Median Suture Research Articles

564. PRONE POSITION THORACOSCOPIC HAND-SEWN ESOPHAGO-GASTRIC ANASTOMOSIS DURING 2-STAGE TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER. SURGICAL TECHNIQUE

Abstract Background Minimally invasive esophagectomy has been introduced in the 2000s in an effort to reduce post-operative pulmonary and cardiac complications. 2-stage totally minimally invasive esophagectomy combines laparoscopic abdominal phase followed by thoracoscopic thoracic phase. The rate limiting step of this approach is the construction of esophago-gastric anastomosis. Herein, we aim to present our anastomotic technique on hand-sewn esophago-gastric anastomosis in prone position, utilizing 3D-assisted thoracoscopy. Methods This is prospective analysis of consecutive patients that underwent 2-stage totally minimally invasive esophagectomy for esophageal and gastro-esophageal junction Siewert type I-II cancers from the same surgical team, over a period of 6 years and more than 250 consecutive esophagectomies. All operations were identical in terms of patient positioning, lymphadenectomy and type of anastomosis formed. The anastomosis was hand-sewn in prone position, in 2-layers, using barbed sutures, with utilization of 3D-assisted thoracoscopy. Thorough technique and key steps of this anastomotic technique are provided. Results Median operative time was 280 minutes while median suturing time for the esophago-gastric anastomosis was 45 minutes. Anastomosis was thoracoscopic, hand-sewn constructed in prone position in all cases. There was no conversion to open. Anastomotic leak complicated n=6 patients (2%); n=5 were type I anastomotic leaks, requiring no intervention and n=1 was type II, which was treated with thoracoscopic lavage and chest drains followed by endoVAC therapy. Conclusion Formation of the esophago-gastric anastomosis is the rate limiting step of 2-stage totally minimally invasive esophagectomy. Most surgeons prefer the construction utilizing mechanical staplers. Our anastomotic technique, present a safe and effective anastomosis, with favorable clinical outcomes. It can be reproduced safely and effectively, offering all the advantages of manual anastomosis and significant reduction of devastating post-operative anastomotic leakage. https://wetransfer.com/downloads/bdf3a3496197daf79ccf5b05f71ba64920240309175850/a4da3be742fd3199e102e553c8a4011e20240309175918/c14cc2

Impact of Suturing Techniques on Microvascular Anastomosis Maturation.

INTRODUCTION Microvascular anastomosis using interrupted suture is a widely accepted standard technique. Continuous suture is less common due to the presumption that its firmness can negatively affect anastomosis maturation. The purpose of this study was to determine whether the use of continuous suture allows maturation of the microanastomosis site. MATERIAL AND METHODS A rat common carotid artery (CCA) end-to-end microanastomosis model was utilized, with 19 Long-Evans rats in the interrupted sutures group and 13 in the continuous suture group. Immediate blood flow of the operated and contralateral intact CCAs was compared before clamping, at the completion of the anastomosis and after 14 days. Quantitative transit time flowmetry measurement and histological examination were employed. RESULTS Initial blood flow in both intact CCAs was similar across all animals (p = .004). In the interrupted suture group, median anastomosis blood flow was 88.9% of the contralateral CCA blod flow, with a median suture time of 46 minutes. After two weeks, blood flow increased to 96.1%. In the continuous suture group, median anastomosis blood flow was 88.3% of the contralateral CCA blood flow, with a median suture time of 30 minutes. After two weeks, blood flow increased to 100.0%. The reduction in suture time achieved with continuous suture was 34.8% (p < .001). Histological examination confirmed scar maturity. CONCLUSIONS The maturation rates of continuous and interrupted suture microanastomosis were comparable in our study, implying that concerns about the suture restricting maturation may be unwarranted. Additional finding is the potential for a reduction in microanastomosis time when using the continuous suture technique.

