Bone Osteotomy Research Articles

Role of the Ilizarov fixator in high tibial osteotomy

Role of the Ilizarov fixator in high tibial osteotomy

Paediatric nasal dermoid: evaluation and management.

The aim of this study was to present the evaluation and current management of congenital paediatric nasal dermoid. There has been a trend towards less invasive surgical excision techniques, including purely endoscopic excision, endoscopic-assisted approaches and midline excision with nasal bone osteotomies and bone flap. These approaches allow adequate access for both total resection and nasal contour and skull base reconstruction. Following resection, if nasal bone osteotomies are insufficient for restoring nasal appearance, free temporoparietal fascial graft and/or conchal cartilage can be considered. For nasal tip deformities, interdomal sutures and free fat grafting are a suitable option. Complete surgical excision remains the treatment of choice for nasal dermoid lesions. The surgical approach taken and reconstruction depends on the type of lesion (cyst versus sinus or fistula), location (intranasal versus extranasal), whether or not there is intracranial extension, and experience of the surgical team.

New method of surgical correction of lesser toes deformity

Background. Patients’ dissatisfaction with the results of surgical correction of lesser toes deformities, the shortcomings of methods aimed at eliminating the lateral deviation of the toe in the metatarsophalangeal joint necessitated the development of a new surgical method.The aim. To evaluate short-term results of the new surgical method for the treatment of patients with lesser toes deformity, accompanied with deviation of the toe.Materials and methods. A method of surgical treatment of deviated deformity of the small toes is proposed. The method includes precise marking of the metatarsal osteotomy line according to the previously calculated parameters of optimal shortening and displacement of the metatarsal bone, performing oblique diaphyseal osteotomy of the metatarsal bone, displacing its distal part along the osteotomy plane. According to the proposed method, nine patients were operated on who had a syndrome of nonrigid hammer-like deformity of the second toe with lateral deviation of the toe in the metatarsophalangeal joint. In all patients, the deformity of the second toe was associated with hallux valgus.Results. As a result of the application of the proposed method, it was possible to achieve deformity correction, eliminate the lateral deviation of the second toe in the metatarsophalangeal joint, restore congruence in the joint, achieve consolidation of bone fragments without loss of correction, and improve the appearance and function of the foot. Three months after the operation, a statistically significant improvement was determined, according to the AOFAS LMIS scale, having reached 94.5 ± 4.64 points, which made it possible to speak about the achievement of a good functional result of treatment. Patients noted the opportunity to wear standard footwear, to carry out their labor activity, to engage in physical culture, were satisfied with the result.Conclusion. The use of the proposed new surgical method for deflected deformity of the lesser toes makes it possible to correct the deformity, eliminate lateral deviation of the toe, relieve pain syndrome, achieve a good cosmetic and functional result, restoring the patients’ ability to wear standard shoes.

Point of Care Virtual Surgical Planning and Three-Dimensional Printing for Feminizing Foreheadplasty.

Point of Care Virtual Surgical Planning and Three-Dimensional Printing for Feminizing Foreheadplasty.

Biomechanical Effects of Graft Shape for the Evans Lateral Column Lengthening Procedure: A Patient-Specific Finite Element Investigation.

The Evans calcaneal lengthening osteotomy procedure is widely used for correcting progressive collapsing foot deformity. However, it can result in overcorrection and degenerations of the calcaneocuboid joint. Different shapes of graft have been used in the Evans calcaneal osteotomy, but potential differences in their biomechanical effects is still unclear. The present study was designed to explore the biomechanical effects of graft shape and improve the Evans procedure to avoid or minimize detrimental effects. Twelve patient-specific finite element models were established and validated. A triangular or rectangular wedge of varying size was inserted at the lateral edge of calcaneus, and the degree of correction was quantified. The stress in spring ligaments and plantar fascia and the contact characteristics of the talonavicular and calcaneocuboid joints were calculated and compared accordingly. The rectangular graft provided a much higher degree of correction than triangular grafts did. However, the contact characteristics of the calcaneocuboid joint and talonavicular joint were abnormal, with clear sensitivity to increased graft size, and the modeled strain of the spring ligament increased. The finite element analysis predicts that the rectangular grafts provide a higher degree of correction, but risks overcorrection compared with triangular grafts. The triangular graft may have a lower degree of disturbance to the biomechanical behaviors of the midtarsal joint. The model shows that both the shape and size of an Evans osteotomy bone wedge can have effects on the contiguous joints and ligamentous structures. Those effects should be considered when selecting a bone wedge for an Evans calcaneal osteotomy. Level III, case-control study.

