Neurosensory Deficit Research Articles

Comparative Study between Titanium Miniplates and Three-dimensional C Plates for Fixation of Mandibular Fractures in the Mental Nerve Region: Randomised, Clinical Study

Abstract Introduction: Mandibular fractures, representing 35.54%–44.2% of facial fractures, often affect the mandibular body and subcondylar region. Effective treatment seeks optimal reduction, stable fixation and functional restoration. This study assesses a modified three-dimensional C plate’s efficacy in treating mandibular fractures, emphasising occlusal forces and the mental nerve region. Materials and Methods: A randomised clinical trial (2019–2024) involving 20 patients with mandibular fractures was conducted. Group A (10 patients) received the modified C titanium plate and Group B (10 patients) received conventional miniplates. The clinical parameters – pain, occlusion, mobility, bite force and neurosensory deficits – were evaluated pre- and postoperatively at various intervals. Statistical analysis was performed using the SPSS software. Results: Group A shows superior bite force and functional outcomes, with significant neurosensory recovery by the 10th day. Both groups had no plate fractures, screw loosening or infections. Group A also had better stability, reduced procedural time and improved post-operative comfort. Conclusions: The modified C miniplate provides superior stabilisation, simplifies application, reduces complications and enhances early functional recovery compared to conventional miniplates.

Comparison of Different Genioplasty Techniques in Terms of Neurosensory Deficit and Haematoma Formation.

To compare different types of genioplasty techniques (chin advancement, rotation and advancement, setback, and reduction) in terms of neurosensory deficit and haematoma formation. Comparative analytical study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from January 2022 to April 2023. Patients requiring genioplasty and fulfilling the inclusion criteria i.e. both genders aged 16-60 years were included and divided into 4 groups according to the type of genioplasty performed. Genioplasty was planned as per the ortho treatment plan and performed under general anaesthesia. Setback genioplasty was performed on 8 patients, advancement genioplasty on 11 patients, reduction genioplasty on 3, and advancement with rotation genioplasty on 16 patients. Postoperatively neurosensory deficit was recorded on follow-up after 1 month by subjective and objective assessments, and haematoma formation was assessed clinically on the 7th day after the procedure. Advancement with rotation genioplasty showed the highest frequency of neurosensory deficit (almost 50%) and reduction type genioplasty showed the least frequency of neurosensory deficit (<1%, p = 0.49). The frequency of haematoma formation was maximum in the advancement with rotation genioplasty (62.5%) and minimum in equal setback genioplasty (25%, p = 0.61). Advancement with rotation genioplasty had the highest rate of postoperative neurosensory deficit and haematoma formation when compared with other techniques of genioplasty. Genioplasty, Neurosensory deficit, Haematoma, Advancement with rotation genioplasty, Setback genioplasty.

Comparative Evaluation of Clinical Outcome Including Neurosensory Deficit and Pain Score Variables Using Rigid Internal Fixation with Three-Dimensional Miniplate Internal Fixation in Simultaneous Angle and Contralateral Body/Parasymphysis Fractures of the Mandible: A Prospective, Randomized Controlled Study.

Purpose There have been numerous advancements in the strategies used for treating mandibular fractures in the present times, while open reduction and internal fixation is still accepted as the most preferred treatment option for such fractures despite numerous drawbacks. The aim of the present prospective, randomized controlled study was to evaluate the clinical outcome including neurosensory deficit and pain score variables in mandibular fractures that were treated using rigid internal fixation with three-dimensional (3D) miniplate internal fixation. Materials and Methods For the present study, a total of 20 patients of either sex in an age range of 18 to 55 years with simultaneous angle and contralateral body/parasymphysis fractures of the mandible were included, while the clinical outcome was compared in relation to the two groups wherein different treatment options were used including using rigid internal fixation in one as against 3D miniplate internal fixation in the other. Results Pairwise comparison of pain scores in Group I and Group II patients by the Mann-Whitney U-test at different time zones revealed the results to be statistically significant for all pairs except when the findings were compared between 1 month and 3 months after the procedure in Group II patients. Also, significant recovery was observed in both Group I and II patients during healing when assessed preoperatively to 1 month and then 3 months after the procedure with the results being statistically highly significant in case of the variations observed in relation to the neurosensory deficit observed at different time zones for both Group I and II patients ( p = 0.0001). Conclusion Based on the results obtained, it can be concluded that 3D miniplate-led osteosynthesis was found comparable to the osteosynthesis accomplished using reconstruction plates during fixation of unfavorable body/parasymphysis fractures of mandible in study, providing optimal stability, while satisfactorily meeting the biomechanical requirements for occlusal loading, and an early return to normal function.

