Insertion Of Muscle Research Articles

Single minimal conjunctival incision for rectus muscles: a pilot feasibility study.

Small conjunctival incision size is desirable in strabismus surgery under topical anesthesia. To study the feasibility and tolerability of a small bulbar conjunctival incision (SB). Non-randomized feasibility pilot study. After applying a 5-0 PGA (polyglycolic acid) traction suture, we did a 3-4 mm single conjunctival incision posterior and parallel to the rectus muscle insertion. A hang-back recession was done (6-0 PGA suture), and the conjunctiva closed (8-0 PGA suture). The outcome measures were feasibility, tolerability, and motor result. Twenty-five patients were included. The median pain scale score was 3/10, and the satisfaction Net Promoter Score was 72. Mean duration of a recession was 12 min (range: 9-14 min). Mean duration of inflammatory signs and hemorrhage were 2.2 days (95% CI, 1.4-2.9), and 8.5 days (95% CI, 7.1-9.9), respectively. Distance deviation at 2 months was 3.1 Prism Diopters (95% CI, 1.5-4.5). SB is feasible and well tolerated for extraocular rectus muscle surgery.

Effect of inferior oblique anterior transposition on vertical deviation.

To evaluate the efficacy and complications of simplified graded inferior oblique anterior transposition (IOAT) in treating at least 10 PD vertical deviation in the primary position and inferior oblique muscle overaction (IOOA). This retrospective study reviewed the medical records of 65 patients treated with simplified graded IOAT procedures for both vertical deviation and IOOA. Patients were grouped according to vertical deviation in the primary position. Group 1: vertical deviation of not > 20 PD; the inferior oblique (IO) muscle was fixed 2mm posterior and 2mm temporal to the inferior rectus insertion. Group 2: vertical deviation > 20 PD; the muscle was fixed at the level of insertion of the inferior rectus muscle. Postoperative outcomes in vertical deviation (≤ 5 PD, excellent; 5-10 PD, fair; > 10 PD, poor), IOOA, anti-elevation syndrome (AES), abnormal head position (AHP), V-pattern, and foveal disc angle (FDA) were assessed. Patients were categorized as 43 (53.5% men) in group 1 and 22 (54.5% men) in group 2. IOAT improved vertical deviation, IO muscle function, AHP, V-pattern, and FDA. IOOA decreased from + 2.1 to 0.02 in group 1 and from + 2.4 to 0 in group 2. Mean vertical reduction after IOAT was 12.4 ± 3.8 and 23.8 ± 7.3 PD in groups 1 and 2, respectively. Excellent results were achieved in 83.7% and 77.3% of patients and fair results in 16.2% and 18.2%, respectively. Among the 48 asymmetric DVD patients, 83.8% and 82.3% in groups 1 and 2, respectively, achieved satisfactory results. No AES occurred in two groups. The simplified graded IOAT procedure, which is graded only on the basis of vertical deviation, can achieve satisfactory results for resolving IOOA with vertical deviation or DVD, AHP, V-pattern, and FDA. In addition, the modified procedure of fixing posterior fibers at a slight posterior tilt is clinically instructive in correcting vertical deviation > 20 PD while reducing AES complications.

Lateral pterygoid muscle enthesis reconstruction in alloplastic total temporomandibular joint replacement: An animal experiment with histological verification.

In current alloplastic total temporomandibular joint replacements (TMJRs) typically the lateral pterygoid muscle (LPM) insertion is sacrificed, affecting joint function. This study assesses a novel additively manufactured TMJR (CADskills BV, Gent, Belgium) designed to enable LPM reinsertion through a scaffold feature on the implant. Thirteen TMJRs were implanted in Swifter crossbreed sheep, with follow-up CT scans after 288 days to evaluate LPM reintegration. Five specimens showed a close approximation between the LPM enthesis and the scaffold. Histological analysis with Masson-Goldner staining and microscopy revealed close bony enthesis alignment with the scaffold, although true bony ingrowth was not observed. One specimen could not be fully evaluated due to preparation issues, limiting conclusions on osseointegration. Random samples from the ramal scaffold showed good integration with the native mandible, with osteogenic activity noted, but no bony ingrowth from the reattached enthesis into the bone grafted titanium scaffold. Despite this, all samples displayed a continuous fibrotic attachment, suggesting functional restoration of the LPM. Findings indicate that while the TMJR design supports fibrotic attachment, further optimization of reattachment techniques, scaffold properties, and post-operative care may improve osseointegration and functional outcomes in future human TMJRs.

