Nerve Complications Research Articles

Deciphering Neuro-Ophthalmic Presentations of Carotid Cavernous Fistulas: A Comprehensive Analysis of Venous Flow Dynamics and Clinical Implications

Background: Carotid cavernous fistulas (CCFs) are abnormal arteriovenous connections between the carotid arterial system and the cavernous sinus, presenting with complex neuro-ophthalmic manifestations due to the redirection of arterial blood into the venous system. This study systematically reviews the diverse neuro-ophthalmic presentations of CCFs, emphasizing the influence of venous flow dynamics. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science, focusing on keywords such as "carotid cavernous fistula," "neuro-ophthalmic presentations," and "optic nerve compression." Recent and historical studies were analyzed to assess the neuro-anatomical impacts on neuro-ophthalmic symptoms from CCFs. This review aimed to consolidate knowledge and refine diagnostic and therapeutic strategies for CCF management. Results: The findings demonstrated that the neuro-ophthalmic presentations were quite distinctive, depending on the direction of venous flow. Anterior flow, overall, was associated with proptosis, conjunctival arterialization, and red, dilated vessels. In contrast, posterior flow was associated with cranial nerve complications, most notably abducens nerve palsy and trigeminal neuralgia, manifesting as double vision and facial pain, respectively. It therefore seems that the symptomatology and severity of CCFs is heavily dependent on the direction of blood flow. Conclusion: The flow direction through the veins is of significant importance in the clinical presentation and prognosis of CCFs. These dynamics must be appreciated to improve diagnosis and allow for optimal treatment, thus averting the risk of fatal complications. In this review, the need for tailored therapeutic strategies through detailed vascular and neuro-ophthalmologic analysis is outlined.

Long-term Outcomes of Complete Tears of the Distal Biceps Tendon: An Analysis of Surgical Management at a Median Follow-up of 14.7 Years.

Surgical repair of full thickness biceps tears has demonstrated adequate outcomes in short and mid-term studies. However, data on the long-term outcomes of full thickness distal biceps injuries and their treatment are currently lacking. The purpose of this study was to report on patient demographics, injury characteristics, and long-term outcomes for patients with full-thickness distal biceps tears. It was hypothesized that complete distal biceps tears managed operatively would demonstrate robust clinical success at long-term follow-up. Case series; Level of evidence, 4. Patients with magnetic resonance imaging-confirmed, complete distal biceps tendon rupture sustained between 1996 and 2016 were identified. Patients were cross-referenced with a regional geographic database. A total of 66 patients (3 female, 63 male) with a median age of 50.8 years (IQR, 41.5-60.4) and a median clinical follow-up of 14.7 years (IQR, 9.6-17.9 years) were included. Patients who sustained a full-thickness distal biceps tendon tear were likely to be in their early 50s, male, right-hand dominant, current/former smokers, and laborers with a history of traumatic injury during an intentional movement. Most of these patients had pain and supination weakness but no loss of range of motion. All included tears were treated operatively. At final follow-up, patients maintained a majority of near-normal range of motion (median total arc of flexion/extension 140° and supination/pronation 80°), excellent elbow flexion strength (91% of patients had full strength), and adequate elbow supination strength (76% of patients had full strength). The overall complication rate was 24%, with 16 out of 66 patients experiencing some type of complication between infection, rerupture, heterotopic ossification, reoperation, and nerve complications. Overall return to work was 98%, and 85% of those who returned to work did so without restrictions. Complete tears of the distal biceps were most common in patients 50 years of age, male sex, right-hand dominant, and current/former smokers. The most common profession was laborer, and injuries were primarily traumatic in nature during intentional activity. Patients managed operatively demonstrated high rates of success at long-term follow-up with respect to elbow function and clinical outcomes.

Emergency practitioner-administered ultrasound nerve blocks in the emergency department: A retrospective analysis.