The Effect of Delayed Photobiomodulation Therapy on Inferior Alveolar Nerve Recovery After Third Molar Removal: A Triple-Blinded Randomized Clinical Trial.

Background: Third molar removal is the primary reason for inferior alveolar nerve (IAN) damage, with 2% causing persistent neurosensory deficits. This study aimed to investigate how delayed photobiomodulation therapy affects long-lasting neurosensory disturbances. Methods: This study was conducted on patients with neurosensory disturbances lasting longer than 6 months. Patients were randomly allocated to the study and control groups, with the study group receiving a low-power diode laser (continuous wavelength of 810 nm, power of 200 mW) on 16 points (30 sec at each) for 12 sessions (2 sessions/week), while the control group received a placebo treatment by switched-off laser probe. Visual analog scale (VAS; ranging from 1 to 5), static light touch, two-point discrimination, direction discrimination, pinprick, and thermal discrimination tests were performed on each visit up to 9 months post-therapy to evaluate the recovery status. Results: Each group comprised 18 participants. The mean time since injury was 8.26 ± 2.05 and 8.38 ± 1.98 months for the control and intervention groups, respectively (p = 0.81). There was a significant improvement in the intervention group on the static light touch (p = 0.041), two-point discrimination (p = 0.028), VAS (p = 0.031), and pinprick (p = 0.014) tests on the 11th session and subsequent visits and also on direction discrimination test on the 12th session (p = 0.044) and after that. There was no significant difference in the thermal discrimination tests between the two groups (p > 0.05). Conclusion: Photobiomodulation demonstrated potential benefits in resolving persistent neurosensory deficits of the IAN, with noticeable improvements typically observed after around 35 days of treatment initiation (10 sessions).

Comparison of Suprainguinal Fascia Iliaca Nerve Block and Epidural Analgesia in Patients Undergoing Periacetabular Osteotomy.

Adequate pain control and early mobilization are critical in the postoperative period after periacetabular osteotomy (PAO). Regional anesthesia can reduce postoperative pain, but certain techniques can increase the risk of postoperative motor block and delayed functional recovery. Continuous lumbar epidurals can provide excellent analgesia but also create challenges with early ambulation. Recently, suprainguinal fascia iliaca (SIFI) single-shot blocks have been shown to provide effective analgesia in PAO patients. The goal of this study was to compare opioid use, time to achieve inpatient physical therapy (PT) goals, and length of stay (LOS) between a cohort of patients receiving SIFI blocks and a cohort of patients receiving epidural analgesia (EA). This retrospective single-surgeon comparative cohort study included all patients who underwent a PAO between 2012 and 2022. Regional anesthetic technique (SIFI vs EA), length of hospital stay, intraoperative and postoperative opioid use, pain scores, and time to achievement of PT milestones before discharge were recorded. Patients were excluded if they had any preexisting neuromuscular syndrome or neurosensory deficit. All opioid use was converted to morphine-milligram equivalents using standard conversions. Two hundred four surgeries were done over the study period; 164 patients received EA, and 40 received a SIFI block. The average age of our cohort was 19.5 years (±6 yrs). The SIFI cohort had a significantly shorter mean LOS than the EA cohort (2.9 vs 4.1 days, P < 0.001). Patients in the SIFI cohort achieved all PT ambulation goals significantly sooner than the lumbar epidural group (P < 0.001), with lower total opioid use on each postoperative day. No notable differences were observed in sex, race, BMI, or pain scores at inpatient PT visits before discharge. After PAO surgery, the SIFI block is associated with shorter hospital LOS, reduced postoperative opioid use, and earlier mobilization when compared with those who were managed with an epidural.