Horizontal extraocular muscle insertion locations in children undergoing extraocular muscle surgery.

The location of extraocular muscle (EOM) insertions is clinically relevant in ophthalmologic surgery. The spiral of Tillaux has been a reference for normal EOM insertion since the nineteenth century. Research on EOM insertions is limited and has focused on adult cadaveric eyes. In this study we investigated the location of EOM insertions in children undergoing EOM surgery. Children who underwent EOM surgery for strabismus or anomalous head position at a large tertiary care center were consecutively identified from October 2022 to December 2023. Intraoperative measurements of medial rectus (MR) and lateral rectus (LR) insertions were compared to the spiral of Tillaux and within patient groups using one-sample and independent-samples t tests, respectively. Associations of EOM insertions with age, refraction, and axial length were evaluated with Pearson correlation. In 292 children who underwent EOM surgery, 528 previously unoperated EOM insertions were recorded. Mean insertions were closer to the limbus than expected by the spiral of Tillaux (MR, 5.21 vs 5.5 mm [P < 0.001]; LR, 6.76 vs 6.9 mm [P = 0.001]). Esotropia was associated with closer EOM insertions than exotropia (MR, P = 0.021; LR, P = 0.045). Males had farther MR insertions than females (5.33 vs 5.03 mm [P < 0.001]). Age was weakly associated with farther EOM insertions (MR, r = 0.215, P < 0.001; LR, r = 0.232, P < 0.001). Myopia was very weakly associated with farther MR insertions (r = -0.145, P = 0.024). In children undergoing EOM surgery, MR and LR insertions were closer to the limbus than expected relative to the spiral of Tillaux. This finding may have implications for surgical planning and outcomes.

Outcomes of OCT imaging-based reoperations in strabismus

PurposeReoperations in strabismus are reportedly needed in 20–40% of cases undergoing surgery. The present study investigated the outcomes of reoperations based on preoperative imaging of extraocular muscle insertions, and whether the Anterior Segment Optical Coherence Tomography (ASOCT) was of value.MethodsPatients with strabismus requiring reoperation with/without previous surgical records at the Advanced Eye Centre, PGIMER, Chandigarh were recruited. All patients underwent a thorough clinical examination and imaging of extraocular muscle insertions on the Swept Source Anterior Segment Optical Coherence Tomography. The accuracy of measuring muscle insertions with the ASOCT was compared with intraoperative caliper readings.ResultsForty-seven muscles (28 patients) were imaged on ASOCT with confirmation intraoperatively during re-operation. The mean age of the patients was 21.6 ± 5.6 years. After looking at the imaging findings, the decision of which muscle to operate on changed in eleven patients (39.2%). The accuracy of ASOCT to measure muscle insertion ± 1 mm was seen in 78.7% (38/47 muscles). The ASOCT could give additional information, such as a slipped muscle and stretched scar in three patients.ConclusionsImaging can be beneficial in achieving successful results in strabismus reoperations with high accuracy. It can be pivotal in surgical planning in reoperations (~ 40%).

