Muscle Transection Research Articles

Presacral Neuroendocrine Neoplasms: A Multi-site Review of Surgical Outcomes.

Presacral neuroendocrine neoplasms (PNENs) are rare tumors, with limited data on management and outcomes. A retrospective review of institutional medical records was conducted to identify all patients with PNENs between 2008 and 2022. Data collection included demographics, symptoms, imaging, surgical approaches, pathology, complications, and long-term outcomes. Twelve patients were identified; two-thirds were female, averaging 44.8years of age, and, for the most part, presenting with back pain, constipation, and abdominal discomfort. Preoperative imaging included computed tomography scans and magnetic resonance images, with somatostatin receptor imaging and biopsies being common. Half of the patients had metastatic disease on presentation. Surgical approach varied, with anterior, posterior, and combined techniques used, often involving muscle transection and coccygectomy. Short-term complications affected one-quarter of patients. Pathologically, PNENs were mainly well-differentiated grade 2 tumors with positive synaptophysin and chromogranin A. Associated anomalies were common, with tail-gut cysts prevalent. Mean tumor diameter was 6.3cm. Four patients received long-term adjuvant therapy. Disease progression necessitated additional interventions, including surgery and various chemotherapy regimens. Skeletal, liver, thyroid, lung, and pancreatic metastases occurred during follow-up, with no mortality reported. Kaplan-Meier analysis showed a 5-year local recurrence rate of 23.8%, disease progression rate of 14.3%, and de novo metastases rate of 30%. The study underscores the complex management of PNENs and emphasizes the need for multicenter research to better understand and manage these tumors. It provides valuable insights into surgical outcomes, recurrence rates, and overall survival, guiding future treatment strategies for PNEN patients.

Facelift: Assessment of Total Platysma Muscle Transection to Prevent the Recurrence of Platysmal Bands

IntroductionDetermining which facelift technique yields the most effective long-term rejuvenation results and ensures optimal stability over time remains a significant question in cosmetic surgery: Does the most invasive surgery lead to the best long-term outcomes? This study aims to evaluate the authors’ approach using total platysma muscle transection to prevent platysma band recurrence, and to provide anatomical observations supporting and justifying their procedure.Material and MethodsA preliminary study in anatomical basic sciences was conducted to establish the rationale for our method. A prospective single-blind study was conducted, involving eighty patients seeking facial rejuvenation with platysmal band correction. They underwent face and neck-lift procedures with total platysma transection by the same surgeon between May 2013 and May 2016. Cosmetic outcomes were assessed using the Face and Neck-Lift Objective Photo-Numerical Assessment Scale. Scores by three blind evaluators before surgery, at 1 and 5 years postoperatively, were compared using a matched T Test (p < 0.05).ResultsThe preliminary anatomical study revealed a consistent anastomotic system between the cervical branch of the facial nerve and the branches of the cervical plexus. Incomplete platysma section during a facelift might contribute to platysma band recurrence. The clinical study demonstrated satisfactory outcomes, with significant overall appearance improvement (p < 0.00001) and no platysma band recurrence. Complication rate was low.ConclusionThe authors’ technique achieved satisfactory long-term results with minimal complications. However, due to the lengthy operating time and steep learning curve, it should be reserved for highly motivated patients.Level of Evidence IIThis 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.

Comparison between cutting versus retraction of anterior cervical musculature during endoscopic thyroidectomy.