Unraveling the challenges in the diagnosis and management of desmoplastic fibroma of the mandible–a case report

Desmoplastic fibroma (DF) is an uncommon bone tumor that originates from the mesenchymal tissue and despite being benign, exhibits aggressive behavior locally. The following report describes the case of a 7-year-old boy with a rapidly enlarging swelling on the right side of the mandible. After a thorough clinical examination, radiographic imaging, and histopathological analysis, the diagnosis of DF was confirmed. Treatment planning was formulated considering both the tumor’s tendency for local recurrence and the patient’s well-being. Due to the patient’s young age, segmental resection was not deemed appropriate, and an aggressive curettage and enucleation of the lesion followed by the bone graft was performed instead. The patient was kept under close follow-up for the first month of post-surgery and later reviewed after 3, 6, 9, and 12 months, respectively. Good bone healing was observed on radiographs. The patient did not show any signs of recurrence based on clinical or radiographic assessments and did not exhibit any neurosensory deficits as well.

Evaluation of Efficacy of Herbert Bone Screw and Lag Screw in Management of Oblique Mandibular Fractures: A Prospective Randomized Comparative Study.

To assess the efficacy of Herbert cannulated bone screw versus Lag screw in fixation of oblique mandibular fractures. Study composed of two groups of 20 patients each and descriptive statistics were performed with p value set at 0.05 with confidence interval of 95%. Group A was treated by Titanium Lag screws; while, Group B was treated by Titanium Herbert Cannulated Bone Screws for the management of oblique mandibular fractures. Postoperatively, all the patients were evaluated clinically and radiographically by recording the incidence of complications (if any) which included trismus, neurosensory deficit, swelling, infection. Parameters such as occlusal discrepancy, rigid fixation (interfragmentary gap) and duration of surgery were also recorded for all the patients. All the patients were followed for a period of three months. Difference in mouth opening was found to be statistically significant during 1st month follow-up (p-Value-0.002). Postoperatively, the mean interfragmentary gap in Group A was significantly more than Group B (p-Value-0.000). Other parameters like neurosensory deficits, occlusal discrepancies, chewing efficiency, stability of fractured fragments and post-operative complications in terms of swelling, hardware exposure, radiolucency surrounding screw and wound dehiscence did not show any statistically significant difference. The obtained results showed that both lag screws and Herbert cannulated bone screws fulfill the treatment goals of adequate reduction, fixation and stabilization of oblique mandibular fractures. Herbert screws have shown to have better results in terms of interfragmentary gapreduction as compared to lag screws.

Neurosensory Recovery Following Skeletonization of Mental Nerve During Open Reduction &amp; Internal Fixation for Mandibular Fractures

Background: Intraoral open reduction and internal fixation (ORIF) procedures used to treat mandibular fractures can result in neurosensory abnormalities due to soft tissue and nerve manipulation. While treating fractures located in the parasymphysis and anterior body regions, where the inferior alveolar and mental nerves are located, there is limited access which can impede correct reduction and hinder the use of optimal fixation. To counter these problems, better access can be gained through skeletonization of the mental nerve, which is known to result in neurosensory disturbances. However, the extent of neurosensory deficits that may result from these procedures and the degree of their recovery remain unknown in current literature. Objective: The primary purpose of our study was to evaluate and correlate the objective and subjective neurosensory recovery of the mental nerve following skeletonization during Open Reduction and Internal Fixation of mandibular fractures. Study Design: This was a prospective observational study. Settings: The adult subjects having mandibular fractures treated at Jinnah Hospital, Lahore Pakistan, a level III tertiary care hospital. Duration: The study duration was from July 1, 2022 and December 31, 2022. Methods: Demographic details were taken and preoperative objective and subjective neurosensory assessment was performed. Following surgery, postoperative objective and subjective neurosensory assessment was performed on post op day 1, after 1 and 6 weeks. Collected data was analysed with significance level of &lt;0.05. Results: Twenty four subjects who completed regular follow-up visits for 6 weeks were included in this study. All subjects had objective or subjective neurosensory deficit preoperatively. Following surgery, all the subjects had FSR grade S0 and subjective loss of sensation at immediate postoperative assessment after surgery. 87.5% of the subjects had complete objective and subjective neurosensory recovery at the end of 6 weeks. There was a significant negative correlation between objective and subjective neurosensory recovery during the initial stages of the study, which became non-significant by the end of 6 weeks. Conclusion: Following mental nerve skeletonization during ORIF of subjects with mandibular fractures having some degree of preoperative paraesthesia, a majority of subjects achieved complete neurosensory recovery 6 weeks postoperatively. Therefore, it is expected for a skeletonized mental nerve to return to normal function within 2 months after ORIF for mandibular fractures.

