking Finlepsin.
 CONCLUSIONS: Balloon microcompression of Gasserian ganglion is a destructive-symptomatic method that must be considered the main modality only in patients with idiopathic trigeminal neuralgia or with contraindications for operative treatment. Balloon microcompression of Gasserian ganglion is a minimally destructive treatment mode, which allows to increase the effectiveness of treatment due to the alleviation of pain paroxysm in the area of trigeminal innervation and the decrease in dosage of anti-epileptic medicine.

Iatrogenic Fracture of the Lower Jaw: A Rare Complication of Lower Molar Extraction.

Iatrogenic mandible fracture is a rare complication of a tooth extraction with an incidence between 0.0033-0.0034%. This study retrospectively analyzes a total of 8 patients who underwent lower molar extraction associated with mandible fracture during tooth removal in the period from April 2006 to March 2019. The assessed parameters were age and sex of patients, method of tooth extraction, side distribution of fracture, type of extracted tooth, the position of a lower third molar, presence of bone pathological lesion formed in connection with a tooth, displacement of bone fragments, and sensory impairment in the innervation area of the mental nerve. The position and impaction of the lower third molars were evaluated according to Pell and Gregory's classification and Winter's classification. One fracture was left-sided, and 7 fractures were right-sided. In 6 cases, Winter's extraction elevator was used. In 7 patients, the mandible fracture was treated surgically by performing stable osteosynthesis with the plates and screws. One patient was treated conservatively. This work analyzes the causes of iatrogenic mandible fractures and provides recommendations to reduce the risk of their occurrence.

Efficacy of Autologous Fat Grafting in Restoring Facial Symmetry in Linear Morphea-Associated Lesions

Morphea is a rare sclerotic autoimmune disorder primary affecting the skin and subcutaneous tissues. The linear head variants involve the facial area, with asymmetries and deformities. Eighteen patients with hemifacial deformity (age range 14–75 years) were assessed before surgery (T0), and after one (T1, 18 patients) or two (T2, six patients) surgical treatments of facial autologous fat grafting. A stereophotogrammetric reconstruction of the facial surface was obtained for each patient and a group of control subjects, and facial symmetry was quantified according to the root mean square distance between homologous areas of trigeminal innervation. Values obtained from the control subjects were used to calculate z-scores for patients. At T0, all facial thirds of the patients resulted significantly more asymmetrical than those of the control subjects (Mann–Whitney test, p < 0.05), while at T1, the symmetry of the middle facial third did not differ from that of control subjects (p = 0.263). At T2, the upper and the lower facial thirds also did not differ from the control values (p > 0.05). The faster result obtained in the facial middle third was in accord with clinical findings. In conclusion, autologous fat grafting significantly improved facial asymmetry after one (middle facial third) or two (lower and upper thirds) treatments; the outcomes were efficaciously quantified by stereophotogrammetry.

Neuronal NADPH oxidase 2 regulates growth cone guidance downstream of slit2/robo2.

NADPH oxidases (Nox) are membrane-bound multi-subunit protein complexes producing reactive oxygen species (ROS) that regulate many cellular processes. Emerging evidence suggests that Nox-derived ROS also control neuronal development and axonal outgrowth. However, whether Nox act downstream of receptors for axonal growth and guidance cues is presently unknown. To answer this question, we cultured retinal ganglion cells (RGCs) derived from zebrafish embryos and exposed these neurons to netrin-1, slit2, and brain-derived neurotrophic factor (BDNF). To test the role of Nox in cue-mediated growth and guidance, we either pharmacologically inhibited Nox or investigated neurons from mutant fish that are deficient in Nox2. We found that slit2-mediated growth cone collapse, and axonal retraction were eliminated by Nox inhibition. Though we did not see an effect of either BDNF or netrin-1 on growth rates, growth in the presence of netrin-1 was reduced by Nox inhibition. Furthermore, attractive and repulsive growth cone turning in response to gradients of BDNF, netrin-1, and slit2, respectively, were eliminated when Nox was inhibited in vitro. ROS biosensor imaging showed that slit2 treatment increased growth cone hydrogen peroxide levels via mechanisms involving Nox2 activation. We also investigated the possible relationship between Nox2 and slit2/Robo2 signaling in vivo. astray/nox2 double heterozygote larvae exhibited decreased area of tectal innervation as compared to individual heterozygotes, suggesting both Nox2 and Robo2 are required for establishment of retinotectal connections. Our results provide evidence that Nox2 acts downstream of slit2/Robo2 by mediating growth and guidance of developing zebrafish RGC neurons.