To compare the different techniques of managing the anterior cervical muscle group during endoscopic thyroidectomy via the trans-thoraco-areolar approach. A total of 90 patients with thyroid tumors less than 3 cm were evaluated. The time for each intraoperative step, total surgery duration, intraoperative blood loss volume, pathology results, number of lymph nodes dissected and patient satisfaction with esthetics were assessed. Intraoperative blood loss volume, drainage volume on the first postoperative day, number of lymph nodes dissected in the central region, postoperative hospitalization duration, number of transient laryngeal nerve palsy cases, and number of transient hypocalcemia cases were similar between the muscle transection (MT) and muscle retraction (MR) groups. The MT group had significantly higher postoperative pain scores after 12 hours, but pain scores at 48 hours postoperatively were not significantly different between the 2 groups. In the unilateral thyroidectomy subgroup, the durations of isthmus resection, freeing the lateral thyroid, exposing the laryngeal recurrent nerve, and management of the inferior pole were similar for both muscle management methods. The muscle dissection and suture time was significantly longer for the MT group than that for the MR group; in contrast, the upper pole management time of the muscle resection group was significantly shorter. In the bilateral resection subgroup, both muscle management methods required similar durations for managing the contralateral upper pole after ipsilateral thyroidectomy. However, intraoperative blood loss was significantly higher for MR than for MT, while postoperative pain was relatively mild. In the malignant tumor subgroup, duration of inferior thyroid pole management was significantly less for MT than for MR. There are significant differences between the 2 muscle management methods in handling and suturing muscles. Both methods have satisfactory postoperative outcomes for resection of thyroid nodules with diameters ≤3 cm. For tumors located in the upper pole, transection of the anterior cervical muscles confers higher feasibility of the thyroidectomy technique; however, suturing becomes difficult in such scenarios.

Simplification of the complex: Successful management of large-angle exodeviation after endoscopic sinus surgery.

To report the clinical characteristics and successful management of large-angle exodeviation due to medial rectus muscle (MR) transection incurred during endoscopic sinus surgery (ESS). The medical records of 5 consecutive inpatients with MR complete transection following ESS resulting in large-angle paralytic exodeviation between November 2014 and June 2021 were reviewed. The type of muscle injury, clinical characteristics, surgical procedure and dosage, and long-term outcomes were evaluated. All 5 patients manifested exodeviations of 72 PD to >133 PD with no adduction capacity (graded -4); all of them had proven orbital trauma and complete MR transection with a ≥20 mm distal (globe attached) stump based on CT scans and/or MRI imaging. They underwent a supra-maximal recession (10-12 mm) of the lateral rectus and resection (10-15 mm) of the medial rectus on the affected eye. At least 1 year (1 to 5 years) following the corrective surgery, the patients still maintained orthophoria or had a small angle of exotropia (≤ 8 PD) in primary gaze with successful fusion, and 3 of them (Case 3, 4, and 5) exhibited a certain degree of stereopsis. In addition, appreciable adduction occurred (graded -1 to -3). A supra-maximal recession/resection shows favorable outcomes in patients with proven complete transection MR with a ≥20 mm distal (globe attached) stump. It can help to achieve good ocular alignment and even yield improvements in adduction over time.

The effect of strap muscle transection on voice and swallowing changes after thyroidectomy in patients without laryngeal nerve injury.

Voice and swallowing symptoms are frequently reported after thyroidectomy even without laryngeal nerve injury. We aimed to evaluate the effect of strap muscle transection on voice and swallowing outcome after thyroidectomy. Group 1 (G1) consisted of 17 patients who had their strap muscles transected during thyroidectomy and group 2 (G2) consisted of 17 patients who had their strap muscles preserved during thyroidectomy. None of the patients had laryngeal nerve injury. Voice impairment scores (VIS) and swallowing impairment scores (SIS) were obtained preoperatively and at 1 week and 1, 3 and 6 months postoperatively. Pre- and postoperative vocal cord examinations were performed for all patients. The external branch of the superior laryngeal nerve (EBSLN) was evaluated by intraoperative cricothyroid muscle electromyography. There was no significant difference in VIS and SIS between the two groups. At postoperative week 1, the VIS and SIS for each group were above preoperative values (G1: p = 0.005 and p = 0.035; G2: p = 0.031, p = 0.346, for VIS and SIS respectively). The VIS and SIS scores at 6 months postoperatively were significantly lower than those of the first week postoperatively (G1: p = 0.04 and p = 0.001; G2: p = 0.022 and p = 0.034 respectively) and similar to preoperative values (G1: p = 0.924 and p = 0.086; G2: p = 0.822 and p = 0.187 respectively). Although voice and swallowing complaints increased in the early postoperative period even without recurrent laryngeal nerve and EBSLN injuries, these symptoms are not related with the strap muscle transection.