Neuropathic arthropathy of the shoulder associated with chronic inflammatory demyelinating polyneuropathy: A case report

Neuropathic arthropathy is a chronic degenerative arthropathy that results from a neurosensory deficit of the affected joint. According to neurovascular theory, the loss of sensation of the joint is responsible for its formation. Chronic inflammatory demyelination polyneuropathy (CIDP) is a rare disease with sensorimotor involvement in which demyelination and axonal damage occur in the peripheral nerves as a result of an abnormal immune response. A case is presented of a 64-year-old male patient with a diagnosis of CIDP who had Charcot arthropathy of the right shoulder.

Efficacy of the titanium double ‘Y’- shaped mini plate compared with conventional mini plates in fixation of anterior mandibular fractures: A prospective clinical study

: Anterior mandibular fracture management is commonly dealt in oral and maxillofacial surgery and most accepted treatment modality is open reduction and internal fixation with miniplates. With ongoing research, various shapes of miniplates were tried for osteosynthesis and biomechanical properties tested in invitro studies, but they lack testing in clinical scenarios. The present study was conducted to compare clinically and radio graphically, the efficacy of double Y-shaped mini plate with two conventional 4 hole mini plates in management of anterior mandibular fractures. : Study consisted of 20 patients, 10 in each group with anterior mandibular fractures. 10 patients (group 1) were treated with double ‘Y’ shaped miniplate with bar and 10 patients (group 2) with conventional 4 hole two miniplates. Clinically post-operative Pain, edema, occlusion, neurosensory deficit and wound healing were assessed. Clinical evaluation was done at 1st postop day, 1st week, and 1st and 3rd month postoperatively. Radiographic evaluation was done to record fracture gap in both the groups and timing for plate adaptation and fixation was recorded intra-operatively. The data was recorded and statistical analysis was done.: Clinical and radiographic evaluation done for each group did not show any statistical difference at 3 months postoperatively. However significant difference was noted in time taken for adaptation and fixation of plates and screws. Double ‘Y’ shaped miniplate was found to be easier to place and required less time to adapt and fix to bone compared to 4-hole miniplates. The study concluded that the double ‘Y’ miniplate and conventional 4-hole miniplates are found to be equally effective for clinical use in treatment of anterior mandibular fractures. The double ‘Y’ miniplate were found to be superior in terms of handling characteristics, less hardware and better radiographic outcome when compared to conventional 4-hole miniplates.

Neurosensory Deficits of the Mandibular Nerve Following Extraction of Impacted Lower Third Molars-A Retrospective Study.

Neurosensory deficits are one of the major complications after impacted lower third molar extraction leading to an impaired patient's quality of life. This study aimed to evaluate the incidence of neurosensory deficits after lower third molar extraction and compare it radiologically to the corresponding position of the inferior alveolar nerve. In a retrospective study, all patients who underwent impacted lower third molar extraction between January and December 2019 were compiled. Therefore, clinical data as well as preoperative radiological imaging were assessed. In total, 418 patients who underwent lower third molar extractions (n = 555) were included in this study. Of these, 33 (5.9%) had short-term (i.e., within the initial 7 postoperative days) and 12 (1.3%) long-term (i.e., persisting after 12 months) neurosensory deficits documented. The inferior alveolar nerve position in relation to the tooth roots showed apical position in 27%, buccal position in 30.8%, lingual position in 35.4%, and interradicular position in 6.9%. A statistically significant increased incidence of neurosensory deficits occurs when the inferior alveolar nerve is directly positioned lingually to the tooth roots (p = 0.01).

Middle superior and anterior superior alveolar nerve injury following trauma to the maxillary sinus: a prospective clinico-radiographic evaluation.

