Lower Border Research Articles

DESMOPLASTIC FIBROMA OF THE MANDIBLE: A RARECASE REPORT AND REVIEW OF THE LITERATURE

Objectives: The desmoplastic fibroma (DF) is a rare, benign, diffuse, infiltrative proliferation of fibroblasts and mature collagen that typically occurs in the first three decades of life. Jaffe first outlined it in 1958.The mandible represents the fourth most affected site, and mandibular (84%) posterior location is favored. The clinical, radiological and histological presentation of desmoplastic fibroma can resemble various other jawbone lesions. The most common treatment for desmoplastic fibroma is block resection or wide local excision, a follow up period of 3 years is recommended. Case Report: A 12-year-old male applied to our clinic with an expanding swelling at the anterior of his mandible. The patient had a stable medical history. Extraoral examination revealed a slight expansion of the right anterior border of the mandible. Intraoral swelling resembled a hard bony texture and there was no inflammation noted. A panoramic radiograph indicated periost reaction at the lower border of the mandible and radiolucent lesion. Incisional biopsy taken. Microscopic examination pointed DF. Treatment option was marginal resection due to aggressive behavior of DP. Resection included 3 mm of healthy bone tissue around the lesion. No recurrencies was observed after 3-and 6-month follow-ups and will be followed for several years. Conclusion: The purpose of this case report is to examine the diagnosis and treatment approaches for desmoid tumors in the maxillofacial region, a condition with very few cases reported so far, in the context of existing literature.

Correlations Between the Pterygomaxillary Junction and Appropriate Osteotome Placement Angles During Junction Separation in Le Fort I Osteotomy.

The authors evaluated pterygomaxillary junction angles across malocclusion patterns and identified the optimal technique for effective pterygomaxillary junction separation during Le Fort I osteotomy, focusing on appropriate osteotome angles and clinical applications. This retrospective study included 211 patients with malocclusion who had undergone Le Fort I osteotomy at Chang Gung Craniofacial Center between December 2015 and September 2023. The patients were stratified by sex and malocclusion class (class I, II, or III). Preoperative cone-beam computed tomography was performed to measure pterygomaxillary junction angles at 2 axial levels: the posterior nasal spine level and the lower border level corresponding to the maxillary tuberosity. Le Fort I osteotomy involving an angle oscillating saw, and a curved-tip Dautrey osteotome was performed, ensuring the precise placement of the osteotome and tilting of the osteotome handle during pterygomaxillary junction separation. The correlations between the pterygomaxillary junction and appropriate osteotome placement angles were investigated. Among the 211 patients, 5%, 15%, and 80% had class I, class II, and class III malocclusion, respectively. At the posterior nasal spine level, the average angles of the pterygomaxillary junction relative to the coronal plane were 16.76, 19.16, and 17.82 degrees in class I, class II, and class III groups, respectively; the corresponding angles at the lower border level were 27.29, 27.80, and 25.91 degrees. No significant between-class or between-sex differences were observed in pterygomaxillary junction angles; however, significant differences were noted between the 2 levels. Our surgical technique was both safe and effective for pterygomaxillary junction separation.

Organs in plain sight-parotid gland doses in short-course palliative whole-brain radiotherapy.

Palliative whole-brain radiotherapy (WBRT) is a useful treatment modality for patients diagnosed with brain metastasis. Our study aimed to document parotid doses using a short course of 20 Gy in five fractions (SC-WBRT) and compare them with the known xerostomia parameters. We retrieved dosimetric parameters for 59 patients who received SC-WBRT. The contouring of parotids was done retrospectively. The data was stratified depending on the lower edge of the planning target volume (PTV) border, up to either the first cervical vertebra (C1) or the second cervical vertebra (C2). The biologically effective dose (BED) of the parotid dose constraints from the literature was calculated and corrected to obtain the dose for a five-fraction treatment. These were used as a reference for assessing the parotid doses of our cohort. With SC-WBRT, the mean doses of either gland (11.46 Gy) and of total parotids (11.48 Gy) were statistically significantly less than the BED corrected constraints of 12.82 Gy (p < 0.01) and 15.31 Gy (p < 0.01). Patients with PTV to C1, compared to those with a PTV to C2, had significantly lower mean doses of either gland (9.44 Gy vs 12.76 Gy, p < 0.01) and total parotid dose (9.44 Gy vs 12.78 Gy, p < 0.01). Patients with PTV to C1 had doses significantly lower than all the reference dose parameters. Routine delineation and documentation of parotid dosimetry would enable parotid sparing, irrespective of the dose regimen used. SC-WBRT provides better parotid sparing dosimetrically which may reduce the related toxicities even in palliative settings. Limiting the lower border of the PTV to C1 will further decrease the parotid doses.