In the realm of acute pain management within emergency departments (EDs), the prevalent reliance on systemic analgesics, notably opioids, presents challenges due to associated risks and suboptimal efficacy. The emerging alternative of ultrasound-guided nerve blocks (USGNBs) has shown promise in prospective studies. However, the safety and efficacy of USGNBs when performed by emergency medicine practitioners remain largely unexplored, necessitating this study to address the research gap. The primary objectives of this study were to assess the efficacy of Emergency physician-performed USGNBs and changes in patient-reported pain (pre- and postnerve block) at 15 and 30 min. In addition, the time taken to perform nerve blocks, type of nerve block, frequency, indications, procedure time, and complications were all studied. Conducted at a Tertiary Care Teaching Hospital in Pune, India, this single-center, retrospective observational study aimed to evaluate the effectiveness of USGNBs in the ED context. A retrospective analysis covered 274 emergency practitioner-performed USGNBs recorded from January 2022 to December 2023. Participants included consecutive ED patients consenting to nerve blocks, with practitioners utilizing bupivacaine (0.25%) and ropivacaine (0.25%) based on individual preferences. The study systematically recorded patient demographics, block types, indications, complications, and pre- and postpain scores on a Numerical Rating Scale. The study demonstrated a significant reduction in pain scores post-USGNB, with an average decrease of 2.9 ± 1.08 at 15 min and 5.8 ± 1.39 at 30 min. Commonly performed blocks included the femoral nerve, fascia iliaca, and serratus anterior, with notable pain relief in fracture management cases. Procedural durations varied, ranging from 2 to 12 min, while four complications were reported, including diaphragmatic paresis and arterial punctures during interscalene nerve block and fascia iliac compartment blocks, respectively. This extensive study in an academic ED setting supports the proficiency of emergency practitioners in performing USGNBs. The findings emphasize the transformative potential of USGNBs in academic ED pain management, showcasing notable pain reduction and minimal complications. These results advocate for the integration of advanced pain relief techniques into emergency medicine training programs, contributing to a comprehensive approach to acute pain management.

Descriptive Epidemiology and Management of Perilunate Injuries.

Perilunate injuries and dislocations, typically caused by high-impact trauma, can lead to acute compression of the median nerve and subsequent complications if left untreated. This study examines the epidemiology, injury mechanisms, immediate treatment, and need for carpal tunnel release in such cases. Perilunate injuries at a single level 1 trauma center were retrospectively reviewed from 2014 to 2023. Data on patient demographics, injury mechanism, initial management, and operative management were collected. Thirty-three cases were analyzed, averaging 33.9 years in age. Injury mechanisms included falls (24% each from 0 to 10 feet and >10 feet, and motor vehicle accidents), bicycle-auto collisions or assaults (10%), pedestrian-auto collisions (5%), and 1 crush injury (3%). Most cases involved trans-scaphoid perilunate dislocation (predominantly Mayfield 3). Initial reduction in the emergency department succeeded in 60% of cases, with 48% showing median nerve paresthesias. Thirty-three percent underwent surgery within 24 hours, and 95% required operative intervention, including open reduction internal fixation (56%), open reduction with percutaneous pinning (30%), and closed reduction with percutaneous pinning (7%). Fifty-two percent needed carpal tunnel release. Prompt evaluation and treatment are crucial for perilunate injuries. If initial reduction fails, urgent operative intervention is warranted, although delayed management may be appropriate in some cases. Various operative fixation methods exist for realigning carpal bones, emphasizing the importance of tailored approaches to individual cases.

Ultrasonography of the median nerve before removal of anterior locking plates from the distal radius.

Both forearms of 36 patients who had been treated with an anterior locking plate using the trans-flexor carpi radialis approach for unilateral distal radial fractures were investigated by ultrasonography from the distal end of the radius to 5 cm proximally before plate removal. After fixation of the anterior locking plate, the median nerve was significantly more radially located to the flexor carpi radialis tendon than on the healthy side and showed hypertrophy and flattening at the distal end of the radius. In six cases, the median nerve on the plate side lay radial to the flexor carpi radialis tendon. The median nerve after plate fixation may lie more radially than its original position. Confirming the radial deviation of the median nerve by ultrasonography before removal of the anterior locking plate is useful to prevent the complication of median nerve injury.Level of evidence: IV.