The Study of the Skeletal Remains of the 16th Century Italian Commander Alessandro Farnese and His Wife, Maria D'Aviz

ABSTRACTEntheseal changes are indicators of persistent and long‐term changes induced by occupational activity and refer to marks on the skeleton where a muscle, tendon, or ligament inserts into the periosteum. Their study makes it possible to deduce further information about the person to whom the human bone remains belong. The authors present here the analysis of these markers on the bone remains of two Italian historical figures who lived in the 16th century. In 2021, the exhumation of the remains of Alessandro Farnese and Maria D'Aviz was authorized for study purposes and the skeletal remains were examined. The data collected from the examination of the mortal remains of Alessandro Farnese are compatible with historical data about his biography. As a skilled leader and assiduous sportsman, he showed signs of entheseal changes in his bone tissue attributable to physical activities. On the other hand, the case of Maria D'Aviz differs significantly from that of Alessandro Farnese in that her bone segments show no signs of entheseal changes. The analysis carried out on the remains results to be very useful in verifying the comparison with the elements present in their biography. The possibility of confirming the connection between entheseal changes and lifestyle habits is fundamental to increasing credibility in the application of these elements in the process of identifying nameless bodies in the forensic context.

The Labiomandibular Fold Anatomy for Comprehensive Lower Facial Rejuvenation: A Micro-Computed Tomography Investigation.

Perioral rejuvenation is challenging due to the lack of spatial anatomical understanding of the labiomandibular fold (LMF). The LMF's formation mechanism remains underexplored due to intricate relationships between musculature and subcutaneous structures. This study aimed to clarify the three-dimensional structures of the LMF using micro-computed tomography and histology. Twenty-two rectangular specimens, following the LMF as the diagonal line, were retrieved bilaterally from eleven fresh frozen cadavers (mean age, 69.3 years). Eleven specimens were imaged with phosphotungstic acid contrast staining for micro-computed tomography, and the rest were histologically examined using Masson and Verhoeff-van Gieson staining. The LMF was divided into three equal-width regions for analysis. The LMF serves as a border between the lateral fat-abundant zone and the medial fat-scant zone statically. Dynamically, the LMF is accentuated with age by the downward pull of depressor muscles via a compact slanted collagen-elastin-muscle (CEM) network composed of the depressor anguli oris, platysma, and buccinator muscle fibers. The LMF formation is governed by subcutaneous composition differences between the lower lip and cheek region and vertical dermal insertions of mimetic muscles. Perioral muscle contractions transmit directly at the skin via the CEM network, governing regional wrinkle severity and appearance. The micro-CT findings provide crucial three-dimensional insights into the layered architecture and intricate musculature correlation of the LMF region, providing regional-specific evidence for holistic rejuvenation practices. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Circumferential nerve wrapping with muscle autograft: a modified strategy of microvascular decompression for trigeminal neuralgia.

Microvascular decompression is considered a first-line treatment in classical trigeminal neuralgia. Teflon is the material commonly used. The use of autologous muscle has been occasionally reported. Failure may result from insufficient nerve decompression, inflammatory reaction to Teflon or late displacement of the offending vessel. In this paper, we illustrate an MVD technique that involves a modified muscle insertion method. In a series of 57 consecutive patients who underwent microvascular decompression, the trigeminal nerve was coated circumferentially with a substantial amount of autologous muscle graft. The coverage was extended well beyond the site of neurovascular conflict to create a cushioned environment and protect the nerve. Pain intensity was assessed using the Barrow-Neurological-Institute (BNI) grading scale. The mean follow-up period was 28.8 months (range: 12 to 75 months). Preoperatively, all patients experienced typical pain that was scored as BNI V. No postoperative mortality was observed. After surgery two patients developed incomplete facial nerve palsy, which resolved over 6-months and one patient experienced hearing loss (the only permanent complication). Ten patients (17.5%) developed mild hemifacial numbness, as detailed in the postoperative data and pain outcome section. There were no infections or cerebrospinal fluid leakages. Immediately after surgery, all patients achieved satisfactory pain control: 55 cases (96.5%) scoring as BNI grade I and 2 cases (3.5%) scoring as BNI grade II. At the latest follow-up, three patients (5.3%) experienced symptoms controlled by medications (grade III). Recurrence of pain BNI IV to V was observed in two cases (3.5%). Circumferential nerve wrapping using abundant autologous muscle resulted in immediate pain control in all patients treated, with a low recurrence rate.