Surfboard Related Orbital and Periocular Injury.

The objective of this study is to present the complexity of surfboard related orbital and periocular injuries and to discuss the different prevention aspects of such injuries. A retrospective review was performed on surfing related orbital and periocular injuries cases in a single tertiary medical center over a period of 10 years. Six patients at a mean age of 34 (range 20-50) years were evaluated. All were amateur surfers. Five patients had an orbital fracture, 3 had a full thickness eyelid laceration, 3 had lacrimal drainage system damage and 3 had intraocular findings related to trauma, but no perforation of the globe was observed. Two patients had complete optic nerve avulsion or transection, 1 of them had extraocular muscle transection. Five patients underwent surgery and 2 required an additional surgical intervention. At the end of follow-up, 3 patients had an unrepairable lacrimal drainage damage, 2 had a malposition of an eyelid, 2 eyes remained blind, 1 patient had a hypoglobus, and 1 had hypoesthesia in distribution of infraorbital nerve. Surfboard related orbital injuries may cause a severe orbital injury, which may debilitate and disable a previously active and healthy group of young people. Hence, protective gear wear should be more vigorously encouraged as already been done in other sports.

Pectoralis Major Tendon Tears During Airborne Operations: Are These Injuries Isolated?

Pectoralis major tendon tears are an injury pattern often treated in military populations. Although the majority of pectoralis major tendon tears occur during eccentric loading as in bench press weightlifting, military service members may also experience this injury from a blunt injury and traction force produced by static line entanglement during airborne operations. Although these injuries rarely occur in isolation, associated injury patterns have not been investigated previously. After obtaining institutional review board approval, medical records were reviewed for all patients who underwent surgical repair of a pectoralis major tendon tear sustained during static line parachuting at a single institution. Radiology imaging, operative notes, and outpatient medical records were examined to determine concomitant injury patterns for each patient identified over a 4-year study period. Twenty-five service members met the study inclusion criteria. All patients underwent presurgical magnetic resonance imaging. Of these 25 service members, 10 (40%) presented with a total of 13 concomitant injuries identified on physical exams or imaging studies. The most common associated injuries were injuries to the biceps brachii and a partial tear of the anterior deltoid. Biceps brachii injuries consisted of muscle contusion proximal long head tendon rupture, proximal short head tendon rupture, partial muscle laceration, and complete muscle transection. Additional concomitant injuries included transection of coracobrachialis, a partial tear of the inferior subscapularis tendon, antecubital fossa laceration, an avulsion fracture of the sublime tubercle, and an avulsion fracture of the coracoid process. Military static line airborne operations pose a unique risk of pectoralis major tendon tear. Unlike the more common bench press weightlifting tear mechanism, pectoralis major tendon tears associated with static line mechanism present with a concomitant injury in 40% of cases, with the most common associated injury occurring about the biceps brachii. Treating providers should have a high index of suspicion for concomitant injuries when treating pectoralis major tendon tears from this specific mechanism of injury.

Incidence of and risk factors for surgical site infection following canine limb amputation.