Positioning of the Inferior Alveolar Nerve and Surgical Implications: A Study on Thai Mandibles.

The inferior alveolar nerve (IAN), a crucial branch of the trigeminal nerve, innervates the mandible. Precise knowledge of IAN positioning ensures surgical safety. This cross-sectional study analyzed head and neck computed tomography scans from Maharaj Nakorn Chiang Mai Hospital. Inclusion criteria comprised dentate adults. Exclusion criteria included mandibular trauma/pathology or prior surgery. The study aimed to determine IAN positioning relative to key surgical landmarks: the first molar, lingula, and mental foramen. A total of 450 Thai mandibles (900 hemimandibles) with a mean age of 36 years (58.2% male) were included. No significant differences were observed in IAN positioning relative to the first molar between the left and right sides in superior and inferior landmarks. However, the buccal distance was significantly closer on the left. The lingula distance was higher on the left, whereas that to the mental foramen was lower. Surgical implications suggest maintaining a 15-mm distance from the lower mandibular border during osteotomy and upper plate placement, restricting horizontal cuts within this 15-mm range from the lingula, and ensuring screws do not extend more than 7 mm from the buccal surface. This study provides valuable guidance for minimizing the risk of iatrogenic injury to the IAN.

Agroforestry-Silvopastoral Systems Suitability for the Plateau Landforms: Devrekani Plateau (Northern Turkiye)

The Devrekani Plateau, located in the Kure Mountains massif (Kastamonu-Türkiye), is a geomorphological unit with flat areas ranging between 1000 and 1300 meters in altitude. Agriculture, animal husbandry, and forestry activities are standard on the plateau. Due to environmental constraints, versatile, holistic, and sustainable land use plans are needed in such high areas. This study examines land use patterns compatible with natural environmental conditions for the Plateau Landforms. Agroforestry-silvopastoral systems where agriculture, pasture, forest lands, and recreational functions are applied together have been evaluated in the study area. Criteria that have a high relationship with land use have been identified. Using Geographic Information Systems, weighted overlay analysis was carried out with factor maps regarding Lithology, Slope, Elevation, and Actual Land Use. The model output reveals that the regions between agriculture and forest are the most suitable for the agroforestry-silvopastoral systems (outside urban areas) and recreation. The most suitable areas for mixed land use plans on the plateau are generally karst areas with sparse vegetation, located above 1200 meters, and having a 6-12% slope. The lower border of these areas is agricultural areas with flat or nearly flat slopes, commonly formed by alluviums. The upper limit consists of forest areas with steep slopes surrounded by high hills. Implementing agroforestry-silvopastoral land use models on plateau landforms can be an effective strategy for sustainable environmental management and land use.

Agroforestry-Silvopastoral Systems Suitability for the Plateau Landforms: Devrekani Plateau (Northern Turkiye)

The Devrekani Plateau, located in the Kure Mountains massif (Kastamonu-Türkiye), is a geomorphological unit with flat areas ranging between 1000 and 1300 meters in altitude. Agriculture, animal husbandry, and forestry activities are standard on the plateau. Due to environmental constraints, versatile, holistic, and sustainable land use plans are needed in such high areas. This study examines land use patterns compatible with natural environmental conditions for the Plateau Landforms. Agroforestry-silvopastoral systems where agriculture, pasture, forest lands, and recreational functions are applied together have been evaluated in the study area. Criteria that have a high relationship with land use have been identified. Using Geographic Information Systems, weighted overlay analysis was carried out with factor maps regarding Lithology, Slope, Elevation, and Actual Land Use. The model output reveals that the regions between agriculture and forest are the most suitable for the agroforestry-silvopastoral systems (outside urban areas) and recreation. The most suitable areas for mixed land use plans on the plateau are generally karst areas with sparse vegetation, located above 1200 meters, and having a 6-12% slope. The lower border of these areas is agricultural areas with flat or nearly flat slopes, commonly formed by alluviums. The upper limit consists of forest areas with steep slopes surrounded by high hills. Implementing agroforestry-silvopastoral land use models on plateau landforms can be an effective strategy for sustainable environmental management and land use.