Vibratory testing with the 64 Hz Rydel-Seiffer tuning fork and its relation to the sural nerve action potential.

Despite its widespread use, little is known regarding the ability of the semi-quantitative Rydel-Seiffer tuning fork to designate peripheral nerve function. We sought to determine in a large sample of normal and abnormal nerves the relationship between vibration sense and compound sensory nerve action potential (SNAP) parameters recorded in a corresponding innervation area. Vibratory thresholds were determined on a scale of 0 to 8 with a 64 Hz Rydel-Seiffer tuning fork placed on the lateral malleolus of 303 subjects. Sural nerve sensory neurography was employed to derive SNAP parameters, which were related to vibration sense by means of multiple linear regression. ROC curve analysis was performed to determine the classification efficacy of the tuning fork in distinguishing normal from abnormal sural nerve responses. SNAP amplitude was the most significant predictor in the whole subjects group and in the subgroup of subjects with normal SNAPs, whereas conduction velocity played a major role in subjects with abnormal SNAPs. Age was significantly associated with vibration perception, particularly in subjects with normal SNAPs. With an area under the curve of 0.730, vibration sense was a fair classifier for decreased SNAP amplitudes. The optimal vibratory cutoff was 4.2. Age is a major determinant of vibratory test results, highlighting the importance of aging of central and peripheral pathways in mediating vibration sense. Hence, neurophysiological testing cannot be omitted in the context of polyneuropathy work-up, since even at the optimal cutoff threshold, vibratory examination still displays 40% false negative test results.

Description of brachial plexus of sloth (Bradypus variegatus)

ABSTRACT: The species Bradypus variegatus is known as the common sloth, an endemic mammal from neotropical regions, which has been suffering from devastating anthropogenic activities. Our study aimed to describe the brachial plexus of B. variegates, regarding the origin and distribution of nerves, through the sampling of 10 adult females. Analyses were carried out at the Anatomy Section, “Departamento de Morfologia e Fisiologia Animal”, “Universidade Federal Rural de Pernambuco”, under license no. 034/2015 of the Ethics Committee on the Use of Animals. The results determined that the brachial plexus of the common sloth starts from the fifth cervical spine segment until the second thoracic segment. This area contains the long and suprascapular thoracic nerves, which originate immediately from the medullary segment 5 and 6, respectively, and from the pectoral, subscapular, axillary, radial, musculocutaneous, medial, forearm and ulnar medial cutaneous nerves, arising from a trunk comprised of cervical spine nerves (C) 7, C8, C9, and thoracic (T) 1 and T2. Regarding other wild and domestic animals, different suggestions were observed about the origin of the plexus in B. variegatus, however, the constituent nerves and their innervation areas did not demonstrate any discrepancies.