Application of palatally positioned mini-screws together with the Herbst appliance for rehabilitating adult patients with skeletal types of distal dental arch relationships: a clinical case

Relevance. Utilizing the Herbst appliance for managing distal occlusal relationships in patients with completed facial growth serves as an alternative to surgico-orthodontic methods. This approach, however, extends the treatment duration and necessitates stabilization of the upper molars following removal of the appliance when moving the anterior segment of the upper dentition distally.Objective. To clinically substantiate the feasibility of combining the Herbst appliance with palatally positioned mini-screws for treating distal dental occlusal relationships in adult patients.Description of сlinical сases. Clinical photographic documentation and diagnostic modeling of facial and dentition were conducted for two patients. This was complemented by the computation and analysis of jaw CT scans and profile cephalometric radiographs. The AMORF method was employed for a quantitative evaluation of dentomaxillofacial anomalies. Hypotheses were drawn based on the employment of a 6.0 mm micro-implant at the median suture in projection with teeth 1.6-2.6, alongside the Herbst appliance, suggesting potential stability of the upper molars during the distal repositioning of the anterior segment of the upper dentition.Conclusion. The outcomes from the documented clinical cases suggest that integrating palatally positioned mini-screws with the Herbst appliance facilitates stable positioning of the upper jaw’s first molars during the distal movement of the anterior segment, attributed to the solid support provided by the mini-screw implant.

Endoscopic hand suturing using a modified through-the-scope needle holder for mucosal closure after colorectal endoscopic submucosal dissection: Prospective multicenter study (with video).

Endoscopic hand suturing (EHS) is a novel technique for closing a mucosal defect after endoscopic submucosal dissection (ESD). We investigated the technical feasibility of colorectal EHS using a modified flexible through-the-scope needle holder. This was a prospective multicenter study conducted at two referral centers between June 2022 and April 2023. This study included colorectal neoplasms 20-50 mm in size located in the sigmoid colon or rectum. A modified flexible through-the-scope needle holder, with an increased jaw width to facilitate needle grasping, was used for colorectal EHS. The primary end-points were sustained closure rate on second-look endoscopy (SLE) performed on postoperative days 3-4 and suturing time for colorectal EHS. Secondary end-points included complete closure rate and delayed adverse events. We enrolled 20 colorectal neoplasms in 20 patients, including four patients receiving antithrombotic agents. The tumor location was as follows: lower rectum (n = 8), upper rectum (n = 2), rectosigmoid colon (n = 4), and sigmoid colon (n = 6), and the median mucosal defect size was 37 mm (range, 21-65 mm). The complete closure rate was 90% (18/20 [95% confidence interval (CI) 68.3-98.8%]), and the median suturing time was 49 min (range, 23-92 min [95% CI 35-68 min]). Sustained closure rate on SLE was 85% (17/20 [95% CI 62.1-96.8%]). No delayed adverse events were observed. EHS demonstrated a high sustained closure rate. Given the long suturing time and technical difficulty, EHS should be reserved for cases with a high risk of delayed adverse events.

Potential for expanded application of endoscopic hand suturing: A pilot study of 15 cases.

Endoscopic hand suturing (EHS) was first developed to firmly close a mucosal defect following endoscopic submucosal dissection and has the potential for expanded applications. This study aimed to investigate the feasibility and safety of EHS in various clinical settings. In this single-center pilot study, 15 patients who had diseases with potential indications for EHS were prospectively recruited. Technical success, clinical success after the procedure, and severe EHS-related adverse events (AEs) were evaluated. EHS was applied for defect closure after gastric subepithelial lesion removal under laparoscopic observation (n = 9), defect closure after rectal endoscopic full-thickness resection (EFTR) (n = 2), defect closure after thoracoscopy-assisted esophageal EFTR (n = 1), mucosal closure for gastric ulcer bleeding (n = 1), mucosal closure after peroral endoscopic myotomy (POEM) (n = 1), and postoperative anastomotic leak (n = 1). EHS was completed without severe AEs and the clinical courses were also favorable in 13 patients (87%). The median suturing time was 61 minutes. In patients with POEM and anastomotic leak, EHS was discontinued because of the narrow lumen. In conclusion, EHS appears feasible and safe in situations.

