Neck Deformity Research Articles

Protective Role of Vitamin B6 Against Teratogenic Effects Induced by Lead in Chick Embryo.

Heavy metals like lead (Pb) have been used by humans for a very long time, but throughout the industrial revolution, their use expanded, increasing exposure to the metal. Lead, however, has no biological purpose in the human body and is hazardous when it gets into soft tissues and organs. Lead is still used in a variety of industries, including battery manufacturing and car maintenance, despite efforts to limit its usage. This study investigates the teratogenic and morphometric effects of lead on chick embryos and the potential ameliorative effects of vitamin B6. Two hundred fertilized eggs from the golden black chicken were divided into four groups: control, lead acetate, vitamin B6, and lead + vitamin B6. On the 14th day, embryos were analyzed. Significant reductions in body weight and size were observed in the lead-exposed group (33.93 ± 1.27 g) compared to the control (41.12 ± 0.97 g). Pronounced deformities included rudimentary beaks, protruding eyes, tridactyl limbs, hydrocephaly, and neck deformities. Appendicular deformities like phocomelia, amelia, and abnormal phalanges growth were also noted. Vitamin B6 demonstrated therapeutic benefits, significantly improving mean embryo weight in the Lead + Vitamin B6 group (42.37 ± 0.99 g). The lead-exposed group showed a reduction in maxilla length (3.61 ± 1.30 mm) compared to the Lead + Vitamin B6 group (7.57 ± 0.79 mm). This group also showed reduced severity of muscular dystrophy and bone thinning, with signs of recovery in beak and bone sizes. The study highlights vitamin B6's beneficial impact in mitigating lead's toxic effects on chick embryonic development.

Numerical modeling and analysis of neck injury induced by parachute opening shock.

Neck injuries from parachute opening shock (POS) are a concern in skydiving and military operations. This study employs finite element modeling to simulate POS scenarios and assess cervical spine injury risks. Validated against various conditions, including whiplash, the model replicates head/neck kinematics and soft tissue responses. POS simulations capture body/head motions during parachute deployment, indicating minimal risk of severe neck injuries (Abbreviated Injury Score/AIS ≥ 2) and low risk of soft tissue tears. Vertebral stress analysis during a rougher jump highlights high stress at C5/C6 lamina, indicating fracture risk. Comparative analysis with rear impact scenarios reveals distinct strain patterns, with rear impacts showing higher ligament strain, consistent with higher soft tissue damage risk. Though POS simulations exhibit lower strain values, they emphasize similar neck deformation patterns. The model's capability to accurately simulate head and neck movements during parachute openings provides critical validation for its use in assessing injury risks. The study's findings underline the importance of considering specific loading conditions in injury assessments and contribute to refining safety standards for skydiving and military operations. By highlighting the differences in injury mechanisms between POS and rear impacts, this research offers valuable insights into tailored injury mitigation strategies. The results not only enhance our understanding of neck injury mechanisms but also inform the development of protective gear and safety protocols, ultimately aiding in injury prevention for skydivers and military personnel.

Papillary microcarcinoma in three generations of the first degree relatives

Family papillary microcarcinoma of the thyroid gland is observed in 3–10 % of patients with cancer from follicular epithelial cells. Diagnosis and treatment are controversial. Three patients from the same family of the first degree of kinship were operated for family papillary microcarcinoma of the thyroid gland in Voronezh Regional Clinical Hospital No. 1. Only the first patient complained of the neck deformity, her son and granddaughter had an asymptomatic course of the disease. Metastases to the lymph nodes of the neck and bilateral localization of the tumor were not revealed. In the third generation, multifocal tumor growth was diagnosed at the age of 19. All patients underwent thyroidectomy. In the first patient, the period of relapse–free follow-up after surgery was 18 years, in the second and third – 5 years. In the family form of papillary thyroid carcinoma, we consider active screening of relatives justified since the disease in the new generation may develop at a younger age and with the risk of multifocal thyroid damage even in microcarcinomas.