To determine the incidence of and risk factors for surgical site infection (SSI) following canine thoracic and pelvic limb amputations. Retrospective, multicenter study. Dogs (n=248). Medical records were reviewed for preoperative, intraoperative, and postoperative variables including indication for amputation, amputation type, method of muscle transection, duration of surgery and anesthesia, and wound classification. Follow up was ≥30 days or until SSI development. Logistic regression and Fisher's exact tests were used to compare SSI incidence to variables of interest. The incidence of SSI was 12.5% for all procedures and 10.9% for clean procedures. Factors increasing odds of SSI were muscle transection with a bipolar vessel sealing device (P=.023 for all procedures, P=.025 for clean procedures), procedure classified as other than clean (P=.003), and indication for amputation of bacterial infection (P=.041) or traumatic injury (P=.003) compared to neoplasia. Use of bipolar vessel sealing devices for muscle transection increased the odds of developing an SSI whereas use of electrosurgery and/or sharp transection did not. Dogs with surgical sites that were other than clean, or with bacterial infection and/or traumatic injury were also at increased odds of SSI. Use of electrosurgery or sharp transection for muscle transection should be considered rather than use of bipolar vessel sealing devices to decrease odds of SSI in dogs undergoing limb amputation. Further studies across a variety of procedures are needed to validate these findings given the increasing popularity of these devices in veterinary medicine.

Lateral Approach in Thyroidectomy- a Comparative Study

Introduction: To enter the thyroid gland, the lateral "backdoor" technique (LA) uses the same central neck incision as the anterior border of the sternocleidomastoid (SCM) and strap muscles. Typically, this treatment is done to redo thyroid surgery. The results of the two procedures were compared in people who were having their first conventional thyroidectomy. Methods: A case-control study was undertaken on 30 people who received a routine open thyroidectomy from January 1, 2018 to December 31, 2019. The first 15 patients were given MA, then another 15 were given LA. All patients received 10 mL of 1 percent Marcaine infiltration before the neck incision was closed. Basic demographic data, surgery time, incision length, gland weight, strap muscle transection required, and complications were all recorded. The study excluded thyroid revision surgery and minimally invasive thyroid surgery. Results: Demographics, surgery time, gland weight, and incisional length did not differ significantly. The LA group experienced significantly reduced post-operative pain. 5 patients (11%) in the MA group required horizontal transection of strap muscles to remove large goitres, compared to 1 patient (2.2%) in the LA group. In neither group, there were any major issues. Conclusion: The LA approach is equally safe as the midline surgery, with a similar surgical time and substantially lower pain levels. By avoiding midline separation and suturing of strap muscles, it reduces the need for strap muscle transection to remove large goitres.

35 Say no to pneumo: Mini-laparotomy myomectomy is the way to go

This video demonstrates how to perform a safe and efficient mini-laparotomy myomectomy utilizing a unique abdominal entry technique. Leiomyomas are the most common estrogen-dependent benign uterine tumors in women. In patients who desire future fertility or a uterine-sparing surgery, myomectomy is an option. This surgical procedure can be performed using abdominal, laparoscopic, or robotic assisted approach; however, the choice of surgical technique depends on tumor size, surgeon experience and patient preference. Although minimally invasive routes such as conventional and robotic laparoscopy for myomectomy are now readily performed, in patients with significantly large leiomyoma, these routes can prove challenging due to limited visualization, increased risk for bleeding, and longer operating times. If the minimally invasive route proves successful, surgeons are still left with the dilemma of how to remove the leiomyoma from the peritoneal cavity. Commonly, a mini-laparotomy incision is performed for leiomyoma extraction. Mini-laparotomy myomectomy has been described in the literature using a vertical skin incision or Maryland incision to obtain abdominal access. The following video demonstrate a case series displaying a 4-step strategy for mini-laparotomy myomectomy with large leiomyomas to include Step 1: Abdominal entry and optimizing visualization, Step 2: Preemptive measures to prevent excessive bleeding., Step 3: Leiomyoma extraction and morcellation technique, and Step 4: Closure of uterine defects and hysterotomy repair. We present a unique surgical technique using a transverse skin incision with a vertical fascial incision to perform mini-laparotomy myomectomy in large leiomyomatous uteri. Unlike previously described techniques, our method is particularly effective as it maximizes visualization without rectus muscle transection, decreasing postoperative pain while maintaining a desirable cosmetic result from the small transverse skin incision.