Morphometric Study of the Larynx: A Cadaveric Study in Sri Lanka

Introduction: Morphometric data of the larynx are important for the diagnosis and treatment of laryngeal disorders, as they provide crucial information for various medical procedures and for surgeries. These measurements are fundamental in the development of biomechanical models of larynx. Objectives: To describe the detailed morphometry of adult human larynx and its variations. Methods: The study was performed on 11 larynges, from 6 male and 5 female cadavers older than 40 years, with no history of laryngeal pathology, neck trauma, or neck surgery. Specific external and internal measurements of the larynx were recorded using a digital vernier caliper with an accuracy of 0.1 mm. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Results: The mean values of external and internal dimensions of the larynx were higher in males than of females, except for the length from the lower border of thyroid cartilage to the upper border of cricoid cartilage (L6) and the length of the sinus. The difference was statistically significant only for the length from floor of thyroid notch to lower border of cricoid cartilage (L3), width of thyroid cartilage (L7), length from floor of thyroid notch to projection of anterior commissure (L8) and length of infraglottic cavity. Although, bilateral asymmetry was present in majority of specimens, there was no statistically significant difference between measurements on left and right sides of bilateral structures (vestibular, vocal, and aryepiglottic folds). Conclusion: There was a wide individual variation in both external and internal dimensions of the larynx, with males having generally higher values compared to females. This knowledge can be integrated on laryngeal morphometry into clinical and surgical practices, as well as into the design of advanced biomechanical models to achieve better patient care and innovative treatment solutions.

Laparoscopic total pancreatectomy with total mesopancreas dissection using counterclockwise technique and tail-first approach.

Laparoscopic total pancreatectomy (LTP) is technically challenging and infrequently documented in the literature. In this paper, we present a new approach for performing fully LTP, a pancreatic tail-first approach with a counterclockwise technique, to accomplish total mesopancreas dissection and standard lymphadenectomy en bloc. Firstly, the tail and body of the pancreas without the spleen were dissected retrogradely, starting from the lower border of the body of pancreas and then from left to right. After that, a counterclockwise dissection of the tail and body of the pancreas was performed. The splenic artery and vein were divided at the terminal end of the pancreatic tail. The spleen was preserved. The entire body and tail of the pancreas were then pulled to the right side. This maneuver facilitated the isolation and dissection of arteries in the retropancreatic region more easily via laparoscopy, including the splenic artery, gastroduodenal artery, and supporting superior mesenteric artery first-approach. It also enabled total mesopancreas dissection. The inferior pancreaticoduodenal artery was resected last during this phase. The remainder of the dissection was like that of a laparoscopic pancreaticoduodenectomy with total mesopancreas dissection, involving two laparoscopic manual anastomoses. The operative time was 490 minutes and the total blood loss was 100 mL. Pathology revealed a low-grade intraductal papillary mucinous neoplasm extending from the head to the tail of the pancreas.

Morphometry of left atrial appendage isthmus and mitral isthmus: implications for atrial fibrillation catheter ablation.

Radiofrequency catheter ablation (RFA) targets the left atrial appendage isthmus (LAA isthmus) and mitral isthmus for treatment of atrial fibrillation. However, proximity of left circumflex artery (LCxA) and great cardiac vein (GCV) in the isthmuses poses fatal risks during ablation. This study investigated relationships of LCxA and GCV across three lines in the LAA and mitral isthmus, using 15 human cadaveric hearts. Distances between the vessels and the endocardium, myocardium, and perivascular fat thickness were measured. The results showed that LCxA was mostly consistently located in lower atrial segments and GCV was in lower/upper atrial segments, with change of course mainly observed in the middle of the LAA. The LCxA was found as close as 3-5 mm from the lower border of the LAA isthmus in 80% of specimens, at a depth of 2-3 mm within the LAA isthmus, where 1 mm consisted of myocardium and the remainder was fat, which may not provide adequate protection due to the possibility of liquefaction of fat with heat application. The effective myocardial thickness was consistently 1 mm across all cases in both isthmuses. LCxA was 2 mm in second and third sections of LAA isthmus ("careful segment"). LCxA distances from left inferior pulmonary vein opening was 5 to 12 mm, occasionally dangerously close as <1 mm in 16% of cases. This study measured LCxA and GCV in the LAA and mitral isthmus across three lines for the first time in the Indian population, aiding surgeons in RFA planning.