Anterior maxillary sinus wall fractures are common in all types of maxillofacial trauma. They can result in various complications, including injury to the surrounding nerves. Owing to its anatomy, trauma to the maxillary antrum can result in injury to the middle superior alveolar nerve (MSAN) and the anterior superior alveolar nerve (ASAN). The purpose of this study is to evaluate neurosensory deficits (NSD) present in maxillary gingiva, incisors, and premolars after injury to the anterior wall of the maxillary antrum. This prospective study was conducted among 39 patients sustaining unilateral fractures of the anterior maxillary sinus wall. Clinical neurosensory tests including two-point discrimination and fine touch discrimination were performed to classify the extent of nerve injuries as mild, moderate, severe, or anesthetic. Additional temperature discrimination and pulpal sensibility tests (electric pulp testing and cold testing) were carried out. A comparison of radiographic fracture patterns and severity of nerve injury was done. Testing was carried out immediately after trauma and at 2-month follow-up. More than half of the patients assessed in the study group presented with NSD of the teeth and gingiva after trauma. The incidence of deficits varied with the type of test used to measure them. Most frequently, patients presented with both loss of two point as well as fine touch discrimination thresholds. Severe nerve injuries were associated with loss of temperature discrimination clinically and displaced fractures radiographically. There was no significant relationship between the recovery of pulpal and gingival sensation. The patterns of injury and recovery in ASAN and MSAN were similar. NSD after trauma to the maxillary antrum is relatively common. Clinical loss of temperature discrimination and radiographic signs of fracture lines passing through the canalis sinuosus are predictors of persistent and severe oral NSD.

Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Treatment.

Neonatal hypoxic-ischemic encephalopathy (HIE) is an important clinical entity because it is associated with death and long-term disability, including cognitive impairment, cerebral palsy, seizures, and neurosensory deficits. Over the past 40 years, there has been an intensive search to identify therapies to improve the prognosis of neonates with HIE. Hypothermia treatment represents the culmination of laboratory investigations including small and large animal studies, followed by pilot human studies, and, finally, randomized controlled trials to establish efficacy and safety. Clinical trials have demonstrated that hypothermia treatment reduces mortality and improves early childhood outcome among survivors. Hypoxic-ischemic encephalopathy is a multi-system disease process that requires intensive medical support for brain monitoring and monitoring of non-central nervous system organ dysfunction. Treatment must be conducted in a level III or IV neonatal intensive care unit with infrastructure for an integrated approach to care for critically ill neonates. Hypothermia treatment is the first and currently the only therapy to improve outcomes for neonates with HIE and indicates that HIE is modifiable. However, outcomes likely can be improved further. Hypothermia treatment has accelerated investigation of other therapies to combine with hypothermia. It has also stimulated a more intensive approach to brain monitoring, which allows earlier intervention for complications. Finally, HIE and hypothermia treatment negatively influences the psychological state of affected families, and there is growing recognition of the importance of trauma-informed principles to guide medical professionals.

Outcomes of Coronectomy and Total Odontectomy of Impacted Mandibular Third Molars

ObjectiveThe aim of this research was to evaluate the surgical complications and neurosensory deficits after coronectomy and the complete removal of mandibular third molars. MethodsThe study sample included patients requiring surgical removal of mandibular third molars. A coronectomy was conducted on 220 teeth showing signs of close proximity to the inferior alveolar canal. A complete extraction was performed on 218 teeth with no risk signs. The patients were evaluated at 1 week and 1, 3, 6, 12, and 24 months after surgery for pain, swelling, neurologic deficit, dry socket, postoperative bleeding, infection, root migration, and eruption. ResultsNo significant difference was noted in pain and swelling; however, bleeding and dry socket were significantly higher in the odontectomy group (P = .017). The inferior alveolar nerve deficit was higher in the odontectomy group (3.7%) than the coronectomy group (0.5%) (P = .017). The percentage and distance of root migration of coronectomised teeth at 3, 6, and 12 months were 60% (2.37 ± 0.96 mm), 66% (3.35 ± 0.86 mm), and 74% (3.85 ± 0.93 mm), respectively. ConclusionsCoronectomy is a safe procedure and should be performed when the roots are closely associated with the mandibular canal. Although root migration is common, the likelihood of root exposure is low and roots rarely need removal.