DURATION OF BLOCKADE OF PERIPHERAL NERVES WITH LOW CONCENTRATED BUPIVACAINE SOLUTION DEPENDING OF THE ADJUVANTS

Background. In recent years, anesthesiology has shown a tendency to reduce the use of narcotic analgesics intra- and postoperatively. This is due to respiratory depression and as a result – hypoxia in the postoperative period. In addition, the use of narcotic analgesics does not allow the patient to mobilize in the early postoperative period, which in turn increases the risk of thromboembolic complications, especially in elderly patients and patients with obesity. However, withdrawal from a narcotic analgesic should not affect the patient’s postoperative comfort and pain-relief. The rapid progress in the development of regional methods of analgesia has significantly reduced the use of narcotic analgesics intra and post operatively and has provided sufficient pain relief for patients. Despite the results achieved, we continue to search for the perfect combination of local anesthetic and adjuvants to ensure long-lasting and safe analgesia.Objective. Suggest a new combination of local anesthetics and adjuvants, compare the duration of postoperative analgesia after peripheral nerve blocks with low concentration bupivacaine solution with dexamethasone and low concentration bupivacaine with dexamethasone and epinephrine. Explore the possibility of orthopedic surgery without using narcotic anesthetics.Materials and methods. Seventy peripheral nerve blocks were performed in patients undergoing orthopedic surgery at Rivne Oblast State Hospital. Patients were randomly assigned to two groups, depending on the adjuvant to the local anesthetic: Group 1 – patients whose blockade was performed with solution of bupivacaine 0,375% and dexamethasone 0,02%; Group 2 – patients whose blockade was performed with a solution of bupivacaine 0,375% with dexamethasone 0,02% and epinephrine 0,00018%. The duration of the blockade was estimated by puncturing the skin with a needle. Pain intensity was assessed at the 6th, 12th, 24th and 36th hours after blockade using a VAS scale. The amount of narcotic anesthetic used in the postoperative period were also recorded. In addition, patients underwent electromyography of the innervation area of the blocked nerve before the surgery and 24 and 36 hours after surgery.Results. The duration of blockade in Group 2 was longer by 10 hours, the intensity of pain (VAS) was significantly higher after 24 hours (1.65 ± 1.35 in Group 2 and 5.3 ± 1.26 in Group 1). According to electromyography, 24 hours after the blockade conductance in Group 1 was restored by 95-100%, unlike Group 2, where conductivity was restored by only 47-59%.Conclusions. The proposed combination of local anesthetics and adjuvants provides both adequate anesthesia during surgery and prolonged post-operative analgesia.

Clinical Outcomes of Atlantoaxial Dislocation Combined with Osteoporosis Using Posterior Atlantoaxial Rod, Screw Fixation, and Posterior Interfacet Fusion: A Retrospective Study of 21 Cases.

BackgroundSurgical procedures on atlantoaxial dislocation combined with osteoporosis remain controversial. This study was established to assess the mid-term clinical outcomes of atlantoaxial dislocation combined with osteoporosis using posterior atlantoaxial rod, screw fixation and posterior interfacet fusion.Material/MethodsFrom January 2017 to January 2020, 21 patients (4 males and 17 females) with coexisting atlantoaxial dislocation and osteoporosis who underwent posterior atlantoaxial rod and screw fixation were included in our study with an average age of 64±8.1 years (range, 57–74 years). The subjective and objective symptoms, together with the neurological function of the patients were measured. Radiography and magnetic resonance imaging (MRI) were performed, Japanese Orthopaedic Association (JOA) score for spinal cord function and VAS score for pain recovery was assessed.ResultsJOA and visual analog scale (VAS) score were significantly improved at 14±5.9 month follow-up compared with pretreatment values. Complete or almost complete anatomical reduction was observed in all 21 patients. All patients had good bony fusion at the final follow-up. No screw-loosening or atlantoaxial redislocation occurred in 21 cases. The only complication was mild numbness in the C2 innervation area of the posterior occipital region in 6 cases, which had no effect on life.ConclusionsThe results suggested that posterior atlantoaxial rod, screw fixation system, and posterior interfacet fusion could achieve satisfactory initial results for the treatment of atlantoaxial dislocation combined with osteoporosis.

SENSITIVITIES OF THE ELECTRODIAGNOSTIC TESTS IN IDIOPATHIC MILD CARPAL TUNNEL SYNDROME

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The diagnosis is based on the history, clinical signs and symptoms of the patient, but electrodiagnostic studies are done to confirm the diagnosis and to manage the treatment. This study aimed to assess sensitivities of clinical symptoms, provocative tests and electrodiagnostic studies (EDS) in patients with idiopathic mild CTS.MATERIAL AND METHODS:The study included 90 hands of 75 patients with idiopathic mild CTS and 30 hands of 15 healthy volunteers. The patients were questioned for symptoms in the innervation area of the median nerve such as pain, paresthesia, weakness in the hand and numbness and pain worsening at night, relief from the symptoms by shaking hands. Tinel and Phalen tests were done. The EDS included; motor, mixed and sensorial (digits 1-2-3-4 and palm) nerve conduction studies (NCS) for median nerve; motor, mixed and sensorial (fifth digit) NCS for ulnar nerve, sensorial NCS (first digit) for radial nerve, median and ulnar F waves. The values for distal latency and nerve conduction velocity (NCV) were calculated for all studied nerves. Sensitivities of median sensory distal latency and NCV to digits 1,2,3,4 and palm-wrist segments and sensitivities of the following comparative tests were detected; median-radial sensory distal latency difference (SDLD) to the first digit, median-ulnar SDLD to the fourth digit, median-ulnar SDLD to the digits 2-5, 3-5, 4-5 and median-ulnar F latency difference.RESULTS: The most common symptoms in patients with idiopathic mild CTS were paresthesia (95.6%) and nocturnal numbness (88.8%). The sensitivity of Phalen’s and Tinel’s tests were 67.8% and 56.7%, respectively. Among the EDS, first digit and palm-wrist sensorial NCV were the most sensitive tests (98.9%). Of the comparative tests, median-ulnar SDLD to digits 4-5 was the most sensitive one (93.3%). Median-ulnar F latency difference had the lowest sensitivity (38.9%).CONCLUSIONS: The most sensitive EDS were first digit and palm-wrist sensorial NCV. Median-ulnar SDLD to digits 4-5 was more sensitive than the other tests. With use of these tests, the diagnostic sensitivity of EDS may be increased in patients with mild CTS.