Multiple dermatofibromas in a patient with Ehlers–Danlos syndrome: a case report

BackgroundDermatofibromas, also known as benign fibrous histiocytomas, are among the most common cutaneous soft-tissue lesions. Association of multiple dermatofibromas with some diseases was described and it has not been reported with Ehlers–Danlos syndrome before. We present a case with Ehlers–Danlos syndrome and multiple dermatofibromas.Case presentationAn 18-year-old Iranian woman presented with multiple purple nodules ranging from 0.5 to 1.5 cm in diameter, which were mobile and located on the proximal part of the lower limb. The dimple sign of these lesions was positive. During the physical examination, several features suggestive of Ehlers–Danlos syndrome were observed, including hyperextensibility and fragility of the skin, wide atrophic scars on the upper limb, hypermobility of joints and fingers, swan neck deformities of the digits, nodules on the knee, and striae alba on the leg. The patient was previously unaware of having Ehlers–Danlos syndrome. She had a history of asthma and atopic dermatitis. Family history was negative. A biopsy of the nodular lesions was performed, and the findings confirmed the diagnosis of dermatofibromas.ConclusionWe describe a patient with Ehlers–Danlos Syndrome who presented with multiple dermatofibromas. To our knowledge, this combination of findings is a previously unreported occurrence.

Simultaneous Necking and Barreling Deformation Behaviors in Bending of Single-Crystal Gold Micro-Cantilever.

Necking and barreling deformation behaviors occurred simultaneously during the bending test of a single-crystal gold micro-cantilever (sample A) with the loading direction parallel to the [1-10] orientation and the neutral plane parallel to the [110] orientation. In contrast, for another single-crystal gold micro-cantilever, sample B, with the loading direction aligned parallel to the [0.37 -0.92 0.05] orientation and the neutral plane parallel to the [0.54 0.28 0.78] orientation, predominant slip band deformation was noted. Sample A exhibited activation of four slip systems, whereas sample B demonstrated activity in only a single-slip system. This difference suggests that the presence of multiple slip systems contributes to the concurrent occurrence of necking and barreling deformations. Furthermore, variations in the thickness of the micro-cantilevers resulted in observable strengthening, indicating that the effect of sample size is intricately linked to the geometry of the cross-section, which we have termed the "sample geometry effect".

3D Printing for the Development of Palatal Defect Prosthetics.

Three-dimensional (3D) printing has emerged as a promising new technology for the development of surgical prosthetics. Research in orthopedic surgery has demonstrated that using 3D printed customized prosthetics results in more precise implant placements and better patient outcomes. However, there has been little research on implementing customized 3D printed prosthetics in otolaryngology. The program sought to determine whether computed tomography (CT) serves as feasible templates to construct 3D printed palatal obturator prosthetics for defects in patients who have been treated for head and neck cancers. A retrospective review of patients with palatal defects was conducted and identified 1 patient with high quality CTs compatible with 3D modeling. CTs of the patient's craniofacial anatomy were used to develop a 3D model and a Formlabs 3B+ printer printed the palatal prosthetic. We successfully developed and produced an individualized prosthetic using CTs from a veteran with head and neck deformities caused by cancer treatment who was previously treated at the Veterans Affairs Palo Alto Health Care System. This project was successful in printing patient-specific implants using CT reproductions of the patient's craniofacial anatomy, particularly of the palate. The program was a proof of concept and the implant we created was not used on the patient. Customized 3D printed implants may allow otolaryngologists to enhance the performance and efficiency of surgeries and better rehabilitate and reconstruct craniofacial deformities to restore appearance and function to patients. Additional research will strive to enhance the therapeutic potential of these prosthetics to serve as low-cost, patient-specific implants.

Congenital Sternoclavicular Sinus-Case Series of a Rare Lower Neck Deformity.