Frequency and Pattern of Presentation of Mental Nerve Injury During Para Symphysis Fracture

Aim: The mandibular fracture at the parasymphysis is the most often seen fracture of a facial bone. The occurrence of anaesthesia or paraesthesia in the skin and mucous membrane within the distribution of the mental nerve may be seen due to mental nerve injury resulting from fractures in the Parasymphysis region. This condition has the potential to impact the overall well-being of affected individuals. Objective: To determine the Frequency and pattern of presentation of mental nerve injury during Para symphysis fracture. Method: The present research is an observational and descriptive investigation including a sample of 65 patients diagnosed with parasymphysis fracture. The study was done at the Nishter Institute of Dentistry in Multan, Pakistan, spanning from September 2021 to February 2023.Following the endorsement of the research by the Ethical Review Board of the hospital, patients were recruited using a non-probability sequential sampling method. The researchers used clinical neuro-sensory testing (NST) as a means of evaluating nerve damage and determining the specific kind of neurosensory impairment that occurred subsequent to a para symphysis fracture. A specifically prepared proforma is used as a tool for data collecting. The data underwent statistical analysis, and findings and observations were derived from the analysis. Results: The study assessed the incidence of mental nerve damage in instances with Para symphysis fracture, revealing that 23 cases (35%) exhibited the presence of mental nerve injury, whereas it was missing in 42 cases (65%). The study observed a total of 23 individuals, consisting of 17 males and 6 females, who were diagnosed with mental nerve damage. The most often encountered neurosensory problems experienced by patients after surgery are paraesthesia. Additionally, it has been shown that the leading cause of parasymphysis fracture in both males and females is road traffic accidents (RTA). Conclusions: Road traffic accidents (RTAs) have been identified as a significant factor contributing to parasymphysis fractures. These fractures may result in the development of neurosensory deficits either as a consequence of the initial trauma or as a complication after surgical intervention. It has been seen that such fractures can lead to persistent complications and a decrease in overall quality of life. Additionally, it is essential to conduct additional research studies that cover a longer duration and include a bigger cohort of patients. Keywords: Mandibular fracture, Mental nerve, Paraesthesia, Trauma

Incidence neurosensory deficit in mandibular fractures.

Sensory disturbances in the inferior alveolar nerve (IAN) prior to treatment can be attributed to various factors, including the site, type of fracture, and fracture displacement. Therefore, it is of interest to assess the incidence of inferior alveolar nerve injuries associated with mandibular fractures before and after surgical treatment. Group A consisted of patients with inferior alveolar nerve paresthesia before treatment, while Group B consisted of patients with inferior alveolar nerve paresthesia after treatment. A significant difference was observed between the two groups, with a p-value of 0.031 (p <0.05) with the overall incidence of IAN deficit was 57.33% before treatment and 61.33% after treatment. These findings highlight the importance of promptly identifying and managing IAN injuries to minimize long-term consequences.

P-580 Virtual reality as tool to reduce anxiety during embryo transfer.

