Posterior Third Research Articles

Never ending diversity: two new species of the genus Allocreadium (Digenea: Allocreadiidae) including new keys to the genus.

Two new species of the genus Allocreadium were isolated from the intestines of the Lake minnow Rhynchocypris percnura caught in the backwater of the Komissarovka River in the South of the Russian Far East. The morphology of A. anastasii n. sp. corresponds to that of Allocreadium sp. from Lake Khar (Mongolia) and Allocreadium sp. Belous, 1952 from the Primorsky region of Russia except for the preacetabular anterior border of the vitelline follicles in A. anastasii n. sp. from the Komissarovka River vs. at anterior half of ventral sucker in Allocreadium sp. Genetic analysis revealed the identity of A. anastasii n. sp. to Allocreadium sp. 1 from the Nezhinka River and Lake Khar. Allocreadium macrolecithum n. sp. was differentiated from Palaearctic Allocreadium spp. by having the following features: respectively large vitelline follicles extending from posterior extremity to anterior margin of the ventral sucker; relatively short caeca reaching the border of middle and posterior thirds of hindbody; and small testes in the middle of hindbody. Interspecific genetic p-distances between Allocreadium spp. were 0.16-7.23% in 28S gene and 18.62-31.54% in Cox1 mtDNA gene. In the phylogenetic tree reconstructed with Maximum parsimony and Bayesian Inference methods, A. anastasii n. sp. and A. macrolecithum n. sp. were nested into different species groups of the genus Allocreadium - sister to A. khankaiense and A. bursense, respectively. Modified dichotomous keys were prepared for 31 Palaearctic species of Allocreadium including A. crassum, A. dogieli, A. papilligerum, A. bursense, A. anastasii n. sp., and A. macrolecithum n. sp.

How malocclusion interferes with tissue inhibitor of metalloproteinase-1 expression and morphology of the articular cartilage of the mandible in female rats

ObjectiveThe purpose of this study was to investigate morphological alterations and tissue inhibitor of metalloproteinase-1 expression in the articular cartilage of the mandible under conditions of experimentally induced malocclusion. DesignTwenty-four 8-week-old female Wistar rats were used and divided into control and experimental groups with two different treatment periods (2 and 4 weeks). Sagittal malocclusions were orthodontically created, causing mesial movement of the first molars and distalization of the third molars unilaterally and on opposite sides of the arches. Sagittal sections of the articular cartilage of the mandible were subjected to hematoxylin and eosin and immunohistochemistry for tissue inhibitor of metalloproteinase-1. Chi-square and MannWhitney U tests were applied. ResultsAnimals treated for 2 and 4 weeks showed morphological alterations in articular cartilage of the mandible. The main findings were thickening of the posterior third, layer derangement, osteoclast activity and osteophyte formation. Among the cellular aspects, the presence of chondrocytes with condensed nuclei and cytoplasm reduction were observed. The enzyme in control animals was observed only in the mature layer. Treated animals showed immunopositive cells in the proliferative and mature layers, and in the 2-week treated group, the posterior third of the cartilage had more immunolabeled cells than control (P=0.0291). ConclusionsThe occlusal disorder caused morphological changes in articular cartilage of the mandible, probably due to the attempt to adapt to the new condition. Tissue inhibitor of metalloproteinase-1 expression may play a role as an initial modulator in the biological events observed in articular cartilage of the mandible.

Rehabilitation of Functional Dysphonia Using Semi-Occluded Vocal Tract Exercises (SVOTE)

This case study evaluated the efficacy of semi-occluded vocal tract (SVT) therapy as a speech intervention for functional dysphonia in a 53-year-old patient. Laryngoscopic examination revealed mild erythema and mucosal irregularity in the posterior third, edema, slight interarytenoid erythema, and phonatory hiatus in the posterior third of the posterior wall. Vocal assessments were conducted before and after rehabilitation, focusing on the perceptual, acoustic, and aerodynamic aspects. The treatment plan incorporated sustained, oscillatory, and transient occlusions over 10 sessions. The results showed enhanced voice timbre quality and normalization of the fundamental frequency appropriate for the patient's age and sex. The jitter, shimmer, and harmonic noise disturbances decreased, indicating improved wave stability and harmonic structure definition. The maximum expiratory and phonatory times, along with the s/z ratio, increased, leading to improved vocal efficiency. Additionally, the vocal risk indicator decreased, articulatory stability improved, and energy utilization became more efficient, resulting in more stable formants. The study concluded that SVT exercises produce positive vocal changes, suggesting that techniques aimed at modifying the vocal tract are effective for speech therapy rehabilitation in patients with functional dysphonia.

How I do it: surgical ligation of posteromedial tentorial dural arteriovenous fistulas.

Tentorial dural arteriovenous fistulas (dAVFs) are categorized based on venous drainage and location. Althoughtheir angioarchitecture may initially appear intimidating, once "decodified," treatment is straightforward. Posteromedial tentorial dAVFs have an arterialized draining vein that emanates from the inferior tentorium along the posterior third of the straight sinus, just slightly off the midline. With the aid of anatomical dissections, intraoperative photos, and operative videos, we outline the key steps for surgical treatment of posteromedial tentorial dAVFs. Posteromedial tentorial dAVFs constitute a precise and well-defined subtype of tentorial dAVF for which surgical ligation has an important role.

Psoas Muscle Morphology: A Novel Classification System and Its Anatomic Relationship with Adjacent Neurovascular Structures.