New material of Cretaceoushormiops Loureno from mid-Cretaceous Burmese amber (Arachnida: Scorpiones: Protoischnuridae).

Among the scarce Mesozoic fossils, protoischnurid scorpions (Arachnida: Scorpiones: Protoischnuridae) represent a Cretaceous extinct group. In this study, we present the description of a new protoischnurid fossil, assigned to the genus Cretaceoushormiops Loureno, from mid-Cretaceous Burmese amber. Distinguished by a median suture and a comparatively short anterior margin in its carapace, the new specimen differs from all other species within Cretaceoushormiops. Our discovery sheds further light on the high diversity of mid-Cretaceous scorpions.

Loss of domain and reduction in median suture tension

Abdominal wall reconstruction in large incisional hernia/laparostoma poses aparticular challenge. A loss of domain is the extreme form of intestinal volume displacement. The challenge lies in overcoming retraction of the lateral abdominal muscles. Experienced surgeons have access to avariety of techniques aimed at gaining lateral length along the abdominal wall or reducing suture tension at the midline. These techniques are intended to facilitate reconstruction even in complex cases and are outlined in this article from apractical perspective. The application of botulinum toxinA (BTA) and progressive pneumoperitoneum (PPP) are described as preoperative methods to gain abdominal wall length. Peritoneal flaps, intraoperative fascial traction (IFT) and component separation including transversus abdominis muscle release (TAR) are available for the surgical reconstruction of the abdominal wall. Bridging and the intraperitoneal onlay mesh approach are fallback techniques. All these techniques were integrated into apractical algorithm for complex abdominal wall reconstruction including preoperative and postoperative care and assessed by the authors with respect to effort, effectiveness and complexity. In the opinion of the authors, the status of complex abdominal wall reconstruction is currently best described by acombination of the most effective and proven techniques in terms of a"categorical algorithm". The combination of BTA, IFT and TAR presently appears to be the most effective method; however, experience and expertise are aprerequisite.

Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study.

To compare leakage pressures of vesicourethral anastomosis (VUA) performed with conventional and unidirectional barbed sutures in canine cadaveric tissue. Experimental, ex-vivo, randomized study. A total of 24 male canine bladders with the urethra. Specimens after prostatectomy were randomly divided into a unidirectional barbed suture (UBS) or a conventional suture (C) group. For the UBS group, the VUA was performed with 4-0 unidirectional barbed sutures. For the C group, the VUA was performed with 4-0 monofilament absorbable suture. The VUA was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and the number of suture bites were recorded. The median suturing time was 12.70 minutes (range: 7.50-16.10min) for the UBS group and 17.30 minutes (range: 14.00-21.30 min) for the C group (p < .0002). The median leakage pressure was 8.60 mmHg (range: 5.00-17.20 mmHg) for the UBS group and 11.70 mmHg (range: 6.00-18.50 mmHg) for the C group (p=.236). The median number of suture bites was 14 (range:11-27) for the UBS group and 19 (range:17-28) for the C group (p=.012). Unidirectional barbed suture does not statistically affect the acute leakage pressure of VUA in normal cadaveric specimen. It resulted in a shorter surgical time and fewer suture bite placements. A urinary catheter will still be required when a unidirectional barbed suture is used to complete a VUA in dogs to prevent extravasation of urine in the postoperative period.

COMPARING LAPAROSCOPIC AND ROBOT-ASSISTED PYELOPLASTY FOR URETERO-PELVIC JUNCTION OBSTRUCTION: INITIAL EXPERIENCE FROM A SINGLE CENTER