We encountered patients with a congenital cutaneous sinus tract in the sternoclavicular joint region, which we designate as "congenital sternoclavicular sinus (CSCS)." The aim of this investigation is to enhance recognition of this subtle yet noteworthy entity and develop standardized protocols for its management. Between 2013 and 2023, 172 patients, including 78 males and 94 females, were referred to our institution for the management of CSCS. Clinical charts were retrospectively reviewed. The majority of patients (60.5%) were young children below 3 years of age, with only six adult patients and a median age of 27.5 months. The left side was implicated in 157 cases (91.3%). In 146 cases (84.9%), a faint skin streak was noted above the orifice. Yet, no pharyngeal sinus tracts were detected, either through barium swallow studies or direct laryngoscopy. All skin lesions featured a diminutive orifice near the sternoclavicular joint, with the tract extending deeply into the subcutaneous tissue and terminating blindly, short of entering the joint, after a distance of 10 mm (ranging from 5 to 21 mm). Histopathological analysis revealed that the epithelial lining predominantly consisted of stratified squamous epithelium (87.8%), with ciliated columnar epithelium accounting for the remaining 12.2%. CSCS, though infrequent, presents with distinctive pathological and clinical features. The condition predominantly affects the left sternoclavicular joint region, with the notable "skin streak sign" aiding in diagnosis. We considered CSCS as one disease entity of branchial arch anomalies. Complete surgical excision offers a definitive cure. 4 Laryngoscope, 134:4402-4408, 2024.

Management of a Proximal Femoral Central Physeal Bar in a 3-Year-Old Child Using a Novel Surgical Technique: A Case Report.

We present a proximal femoral central physeal bar secondary to femoral neck fracture management, in a 3-year-old boy. He presented with progressive femoral neck deformity and limb length discrepancy. He was managed with a novel technique of bar resection by drilling and polymethylmethacrylate interposition. After 5 years of follow-up, the hip score by Ratliff criteria was good. Screw penetration across physis during management of femoral neck fracture can cause growth arrest in a young child. Our technique is useful when physeal bar is central and linear. It can allow sufficient growth and remodeling to restore a near-normal hip both radiologically and clinically.

KLIPPEL FEIL SYNDROME AND ASSOCIATED ANOMALIES

Introduction: Klippel-Feil syndrome (KFS) is a rare genetic disorder characterized by abnormal the development of the cervical spine, which leads to the fusion of two or more cervical vertebrae. Incidence is 1:40 000 - 42 000. Inheritance is usually autosomal dominant. The gene mutation is most often found on the long arm of chromosome 8q22.1.The syndrome was first described by French physicians, Maurice Klippel and André Feil in 1912 with the classic clinical triad of manifestations consisting of a low posterior hairline, short neck, and limited neck range of motion. There may be skin folds on the neck - Pterygium colli, and the shoulder blades are high - Sprengel Deformity. Scoliosis is often present. Accompanying, hidden anomalies may be more important than neck deformity. A clinical finding with an objective examination is sufficient to suspect this syndrome. And then additional diagnostic methods are applied. Surgical intervention is carried out in the event of instability on the spine with the aim of eliminating it, as well as correcting scoliosis. Therapy of accompanying anomalies - kidney, neurological disorders, hearing disorders. Physical therapy is also recommended, which gives modest results. The life span of people with Klippel-Feil syndrome is shortened due to frequent anomalies of the internal organs. Case report: The paper presents a girl aged 10 years and 10/12 months. Pronounced hypertelorism. On the upper lip, a scar after cleft lip and palate surgery, left. Teeth carious, irregularly arranged. Neck short with pterygium. Low hairline. Pronounced scoliosis. High position of the shoulder blades. Abdominal ultrasound shows agenesis of the right kidney. IVP - the right kidney is not shown, the left kidney is compensatory enlarged. A diagnosis of Klippel Feil syndrome was made in a tertiary institution. Parents refuse further tests and treatment. Conclusion: In every child with Klippel-Feil syndrome, further examination and detection of accompanying, hidden anomalies that may be more important than the neck deformity is necessary.