Abstract Study question Is the use of virtual reality during embryo transfer effective as a measure to reduce anxiety during the procedure? Summary answer With the current evidence, it cannot be affirmed that virtual reality is useful as a tool to reduce anxiety during embryo transfer. What is known already The embryo transfer (ET), the last and crucial procedure of in vitro fertilization (IVF), generates anxiety, especially in couples with a history of reproductive failure. The latest evidence suggests that a high level of stress can influence reproductive results. Virtual reality (VR) seems to be a useful tool that helps to relieve pain, stress, anxiety and depression symptoms. VR has recently been proposed as a method to alleviate pain and emotional impact in other gynecological procedures such as hysteroscopy. It would be interesting to study the potential beneficial impact of the application of virtual reality to reduce anxiety during ET. Study design, size, duration This is an experimental and ramdomized study. A total of 128 infertile women undergoing ET were included, who were grouped into two groups based on whether or not they used VR glasses. In all of them, the level of anxiety was assessed according to validated questionnaires (STAI and GAD-7) along with other clinical parameters such as pain (VAS) or blood pressure. The recruitment period was from May to June 2022. Participants/materials, setting, methods 128 women between the ages of 18 and 40 who underwent vitrified or fresh embryo transfer were included. Patients under treatment with antidepressants or anxiolytics, drug users, or neurosensory deficits were excluded. In the experimental group, the usual ET procedure was performed applying VR (virtual reality class 1 medical device developed by Deepsen and Metronic®). The study was carried out in the Assisted Human Reproduction Unit of the Virgen de Valme University Hospital (Seville). Main results and the role of chance The 128 participants were randomized into two groups, 64 in each study arm: experimental group (exposed to VR) and control group (normal ET procedure). The characteristics of the patients were comparable between the two groups. Systolic blood pressure (120.62 ± 15.11 vs 126.04 ± 12.26), diastolic blood pressure (75.41 ± 9.58 vs 81.28 ± 9.28) and mean blood pressure (90. 14 ± 10.97 vs 95.54 ± 9.79) after embryo transfer were significantly (p &amp;lt; 0.05) lower in the experimental group compared to the control group. However, no differences were observed between the two groups in pain (VAS), blood pressure before the procedure, respiratory rate and oxygen saturation before and after ET. Anxiety level scores (STAI and GAD-7) were comparable between the two groups. Unlike the only comparable study in which a higher pregnancy rate was observed in the experimental group (although without statistical significance), in our study the pregnancy rate was higher in the control group (33.3% vs 43.8%). However, in our study the gestation rate that exceeded 6 weeks of pregnancy was higher in the experimental group (81% vs 71.4%), although without statistical significance. Limitations, reasons for caution The sample size is too small, making it difficult to find significant relationships. In addition, there are no previous studies that support the theory of the study. Wider implications of the findings There is only one previous comparable study evaluating the use of VR in assisted reproduction. Our findings suggest changes in blood pressure with the use of VR, although this is not the case in the rest of the parameters analyzed. A larger sample is needed to confirm these findings. Trial registration number Not applicable

CLINICAL PATHOLOGIC CONFERENCE CASE 1: A MULTILOCULAR RADIOLUCENCY OF THE RIGHT MANDIBLE

CLINICAL PATHOLOGIC CONFERENCE CASE 1: A MULTILOCULAR RADIOLUCENCY OF THE RIGHT MANDIBLE

Emphysematous cystitis, iliopsoas abscess, and pneumorrhachis in an elderly woman: a case report

BackgroundEmphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis.Case presentationThis is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock.ConclusionsOur case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.

What are the Effects of Internal Fixation on Trigeminal Neurosensory Function and the Temporomandibular Joints Following Intraoral Vertical Ramus Osteotomy?

Intraoral vertical ramus osteotomy (IVRO) has, traditionally, been accomplished without internal fixation, necessitating a period of maxillomandibular fixation (MMF). With advances in instrumentation, internal fixation of IVRO is feasible, obviating the need for MMF. The purpose is to investigate the effects of transoral internal fixation on the prevalence of third division trigeminal nerve (CNV3) injury, temporomandibular joint (TMJ) arthralgia, and surgical site bleeding following IVRO. A retrospective study was conducted on patients who underwent IVRO at Vanderbilt University Medical Center between January 2017 and December 2020. The primary predictor variable was fixation status-internal fixation versus MMF. The primary outcome variable was postoperative CNV3 neurosensory disturbance. The secondary outcome variables were TMJ arthralgia and surgical site bleeding. Statistical analysis included Fisher's exact test and McNemar's Chi-squared test. Seventy two subjects (59 IVROs without internal fixation and 65 IVROs with internal fixation) were studied. The frequency of CNV3 neurosensory deficit was 0% in the IVRO without internal fixation group and 3.1% in the IVRO with internal fixation group (P=.49). Within group analysis showed a decreased frequency of postoperative TMJ arthralgia compared to preoperative records in both groups (IVRO without internal fixation group, P=.04 and IVRO with internal fixation group, P=.004). The frequency of active surgical site bleeding controlled with local measures was 1.7% in the IVRO without internal fixation group and 3.1% in the IVRO with internal fixation group (P=1). Internal fixation of IVRO is associated with low incidence of neurosensory deficit, TMJ arthralgia, and active surgical site bleeding.