Horizontal rectus muscle insertion sites in patients with infantile esotropia and acute acquired concomitant esotropia.

To investigate the characteristics of horizontal rectus muscle insertion sites in patients with infantile esotropia (IE) and acute acquired concomitant esotropia (AACE). The medical records of 166 IE patients and 261 AACE patients who underwent horizontal rectus muscle surgeries were reviewed retrospectively, including age at surgery, spherical equivalent (SE), and angle of esodeviation at near and distance. The limbus-insertion distances (LID) and widths of the medial rectus (MR) and lateral rectus (LR) muscles were measured intraoperatively using a caliper. The insertion parameters and clinical features were compared between different ages and types of esotropia, and a correlation analysis was performed between these variables. In IE patients under 12 years old, the MR LID was positively correlated with age, whereas the LR LID was negatively correlated with the angle of esodeviation at distance. In IE patients over 12 years old, the LR width was negatively correlated with the angle of esodeviation at near. In AACE patients, the MR LID was negatively correlated with the angle of esodeviation at distance, whereas the LR width was negatively correlated with the SE. The LID and width of the horizontal rectus muscle insertions were not significantly different in age-matched patients with IE and AACE. In IE patients, the LR insertion parameters were correlated with the angle of esodeviation, but in AACE patients, the MR LID was correlated with the angle of esodeviation. The clinical significance of these findings still needs to be investigated further.

To remove or not to remove: Intraconal metallic foreign body following perforating ocular injury

Background: Foreign bodies (FB) are implicated in 17-30% of penetrating ocular injuries. We encountered 2 cases of perforating ocular trauma with metallic intra-orbital FB in 2 teenage males. Case report: A 17-year-old male presented with a nail-hammer injury 6 hours after trauma. Snellen’s acuity was 3/60 with a corneal laceration of 5mm with lens matter in the anterior chamber and vitreous hemorrhage. After primary repair by the anterior segment surgeon, posterior segment surgery was done following the diagnosis of retinal detachment (RD) and intra-ocular Foreign Body(FB) by ultrasound. No FB was noted intraoperatively. On Computerized Tomography (CT), metallic FB 5.2x3.5 mm was noted at the insertion of the inferior oblique muscle. Removal of IOFB was deferred by the oculoplasty department. Delayed oil removal was done with final Snellen’s acuity 6/12p. Another 16-year-old male attended the retina clinic 20 days after injury with a metal-on-metal hammering incident. Primary topical management was done elsewhere. Snellen’s acuity was 6/18p in the affected eye. The site of FB entry was scleral,1.4 mm from limbus at 9 o’clock with no associated lens trauma. CT scan of the brain and orbit showed intra-orbital FB medial to the medial rectus near the orbital apex. FB (4.4x4.3 mm) left a tract in subretinal space to enter intraconal space 1 disc diameter nasal to optic disc. Vitrectomy was done for tractional RD and postoperative Snellen’s vision was 6/12. Conclusion: A high degree of clinical suspicion is necessary to detect and localize IOFB. Non-toxic intra-orbital FB may be left in the context of good vision in the affected eye and possible iatrogenic optic nerve damage.

Hindlimb biomechanics of Lagosuchus talampayensis (Archosauria, Dinosauriformes), with comments on skeletal morphology.