Social terminology in “Traité de la Noblesse” by Gilles-André La Roque de La Lontière (1678)

The “Traité de la noblesse” by Gilles-André de La Rocque de La Lontière is an example of the treatises on nobility that were prevalent in early modern Europe. The author, a renowned French genealogist, heraldist, and royal historiographer, presented his work as a comprehensive summary and conclusion on the issues surrounding nobility in French society. Although Larocque’s voluminous treatise has been referenced by researchers of the French nobility, it has not been the subject of in-depth investigation by Russian historians. This paper aims to address this gap in the historical literature by analysing the major problems outlined in the treatise and the social terminology used by Larocque as a reflection of the process of defining the boundaries of the noble estate in early modern France. The close subject and epistemic connection between the nobiliary discourse and the French erudite intellectual current is demonstrated. The process of closure of the nobility that took place at that time required the delineation of the boundary between the nobility and the roturiers. In this regard, the internal structure of the French nobility was of little interest to La Rocque, who focused on clarifying its lower border. He provides a detailed account of the terms used to define the borderline between the lower levels of nobility. Larocque addresses the controversial question of the dignity of the old and new nobility, concluding that they are equivalent.

Prevalence Of Metabolic Syndrome In Vitiligo: A Cross-sectional Study

Introduction Vitiligo is a common acquired hypomelanotic disorder of the skin and is characterized by depigmented macules and patches that can appear anywhere on the skin. In pathogenesis, the researchers have suggested an interplay of multiple factors such as genetic, neural, oxidant-antioxidant, biochemical, minerals, and autoimmune processes in the induction of vitiligo. Metabolic syndrome (MetS), also known as Syndrome X is a pathological condition typically characterized by the combination of various interrelated metabolic disorders that include abdominal obesity, impaired glucose tolerance, dyslipidemia, and hypertension. The linkage of skin diseases and MetS is due to ongoing chronic inflammation due to elevated pro-inflammatory cytokines, imbalance between reactive oxygen species and antioxidants, and hormonal abnormalities mostly insulin resistance. Methodology This cross-sectional study included patients diagnosed with vitiligo and above 16 years of age. All the patients were sent for analysis of fasting lipid profile and fasting blood glucose level. The waist circumference was measured at the mid-point between the lower border of the rib cage and the iliac crest with a flexible inch tape. The blood pressure was taken in a sitting posture after 10 minutes of rest. The data was collected using a preformed proforma. Results Of the 70 patients, the majority (N=38) were male. The mean age was 37 years with a range from 16 to 79 years. The mean age of male patients was 39.87 ± 17.24 years and female patients was 33.59 ± 13.58 years. The most common clinical type of vitiligo was generalized vitiligo (48.6%) followed by focal (18.6%) and segmental (15.7%). The metabolic syndrome was present in 26 patients (37.1%). The patient with generalized vitiligo had maximum prevalence (n=10) followed by acrofacial vitiligo (n=6). Conclusion This study found a high prevalence of metabolic syndrome and its components in patients with vitiligo. Therefore, vitiligo patients need to be screened for metabolic syndrome to prevent unforeseen complications.