Navigated Transconjunctival Endoscopic Approaches to the Orbit

ABSTRACT BACKGROUND Standard cranial approaches to the orbit involve lengthy skin incisions, extensive soft tissue dissection, and large craniotomies, increasing morbidity. OBJECTIVE To evaluate less invasive approaches to the orbit, using endoscopic transconjunctival approaches. METHODS Neuronavigated transconjunctival approaches to the orbit were performed on 4 cadavers using 30°/3 mm and 0°/6 mm rigid endoscopes. A special head frame was designed for this study to prevent excessive movement of the endoscope tip in the orbit. Lateral and medial transconjunctival supra- and infrabulbar approaches to the extra- and intraconal spaces were performed. The incision length, maximal penetration depth in the extra- and intraconal spaces, and distance from the orbital rim to the optic nerve were measured. RESULTS All 4 approaches afforded satisfactory exposure and access to the extra- and intraconal spaces. The mean incision length for the transconjunctival approach was 10.4 mm. The optic nerve could be exposed through all 4 approaches. The mean maximal penetration depths in the extraconal space were 28.6 ± 3.5 mm for the 30°/3 mm and 20.7 ± 4.5 mm for the 0°/6 mm endoscope. In the intraconal space, the mean maximal depth of penetration was 23.8 ± 2.4 mm for the 30°/3 mm and 19.4 ± 3.4 mm for the 0°/6 mm endoscope. Based on these measurements, the orbit was classified into quadrants and zones. CONCLUSION Transconjunctival endoscopic approaches to the orbit allow maximal exposure of the extra- and intraconal spaces through a minimally invasive approach requiring no muscle transection. Infrabulbar approaches have better cosmetic results than suprabulbar approaches, which require incision of the eyelid.

Inferior Rectus and Inferior Oblique Muscle Transections with Medial Rectus Muscle Partial Avulsion, following Metal Hook Injury

ABSTRACT Avulsion or transection of three extraocular muscles following trauma is a rare finding, and there are few case reports and series discussing the approach to surgical repair. The authors report a case of a penetrating metal hook injury resulting in partial avulsion of a medial rectus muscle and transection of the inferior rectus and inferior oblique muscles. This case highlights the importance of identification and primary repair of a complete inferior rectus muscle transection and a partial medial rectus muscle avulsion with an excellent functional outcome.

A new application of modified Nishida muscle transposition procedure for medial rectus muscle transection following endoscopic sinus surgery without tenotomy or splitting muscles

The modified Nishida muscle transposition procedure, in which the one-third of the vertical rectus muscle bellies are sutured onto the sclera in the infero- and superotemporal quadrants without either tenotomy of the vertical rectus muscles or splitting of the vertical rectus muscle is an effective treatment for abducens nerve palsy. We report 2 cases of large-angle exotropia caused by medial rectus transection following the endoscopic sinus surgery treated using the modified Nishida procedure to transpose both vertical rectus muscles nasally, combined with lateral rectus muscle recession.

Myth-Busting the DIEP Flap and an Introduction to the Abdominal Perforator Exchange (APEX) Breast Reconstruction Technique: A Single-Surgeon Retrospective Review.