Clinical Features and Surgical Outcomes of Jugulotympanic Paraganglioma

Introduction: Jugulotympanic paraganglioma (JTP) refers to paraganglioma arising from jugular bulb, which can invade surrounding structures such as the bones, blood vessels, meninges, and cranial nerves. The authors conducted a study to find surgical indications to avoid a serious cranial nerve complications by analyzing the medical records of patients who underwent surgical management for JTP. Methods: We performed a single-institution, retrospective review of patients who underwent resection of JTP from 2004 to 2022. Patients underwent either Fisch infratemporal fossa approach type A (ITFA-A) or modification of ITFA-A with partial rerouting of the facial nerve. Preoperative and postoperative lower cranial nerve (LCN) function and facial function using the House-Brackmann (H-B) grade were evaluated. Results: The study included 19 patients with a mean age of 43.1 years (standard deviation [SD], 16.1 years). The average tumor size was 28.6 mm (SD 12.6 mm). In patients with Fisch classes C1 and C2 tumors, there were 3 and 11 patients, respectively. Gross total tumor removal (GTR) was performed in all patients with classes C1 and C2. GTR was achieved in 2 out of the 5 patients with class C3 tumor. Seventeen patients underwent ITFA-A and 2 patients underwent partial rerouting. Facial function before surgery was normal in all but 3 cases. Among 16 patients with preoperative normal facial function, 13 had H-B grade I to II and 3 had H-B grade III at 1 year after surgery. Total and partial rerouting did not significantly affect facial function immediately after surgery or at the postoperative 1-year evaluation (p = 1.00). Preoperative LCN function was normal in all patients. LCN palsy lasting more than 1 year occurred in 7 patients after surgery. Patients with Fisch class C1 tumor did not develop postoperative LCN palsy. Among the patients with class C2 tumor, none of 5 patients with medial invasion depth less than 9.5 mm developed LCN palsy, whereas 5 of 6 patients (83.3%) with invasion depth of 9.5 mm or greater developed LCN palsy (p = 0.02). Conclusion: JTPs with deep medial invasion should be managed conservatively to prevent LCN palsy.

Risk of Nerve Injury Following Peroneus Longus Harvest is Very Low: A Prospective Cohort of 600 Patients.

Peroneus longus (PL) graft harvest has gained popularity in recent years for a variety of ligament surgeries. One of the common apprehensions regarding its more widespread usage has been the risk of injury to the common peroneal nerve or the sural nerve during graft harvest. The purpose of the current study is to assess the rate of injury to the peroneal and sural nerve following PL harvest using our technique in a large cohort of patients. A prospective cohort of 600 consecutive patients undergoing PLG harvest over a period from January 2022 to December 2022 at a single tertiary referral centre were included for analysis. Patients had baseline screening of nerve function prior to surgery and were regularly followed up at 3 weeks, 6 weeks, 3 months and 6 months post-harvest. Grouped variables for the sural and peroneal nerve were completed and analysis was carried out using Cochrane's Q test and McNemar's test. We found that only 0.01% of patients had any nerve complications at 6 months follow-up, and three times more patients had sural nerve complaints than peroneal nerve complaints at the end of the 6 months follow-up. Peroneus longus harvest is a safe and reproducible technique with low complication rate. The rate of nerve complications post-harvest is grossly overestimated in the literature secondary to low-powered and low evidence studies. We believe that using our safe surgical technique for PL harvest with respect to surface landmarks allows for PL harvest with a low nerve complication rate.