Effect of thermal radiation and inclined magnetic field on thermosolutal mixed convection in a partially active wavy trapezoidal enclosure filled with hybrid nanofluid

This work focuses on the examination of the magneto-thermosolutal convection in a lid-driven wavy trapezoidal enclosure in the presence of thermal radiation. The wavy cavity is filled with radiative Fe3O4-Cu-H2O hybrid nanoliquid. In this work, two cases are considered depending on the location of heat and concentration sources. A portion of the vertical walls are kept hot and in high concentration while the remaining parts are in adiabatic condition. The adiabatic flat upper lid is moving towards the right with equal speed. In addition, the lower wavy border is cold and low concentration. The governing Navier–Stokes equations are modeled to describe thermosolutal phenomena within the wavy enclosure. These equations are solved by reconstructing a recently developed compact scheme. Computed outcomes are presented in terms of streamlines, isotherms, iso-concentrations, average Nusselt and Sherwood numbers to evoke the thermosolutal phenomena for various physical parameters. Also, computing in-house code is validated with the published numerical and experimental and literatures. This investigation surveys the roles of several well-defined parameters such as Richardson number (Ri), Lewis number (Le), Buoyancy ratio number (N), Radiation parameter (Rd), Hartmann number (Ha), inclination of angle (γ), undulation of the wavy surface (d) and solid volume fraction (ϕhnp) of the hybrid nanofluid. An increase in the Lewis number (Le) enhances species diffusion within the system but diminishes thermal transport. This work reveal that a change in ϕhnp from 0% to 4%, heat transfer is upgraded up to 4.28% in Case I and 3.93% in Case II while mass transfer is declined by 2.24% in Case I and 1.60% in Case II. Results indicate that Case I performed better than Case II in the case of energy and solutal transfer. This work has many practical applications such as heat exchangers, electronic device cooling, food processing and porous industrial processes.

Assessment of the mandibular incisive and mental canal in dentate and edentulous mandibles using cone-beam computed tomography

ObjectivesThis study evaluated the prevalence, diameter and location of the mandibular incisive canal (MIC) and the transition pattern and anterior loop length (ALL) of the mental canal and compared these values between dentate and edentulous mandibles. MethodsA total of 187 cone-beam computed tomography (CBCT) images of mandibles, namely, 100 images of dentate mandibles and 87 images of edentulous mandibles, were obtained. CBCT data related to the incisive canal and mental canal were analyzed by one examiner. ResultsThe prevalence of the MIC was 75∼78 %, showing no difference based on laterality or the presence of teeth. The ALL significantly differed depending on the presence of teeth as well as sex. The presence of teeth affected the size of the MIC in the female group, and the diameter of the MIC in the edentulous group was significantly narrower than that in the dentate group. The diameter of the MIC was significantly greater in males than in females in the edentulous group. Meanwhile, the location of the MIC in the male group depended on the presence of teeth at each measuring point, and the MIC was significantly closer to the lower border of the mandible in the female group than in the male group at all measuring points except at 0 mm. ConclusionsThis study indicated that the presence of teeth significantly affects the type of transition of the mental canal, the ALL, and the diameter and location of the MIC. Additionally, sex could be a factor affecting MIC location, MIC diameter and anterior loop length.

Does the modified inferior border osteotomy improve the surgical outcomes in bilateral sagittal split osteotomy?

BackgroundTo investigate the effect of lower border osteotomy on the lingual split pattern and IAN in BSSO procedures. Materials and MethodsThe study comprised 32 patients (64 operated sides) who underwent bilateral sagittal split osteotomy (BSSO) due to dentofacial abnormalities between the periods of April 2021 and April 2022. In the mandible, 32 sides (the conventional group) received standard BSSO surgery, while 32 sides (the modified group) additionally received lower border osteotomy. Data regarding the split difficulty of the mandibular in BSSO surgery and the recovery status of the inferior alveolar nerve (IAN) one year after surgery were obtained and evaluated from patient records. The fracture line was radiographically evaluated for the lingual split pattern following surgery. ResultsA statistically significant difference was observed in favor of the modified group when the mandibular split difficulty of the groups was compared (p = 0.032). The split time of the modified group was found to be statistically shorter than the conventional group (p ≤ 0.001). The mean numbness level of the modified group one year after surgery was statistically significantly lower than that of the conventional group (p = 0.019). Although there was no statistically significant difference between the two groups in terms of lingual fracture pattern, the rate of type 1 (87.5 %) fracture was higher in the modified group compared to the other group (68.8 %) (p = 0.089). ConclusionThe lower border osteotomy performed in addition to the conventional BSSO surgery allows the split procedure easier and in a shorter time. The modification resulted in an increased incidence of type 1 lingual fracture pattern in the mandible. The neurosensory recovery capacity of the IAN in the postoperative period is higher in areas where lower-border osteotomies are performed.