MP03-11 THE EFFECT OF POSTOPERATIVE TADALAFIL IN REDO-URETHROPLASTY FOR PATIENTS WITH PELVIC FRACTURE URETHRAL INJURY: A NON-RANDOMIZED TWO ARMS TRIAL

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP03)1 Sep 2021MP03-11 THE EFFECT OF POSTOPERATIVE TADALAFIL IN REDO-URETHROPLASTY FOR PATIENTS WITH PELVIC FRACTURE URETHRAL INJURY: A NON-RANDOMIZED TWO ARMS TRIAL Pankaj M. Joshi, Marco Bandini, Amey Patil, Shreyas Bhadranavar, Yatam L. Shreeranga, Vipin Sharma, Guido Barbagli, Francesco Montorsi, and Sanjay B. Kulkarni Pankaj M. JoshiPankaj M. Joshi More articles by this author , Marco BandiniMarco Bandini More articles by this author , Amey PatilAmey Patil More articles by this author , Shreyas BhadranavarShreyas Bhadranavar More articles by this author , Yatam L. ShreerangaYatam L. Shreeranga More articles by this author , Vipin SharmaVipin Sharma More articles by this author , Guido BarbagliGuido Barbagli More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Sanjay B. KulkarniSanjay B. Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001964.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic fracture urethral injury (PFUI) is common in developing countries, invariably as a result of road traffic trauma. Repair is complex and redo cases are even more challenging with decreasing chances of success. The reasons behind the low success rate are the compromised the blood supply, and the fibrotic process which respectively decrease and increase at any attempted surgery. We believe that blood supply can be pharmacologically improved after redo-surgery, with the use of phosphodiesterase (PDE) inhibitors. Similarly, we also believe that PDE inhibitors may decrease the amount of post-operative fibrosis. We aimed to test the effect of tadalafil on success rate after redo-urethroplasty in patients referred for PFUI. METHODS: This was a prospective (2017-2019) non-randomized and non-placebo-controlled trial (KESI02012017). Men with PFUI receiving redo-urethroplasty were allocated to two non-randomized groups. Group 1 received tadalafil 5mg from the first postoperative day for 90 days after surgery. Group 2 did not receive tadalafil. Inclusion criteria were patients undergoing redo-urethroplasty willing to enter the trial and accepting to take low dose of tadalafil postoperatively. Exclusion criteria were <18 years, females, primary cases and complex cases such as those with recto-urethral fistula. Failure was defined as redo urethroplasty or any need for instrumentation (i.e. DVIU or dilatation) after surgery. RESULTS: Overall, 60 patients were enrolled (29 Group 1 vs 31 Group 2) in our study. No statistically significant differences emerged between groups in terms of age (32 vs 30 yrs), diabetes (10 vs 6.4%), length of gap (2.9 vs 2.8 cm), and previous attempted surgery (1.3 vs 1.1), all p>0.05. The majority of patients in both groups required Step 3 (pubic bone osteotomy) anastomotic urethroplasty (72 vs 65%). Median follow up was 19.5 months (5-39 months). Overall success rate was 83.3% (50 patients). Only 1 patient in the tadalafil group failed, compared to 9 in the non-tadalafil group. The success with tadalafil was 96.6%, compared to 71.0% in the non-Tadalafil group (p 0.0008). CONCLUSIONS: In our non-randomized and non-placebo-controlled trial, we found an improved success rate, after redo-urethroplasty for PFUI, in those patients receiving 5 mg of tadalafil for 3 months after surgery compared to those who did not receive tadalafil. Future randomized double-blinded placebo-controlled trials are awaited to evaluate the use of postoperative tadalafil 5mg in patients undergoing redo-urethroplasty for PFUI. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e25-e25 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj M. Joshi More articles by this author Marco Bandini More articles by this author Amey Patil More articles by this author Shreyas Bhadranavar More articles by this author Yatam L. Shreeranga More articles by this author Vipin Sharma More articles by this author Guido Barbagli More articles by this author Francesco Montorsi More articles by this author Sanjay B. Kulkarni More articles by this author Expand All Advertisement Loading ...