Rate of skin and nerve complications as a result of cutaneous traction with modern foam boots

IntroductionCutaneous traction is used to temporize lower extremity fractures and relies on friction between the skin and surrounding material to apply a longitudinal force. This circumferential compressive force can lead to pressure sores, skin sloughing, or compressive neuropathies. These complications have been reported in up to 11% of patients when the cutaneous traction relies on adhesive tapes, plaster, and rubber bandages being in immediate contact with the skin. The rates of these complications are not well documented when using modern foam boots. MethodsA retrospective chart review was performed on all orthopedic trauma patients who suffered pelvic or lower extremity injuries between March 1st, 2020 and April 30th, 2021 at a single Level-1 trauma center. We included all patients with femoral fractures, axially unstable pelvic ring and/or acetabular fractures, and unstable hip dislocations temporized with the use of cutaneous traction. All patients had intact skin and lower extremity nerve function prior to application. ResultsThere were 138 patients identified with 141 lower extremities. The average patient age was 50.7 (6–100) years. Mean traction weight of 9.8 (5–20) pounds. Average traction duration was 20.9 (2.3–243.5) hours. At the time of traction removal, there was 1 (0.7%) new skin wound and 0 nerve palsies. The new skin wound was a stage one heel pressure sore and did not require further treatment. ConclusionCutaneous traction with a modern foam boot was found to have a skin complication rate of 0.7% and a nerve palsy complication rate of 0% for an overall complication rate of 0.7%, which has not been previously established and is lower than historically reported complication rates of 11% when utilizing adhesive and plaster directly on skin. Foam boot Cutaneous traction may be considered a safe option for traction placement.

Ipsilateral Supracondylar and Medial Epicondyle Humerus Fractures in Pediatric Patients: A Retrospective Analysis of Incidence, Epidemiology, Treatment, and Outcomes.

Pediatric supracondylar humerus (SCH; AO/OTA13-M/3.1) and medial epicondyle fractures (AO/OTA13u-M/7.1) are common. Concomitant SCH with ipsilateral medial epicondyle fractures remain scarcely reported. We investigated the epidemiology, treatment, and outcomes of this rare, combined injury. A retrospective review of pediatric patients with concomitant SCH and medial epicondyle fractures at a level 1 hospital from 2010 to 2020 was performed. Patient data, treatments, and outcomes were assessed. Radiographs were reviewed for fracture classification and alignment. Patients aged above 18 years and those with inaccessible imaging were excluded. Descriptive statistics were performed. Of 3344 patients undergoing surgery for SCH fractures, 14 (6 females, mean: 10.59y) with concomitant SCH and medial epicondyle fractures were included. Overall, 28.6% of patients exhibited preoperative nerve palsies (3 PIN, 1 median nerve). There was 1 flexion type and 13 Gartland type III SCH fractures. Medial epicondyle fracture displacement averaged 4.13mm (range: 2 to 7mm). Thirteen medial epicondyle fractures occurred medial to the physis with 1 through the physis. Eight patients (57.1%) had medial fixation-7 medial pins, 1 medial screw-which captured both the medial epicondyle and medial column of the SCH fracture. Six medial epicondyles were treated closed. The average time to pin pull was 33.1 days (range: 27 to 51d) with average follow-up of 138.6 days (range: 27 to 574d). Overall, 50% of patients completed physical therapy (PT). Complications occurred in 4 cases: prominence of a medial pin, 1 patient required additional PT and dynamic splinting for loss of functional extension, 1 patient underwent a manipulation under anesthesia 3.5 months postoperatively for flexion contracture, and 1 patient developed medial epicondyle nonunion and SCH malunion that underwent corrective osteotomy 10.5 months postoperatively. Concurrent SCH and medial epicondyle fractures exhibited a high rate of nerve palsy (28.6%) and complications (28.6%) and were frequently referred to physical therapy. While patients treated without medial fixation went on to union, this combined injury might represent a relative indication for medial pinning of the SCH fracture. Further studies on this rare injury pattern are needed to determine optimal treatment methods. Level IV-therapeutic.