Lagosuchus talampayensis is a small-bodied (~0.5 m long) Late Triassic dinosauriform archosaur from Argentina. Lagosuchus long has been a pivotal taxon for reconstructing the evolution of form and function on the dinosaur lineage. This importance is because it has a mix of ancestral archosaurian traits, such as a small pelvis with a mostly closed acetabulum lacking prominences that would restrict hip mobility much, with derived "dinosaurian" traits such as bipedalism, proximally shifted thigh muscle insertions, elongate hindlimbs, "advanced mesotarsal" ankle joints and digitigrade feet. Here, to quantify key functional traits related to the locomotor biomechanics of Lagosuchus, we build a three-dimensional musculoskeletal model, focussing on morphofunctional analysis of the pelvic limb. We survey skeletal material that we have digitised, pointing out hitherto undescribed features and elements, many of which are from taxa other than Lagosuchus. Next, we select ideal elements amongst these to construct a composite model, and articulate adjacent body segments into joints, then estimate body shape including centre of mass, and add muscle paths to create a musculoskeletal model. Finally, we use two methods to quantify the hindlimb muscle parameters ("architecture") in the model. We find that they produce similar estimates of force-generating capacities, and compare these data to the few available data from other archosaurs in an evolutionary context, to reconstruct fundamental patterns of changes in muscle architecture and pelvic limb morphology. Our model forms a valuable basis for future quantitative analyses of locomotor function and its evolution in early archosaurs, and an example of how to navigate decision-making for modelling problematic specimens.

Quantitative assessment of masticatory muscles based on skull muscle attachment areas in Carnivora.

Masticatory muscles are composed of the temporalis, masseter, and pterygoid muscles in mammals. Each muscle has a different origin on the skull and insertion on the mandible; thus, all masticatory muscles contract in different directions. Collecting in vivo data and directly measuring the masticatory muscles anatomically in various Carnivora species is practically problematic. This is because some carnivorans can be ferocious, rare, or even extinct. Consequently, the most practical method to collect data on the force generated by the masticatory muscle is to estimate the force based on skulls. The physiological cross-sectional area (PCSA) of each masticatory muscle, which correlates to the maximum force that can be produced by a muscle, was quantified. Using computed tomography, we defined the three-dimensional measurement area for 32 carnivoran species based on the origin and insertion of masticatory muscles specified by observable crests, ridges, and scars. Subsequent allometric analysis relating the measurement area on skull surface to the PCSA for each masticatory muscle measured in fresh specimens revealed a strong correlation between the two variables. This finding indicates that within Carnivora, an estimation of absolute masticatory muscle PCSA can be derived from measurements area on skull surface. This method allows for the use of cranial specimens, housed in museums and research institutions, that lack preserved masticatory muscles in quantitative studies involving masticatory muscle PCSA. This approach facilitates comprehensive discussions on the masticatory muscle morphology of Carnivora, including rare and extinct species.

Quantitative Analysis of the Brachialis and Triceps Brachii Insertion Sites on the Proximal Epiphysis of the Ulna in Modern Hominid Primates and Fossil Hominins.

In several species of hominid primates with different types of locomotor behavior, we quantitatively studied the insertion sites of the brachialis and triceps brachii on the proximal epiphysis of the ulna. Our main objective was to evaluate the possibility of using the anatomical features of these insertion sites to infer the locomotor behavior of different species of fossil hominins. We measured the area of these muscle insertion sites using 3D bone meshes and obtained the value of each insertion site relative to the total size of the two insertion sites for each of the species studied. We also compared these relative values of the osteological samples with the relative mass of the brachialis and triceps brachii, which we obtained by dissecting these muscles in the same primate species. The relative values for the brachialis insertion were highest in orangutans, followed by bonobos, chimpanzees, gorillas, and humans. Fossil Australopithecus and Paranthropus had values similar to those of bonobos, while fossil Homo had values similar to those of Homo sapiens. The observed similarity in ulnar attachment sites between Australopithecus and Paranthropus and extant bonobos suggest that these hominins used arboreal locomotion to complement their bipedalism. These adaptations to arboreal locomotion were not observed in Homo.

Waxing and waning pattern of choroidal detachment post scleral buckle.