Branching Patterns of Mental Nerve in Newborns.

In classical textbooks of Anatomy, the mental nerve is considered to be the terminal or main branch of the inferior alveolar nerve, especially trifurcate with no designated names as soon as it emerges from the mental foramen. The textbooks define the innervation area of the mental nerve regionally without naming its terminal branches. Nomina Anatomica designates 3 terminal branches of mental nerve as "labial, gingival, and mental branch" but offers no description about their distribution on the mandible. In the present study, bilateral dissections were performed on the lower lip specimens of 20 newborns for 40 mental nerves to determine the branching types of mental nerve. Although anatomy textbooks indicate that mental nerve divides into 3 branches, the authors noted that mental nerve branched into 1, 2, or 3 branches at or right after its exit from the mental foramen. Branching patterns were typed in 13 different subclasses under 3 main groups (Form I-II-III). Moreover, the branching patterns that could not be included in one of these 3 main groups were defined as "Complex Form." The most common type of branching that the authors observed was Form II, which had 2 terminal branches with an incidence of 41.9% (16 specimens). The next frequently encountered type was Form III, having 3 terminal branches, and it was detected in 32.0% of patients (12 specimens). The least common form was Form I, which had 1 terminal branch with a frequency of 15.8% (6 specimens). The unclassified group, Complex Form, was found 10.5% (4 specimens).

Hollow screw in treatment of basilar part fracture of hamate hook

To explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook. Five patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness. All the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] ( t=0.094, P=0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] ( t=18.108, P=0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case. For the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.

Percutaneous Isthmus Foraminoplasty and Full-Endoscopic Lumbar Discectomy for Very Highly Upmigrated Lumbar Disc Herniation: Technique Notes and 2 Years Follow-Up

To report the technical notes and clinical outcome of percutaneous isthmus foraminoplasty and full-endoscopic lumbar discectomy (PIF-FELD) for the treatment of very highly upmigrated lumbar disc herniation (VHUM-LDH). From January 2014 to December 2017, 16 patients with VHUM-LDH underwent PIF-FELD surgery. A 10-mm-diameter semi-open foraminoplasty was performed on the dorsal side of the upper intervertebral foramen with lateral isthmus resection by a safe trephine system, in which the facet joint was not injured. Full-endoscopic transforaminal fragmentectomy in the spinal canal and discectomy in the intervertebral space were performed simultaneously. Magnetic resonance imaging of the lumbar spine was reexamined on the second day and 3 months after the operation to evaluate the completeness of the disc fragmentectomy and nerve decompression. The patients were followed up on the visual analog scale (VAS) of lumbar pain and leg pain and Oswestry Disability Index on the second day, 3 months, 6 months, 1 year, and 2 years after operation. The MacNab score and nerve root function recovery were evaluated at 2 years postoperative follow-up. All operations were successfully completed without any change in the surgical method. During the operation, 5 patients were found to have a single sequestered fragment, and the remaining 11 patients had multiple sequestered fragments. There were no complications (e.g., dural tear and nerve injury) during the operation, and no complications (e.g., infection, cerebrospinal fluid leakage, exacerbation of nerve root function injury, and recurrence of intervertebral disc herniation) occurred. Postoperative reexamination of lumbar magnetic resonance imaging in all patients showed complete disc fragmentectomy and adequate nerve decompression. The postoperative low back pain VAS and leg pain VAS scores and Oswestry Disability Index on the second day, 3 months, 6 months, 1 year, and 2 years after operation were significantly improved compared with preoperatively (P < 0.01). At 2 years follow-up, the sensation and muscular strength of the affected nerve root innervation area were significantly restored (P < 0.05), but tendon reflex function was not significantly restored (P > 0.05). At 2 years follow-up, MacNab scores included 6 excellent, 9 good, and 1 fair. PIF-FELD is a safe and effective minimally invasive spine surgery technique for VHUM-LDH.