Post-Burn Cervical Retraction: 2 Cases and a Survey of the Literature

Burns are still a fairly frequent accident, affecting more children and women in our society. They generally lead to sometimes dramatic functional, aesthetic and psychological after-effects. Treatment in the acute phase, or at a later stage, conditions the patient's image. The neck, however, remains a high-risk area for the development of retractions, due to its anatomy. The skin is thin, the platysma directly subcutaneous, the hypodermis thin, and immobilization difficult. Once the flange has set in, it can be reconstructed using a variety of plastic and reconstructive surgery techniques, in conjunction with physiotherapy. However, the choice of treatment will depend on the quality and quantity of healthy skin tissue available in the neck. Skin grafting gives good results at a distance, when post-operative preventive measures are followed. Local plasty is a simple and effective solution for the treatment of simple localized bridges. Our work is a case study spread over a 2-year period from November 2021 to November 2023, which includes 2 cases of cervical sprains followed up in the plastic and reconstructive surgery and burns department of the Mohammed VI University Hospital in Tangier. Directed wound healing had been the initial treatment in both our patients, with good compliance in patient N2. Moderate and severe cervical sprains (according to Achauer's classification) were found in both our patients. In both patients, the flange had a functional impact, with limited neck extension and deformity of the cervico-chinese angle. Surgical treatment involved skin grafts in the 1st case, and local plasty in the second. Post-operative re-education remains a therapeutic pillar for obtaining satisfactory results.

Modeling of rigidly-constrained pure shear dielectric elastomer actuators: electromechanical coupling network method

The rigidly-constrained pure shear dielectric elastomer actuator (PS-DEA) has become one of the critical configurations in linear soft actuator design due to its excellent uni-directional actuation performance and convenient preparation process. However, the theoretical analyses are primarily conducted by employing ideal models and lack consideration of the lateral necking deformation of PS-DEA, which has an essential impact on the performance evaluation and optimal design of PS-DEA. Therefore, in this paper, a user subroutine that describing the behavior of the electromechanical behavior of DE in terms of the Gent free-energy model is developed, and then a parametric model of the PS-DEA is established. Different combinations of actuator parameters are obtained by Latin hypercube sampling, and the actuator’s performance under the parameters is simulated by the finite element method. The finite element results are taken as a sample set, and a BP neural network with three hidden layers is employed to train the samples and obtain a PS-DEA network prediction model, which is experimentally analyzed to validate its accuracy and effectiveness. The prediction model explores the influence of geometric and pre-stretching parameters on the actuator’s performance and obtains the difference between the ideal theoretical and the network prediction model under various parameters. The method in this paper provides a new design methodology and theoretical basis for developing high-performance DE actuators.

Talar neck rotation angle in adults with clubfoot deformity: Observed values and intra- and inter-observer reliability using weightbearing CT

IntroductionAdults presenting with symptomatic clubfoot represent a challenging cohort of patients. An appreciation of the location and degree of deformities is essential for management. Talar anatomy is often abnormal with varus within the talar neck, however, there are few reproducible methods which quantify talar neck deformity in adults. We describe a technique of assessing talar neck deformity, and report on observed values and intra- / inter-observer reliability. MethodsThis was a single-centre, retrospective study including 96 feet from 56 adult patients with clubfeet (82 feet had clubfoot deformity, 14 were normal). Mean age was 34.3 ± 16.9 years and 31 (55.3%) were male. Weight-bearing CT scans captured as part of routine clinical care were analysed. Image reformats were oriented parallel to the long axis of the talus in the sagittal plane. In the corresponding axial plane two lines were drawn (on separate slices): 1) a line perpendicular to the intermalleolar axis, 2) a line connecting the midpoints of the talar head and narrowest part of the talar neck. The talar neck rotation angle (TNR angle) was the angle formed between these lines. Intraclass correlation coefficients (ICC) were performed for intra- and inter-observer reliability. ResultsMean TNR angle in clubfeet was 27.6 ± 12.2 degrees (95%CI = 25.0 to 30.2 degrees). Mean TNR angle in normal feet was 18.7 ± 5.1 degrees (95%CI = 16.0 to 21.4 degrees) (p < 0.001). The ICC for clubfeet was 0.944 (95%CI = 0.913 to 0.964) for intra-observer agreement, and 0.896 (95%CI = 0.837 to 0.932) for inter-observer agreement. ConclusionThis measurement technique demonstrated excellent intra- and inter-observer agreement. It also demonstrated that compared to normal feet, clubfeet had about 9 degrees of increased varus angulation of the talar neck. This technique and data may be used for future research into clubfoot deformity and in planning treatment. Level of clinical evidence3

Aesthetic Considerations of Simultaneous Reconstruction With Free Flap for Local Advanced Hypopharyngeal Combined With Cervical Esophageal Cancer.