(Objective) To compare the initial results of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) for uretero-pelvic junction obstruction (UPJO). (Methods) Between April 2008 to October 2021, we identified 104 cases of UPJO where LP was performed and 18 cases where RALP was performed at our hospital. We retrospectively analyzed their perioperative outcomes. Furthermore, we recorded the operative times for each cases of LP and RALP. (Results) The median operative time for RALP was 141 minutes, which was significantly shorter than that for LP (204 minutes). No patient in the RALP group demonstrated any Clavien-Dindo complications (≥grade 3). During the observation period, improvement of symptoms was observed in all cases. The median suturing time in RALP was 38 minutes. Compared with the last 20 cases of LP, the time to expose the uretero-pelvic junction, the time of renal pelvis incision, and suturing time were significantly shorter in RALP. In addition, the console and suturing times were stable since the initial stage. In cases with a high grade of hydronephrosis, there was a large variation in the time to expose the uretero-pelvic junction and suture the renal pelvis and ureter in LP; however, this variation was smaller in RALP. (Conclusion) At our hospital, RALP for UPJO is considered to be a safe procedure. In the future, it is necessary to consider the long-term results and effectiveness of RALP.

'The parachute method': A novel technique for laparoscopic tumour handling.

Although laparoscopic surgery for submucosal tumours (SMTs) may require multiple support threads, the traction direction of a single thread is only one option and cannot be freely changed. To solve this problem, we introduced a novel innovative technique for tumour handling, named 'the parachute method'. Prior to suturing, the surrounding vessel was treated when the tumour was located near the lesser or greater curvature. A monofilament thread was ligated in the serous muscle layer along the peritumoural markings with approximately five stitches in a row, with moderate deflection. Next, the other monofilament thread was passed through the deflection and ligated; this resembled a parachute shape that could be pulled in any direction over the entire circumference with uniform tension. We performed this procedure in three patients with extramural growth-type gastrointestinal stromal tumours of approximately 2-3 cm. The median suturing time was 10 minutes. Laparoscopic local resection of the stomach was safely performed, and the patients were discharged without any complications. In this study, we demonstrate a novel, simple, inexpensive, useful and reasonable technique for handling SMTs, named 'the parachute method'. We believe that this technique will have additional applications in cooperative surgery with endoscopy.

587. ROLE OF THORACOSCOPIC HAND-SEWN ESOPHAGO-GASTRIC ANASTOMOSIS IN 2-STAGE TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY. REPORT OF 200 CONSECUTIVE CASES

Abstract Esophagectomy is the mainstay of treatment of esophageal and gastro-esophageal junction cancer. Minimally invasive esophagectomy has been introduced in the 2000s in an effort to reduce post-operative pulmonary and cardiac complications. 2-stage totally minimally invasive esophagectomy combines laparoscopic abdominal phase followed by thoracoscopic thoracic phase. The rate limiting step of the procedure is the construction of esophago-gastric anastomosis. We aim to present our technique and results on hand-sewn thoracoscopic esophago-gastric anastomosis in prone position. This is prospective analysis of consecutive patients that underwent 2-stage totally minimally invasive esophagectomy for esophageal and gastro-esophageal junction Siewert type I-II cancers. All operations were identical in terms of patient positioning, lymphadenectomy and type of anastomosis formed. Study included adult patients with no upper age limit (&amp;gt;18 years); all hybrid esophagectomies, esophagectomies for malignancy and emergency operations were excluded from the study. The anastomosis was manually facilitated thoracoscopic in prone position, in 2-layers, using barbed sutures. Primary endpoints were anastomotic leakage and anastomotic stricture rate. Secondary endpoints were 30- and 90-day mortality rates. During a 5-years-period, n=200 consecutive patients underwent 2-stage totally minimally invasive esophagectomy for cancer. Most patients were males. Median age was 65.5 years. Median operative time was 280 minutes while median suturing time for the anastomosis was 50 minutes. Anastomosis was thoracoscopic, hand-sewn constructed in prone position in all cases. There was no conversion to open. Anastomotic leak complicated n=5 patients (2.5%); n=4 were type I anastomotic leaks and n=1 was type I, which was treated with chest drainage. Anastomotic stricture was presented in n=13 patients (6.5%). 30-day mortality rate was 1% and 90-day mortality rate was 2.5%. Formation of the esophago-gastric anastomosis is one of the most challenging aspects during 2-stage totally minimally invasive esophagectomy. Most surgeons prefer the construction using circular or linear staplers. Our anastomotic technique, present a safe and effective anastomosis, with favorable clinical outcomes. It can be reproduced and established in the hand of experts, offering all the advantages of manual anastomosis and reduction of devastating post-operative anastomotic leakage, which still complicates stapled constructed anastomosis with significant incidence.