Evaluation of the Vertical Loop of the Inferior Alveolar Nerve at the Mental Foramen Region - A Retrospective Study

Abstract Introduction: The objective of this study was to assess the vertical loop of the inferior alveolar nerve (IAN) at the mental foramen region by measuring the vertical height of the loop from the lower border of the IAN canal to that of the lower border of the mental foramen using cone-beam computed tomography (CBCT) scan. Materials and Methods: A retrospective study was conducted using CBCT scans of 541 patients aged 18 years and above from March 2015 to March 2022. These scans were analysed to determine the height of the vertical loop of IAN at the mental foramen. Results: Statistically significant value was obtained, with the highest value being 11.6 mm and a mean value of 3.81 mm. The right-side vertical loop of IAN at the mental foramen region was significantly higher in males (3.92 ± 1.78) than in females (3.59 ± 1.42). Statistically significant results were obtained on both sides amongst the different age groups. Discussion: The vertical loop at the mental foramen region is considered to be significant for planning and performing various oral and maxillofacial surgical procedures. A CBCT is a must, but in its absence, a safety zone of 7–10 mm is to be allowed to prevent inadvertent nerve damage.

Clinical Diagnosis of Esophageal Dysphagia Using Transnasal Esophagoscopy: A Case Report.

The aim of the present study was three folds; (i) to correlate clinical case history with objective findings of a client presented with sternal discomfort along with odynophagia; (ii) to evaluate the cause for retrosternal discomfort using Functional Esophagoscopy (FE); and (iii) to reaffirm the Cook's (2008) algorithm for clinical diagnosis of esophageal dysphagia in single sitting using Transnasal Esophagoscopy (TNE). A 72 years old male (named 'G') visited a tertiary health care hospital with a complaint of imbalance for past 2 months. Also, had a complaint of pain while swallowing for the past 15 days along with left arm weakness (for past 2 days) and got admitted for treatment. Pertaining to swallowing, a detailed case history was taken and Fiber-optic endoscopic evaluation of swallowing (FEES) was performed to evaluate swallowing safety functions using digital swallowing workstation (KAYPENTAX, New Jersy, USA). A large growth was noticed in the lower border of esophagous using TNE in this patient. The oral, oro-pharyngeal, and pharyngeal phase of swallowing was intact. Esophageal phase of swallowing revealed reduced peristaltic movement including a mass lesion observed in client 'G' from TNE procedure. Clinical correlation of objective findings in this client corroborated well with history. Visualization studies including TNE can be used safely, comfortably in OPD basis without any anesthesia would be few advantages of TNE procedure. Even lesions at lower end of esophagus can be detected using TNE and it is concluded that the symptom retro-sternal discomfort might be clinically correlated with history and objectively determined by TNE procedure as esophageal dysphagia due to structural lesion. Also, algorithm of Cook's (2008) guides the investigation procedure quickly in a single sitting. Therefore, clinical history about patient is imperative that accurately guides further in terms of patient's care for assessment and treatment.

EVALUATION OF THE RELATIONSHIP OF CURVE OF SPEE WITH DENTOSKELETAL MORPHOLOGY IN SAGITTAL MALOCCLUSIONS

Curve of Spee is defined as the line on a cylinder which is tangent to incisal edges of lower anteriors, occlusal surface of lower second molar and anterior border of condyle. The aim of the study is to determine whether there is a relationship between curve of Spee and craniofacial morphology in different sagittal malocclusions and to determine the influence of craniofacial morphological features in different sagittal malocclusions on curve of Spee. The research consists in the analysis of lateral cephalograms and study models of 90 patients, age 15-25 years which includes skeletal class I, class II and skeletal class III. Patients are divided into three groups: group A-flat curve of Spee i.e. &lt; 2mm, group B - normal curve of Spee i.e. 2-3 mm, and group C - deep curve of Spee i.e. &gt;3mm. In the literature, there is little data on research that has been done on this topic, on the other hand, in our daily work as orthodontists, we encounter the problem of leveling the deep bite.