Patients with local advanced hypopharyngeal combined with esophageal cancer often require total laryngectomy and cervical esophagectomy, which result in big-sized upper aerodigestive tract defects and neck deformities. Although free flap is widely used to reconstruct aerodigestive defects, the aesthetic results especially that of neck contour have not brought to the forefront or discussed extensively. This article aims to report the preliminary aesthetic results of free flap reconstruction for local advanced hypopharyngeal cancer combined with cervical esophageal cancer defects, highlighting the thickness of subcutaneous fat of the flap. A retrospective study of 21 patients with local advanced hypopharyngeal combined with cervical esophageal cancer from July 2010 to August 2022 was conducted. After completing total laryngectomy, bilateral neck dissection, and removal of the tumor with safe margin, a free thigh flap of subcutaneous fat greater than 1 cm in thickness was used to reconstruct the hypopharyngeal and cervical esophageal defects. In addition to general demographic, oncological, and reconstructive data, preoperative and postoperative neck circumferences were recorded and compared. A subjective questionnaire survey was conducted on patients' satisfaction with postoperative neck contour. The patients were followed up from 3 to 10 years, with an average of 3 years. There were 2 cases (2/21) of free flap loss because of flap necrosis and secondary repair with a pedicled pectoralis major flap. Nineteen flaps (19/21) survived. Three cases (3/21) developed a pharyngeal fistula and one case (1/21) experienced salivary fistula, all of the fistulae healed after drainage and dressing change. There was a relatively high satisfaction rate among patients (16/21) with the postoperative neck contour. A paired sample t test showed no statistically significant difference between the preoperative and postoperative values ( t = 2.002, P > 0.05). Patients with a thicker subcutaneous fat flap (≥1.5 cm) had a more symmetrical and fuller neck contour during long-term postoperative follow-up. The application of a fat-rich subcutaneous free thigh flap to reconstruct the defect of local advanced hypopharyngeal combined with cervical esophageal cancer can achieve better neck aesthetic contour.

Mid Term Results of Treatment of Unstable Slips of Proximal Femoral Epiphysis by Closed Reduction

The study aimed to evaluate the results of closed reduction and epiphyseodesis of unstable slips of the proximal femoral epiphysis. The hypothesis was that the clinical and radiological results of this method and incidence of avascular necrosis are comparable to the results of closed reduction and open reduction using surgical hip dislocation reported by literature. In the period 2013-2023, 20 patients were treated for unstable slips in one institution. Whereas the boys were older (mean age of 13.4 years) than girls (mean age of 11.6 years), the gender distribution was equal. Acute on chronic slips prevailed over the acute slips (ratio 3:1). The slips were treated using the closed reduction, transphyseal fixation and capsular decompression at 6 to 240 hours after slip (81 hours on average). All patients were treated concurrently on the contralateral side as the prevention of the slip or to treat the grade I slips (two patients). The follow-up ranged from 7 months to 7 years. Clinical results were evaluated according to two scores: 1) own score (Bulovka University Hopspital score) based on the reduction of ROM, shortening of extremity and limitations of activities; 2) D'Aubigne-Postel score. In the radiological evaluation, correction of slip angle, alpha-angle, avascular necrosis (AVN) and the prominence of the anterior margin of the femoral neck on axial radiographs were evaluated. According to the Bulovka University Hospital score, there were 10 excellent results (50%) with no limitation of activity, including sport, in tree cases the results were very good (15%) and in five cases good (25%), respectively, with some limitation of activity, and two results were unsatisfactory (10%) with severe limitation of activity due to the AVN. According to the D'Aubigne-Postel score, there were 14 excellent results (70%), four good results (20%), and two unsatisfactory results (10%). The slip reduction was as follows: under 20 deg. in five patients; under 30 deg. in 10 patients, and over 30 deg. in five patients, respectively. Alfa-angle was greater than 63 degrees (range 45-88 deg.) on average. Prominence of the off-set epiphysis-femoral neck and femoroacetabular impingement (FAI) were observed in six patients. Remodelling of this prominence was seen in one patient four years after surgery. Shortening of the femoral neck over 1 cm was reported in two patients. Complete AVN with severe deformity of the hip was noted in two patients. Our hypothesis was confirmed because the results of treatment of the unstable slips by closed reduction are comparable with the published results of the same method and with surgical hip dislocation. The results correspond with those of large published cohorts of patients concerning the correction as well as rate of complications. According to our results, urgent gentle closed reduction, transphyseal fixation and capsular decompression represent efficient and relatively safe methods of treatment of unstable slips with low incidence of complication. Residual deformity of the off-set epiphysis-femoral neck and FAI represent limitations of this method. slipped proximal femoral epiphysis, unstable slips, closed reduction, transphyseal fixation.