Analysis of clinical effect of nasal endoscope-assisted nasal columella approach for simultaneous correction of nasal septum deviation and crooked nose deformity

Objective:To analyze the clinical effect of nasal endoscope-assisted nasal columella approach in the correction of nasal septum deviation and crooked nose deformity. Methods:The clinical data of 33 patients with deviation of nasal septum with crooked nose deformity in First Affiliate Hospital of Air Force Military Medical University from January 2016 to June 2019 were collected. All patients underwent surgery under general anesthesia. Nasal columella inverted "V" incision was used to expose and release. The deviated nasal septum cartilage and bone were removed with the assistance of nasal endoscope. Twelve（36.4%） patients underwent osteotomy of nasal bone and frontal process of maxilla at the same time, 13（39.4%） patients used autologous nasal septum to reshape the tip, back and external nose. Results:During a follow-up of 18 months to 60 months, 30（90.9%） patients were satisfied with the improvement of postoperative nasal function, 3（9.1%） patients were basically satisfied; 23（69.7%） patients were satisfied with the appearance of the nose after operation, 8（24.2%） patients were basically satisfied, and 2（6.1%） patients were dissatisfied. No postoperative complications such as nasal adhesion, nasal septum perforation, nasal septum hematoma and nasal dorsal collapse occurred in all patients. Conclusion:The nasal endoscope-assisted nasal columella approach and the correction of nasal septum deviation and crooked nose deformity can solve the nasal deformity and nasal ventilation function at the same time, realize the unity of cosmetology and function, and reduce the frequency and cost of surgical treatment at the same time. The effect is good, and the patients benefit greatly.

First clinical experience of a new surgical technique including correction of bony alignment of first foot ray combined with reconstruction of muscle balance in case of adolescent hallux valgus

BACKGROUND: Hallux valgus deformity of the big toe in adolescents accounts for 22%44% of all relevant cases. Despite a relatively large number of surgical treatment methods proposed to correct this deformity, treatment results are not always satisfactory. The problem of imbalance between the external traction of the abductor hallucis muscle and the contracted adductor muscle in hallux valgus remains controversial and is not covered in the literature.&#x0D; AIM: This study aimed to examine the results of hallux valgus deformity treatment, following the suggested combined technique.&#x0D; MATERIALS AND METHODS: Eight teenage patients (10 feet), aged 15 years on average, were assessed. Patients were undergoing treatment in the department of pediatric orthopedics of the Dana Hospital, Tel Aviv, within the period from 2015 to 2019. The average postoperative observation period was 30 months. This study suggested a new combined technique, including (1) modified oblique Chevron osteotomy with a V-shaped cut in the distal aspect of the first metatarsal with the dorsal wedge excision performed at the apex of its angulation, (2) valgus osteotomy of the medial cuneiform bone with the insertion of the V-shaped bone allograft, and (3) transfer of the dorsal portion of the pre-split tendon of abductor hallucis muscle to the base of the triangular medial capsular flap of the first metatarsophalangeal joint (MPJ). The tendon received optimal tension to restore the muscular balance.&#x0D; RESULTS: This surgical technique provided safe and stable correction of the hallux valgus deformity, restored muscular balance, avoided movement restriction of the first MPJ, and restored the function and strength of the abductor halluces muscle that prevented the recurrence of the deformity. The number of good and excellent results was much greater than those in published reports.&#x0D; CONCLUSIONS: Despite a relatively small group of patients, the suggested technique has shown improvements in hallux valgus deformity in adolescents.

A hybrid feature-based patient-to-image registration method for robot-assisted long bone osteotomy.