New species of Liostracina Monke, 1903 (Trilobita, Cambrian) from Yunnan, China: complete holaspid exoskeleton and implications for higher level classification

AbstractThe trilobite Liostracina has been recognized as important in taxonomic and stratigraphic studies for more than a century. Until now, the genus Liostracina and family Liostracinidae have been known from only incomplete holaspid material, a degree 2 meraspis, and protaspides. A new locality in the Longha Formation (Cambrian: Guzhangian) of southeastern Yunnan, China, yields a rich collection of articulated holaspid exoskeletons and disarticulated sclerites of a new species, Liostracina fuluensis n. sp. These specimens reveal thoracic and ventral morphology that was previously unknown for Liostracina; they demonstrate that it has a rostral plate plus rostral and connective sutures, rather than a ventral median suture on the cephalic doublure. This confirms a natant hypostomal condition for the genus. Holaspid exoskeletal features, combined with evidence of a non-asaphoid-type protaspis, indicate that Liostracina is neither a primitive trinucleoid nor a primitive asaphoid. The family Liostracinidae is excluded from the superfamily Trinucleoidea and the order Trinucleida and reassigned to the order Ptychopariida.UUID: http://zoobank.org/48dcbe31-e25d-4657-8441-732d5ea2b49d

Non-absorbable Barbed Sutures for Primary Fascial Closure in Laparoscopic Ventral Hernia Repair.

PurposeThe aim of this study is to describe the safety and effectiveness of laparoscopic ventral hernia repair with intraperitoneal fascial closure using a barbed suture prior to mesh placement.Materials and methodsPatients who underwent laparoscopic ventral hernia repair were included in this retrospective review. Patients were divided into two groups. In the first group, primary fascial closure was performed with a 2-polypropylene non-absorbable unidirectional barbed suture followed by fixation of the intraperitoneal mesh. In the second group, the mesh was fixed intraperitoneally using tacks without closing the fascial defect.ResultsA total of 148 patients who underwent laparoscopic primary ventral hernia repair were included. A total of 72 (48.6%) patients were included in the barbed suture with mesh group and 76 (51.4%) patients in the mesh-only group. The mean fascial defect size was 25 cm2 in the first group and 64 cm2 in the second group. The median suturing time for fascial closure was 15 minutes. The average surgery time was 98 minutes in the first group and 96 minutes in the second group. The mean follow-up period was 80 days for Group 1 and 135 days for Group 2. No hernia recurrence or mortality occurred in this study.ConclusionThe barbed suture closure technique is a fast, safe, and effective technique for fascial closure during laparoscopic ventral hernia repair in combination with mesh placement. Further evidence to support these findings and longer follow-up periods are warranted to evaluate long-term outcomes.

Endoscopic surgery suturing techniques: a randomized study on learning

BackgroundSurgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems. The FlexDex is a novel articulating laparoscopic needle driver providing enhanced dexterity in laparoscopic surgery. This study evaluates and compares the learning curve of endoscopic suturing with conventional laparoscopy, the FlexDex and robotic suturing in novices.MethodsParticipants performed a minimal invasive suturing task in three different ways in a randomized order: with a conventional laparoscopic needle driver, using the FlexDex needle driver and third, using the Da Vinci Si surgical system. Primary outcome was suturing task time. Secondary outcome parameters were assessment of suturing quality and workload perception.ResultsA total of 10 novice participants were included and completed a total of 300 sessions. Median (IQR) suturing time of the first 5 sessions was 231 s (188–291) in the laparoscopic group versus 378 s (282–471) in the FlexDex group versus 189 s (160–247) in the DaVinci Si group. The last 5 sessions showed significant reduction of median suturing time of 143 s (120–190), 232 s (180–265) and 172 s (134–199) respectively. Analysis identified that the learning curve for the laparoscopic needle driver and Da Vinci Si was reached in 5 sessions, compared to 8 sessions for the Flexdex. The laparoscopic needle driver and Da Vinci Si showed a significant shorter median suturing time compared to the FlexDex (p = 0.00). The FlexDex quality assessment scores were significantly lower compared to the laparoscopic (p = 0.00) and robotic (p = 0.00) scores and perceived workload remains high for the FlexDex users.ConclusionsEx vivo endoscopic suturing with the FlexDex demonstrated a prolonged learning curve compared to laparoscopic and robotic suturing. The learning curve of the FlexDex is fundamentally different from conventional laparoscopic and robotic instruments. This study provides further insights in the implementation and training of endoscopic suturing techniques.