Reconstructing Smiles: Maxillofacial Prosthesis

Maxillofacial prosthesis are required for the reconstruction of head and neck deformities in patients with congenital anomalies or defects which are acquired like trauma, surgery, infection, burns, or cancer . These defects might need both extra oral and intraoral prosthetic rehabilitation. Re-evaluating the materials used in the field of maxillofacial prosthesis is beneficial because facial rehabilitation is necessary for the person to live a comfortable life. In addition to addressing the functional and aesthetic impairment, the prosthodontic therapy of these patients should focus on ensuring psychological wellbeing. From wax, metal, leather, rubber, etc., to the most recent biomedical material, like polymers, the materials have come a long way. While the new materials have shown some fantastic qualities, they have certain disadvantages. We are still looking for a material that possesses all the necessary qualities to rehabilitate maxillofacial deformities in the best way possible.

Dorsal capsule release and lateral band translocation for a stiff swan neck deformity without articular involvement.

The treatment for proximal interphalangeal joint (PIP) stiffness in extension requires extensor tenolysis, concomitant procedures to restore flexion, and intensive therapy. A stiff swan neck deformity without articular involvement is rare and the treatment is always challenging. Six patients with stiff swan neck deformities were operated between 2016 and 2023, and the outcome was analyzed retrospectively. A dorsal capsule release and radial lateral band translocation volar to the PIP joint axis were done. This translocation was maintained by a sling formed by the flexor digitorum superficialis and the free margins of the accessory collateral ligament. The range of movements in the PIP joint, visual analog scale (VAS), and functional outcomes were analyzed by the Michigan Hand Outcome Questionnaire (MHOQ) score. The mean follow-up was 49.5months (range 48-52months). The mean preoperative PIP joint extension was 8 (range 5-10) degrees of extension), and the mean preoperative PIP joint flexion was 0. All patients improved after the surgery and the mean flexion of the PIP joint at follow-up was 95 degrees; extension was 1 degree (range 0-5 degrees). The mean Michigan Hand Outcomes Questionnaire (MHOQ) score was 92 (range 90-95) and the VAS was 0. Dorsal capsule contracture release and lateral band translocation to the volar axis of the PIP joint seem to be the possibilities for correcting stiff swan neck deformity. IV, retrospective case study.

Correction of proximal femoral deformities in children by a guided growth technique: A review