The purpose of this study is to provide a simple, feasible and effective patient-to-image registration method for robot-assisted long bone osteotomy, which has rarely been systematically reported. The practical requirement is to meet the accuracy of 1mm or even higher without bone-implanted markers. A hybrid feature-based registration method termed CR-RAMSICP is proposed. Point-based coarse registration (CR) is accomplished relying on the optical retro-reflective markers attached to the tracked rigid body fixed out of the bone. In surface-based fine registration, an improved iterative closest point (ICP) algorithm based on the range-adaptive matching strategy (termed RAMSICP) is presented to cope with the robust precise matching between the asymmetric patient and image point clouds, which avoidsconverging to a local minimum. A series of registration experiments based on the isolated porcine iliums are carried out. The results illustrate that CR-RAMSICP not only significantly outperforms CR and CR-ICP in the accuracy and reproducibility, but also exhibits better robustness to the CR errors and less sensitiveness to the distribution and number of fiducial points located in the patient point cloud than CR-ICP. The proposed registration method CR-RAMSICP canstably satisfythedesiredregistration accuracy without the use of bone-implanted markers like fiducial screws. Besides, the RAMSICP algorithm used in fine registration is convenient for programming because any complex metrics or models are not involved.

Subjective and Objective Outcomes of Surgery for Rheumatoid Forefoot Deformities Under the Current Treatment Paradigm

We investigated the clinical outcomes of surgical procedures for the treatment of forefoot deformities in patients with rheumatoid arthritis. Twenty feet in 16 women (mean age 62.1 years) underwent corrective osteotomy of the first metatarsal bone with shortening oblique osteotomy of the lesser metatarsophalangeal joints (joint-preservation group), while 13 feet in 12 women (mean age 67.4 years) underwent arthrodesis of the first metatarsophalangeal joint with resection arthroplasty of the lesser metatarsophalangeal joints (joint-sacrifice group); mean follow-up for each group was 25.8 and 23.8 months, respectively. The mean total Japanese Society for Surgery of the Foot (JSSF) scale improved significantly from 64.2 to 89.2 in the joint-preservation group (p < .001), and from 54.2 to 74.2 in the joint-sacrifice group (p = .003). In the joint-preservation group, the postoperative range of motion (ROM) of the joint, walking ability, and activities of daily living scores of the JSSF scale were significantly higher than those in the joint-sacrifice group (p = .001, p = .001, and p = .019, respectively). There were no differences in the subscale scores of the self-administered foot evaluation questionnaire between 2 groups either pre- or postoperatively. No differences in the postoperative complications were found between 2 groups. Although the joint-sacrificing procedure resulted in lower objective outcomes than the joint-preserving procedure regarding the ROM of the joint, the walking ability, and the level of activities of daily living, both procedures resulted in similar treatment outcomes when evaluated by the subjective measures.

Comparison of Intra-Articular versus Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Study

Background: Total Knee Arthroplasty (TKA) is widely used in clinical applications. Considerable postoperative blood loss, however, is an unavoidable occurrence due to the extensive soft-tissue release, and the large area of cancellous bone osteotomy associated with the procedure. Besides, knee flexion and extension activities those begin the day after the operation adds to the problem. Aim of the Work: To compare between the intra-articular and the intravenous application of Tranexamic Acid (TXA) in total knee arthroplasty. Patients and Methods: It is a prospective Double-blinded Randomized controlled trial. This prospective study was conducted at El-Hussein University Hospital &amp; El Agouza Hospital on 30 patients who undergo total knee arthroplasty and fulfill all inclusion and exclusion criteria. Results: The results were the average total blood loss in the drain after 48hrs. In the 1st group was 365±74.722 while average blood loss in the 2nd group was 575±88.976. This indicates a significant decrease in blood loss in the 1st group (intraarticular TXA group) than the 2nd group (intravenous TXA group) the P value &lt;0.001 which is highly significant. It was found that The decrease in Hb level is less in the 1st group than in the 2nd group which indicates less postoperative anemia in the blood count, the P-value &lt;0.05 considered significant.

More than 20 years of experience with Dega transiliac osteotomy in the treatment of dislocated hip joints in children with cerebral palsy.