Anatomical variations in perforator arrangement may impair the surgeon's ability to effectively avoid rectus muscle transection without compromising flap perfusion in the deep inferior epigastric artery perforator (DIEP) flap. A single surgeon's experience was reviewed with consecutive patients undergoing bilateral abdominal perforator flap breast reconstruction over 6 years, incorporating flap standardization, pedicle disassembly, and algorithmic vascular rerouting when necessary. Unilateral reconstructions were excluded to allow for uniform comparison of operative times and donor-site outcomes. Three hundred sixty-four flaps in 182 patients were analyzed. Operative details and conversion rates from DIEP to abdominal perforator exchange ("APEX") arms of the algorithm were collected. Patients with standardized DIEP flaps served as the controlling comparison group, and outcomes were compared to those who underwent abdominal perforator exchange conversion. The abdominal perforator exchange conversion rate from planned DIEP flap surgery was 41.5 percent. Mean additional operative time to use abdominal perforator exchange pedicle disassembly was 34 minutes per flap. Early postsurgical complications were of low incidence and similar among the groups. One abdominal perforator exchange flap failed, and there were no DIEP flap failures. One abdominal bulge occurred in the DIEP flap group. There were no abdominal hernias in either group. Fat necrosis rates (abdominal perforator exchange flap, 2.4 percent; DIEP flap, 3.4 percent) were significantly lower than that historically reported for both transverse rectus abdominis musculocutaneous and DIEP flaps. This study revealed no added risk when using pedicle disassembly to spare muscle/nerve structure during abdominal perforator flap harvest. Abdominal bulge/hernia was nearly completely eliminated. Fat necrosis rates were extremely low, suggesting benefit to pedicle disassembly and vascular routing exchange when required. Therapeutic, III.

Challenging Management of Double Vision After Functional Endoscopic Sinus Surgery—A Series of 6 Cases

To present 6 cases of orbital trauma, diplopia and strabismus after functional endoscopic sinus surgery (FESS). Retrospective observational case series. The medical charts of suitable patients were reviewed for information on medical examination, imaging studies, the type of corrective surgery, and surgical outcomes. All patients with diplopia and strabismus after undergoing FESS who were treated or consulted at our institution between 2008 and 2017 were included. The presence and extent of strabismus and double vision at the end of follow-up. Six patients complained of diplopia after FESS; all of them had proven orbital trauma. In Cases 1-5, patients suffered medial rectus (MR) muscle transection and subsequent exotropia. Their prognosis was guarded despite prompt surgical intervention, and ranged from large exotropia when direct recovery of the MR was attempted, to primary gaze orthotropia but with minimal adduction capacity, during which vertical recti transposition was attempted. Patient 6 sustained transient diplopia, although all of his extraocular muscles appeared intact on imaging. His eye position and movement were completely resolved with conservative measures only. Our experience was that immediate recovery procedures to reattach the muscle in cases with proven transection of the MR muscle are futile, and that definitive corrective strabismus surgery (ie, vertical muscle transposition) has a better chance to achieve favorable results.

The lateral “backdoor” approach to open thyroid surgery: A comparative study

The traditionally taught technique for conventional open thyroidectomy is via a midline splitting of the strap muscles following a skin crease neck incision - midline approach (MA). The lateral "backdoor" approach (LA) uses the same central neck incision but approaches the thyroid gland between the anterior border of sternocleidomastoid (SCM) and strap muscles. This technique is usually reserved for re-do thyroid surgery. We compared the results of the two approaches in patients undergoing conventional thyroidectomy for the first time. A case-control study was performed on 90 patients undergoing conventional open thyroidectomy from 2012 to 2014. The first 45 patients underwent MA and subsequent 45 patients underwent LA. All patients were given 10ml of 1% Marcaine infiltration into the neck incision before closure. Basic demographic data, operative time, incision length, weight of gland, need for transection of strap muscles and complications were recorded. Revision thyroid surgery and minimally invasive thyroid operations were excluded. The demographics, operative timing, gland weight and incisional length showed no significant difference. Post-operative pain was significantly lower in the LA group. 5 patients (11%) in MA group needed horizontal transection of strap muscles to extract large goitres compared to 1 patient (2.2%) in the LA group. No major complications occurred in either group. The LA method is as safe as the midline technique with comparable operative time and significantly lower pain scores. It avoids midline separation and suturing of strap muscles and reduces the need for strap muscle transection to removal large goitres.