BACKGROUND: After surgical treatment of proximal femoral deformities in children, secondary deformities can often develop. They can be corrected successfully by epiphysiodesis — a method of working with growth zones.&#x0D; AIM: To analyze the literature about the development of epiphysiodesis, a proximal femoral technique, and the results of its use in pediatric patients with hip joint pathologies.&#x0D; MATERIALS AND METHODS: The results of using epiphysiodesis for treating secondary deformities in children with hip joint pathologies were analyzed. The literature search was performed in open electronic scientific databases eLibrary and PubMed for the period from 1933 to 2022.&#x0D; RESULTS: Most authors reported good and satisfactory results in the correction of secondary proximal femoral deformities in children. They also suggested that the development of these deformities could be prevented by epiphysiodesis in time frames, which should be chosen correctly. However, no consensus has been established on the timing of surgical intervention and methods of its implementation.&#x0D; CONCLUSIONS: Proximal femoral deformities in children, such as valgus deformity of the femoral neck and its recurrence, consequences of Kalamchi type II avascular necrosis, and hypertrophy of the greater trochanter, were corrected for a long time by a complex surgical intervention–intertrochanteric osteotomy of the femur. Improvement in examination methods and a deeper understanding of the growth zone functioning of the proximal femur allow orthopedists to introduce into practice less invasive and less traumatic but effective methods for correcting these proximal femoral deformities by controlled blocking of the growth zones.

Integral thermo-mechanical performance analysis of helium-cooled T-tube divertor

To verify the mechanical properties of the helium-cooled T-tube divertor, based on the thermal hydraulic optimization of the T-tube divertor, a preliminary analysis was conducted through a combination of elastic and elasto-plastic analysis.The results show that for the M-type damage mode, the T-tube divertor exhibits a small-scale plastic yielding phenomenon, but this has no effect on the overall divertor. The T-tube divertor has local necking deformation but does not fail due to immediate local fracture, and the T-tube divertor has no creep rupture. For the C-type damage mode, the plastic strain of the T-tube divertor is not accumulated under cyclic loading, but in the fatigue analysis, the life of the divertor does not meet the design standards and further optimization is needed.The conclusion shows that the optimized helium-cooled T-tube divertor has good thermo-mechanical properties, and the safety of the helium-cooled T-tube divertor unit can be guaranteed.

Revision Rhytidectomy: Pearls and Pitfalls.

While rhytidectomy can yield remarkable results, some patients may subsequently require revision rhytidectomy due to either unsatisfactory outcomes from primary surgery or the natural aging process many years later. Like most other secondary plastic surgical procedures, revision rhytidectomy is a complex undertaking and fraught with potential pitfalls. This can be attributable to natural or postsurgical alterations that can occur with the facial skin, superficial musculoaponeurotic system/platysma muscle, and/or facial nerve landmarks. Additionally, complications such as cobra neck deformity, pixie ear deformity, and synkinesis can add an extra level of complexity to revisional surgery. Furthermore, as more surgeons are performing deep-plane facelifts and more aggressive neck procedures, the risks are further amplified in revisional surgery. In this article, we review the challenges that a facelift surgeon may face when performing revision rhytidectomy and the technical considerations to overcome these obstacles.

Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients.

Objective Various modalities have been suggested to manage mallet fractures; however, inappropriate treatment can lead to extension lag, a swan neck deformity, or arthritis of the distal interphalangeal joint (DIPJ). The current study aimed to evaluate the results (functional, radiological, and complications) of open reduction and internal fixation (ORIF) of mallet fractures using low-cost hook plates fabricated from low-profile titanium mini plates. Methods A prospective case series of 17 consecutive patients (average age of 32.3 years) with mallet fractures (six were Wehbe Type IB and 11 were Wehbe Type IIB). Eleven (64.7%) were males. The affected hand was dominant in all patients, and the affected digit was the index in 6 (35.3%), the ring in 5 (29.4%), the small in 3 (17.65%), and the middle in 3 (17.65%) patients. The same fellowship-trained hand surgeon performed all surgeries. Results The average operative time was 37.65 minutes. After an average follow-up of 10.94 months (range 6-27), the average DIPJ motion was 50° ° (range 20°-70°), the extensor lag was noted in 4 (23.5%) patients, and complications were reported in 6 (35.29%) patients. According to Crawford criteria, 6 (35.3%) patients achieved excellent results, 7 (41.2%) achieved good results, and 4 (23.5%) achieved fair results. Conclusion The modified hook plate technique for fixation of mallet fractures is a beneficial, economical, yet demanding technique that adequately provides stable fixation to allow early DIPJ motion with acceptable functional outcomes.