Cerebral palsy in children, which is the result of a nonprogressing damage to the central nervous system, causes motor and posture disorders that change with age. The level of child activity correlates with the hip dislocation risk. It most often affects nonwalking patients and those with tetraparesis or oblique pelvis. The aim of the study was to assess the effectiveness and clinical value of Dega pelvic osteotomy with accompanying directional femoral bone osteotomy after minimum of 20 years from surgery of patients with cerebral palsy. The conducted research was retrospective and concerned the children operated at our Hospital. The assessment was carried out in 346 children with spastic hip during the years 1993-2000. The inclusion criteria were applied: unilateral dislocation of the hip, the observation period of at least 20 years, pelvic osteotomy by Dega method and combined with varus derotation femur osteotomy. The analysis involved fifteen patients. The follow-up period was minimum 20 years (20-27 years). The average migration percentage decreased from 88% down to 25%, and an improved range of mobility was observed in the operated joint after surgery. However, the range of mobility was again significantly reduced during the last control examination after a minimum of 20 years. In all hips, the degenerative joint disease was present. Pelvic transiliac osteotomy, according to Dega, with VDRO, ensures very effective correction of the deficit in femoral head coverage by the acetabulum in the upper, lateral and posterior parts. However, it does not prevent the development of the early degenerative disease of the joint.

A Unique Bone Osteotome Technique for Extraction of Palatally Inclinated Maxillary Impacted Tooth: A Technical Note

Background: There have been reported about impacted tooth[1,2,3], but a very few literature about extraction technique using bone osteotomy. Bone osteotome is routinely used in various oral surgeries. We describe a technique of a unique bone osteotome technique for extraction of palatally inclinated maxillary impacted tooth. Methods: We occasionally encounter the patient with tooth crown of impacted tooth inclinated from the buccal site toward the palatal site. When the use of an elevator and forceps is difficult due to the palatal tilted and interference of neighboring teeth, tooth extraction is a challenge.Using this osteotome from the buccal site causes the canine to easily rise out of the socket in the palatal direction. Results and Conclusion: This bone osteotome technique for extraction of palatally inclinated maxillary impacted tooth was very useful and convenient.This is because the impacted canine can be removed with a bone osteotome, a minimally invasive surgical instrument. No appreciable disadvantages are noted with this bone osteotomy. Keywords: Unerupted Tooth; Impacted Canine; Supernumerary Teeth

Improved Ilizarov method for management of deformity and ulceration on foot and ankle of spina bifida.

ObjectiveTo analyze the characteristics of foot and ankle deformity with ulceration in patients with spina bifida, to conclude experiences on management with improved Ilizarov method in one stage.Methods77 cases suffering foot and ankle deformity with ulceration of spina bifida were included from January 2008 to June 2019, in which 30 male and 47 female, aged 6–46 years with an average age of 22.86 years. There were 10 cases on left, 14 on right and 53 on both. The improved Ilizarov method combined soft tissue surgery, bone osteotomy and Ilizarov technique in one stage, by which the ulcer was dressed aseptically and avoid weight bearing preoperatively, no special treatment, no debridement, no flap coverage and no bacterial culture. Antibiotics were given for 3 days routinely, and the dressing was removed 5 days later. If there was exudation, gauze could be used to wrap continually, if there was no swelling and exudation, no need further more caring. General appearance and radiological image of ulcer and deformity were observed during the period of evaluation and treatment, surgical method and complications, foot & ankle function and overall function were evaluated using AOFAS scoring system and special table designed by authors.Results77 cases were followed up for 6–132 months with an average of 50.5 months. Achilles tendon subcutaneous lengthening was performed in 2 cases, posterior tibial tendon and Achilles tendon simultaneous released for 31cases, subtalar joint arthrodesis 25 cases, calcaneus osteotomy 5 cases, triple osteotomy 28 cases, ankle arthrodesis 19 cases, internal rotation osteotomy of tibia was performed in 1 case and 1 case in external rotation osteotomy. There were 67 cases using Ilizarov fixators and 10 cases using Hybrid fixators for immobilization and correction. Stable feet were obtained and ulcers healed simultaneously when all deformities of foot and ankle had been corrected. The healing time of ulcer was average 26.5 days ranging 7–36 days, and there was no infection or delayed healing occurred in any case. Ankle ankylosis in 25 cases, 3 cases of pin tract infection, 2 wires were broken. The AOFAS score significantly increased from 70.5 ± 4.5 preoperative to 81.6 ± 3.9 postoperative; based special table evaluating, Excellent 28 cases, Good 42 cases, Fair7 cases.ConclusionThe patients with foot & ankle deformity and ulceration suffered from spinal bifida can be treated by improved Ilizarov method in one stage, and the results are satisfactory with short treatment period and decreased complications.Translational potential of this articleThe characteristics of foot and ankle deformity with ulceration inpatients with spina bifida have been analyzed and the experiences on management with improved Ilizarovmethod in one stage have been summarized in this study, which updated treatment concept of neurogenic deformity with ulceration on foot and ankle joint.