Electrophysiological Assessment of Paresthesia in Patients Following Radial Angiography: AProspective Study.

Radial angiography, preferred for its safety and comfort in percutaneous coronary interventions, occasionally leads to paresthesia-a tingling or numbing sensation in the hand. This study aimed to investigate the presence of nerve damage in patients experiencing paresthesia post-radial angiography through electrophysiological examination. This prospective study involved 77 patients who developed hand paresthesia following radial angiography. Excluded were those with malignancy, pregnancy, pace-makers, or recent angiography. Nerve conduction studies were performed using the Neuropack MEB 9102K EMG device, assessing sensory and motor amplitudes, latencies, and velocities of median, ulnar, and radial nerves. The study included 77 patients (23 females, 54 males; average age 58.39 ± 10.44 years). In 11 diabetic patients, polyneuropathy was detected. For the remaining 66 patients, electrophysiological evaluations showed no significant pathological findings. Comparative analysis of both upper extremities revealed no significant differences in nerve conduction parameters between the side where angiography was performed and the other side. Despite paresthesia complaints, no electrophysiological evidence of nerve damage was found, suggesting that symptoms might be due to local irritation rather than direct nerve injury. This aligns with the safety profile of radial angiography and underscores the importance of distinguishing between transient paresthesia and serious nerve complications. Paresthesia post-radial angiography, while clinically notable, is not typically associated with nerve damage. This study is significant as it is the first in the literature to demonstrate that radial angiography does not cause nerve damage.

Clinical Observation of Posterior-Chamber Phakic Implantable Collamer Lens V4c Implantation in Myopic Patients with Shallow Anterior Chamber Depth: A Retrospective, Consecutive Observational Study.

The reference range for the preoperative anterior chamber angle width for ICL surgery is unclear. Our objective was to assess the clinical effect and the range of anterior chamber angle width of posterior-chamber implantable collamer lens V4c (ICL V4c) implantation in patients with anterior chamber depth (ACD) < 2.8 mm. Patients who underwent ICL V4c implantation with shallow ACD were included in this retrospective study. The patients' uncorrected and corrected distance visual acuity, angle of trabecular-iris (TIA), angle-opening distance (AOD500), trabecular-iris space area (TISA500), corneal endothelial cell density, vault, retinal nerve fiber layer thickness, intraocular pressure, visual field, and complications were analyzed. Forty-one patients (68 eyes) completed at least 12 months of follow-up (median follow-up, 30 months). The effectiveness and safety indices were 1.09 ± 0.13 and 1.04 ± 0.21, respectively. The preoperative TIA values on the nasal and temporal sides were 39.78 ± 7.68 degree (range, 25.8-65.1 degree) and 41.54 ± 8.03 degree (range, 28.5-63.00 degree). Forty-seven eyes had uncorrected distance visual acuity ≥1.0, and 55 had corrected distance visual acuity ≥1.0 at the last follow-up visit. The TIA, AOD500, and TISA500 on the nasal and temporal sides were significantly reduced compared to those before surgery (all P < 0.01); no eye had an angle closure or elevated intraocular pressure. The ICL V4c vault was 290.88 ± 153.36 μm (range, 60.0-880.0 μm). No severe complications occurred in any patient. In patients with myopia with shallow ACD (2.55-2.79 mm), a preoperative TIA >25.8° is safe and effective for a relatively long time after surgery; however, an extended long-term close follow-up is needed.

Cranial Nerve Injuries in Orthognathic Surgery: A Review of Literature.

Orthognathic surgery is increasingly utilized to correct facial deformities and dental malocclusions, as well as to enhance facial aesthetics. Significant advancements in surgical planning and execution have made it more widespread and accessible. However, unfavorable outcomes or complications can occur, leading to potentially severe and possibly long-term consequences, such as cranial nerve injuries. This literature review investigates the cranial nerve complications associated with orthognathic surgery. We conducted an extensive search across available databases, analyzing relevant studies published up to September 30, 2023. Two authors independently selected articles for full-text review based on their titles and abstracts. The eligible studies reported cranial nerve injuries in individuals who had undergone orthognathic surgery. Our findings highlight the risk of cranial nerve injuries, their possible mechanism, management, and outcomes. It is imperative for surgeons to remain vigilant and informed and to communicate such information during preoperative patient consultation.