Determination of sex dimorphisms of the thickness of the hard palate in adolescence using computed tomography: Pilot study

BackgroundIn addition to traditional craniometric techniques, computer craniometry has been used in recent decades, including stereometric methods, which make it possible to determine the microanatomical spatial relationships and dimensional features of various structures of the skull, in particular the thickness of the inert palate of the maxilla. AimDetermination of the gender-specific variability of the thickness of the bony palate at the age of 18–20 years using CT. Material and methodsThe material of the pilot study were 40 computed tomograms of young males and females aged 18–20 years. The method of computer craniometry was used to measure the thickness of the bony palate in sagittal projection taking into account the gender. A graphic raster map was created to identify the palatal areas, then analyze their thickness and determine the safe zones for the mini dental implants. ResultsIn young males and females (18–20 years) the thickness of the bony palate decreases at different levels from front to back and from the median suture to the alveolar process. The greatest thickness of the bony palate corresponds to its anterior third and reliably predominates in young males at all levels compared to young females. In the middle and posterior third palate, the averages do not show gender differences and their variation is insignificant. ConclusionsThe greatest thickness of the bony palate can be used as the most favorable zone for the fixation of orthodontic mini dental implants. The variability in the thickness of the bony palate should be considered when selecting the most optimal zones and depth of mini-implant placement.

Trentino Hernia Team Technique Plus Endoscopic Transversus Abdominis Release for Large Ventral Incisional Hernias: Description of the First Case

Trentino Hernia Team Technique Plus Endoscopic Transversus Abdominis Release for Large Ventral Incisional Hernias: Description of the First Case

Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue.

To compare conventional and intracorporeal vesicourethral anastomosis (VUA) in canine cadaveric tissue. Cadaveric ex vivo study. Twenty-eight canine bladders with urethra. Specimens after prostatectomy were randomly divided into intracorporeal (I) group or conventional (C) group. For the I group, VUA was performed in a simulator with laparoscopic needle holders and telescope. For the C group, the anastomosis was performed in vitro with standard instruments. The VUA was performed with 4-0 monofilament absorbable suture and was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and number of suture bites were recorded. Fourteen samples were entered in each group. The dorsal side of the anastomosis was initially performed, followed by the ventral side. The median suturing time was 30.8 minutes (range, 19.3-39.2) for the I group and 17.3 minutes (range, 9.2-21.3) for the C group (P < .0001). The median leakage pressure was 10.9 mm Hg (range, 4.1-29.7) for the I group and 10.8 mm Hg (range, 6.2-18.5) for the C group (P=.94). The median number of stitches was 20 (range, 14-26) for the I group and 19 (range, 11-28) for the C group (P=.96). The distribution of the site of leakage was similar between groups (P=.381). Vesicourethral anastomosis can be performed with leakage pressures similar to intracorporeal and conventional suturing. This study represents the first step toward laparoscopic radical prostatectomy in dogs.

Pygidiapion De Sousa amp; Mermudes, a new genus of Apioninae (Brentidae: Apioninae: Apionini) associated with Fabaceae from Brazil, with the description of a new species and transfer of Apion zikani Heller, 1922.