Description of evolving and resolving pattern of choroidal mounds at different quadrants post scleral buckle surgery in a myopic patient. A 48-year-old male with axial length of 32mm underwent scleral buckling for subtotal fresh retinal detachment with 360-degree multiple lattices with superior horse shoe tear. A posterior buckle was placed superiorly traversing 180-degree, 14 mm beyond muscle insertion. Uneventful drainage of sub-retinal fluid was performed intra-operatively. Post-operative day 1 depicted two choroidal detachment (CD) mounds in the ST quadrant with an adequate break buckle relationship. Post-operative day 2 depicted an additional CD mound in the inferonasal with an additional mound supero-nasally on day 4. Spontaneous resolution of the mounds was observed from day 7 with complete resolution by one month. Fragility of the choroidal vasculature in axial myopia can aggravate venous congestion when associated with one or two vortex vein obstruction after scleral buckle. Choroidal vasculature remodeling occurs after vortex vein obstruction leading to formation of new venous drainage routes.

Ultrastructure and Function of the Stalk Gland Complex of Pompholyx faciemlarva (Rotifera: Monogononta).

Many planktonic rotifers carry their oviposited eggs until hatching. In some species, the eggs are attached to the mother via secretions from her style gland, which forms a thread that extends from her cloaca. In species of Pompholyx, the mother possesses the rare ability to change the tension on the secreted thread, which alters the proximity of the egg with respect to her body. In this study, we used behavioral observations, confocal microscopy, and transmission electron microscopy to study the functional morphology of the stalk gland, which secretes a similar thread to the style gland. Our observations reveal that six longitudinal muscles insert on a stalk-gland complex, which is a combination of a two-headed gland and an epithelial duct that connects to the posterior cloaca. The gland secretes a single, long, electron-dense thread that traverses the duct and attaches to the egg surface through the cloaca. Three retractor muscles insert on the stalk gland and function to pull the entire complex anteriorly, thereby increasing tension on the thread and moving the egg close to the mother's body. A set of three (two pairs and a single dorsal) protractor muscles antagonize these actions, and their contraction pulls the gland complex close to the cloaca, thereby releasing tension on the thread and allowing the egg to distance itself from the mother. The stalk gland complex does not appear to be homologous to the style glands of other rotifers, but we hypothesize that it functions as a form of maternal protection as is the case with style glands.

The Scutulum and the Pre-Auricular Aponeurosis in Bats.

The external ear in eutherian mammals is composed of the annular, auricular (pinna), and scutellar cartilages. The latter extends between the pinnae, across the top of the head, and lies at the intersection of numerous auricular muscles and is thought to be a sesamoid element. In bats, this scutulum consists of two distinct regions, (1) a thin squama that is in contact with the underlying temporalis fascia and (2) a lateral bossed portion that is lightly tethered to the medial surface of the pinna. The planar size, shape, and proportions of the squama vary by taxa, as does the relative size and thickness of the boss. The origins, insertions, and relative functions of the auricular muscles are complicated. Here, 30 muscles were tallied as to their primary attachment to the pinnae, scutula, or a pre-auricular musculo-aponeurotic plate that is derived from the epicranius. In contrast to Yangochiroptera, the origins and insertions of many auricular muscles have shifted from the scutulum to this aponeurotic plate, in both the Rhinolophidae and Hipposideridae. We propose that this functional shift is a derived character related primarily to the rapid translations and rotations of the pinna in high-duty-cycle rhinolophid and hipposiderid bats.

Case report: Two cases of Cleft rhinoplasty

The correction of cleft lip nose deformity remains a great challenge for any cleft surgeon. The nose is a prominent part of the face, and any cleft lip repair directs the beholders’ eyes from the deformed lip to the deformed nose, Controversies exist on the timing of rhinoplasty in cleft lip patients and is categorized as primary rhinoplasty performed at the time of cleft lip repair, intermediate rhinoplasty at the age of 5–11 years and definitive rhinoplasty. This article presents two cases of unilateral nasal cleft in two adults treated by secondary rhinoplasty using an open technique. The primary deformity is an imbalance between abnormal muscle insertion and maxillary skeletal hypoplasia. The general characteristics of this deformity are a very short columella, downward rotation of the tip and diminished nasal projection, and treatment of this depressed and hypoplastic bony scaffolding is the secret to successful secondary rhinoplasty. Proponents of delayed nasal repair suggest that altering the cartilages in early nasal repair at the time of lip repair would complicate future corrective nasal surgeries if the primary repair would prove unsatisfactory. However, we know that repositioning the wing cartilage at the same time as closing the lip respects nasal growth by using a rigorous technique and control of scars The aim of cleft lip rhinoplasty is both aesthetic and functional: to obtain a normal nose with nasal breathing.