Hybrid percutaneous technique guided by ultrasound and fluoroscopy: anatomical bases for sensitive glenohumeral joint neuroablative denervation

IntroductionSince John Hilton (1873), an anatomist physician and British surgeon, joint sensitive innervation had been studied. Understanding this anatomy allows neuroablative joint denervation (NJD) through percutaneous access to the treatment of joint pain in cases of osteoarthritis and shoulder capsulitis, for examples. The shoulder has a rich sensory innervation from mixed nerves, with motor components. Thus, for the NJD the approach should be guided to the sensitive branches of the nerves, avoiding motor sequelae. Suprascapular (SSN), axillary (AN) and lateral pectoral (PLN) nerves are responsible for 98% of sensory innervation of the glenohumeral joint, then represent the most important anatomical target in NDJ procedure.ObjectiveThe aim of this study is to show the anatomical and radiological landmarks for NDJ procedure.Method Dissection of SSN, AN and PLN nerves sensitive branches. Definition of anatomical landmarks of SSN, AN and PLN nerves sensitive branches, by fluoroscopy (FC) and ultrasound (US). NJD was performed on the glenohumeral joint of 8 patients, by cooled radiofrequency (CRF), through percutaneous anatomical accesses using hybrid technique, guided by US and the positioning of the cannulas by bone anatomical references were confirmed by FC. The 8 patients presented joint pain without muscle or tendinous components and without indication of surgical therapy. The visual analogue scale (VAS) and shoulder disability index test were applied before and after the procedure during 6 months. (Figure 1, 2)ResultsThe dissection of SSN, AN and PLN nerves sensitive branches showed the anatomical topography of the sensitive area of the glenohumeral joint innervation. Those anatomical information supported the NDJ procedure in all the 8 patients, were performed feasible and safely, using the hybrid technique (FC and US).Discussion and ConclusionSupported by the anatomical results, the steps of the NDJ procedure were established. The SSN, after passing through the spinoglenoid notch, sends laterally articular sensory branches. Thus, guided by US, the needle tip was placed at the lateral extreme point from the glenoid notch without joint or labrum injury. The AN sends sensory branches after passing through the greater tuberosity inferior margin of the humerus, accessed by US locating the tip of the needle cranially to the posterior humeral circumflex artery and touching the humerus laterally. The PLN sensitive branches go through the caudal and lateral region of the coracoid process, and this area is identified for US guided cannula position. After the cannulas were located, their position was checked by FC, using the bone as reference, and some adjustments could be performed, if necessary. Sensory innervation was properly accessed and NJD procedure was performed without motor innervation damages. Knowledge of anatomical landmarks recognized by dissection or by radiographic or dynamic images such as ultrasound, when combined, can present themselves as tools that contribute to increasing the effectiveness and safety of clinical procedures.Support or Funding Information www.mobissom.com.brA, B, C, D ‐ Suprascapular nerve (SSN); E, F, G, H – Axillary nerve (AN); I, J, K ‐ Lateral pectoral nerve (PL). C, G, J – Ultrasound; D, H, K ‐ Fluoroscopy.1. SSN; 2. M. Infraspinatus1. SSN; 3. Fossa supraspinata; 4. Fossa infraspinataYellow arrow – SSNE. 1. AN (anterior view)F. 1. AN (posterior view); 2. Sensitive branch of ANG. Yellow arrow – NAI. 1. M. pectoralis major; 2. M. pectoralis minor; 3. PL; 4. Sensitive branch of PL.J. Yellow arrow – PLFigure 1Ultrasound.Figure 2