The genus Pygidiapion De Sousa Mermudes gen. n., described and illustrated here, includes two species from Brazil: the type-species Pygidiapion zeppelinii De Sousa Mermudes sp. n. (type-locality: João Pessoa, Paraiba state), which develops in flower buds of Pterocarpus violaceus Vogel (Fabaceae); and Pygidiapion zikani (Heller, 1922) comb. n. (from Apion) (type-locality: Passa Quatro, Minas Gerais state), which develops in flower buds of Dalbergia foliolosa Benth. (Fabaceae). Pygidiapion is defined by the following set of characters: rostrum of males with two elongate longitudinal and punctate latero-ventral sulci; hind wings with small radial window; hypomeral lobes divided by median suture and sternellum distinctly exposed; meso- and metatibiae mucronate; pygidium of the apionine incomplete type; and tegminal plate fused with basal piece. Pygidiapion zeppelinii is diagnosed by: meso- and metatibiae mucronate; pygidium distinctly modified, with deep transverse dorsal sulcus, medially deeper and rounded, and proximal marginal rim angulate (apical flange), corresponding to the distal margin, which is emarginate; tegminal plate fused to basal piece, apical portion of parameroid lobes weakly notched medially, each side of suprafenestral plate with five macrochaetae, fenestral width 1.25 times length, separated by about 3.2 times fenestral width, linea arquata visible, prostegium protruding medially, tegminal apodeme 0.76 as long as basal piece, with apex narrow and rounded. Pygidiapion zikani is distinguished from P. zeppelinii by smaller size; head, rostrum and antennae brownish; scutellum subquadrate; and by association with Dalbergia spp. (Fabaceae). Association principally with the papilionoid group of Fabaceae suggest allocation of the new taxon to the subtribe Oxystomatina.

Bone-borne distractor versus tooth-borne distractor for maxillary expansion: a Systematic Review

The etiology of transverse maxillary deficiency is considered multifactorial, and has a deleterious effect on the bone development of the maxilla and nasal cavities, causing maxillary atresia and posterior crossbite. The objective of this systematic review was to compare in the scientific literature the effectiveness of the maxillary disjunction treated using dental distractor versus bone distractor. A systematic literature review was performed using the Science Direct, Embase, Cochrane Collaboration Library, and PubMed / MEDLINE databases. The search strategy provided a total of 119 studies. After screening by reading the titles and abstracts, seven articles met all the criteria and were included in this systematic review. Studies have shown that the choice of type of orthodontic-orthopedic appliance is directly related to the prior individualized planning of each patient. With regard to patients who are in the development phase, the recommendation is the use of dental maxillary expanders, such as the Hyrax appliance. In addition, it is not recommended to perform rapid maxillary expansion in adult patients, due to the expansion resistance that occurs in the palatine sutures. The treatment of patients with closed median palatine suture must be done by surgically assisted maxillary expansion.

Developmental changes in the occipital cranial sutures of children less than 2years of age.

The occipital bone is located on the boundary between the membranous and cartilage bones and contains a wide variety of accessory sutures. In this study, we describe the age distribution of pediatric patients who are less than 2years of age with occipital cranial sutures using a three-dimensional computed tomography (3D-CT). A total of 167 consecutive patients who are less than 2years of age and underwent computed tomography for head trauma were included in this study. Based on the results of this study, various types of sutures were observed among the pediatric participants. In particular, superior median fissures, mendosal sutures, other interparietal segment's accessory sutures, and interparietal sutures were noted in 21%, 35%, 9%, and 6% of the participants, respectively. Additionally, Wormian bones within the lambdoid suture were noted in 32% of the patients. The median age of children with superior median fissure and mendosal suture was 0month. Meanwhile, superior median fissure was not observed among children older than 5months of age. In this population, 13 patients (8%) were found to have skull fracture. Knowledge of the normal cranial anatomy and developmental patterns of cranial sutures is crucial in the evaluation of questionable fractures in the occipital region. A combination of 3D-CT and axial bone window imaging is useful in differentiating normal structures from pathological changes in the cranium.