Piezoelectric tools versus traditional oscillating saw for distal linear osteotomy in hallux valgus correction: Triple-blinded, randomized controlled study

BackgroundThe main goal of the surgical correction of the hallux valgus is the morphological correction associated with the functional rebalancing of the first ray. The aim of this triple-blinded, randomized controlled study was to show the efficacy of piezosurgery in performing distal linear osteotomy of the first metatarsal bone in HV correction, in terms of clinical and radiological outcomes at 1-year final follow up. Methods and materialsThis study was performed collecting prospectively pre-operative and post-operative data for all patients. 34 patients were included in the trial and were randomly allocated (1:1) in a Piezoelectric Group (PG) that involved the use of piezoelectric tools and in a Control Group (CG) that provided for the use of a traditional oscillating saw. In both groups, all patients were treated with a distal linear osteotomy of the first metatarsal bone. Clinical and radiographic assessments were performed. ResultsThe AOFAS score between the two groups was similar pre-operatively and during the follow-up period, with a slight superiority in the PG at each evaluation. The osteotomy surgical time was registered for both groups. Among the endpoints of the study, the radiological bone healing time was independently assessed by a radiologist that reported a lower mean value in the piezoelectric group compared with the control group. ConclusionsThis trial has shown that piezoelectric surgery is not inferior to traditional methods from the clinical-functional point of view, but can even lead to an evident reduction of bone healing time with a statistical significance. Level of evidenceLevel I.

Intra-osseous heat generation during implant bed preparation with static navigation: Multi-factor in vitro study.

To compare the intra-osseous temperature reached during bone drilling for dental implant placement using open versus closed static surgical guides and evaluate the influence of bone density, osteotomy drilling depth, and irrigation fluid temperature. 960 osteotomies were performed with 2mm pilot drills in 16 solid rigid polyurethane foam blocks. Two main variables were considered: the guide type (open or closed guide) and bone density (hard (D1) or soft (D4). The blocks were divided into four groups according to the type of surgical template and bone density as follows: group one: closed guide and hard bone; group two: open guide and hard bone; group three: closed guide and soft bone; and group four: open guide and soft bone. A combination of different experimental conditions was used, including different bone osteotomy depths (6 or 13mm) and irrigation fluid temperatures (5°C or 21°C). The highest mean temperature was found in group one (28.29±4.02°C). In the soft bone groups (three and four), the mean maximum temperature decreased compared to groups one and two (dense bone) and was always higher with closed guides (23.38±1.92°C) compared to open guides (21.97±1.22°C) (p<.001). The osteotomy depth and irrigation fluid temperature also significantly influenced the bone temperature (p<.001), especially in hard bone. The greatest heat generation was observed in high-density bone. The final intra-bone temperature was about 1°C higher with a closed static surgical guide than with an open guide. The heat generation in osteotomy sites was substantially reduced by cooling the irrigation fluid to 5°C.

Finite element simulation and integration of CEM43 °C and Arrhenius Models for ultrasonic-assisted skull bone grinding: A thermal dose model

The aim of the study was to develop a novel automated setup for bone grinding to limit the temperature to below 43 °C. The feasibility of using ultrasonic actuation during bone osteotomy was explored with different machining variables, such as rotational speed, feed rate and ultrasonic frequency, in terms of the criterion variable (i.e., temperature). A thermal dose model based on the CEM43 °C and the Arrhenius model was developed for the prediction of tissue damage during bone grinding. CEM43 °C is a normalizing method to convert the time-temperature relationship into an equivalent number of minutes at 43 °C. For every degree rise in temperature above 43 °C, the cell viability significantly increased. The temperature generated during bone grinding was measured with an infrared thermography technique. The increase in temperature above threshold levels of 43 °C and 47 °C may harm the bone tissues and cause thermogenesis and osteonecrosis, respectively. A finite-element simulation was conducted to visualise the spatial and temporal distribution of temperature on the bone surface after bone grinding. Furthermore, simulation results were used to measure the depth of thermogenesis and osteonecrosis at the grinding site. Evaluation of the optimised set of bone grinding process parameters was supported with analysis of variance at the 95% confidence level.