Template for positioning miniplates (PUNPLAPOT-M) on mandibular symphysis: Novel innovation

Purpose: This study was conducted to check the efficacy of PUNPLAPOT-innovative Template for positioning of the bone miniplate for fracture fixation. Material and Methods: Twenty dried mandible specimens were used in this study. The specimens were then divided into two groups using random sampling. Each group consisted of ten mandibles each. The mandibles were fractured in mandibular symphysis region. Study group mandibles were subjected to fixation using 2.5 mm titanium miniplate using PUNPLAPOT plate positioning template. Control group specimens were subjected to fracture fixation without the use of template. All the 20 specimens were then subjected to dial gauge test of parallelism. Plate orientation with respect to lower border of mandible was checked for both the groups. PUNPLAPOT 2.0 is developed to be used in extremely oblique fractures. Results: Significant difference was noted in review parameters -plate parallelism and distance of screws from fracture line within study and control group. Results obtained with this template were statistically significant. Conclusion: PUNPLAPOT definitely provides the maxillofacial surgeons a reliable template to position the miniplate at an optimum position. The template has few limitations like comminuted lower border fractures and severely oblique fractures. Further device development is aimed towards overcoming these.

Ribs with Anterior Protrusion (Winged Ribs) Treated Using Percutaneous Chondroplasty.

Thoracic features play a significant role in determining various plastic surgery techniques. Particularly, the thorax has potential for excessive anterior projection, commonly referred to as winged ribs. This study aimed to describe a treatment method for addressing winged ribs for aesthetic purposes using percutaneous chondral management. Thirty-two female patients underwent FrontXribs from February to March 2023. Two angular measurements were obtained: (1) the angle formed by lines intersecting tangentially to the shoulder and the lower gluteal border; and (2) the angle formed by a line tangential to the greatest anterior projection, intersected by a vertical line on the standing axis. Length measurements were obtained using a tape measure at the position of the greatest thoracic projection. Pulmonary function studies were conducted. All variables were measured before surgery and 6 months postoperatively. On average, patients were 25 years old. The average operative time was 51.1 minutes, and all patients underwent general anesthesia. The average increase for angular measurement 1 was 26.1 degrees, whereas that for angular measurement 2 was 3.43 degrees. The average decrease in anterior chest length during the postoperative period was 9.66 cm (P < 0.001). Spirometric tests showed no significant changes 6 months postoperatively. The FrontXribs technique for treating winged ribs effectively reduces anterior costal protrusion, as evidenced by the angular variation of projections and the reduction in thoracic length at this level. No adverse effects on respiratory function were observed 6 months postoperatively.

An anatomical analysis of the occipital nerve complex: an essential tool for the application of occipital nerve blocks

BackgroundOccipital nerve blocks are essential in diagnosing and treating headache disorders such as migraine, cervicogenic headache, occipital neuralgia, and cluster headache. In this study, we aimed to investigate the potential compression points of the greater occipital nerve (GON), third occipital nerve (TON), and lesser occipital nerve (LON) which are targeted to block in occipital nerve blocks and to develop a method to detect these points easily.MethodsTo identify potential compression points of the GON, TON, and LON, we dissected 43, 41, and 26 cadavers, respectively. A rigid, transparent tool divided into 1 × 1 cm sections was placed on the external occipital protuberance to measure the determined points. The cadaveric head was viewed from above, vertically, and the coordinates corresponding to each point were noted separately.ResultsSix, four, and one potential entrapment points were detected for the GON, TON, and LON, respectively. The distances of the point where the GON arose from the lower border of the obliquus capitis inferior muscle and the emerging point of the TON from the C2-C3 vertebrae to the posterior midline were statistically significant in terms of the sides (p = 0.040). Similarly, there was a statistical significance between genders for the distance of the point where the LON arose from the posterior edge of the sternocleidomastoid muscle to the posterior midline (p = 0.002).ConclusionsWe believe that with the method developed, the GON, TON, and LON compression points can be easily localized and blocked in diagnosing and treating patients experiencing headaches such as migraines, cervicogenic headaches, occipital neuralgia, and cluster headache.