Long-term therapeutic outcome of ophthalmic complications following endoscopic sinus surgery

Ophthalmic complications associated with endoscopic sinus surgery (ESS) are quite rare. There is a paucity of reliable data and limited experience on the clinical findings and treatments of these injuries. Our study here is to characterize the types of orbital injury following ESS, in particular extraocular muscle injury, and to evaluate the long-term therapeutic outcomes as compiled from a relatively large sample of Chinese patients.A series of 27 patients (21 males and 6 females; mean age = 42.6 years, ranges: 10–60 years) were retrospectively reviewed. The mean duration of orbital complication was 6.6 months (ranges: 1 day to 24 months). The right eye was affected in 19 patients and the left in 8 patients. All patients had various extraocular muscle dysfunction, including contusion, oculomotor nerve damage, muscle entrapment, muscle transection, and muscle destruction. All patients subjected to strabismus surgery showed an obvious reduction in deviation. Three patients achieved orthophoria without any surgery during the period of observation. All patients displayed mild to complicated orbital hemorrhage that often disappeared within 2 weeks. Optic nerve injury occurred in 29.6% of patients and vision damage in these patients was often irreversible.All patients with ophthalmic complications after ESS had strabismus and extraocular muscle dysfunction. Timing and type of strabismus surgery performed depended on the severity and number of muscles involved as well as the type of injury. This surgery is less effective in cases of restriction factor adhesion and/or entrapment as compared to that of patients with other types of strabismus. Orbital hemorrhages were usually resolved spontaneously, but optic nerve injury was mostly irreversible.

Extraocular muscle injury during endoscopic sinus surgery: an ophthalmologic perspective.

PurposeThe purpose of this study is to describe the clinical characteristics and treatment results of medial rectus muscle (MR) transection incurred during endoscopic sinus surgery.MethodsThis retrospective study included 16 patients with MR transection incurred during endoscopic sinus surgery between 1994 and 2015. The operative notes of the surgical procedure, the pattern of strabismus, the type of muscle injury, the type of corrective strabismus surgery, and the surgical outcomes were reviewed.ResultsNine patients had partial resection of MR and seven patients had complete transection of MR, resulting from an injury incurred during endoscopic sinus surgery. Three of the nine patients with partial resection injury were initially diagnosed as complete resection and subsequently re-diagnosed as partial resection in a review of the images during this study. Five of the nine patients with partial MR resection underwent only simple recession/resection surgery. Patients with complete MR transection underwent muscle transposition or globe fixation surgeries and often multiple operations were required.ConclusionsThe results of this study showed that the treatment strategies could vary depending on the nature of muscle injury. In cases with complete transection, muscle transposition or globe fixation surgeries are often required, with multiple operations. However, partial muscle resection with only simple recession/resection surgery shows a favorable outcome in many cases. The use of proper imaging techniques, a thorough review of the images with various planes, and close follow-up are important for determining the nature of the muscle injury.

Peer review report 1 on “Iliopsoas impingement after revision total hip arthroplasty treated with iliopsoas muscle transection”

Peer review report 1 on “Iliopsoas impingement after revision total hip arthroplasty treated with iliopsoas muscle transection”

Endoscopic transconjunctival surgical approach to intraconal space of the orbit: First clinical experience

Background and purposeRecently, a transconjunctival, endoscope-assisted (TEA) approach to the medial intra-orbital space was developed based on cadaver preparations, with an ultimate goal of minimizing disturbances of the anatomic structures of the orbit. However, no report on clinical validation of this promising technique was published thus far. We present our experiences with the TEA approach in two patients. Material and methodsIn emergency conditions, we approached the lateral retrobulbar space of a 42-year-old male through a 180° incision close to the corneal limbus; a scrap of metal, which had perforated the globe and resided at its posterior wall, was removed endoscopically. Moreover, we used the TEA approach to remove a tumor from the upper intraconal space in a 63-year-old woman. ResultsIn both patients the surgical goal was achieved with no muscle transection and without additional morbidity and complications. ConclusionsOur experiences with TEA approach suggest that the procedure is clinically feasible, produces no co-morbidity and yields good functional and cosmetic results. As a result, the whole circumference of the retrobulbar space can be conveniently explored.