Use of the spider limb positioner for fibular free flap reconstruction of head and neck bony defects

BackgroundOsseous and osteocutaneous fibular free flaps are the workhorse of maxillomandibular reconstruction over 30 years after the initial description. Since 2019, we have routinely used the Spider Limb Positioner, adapted from its use in shoulder orthopedic procedures, for fibular free flap harvest. Herein, we describe this novel technique in our cohort. MethodsWe describe our intraoperative setup and endorse the versatility and utility of this technique in comparison to other reported fibular free flap harvest techniques. ResultsThe Spider Limb Positioner was used 61 times in 60 different patients to harvest osseous or osteocutaneous fibular free flaps. Median (range) tourniquet time for flap harvest was 90 (40–124) minutes. No iatrogenic nerve compression injuries or complications related to lower extremity positioning occurred. ConclusionWe describe a novel approach to fibular free flap harvest utilizing the Spider Limb Positioner, which affords optimal ergonomics, visibility, and patient repositioning. There were no nerve injuries or complications related to positioning in our series.

Different techniques for identification of facial nerve during superficial parotidectomy

BackgroundParotidectomy is a common surgical procedure for the treatment of benign and malignant lesions of the parotid gland. Identification of the facial nerve trunk is essential during surgery of the parotid gland to avoid facial nerve injury. A comprehensive knowledge of its anatomy and meticulous dissection are the keys for the identification of the facial nerve trunk and its branches.AimTo compare between the traditional antegrade parotidectomy and retrograde in identification of facial nerve during superficial parotidectomy, determination the best anatomical landmark, the time of exploration of facial nerve, outcomes, facial nerve complication, duration of surgery, patient satisfaction as well as other complications.MethodsTwelve patients who were diagnosed with having parotid gland neoplasms, and had undergone superficial Parotidectomy were recruited and assessed for eligibility at General Surgery Department, Beni-Suef University Hospital. Patients were divided according to the surgical technique into two equal groups, group A (the antegrade dissection group), and group B (the retrograde dissection group), follow-up was 6 months.ResultsThere was no statistically significant differences between both groups regarding pain, paresthesia and pathology postoperation (Pvalue&gt;0.05). Longer mean operation time was observed in the antegrade dissection group in comparison with the retrograde dissection group (2.06±0.75 and 1.61±0.31 h, respectively), which was statistically insignificant (Pvalue&gt;0.05). There was a statistically significant increase in facial nerve injury among patients in the antegrade dissection group in comparison with the retrograde dissection group (Pvalue=0.046). There was no statistically significant difference between techniques regarding hospital stay duration and complications three months postoperation (Pvalue&gt;0.05).ConclusionRetrograde facial nerve dissection technique is better than the classical antegrade technique in the superficial parotidectomy within this study.

Dose-Painting Linear Accelerator Radiosurgery of Glomus Jugulare With Dosimetric Comparison to Gamma Knife.