An algorithm of orthodontic treatment of teenagers with the bilateral cleft lip and palate

Relevance . Bilateral cleft lip and palate (BCLP) is the malformation of the maxillo-facial region caused by the defect of the alveolar bone, palate and upper lip. According to the World Health Organisation, the incidence rate is 0.61.6 per 1000 newborns. The protrusive premaxilla is often treated by osteotomy for esthetic reasons. However, the osteotomy of the protrusive premaxilla slows down the growth of the child’s midface, which leads to the skeletal deformations with complications. The study explores the method that allows performing the premaxillary osteotomy to improve the facial profile in the long term. Materials and methods . During the study, 12 patients with BCLP aged 10 to 14 were treated from 2016 to 2019. All patients had head computed tomography by Planmeca ProMax. The results were uploaded into the Dolphin Imaging for further cephalometric analysis. The growth was predicted by Ricketts prediction analysis. Results . The patients were divided into two groups according to the type of the facial growth. The patients of the first group were diagnosed with the vertical type of the growth. The treatment was performed with microimplants. The patients of the second group, with a horizontal growth type, underwent osteotomy of the intermaxillary bone. Consequently, the growth was predictable, which improved the overall facial profile. Conclusions . The osteotomy of the premaxillary bone is recommended only in patients over 10-11 years with the protrusive premaxilla who were diagnosed with the horizontal growth type.

Cold Ablation Robot-Guided Laser Osteotome (CARLO®): From Bench to Bedside.

Background: In order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools, a Swiss start-up company. We present our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO®). Methods: The CARLO® device employs a stand-alone 2.94-µm erbium-doped yttrium aluminum garnet (Er:YAG) laser mounted on a robotic arm. A 19-year-old patient provided informed consent to undergo bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO® device. The linear part of the Le Fort I osteotomy was performed autonomously by the CARLO® device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images. Results: The CARLO® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications. Conclusion: The newly developed stand-alone CARLO® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. However, the technical workflow concerning the positioning and fixation of the target marker and the implementation of active depth control still need to be improved. Further research to assess safety and accuracy is also necessary, especially at osteotomy sites where direct visual control is not possible. Finally, cost-effectiveness analysis comparing the use of the CARLO® device with gold-standard surgery protocols will help to define the role of the CARLO® device in the surgical landscape.

Feasibility of the application of mixed reality in mandible reconstruction with fibula flap: A cadaveric specimen study

BackgroundIn recent years, a new technology, mixed reality (MR), has emerged and surpassed the limitations of augmented reality (AR) with its inability to interact with hologram. This study aimed to investigate the feasibility of the application of MR in mandible reconstruction with fibula flap. MethodsComputed tomography (CT) examination was performed for one cadaveric mandible and ten fibula bones. Using professional software Proplan CMF 3.0 (Materialize, Leuven, Belgium), we created a defected mandibular model and simulated the reconstruction design with these 10 fibula bones. The surgical plans were transferred to the HoloLens. We used HoloLens to guide the osteotomy and shaping of the fibular bone. After fixing the fibular segments using the Ti template, all segments underwent a CT examination. Before and after objects were compared for measurements of the location of fibular osteotomies, angular deviation of fibular segments, and intergonial angle distances. ResultsThe mean location of the fibular osteotomies, angular deviation of the fibular segments, and intergonial angle distances were 2.11 ± 1.31 mm, 2.85°± 1.97°, and 7.24 ± 3.42 mm, respectively. ConclusionThe experimental results revealed that slight deviations remained in the accuracy of fibular osteotomy. With the further development of technology, it has the potential to improve the efficiency and precision of the reconstructive surgery.