Complete foot drop due to atypical peroneal ganglion in a 13 ½ year old boy

IntroductionPeroneal nerve palsy due to compression by an intraneural ganglion is an uncommon entity in the pediatric setting with a need for surgical treatment. Uniquely in this case, the ganglion presented as an elongated instead of a typical round cyst, delaying diagnosis and treatment. Case presentationWe present the case of a 13 ½ year old boy with increasing peroneal nerve palsy due to an atypically shaped intraneural ganglion. An MRI of the knee revealed an elongated peroneal ganglion compressing the nerve between the lateral insertion of the gastrocnemius muscle and fibular head over a length of 10 cm. After surgical decompression and physiotherapy the peroneal nerve recovered well, achieving M 4–5 one year after surgery. ConclusionThe atypical shape of the present peroneal ganglion delayed diagnosis and correct treatment. Though rare in the pediatric setting, this entity must be specifically looked for during the diagnostic workup of peroneal palsy, for time to surgery determines neurological outcome.

Proton Therapy in Uveal Melanoma

Background/Objectives: Uveal melanoma is the most common primary intraocular malignancy in adults. Treatment options for localized, early-stage disease include enucleation, brachytherapy, and proton beam therapy. This review aims to evaluate the role of proton therapy in the definitive management of uveal melanoma, focusing on its physics, radiobiology, treatment techniques, and associated outcomes. Methods: This narrative review synthesizes current literature on proton therapy for uveal melanoma, emphasizing case selection, treatment efficacy, and side effects. Results: Proton therapy offers significant advantages for thicker uveal melanomas (over 8 mm) due to its unique physical properties, including a rapid dose fall-off that protects critical structures like the retina and optic nerve. Proton therapy may have benefits in tumor control for ocular melanomas given its increased relative biological effectiveness relative to photon therapy for these typically more radioresistant melanomas. Proton therapy may also hold special value for uveal melanomas in close proximity to the optic nerve, as patients are at high risk of visual toxicities with brachytherapy. The review discusses the efficacy of proton therapy across small, medium, and large tumors, along with strategies for improving patient survival through combined systemic therapy. Additionally, the potential of ocular reirradiation with proton therapy is addressed. Conclusions: Proton therapy is an effective treatment for uveal melanoma. It offers advantages over brachytherapy for large tumors, tumors that are close to the optic nerve or insertion of extra-ocular muscles.

Animation of latissimus dorsi flap in breast reconstruction: a retrospective analysis based on 203 cases.

Breast animation is a common postoperative complication of breast reconstruction surgery. This study investigates the factors affecting the onset and degree of animation to suggest an ideal treatment strategy for this complication. This study included patients who underwent latissimus dorsi reconstruction at Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, between 2009 and 2020 and had an outpatient visit after July 2020. Statistical analysis was performed and the patients' background and surgical factors were examined to determine whether they affected the animation incidence rate. The animation incidence rate was 69.6%. There was no significant relationship between animation incidence and any patient background or surgical factors, except for the complete dissection of insertion into the humerus of the latissimus dorsi muscle (p = 0.0039). The rate of uncomfortable animation was 4% and recurrence of animation was observed in one of the two patients who underwent denervation. Prophylactic denervation is not considered necessary and should be offered only for persistent discomfort with animation. Instead, the muscle insertion must be dissected during flap elevation to prevent animation, and the thoracodorsal nerve must be preserved to avoid muscle atrophy.