Objectives In this study, we outline our rationale for delivering a dose of ≥15 Gy in stereotactic radiosurgery (SRS) of glomus jugulare tumor (GJT) while ensuring the avoidance of complications associated with doses >13 Gy to the facial nerve. To avoid such complications, we initially utilized the Gamma Knife Perfexion (GK) system (Elekta Instrument AB, Stockholm, Sweden) at our institution but encountered challenges related to lengthy treatment times and difficulty in sculpting doses to minimize doses to spare the facial nerve. As a potential solution, we propose the use of HyperArc (Varian Medical Systems, Palo Alto, CA), a newly developed automated delivery platform for linear accelerator (LINAC)-based SRS. HyperArc offers the potential for faster treatment and more complex shaping of the radiotherapy dose with multiple arcs and multi-leaf collimators. Methods We retrospectively reviewed nine cases of patients with GJT treated with HyperArc. Patients' demographic and treatment data were collected. Additionally, simulated GK treatment plans were created and compared with HyperArc plans to assess time savings, PTV coverage, and plan quality. Results One male and eight female patients, with a mean age of 63.9 years, were included. Treatments were delivered on average in 29 minutes, achieving 95-100% of the tumor while limiting the facial nerve to <13 Gy. Treatments replanned using our GK system could achieve only 92-99% tumor coverage while respecting facial nerve constraints, with average treatment times of 180 minutes. Comparable plan quality parameters were attained with both modalities. Conclusions The HyperArc system provides a qualitatively satisfactory and rapid treatment delivery of a highly sculpted radiotherapy dose to maximize tumor coverage and minimize facial nerve complications.

Appropriate imaging in the management of first branchial cleft anomalies

Background: First branchial cleft anomalies (FBCA) are rare clinical entities of the head and neck.The low incidence and varied presentation often result in misdiagnosis and inappropriate treatment.Correct diagnosis is essential for proper management, while an incorrect diagnosis will often lead toinadequate treatment. A good understanding of the regional anatomy and embryology can lead to anearly diagnosis and thereby effective management of FBCA. Purpose: To present how to diagnose andmanage FBCA. Case report: A case of a 6-year-old female who had an FBCA with a history of swellingand recurrent discharge from the fistula in the infra-auricular area. Complete excision of the tract wasperformed without facial nerve complication. Clinical question: What is the appropriate imaging fordiagnosis FBCA? Review method: Scoping review was done to identify the scientific evidence aboutimaging for diagnosis FBCA. Systemic searching in 4 databases (PubMed, Embase, Proquest, and Webof Science) using keywords “first branchial cleft”, “anomaly”, and “imaging”. Result: Three article wasfound relevant with the topic of imaging for diagnosis FBCA. Conclusion: Proper diagnosis of FBCAcan lead to proper management and good results. Imaging can provide an anatomical picture of eachbranchial arch anomaly, which can be very helpful in preoperative planning to determine a definitivesurgical approach. Early management of FBCA can reduce the recurrence rate significantly.Keywords: first branchial cleft, anomaly, children, imaging

Neurological Complications following Surgical Treatments of the Lower Molars.

The current review aims to explore postoperative neurological complications in third molar extractive surgery. The PRISMA protocols were followed when conducting this review. We found a total of 2,250 articles that matched our topic using the Boolean keywords, mandibular nerve complications AND oral surgery, from PubMed (1,083), Scopus (435), and Web of Science (732), with the filters of English language articles, time range January 1, 2003, to September 30, 2023, and human studies. After 762 duplicates were eliminated, there remained 1,488 articles. Eleven final articles were deemed of the highest relevance to our topic by eliminating articles in animals, non-English language, reviews, meta-analysis, and off-topic. A potential risk in the third molar extraction was temporary loss of sensibility often caused by mild compression or irritation of the mandibular nerve. This typically resolves within weeks or months, but in severe cases, recovery might take longer. Permanent loss of sensation can occur, indicating significant nerve damage and lasting effects on touch, temperature, or pain perception. Various treatments exist for nerve damage, including low-level laser therapy, pain management medications, or physical therapy. While these therapies may improve neurosensory impairment, patients often report a decline in their quality of life.

17 years' experience of surgical management of thoracic outlet syndrome at a district general hospital.

Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular structures passing through the thoracic inlet. It is categorised into three subtypes: neurogenic TOS (NTOS), venous TOS (VTOS) and arterial TOS (ATOS). This study evaluates the outcomes of patients who underwent first rib resection (FRR) for TOS during a period of 17 years at a single district general hospital. Retrospective review of patient notes of individuals treated with FRR from August 2004 to August 2021. A total of 62 FRRs were performed on 51 individual patients. Indications for FRR included 42 NTOS (68%), 6 VTOS (10%) and 14 ATOS (23%). Thirty-four patients (64%) were female and the mean age at time of surgery was 39 years (range 27 to 64 years). Eleven patients (21%) underwent bilateral FRR and seven cases of cervical ribs were observed. The mean time from initial symptoms to diagnosis was 18 months (range 2 to 60 months). Overall, outcomes after surgery were positive across all subtypes of TOS. Based on Derkash's classification, 52 patients (84%) reported excellent/good, 8 (13%) reported fair and 2 (3%) reported poor resolution of symptoms at 6 month follow-up. Complications included four (9%) pneumothorax, two (4%) wound infections, two (4%) haematoma, one (2%) haemothorax, three (5%) phrenic nerve complications and one (2%) brachial neuropraxia. FRR for TOS can be performed safely and effectively in a district general hospital environment with excellent patient clinical outcomes.

Dry Eye and Some Related Factors in Patients with Type 2 Diabetic Nephropathy: A Cross-Sectional Study in Vietnam.

To determine the prevalence of dry eye (DE) and some related factors in patients with type 2 diabetic nephropathy (T2DN). We performed a cross-sectional study on 338 people, who were divided into 2 groups: 169 T2DN patients and 169 patients diagnosed with type 2 diabetic mellitus (T2DM) without renal complications as a control group. The Ocular Surface Disease Index (OSDI) and test fluorescein tear-film break-up time (TBUT) were done in all 338 subjects. Patients with OSDI scores < 13 and TBUT values equal to or under 10 seconds were diagnosed with dry eye. The prevalence of DE in T2DN patients was significantly higher than T2DM group (55.6% versus 37.3%). The T2DN groups with dry eye had a median duration of DM, the proportion of hypertension, peripheral nerve complications, anemia, proportion of using insulin, and concentration of plasma glucose, HbA1C, urea, creatinine, CRP-hs significantly higher than those of T2DN without dry eye. Advanced age, high HbA1C level, and decreased eGFR were independent factors associated with dry eye in T2DN patients. Dry eye was a common condition associated with advanced age, high HbA1C levels, and decreased GFR in T2DN patients.

Neuropathy 10–15 years after Roux-en-Y gastric bypass for severe obesity: A community-controlled nerve conduction study

ObjectiveWe searched for long-term peripheral nerve complications 10–15 years after Roux-en-Y gastric bypass surgery (RYGB), using a comprehensive nerve conduction study (NCS) protocol. MethodsPatients (n = 175, mean age 52.0, BMI 35.2) and 86 community-controls (mean age 56.8, BMI 27.2) had NCS of one upper and lower limb. New abnormality scores from 27 polyneuropathy-relevant (PNP27s) and four carpal tunnel syndrome-relevant NCS-measures (CTS4s) were compared between groups with non-parametric statistics. Estimated prevalences were compared by 95 % confidence limits. The clinical neurophysiologist’s diagnosis was retrieved from hospital records (PNP-ncs, CTS-ncs, other). ResultsAbnormality score did not differ between RYGB and control groups (PNP27s: 1.9 vs 1.7, CTS4s: 0.7 vs 0.6, p > 0.29). BMI correlated weakly with CTS4s in patients (rho = 0.19, p = 0.01), and less with PNP27s (rho = 0.12, p = 0.12). Polyneuropathy (PNP-ncs) prevalence was 12 % in patients and 8 % in controls. CTS-ncs prevalence was 21 % in patients and 10 % in controls (p = 0.04). ConclusionsNCS-based abnormality scores did not differ between patients 10–15 years after RYGB and community-recruited controls, neither for PNP nor CTS. SignificanceLong-term polyneuropathic complications from RYGB have probably been avoided by modern treatment guidelines. NCS-diagnosed CTS is common in overweight RYGB patients. RYGB-patients with significant neuropathic symptoms need clinical evaluation.