Cross-sectional radioanatomic study. To introduce a classification system using MRI to describe psoas morphology and examine the position of nearby neurovascular structures. Oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) offer sagittal malignment correction and reduced morbidity. LLIF has a higher incidence of nerve injuries, while OLIF has a higher incidence of vascular injuries. Measurements were completed on the left psoas at the inferior L4 endplate. Class A was designated if the ventral border of the psoas muscle was >2mm anterior; B if it was ≤ 2mm anterior or posterior to the vertebral body, and C if >2mm posterior to the vertebral body ventral border. Modified oblique corridor, measured as the distance between two lines, one at the medial border of the psoas muscle and the other at the lateral border of the nearest vascular structure, and a preferred LLIF trajectory was projected onto an axial image of the left psoas. If the trajectory violated the posterior third of the psoas, it was considered a dangerous approach due to potential iatrogenic nerve injury. 100 patient MRIs (Class A: 44; Class B: 27; Class C: 29) were analyzed. Average modified oblique corridor was 7.49mm. Modified oblique corridor varied amongst the three types of psoas morphologies (A: 8.99mm vs. B: 8.10mm vs. C: 4.66mm, P=0.040). LLIF trajectory intersected the 'danger zone' in 34.1%, 3.7%, and 0.0% of patients, (P<0.001) respectively. Class A psoas had the largest modified oblique corridor but highest proportion of those with a dangerous LLIF trajectory. Class C psoas had the narrowest modified oblique corridor, but no dangerous LLIF trajectories were identified.

Sihler's staining of the anterior belly of digastric muscle for botulinum toxin injection.

The anterior belly of the digastric muscle (ABDM) is the target of botulinum toxin injection; however, anatomical considerations related to the injection point are absent. This study used Sihler's staining to analyze the intramuscular nerve distribution of ABDM to identify the most effective botulinum toxin injection points. We used 12 specimens from 6 embalmed cadavers in this study. The specimens were manually dissected to preserve the mylohyoid nerve and subjected to Sihler's staining. From the gnathion to and hyoid bone, the ABDM was divided into three equal parts, distinguishing the anterior, middle, and posterior thirds. Only a branch of the mylohyoid nerve entered the ABDM, and its entry point was located in the middle-third region in all cases. The nerve endings were concentrated in the middle third (100%), followed by the anterior third (58.3%) and were not observed in the posterior third. The landmarks used in this study (gnathion and hyoid bone) are easily palpable on the skin surface, allowing clinicians to target the most effective injection site (middle third of ABDM). These results provide scientific and anatomic evidence for injection points, and will aid in the management of ABDM injection procedures in clinical practice.

Intracranial venous manometry in patients with idiopathic intracranial hypertension

Objective ‒ to analyse the results of cerebral angiography and venography with venous manometry in patients with medically refractory sdiopathic intracranial hypertension (IIH) and venous sinus stenosis.Materials and methods. Informed consent was obtained from each patient (parent or guardian) enrolled in the study and the study protocol conforms to the ethical guidelines of the Declaration of Helsinki as reflected in a priori approval by the Institutional Ethical Review Board (Institution's Human Research Committee). A retrospective analysis of the clinical and neuroimaging features of 9 patients with suspected IIH was performed. All patinets were treated at the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine» from January 2022 to January 2024. The criteria for inclusion in the study were: clinical symptoms of IIH without any other intracranial pathology according to imaging, lumbar pressure &gt;20 cm H2O, and symptoms refractory to medication treatment (optic disc edema, pulsatile tinnitus, etc.). Pressure gradients in contiguous sites were calculated for each patient in standard anatomical sites (superior sagittal sinus ‒ sinus drain, sinus drain ‒ transverse sinus, transverse sinus ‒ sigmoid sinus, sigmoid sinus ‒ internal jugular vein). The adjacent anatomical gradients were defined as the difference between the mean venous sinus pressure measurements in the venous sinuses where the manometry was performed. Pathological pressure gradients in the venous sinuses were defined as pressure gradients &gt;8 mm Hg based on established guidelines. Results. Out of the 9 patients with suspected IIH treated at the clinic, 2 patients were excluded. One female with combination of thrombosis in posterior third of superior sagittal sinus with left transverse sinus stenosis, the second (male) with bilateral jugular vein occlusions. Of the 7 patients (4 women and 3 men) with a mean age of 39.7 years, 4 (57.1 %) had pressure gradients &gt;8 mm Hg (transverse sine ‒ sigmoidal sine) and underwent sinus stenting. All procedures were successful. After stent implantation, control manometry was performed, which showed the gradient decreasing to 0‒2 mm Hg at the level of stenosis. The control examination after stenting was performed in all patients and showed regression of general cerebral symptoms, as well as varying degrees of ocular improvement. Conclusions. Our study evaluated the degree of pressure reduction in the anatomical sites of the cerebral venous system and showed a progressive decrease in pressure from the sigmoid sinus to the jugular vein. The venous sinus stenting leads to elimination of the pressure gradient, as well as neurological and ophthalmic improvement in carefully selected patients with refractory to conservative therapy IIH with a transstenotic pressure gradient &gt;8 mm Hg.

New species of Batrochoglanis Gill (Siluriformes: Pseudopimelodidae) from the Capim River basin, State of Pará, Brazil

Batrochoglanis labrosus new species, is described from the Capim River Basin, State of Pará, Brazil. The new species differs from congeners by the stout, inferior mandible, hypertrophied lips on the lateral of the mouth, a broad dark brown band extending dorsoventrally from the beginning of the trunk to the posterior third of the adipose fin followed by a second dark brown band on the caudal peduncle, dark brown pelvic fin, and caudal fin hyaline with a concentration of dark brown spots on the posterior margin, sometimes forming an irregular band. The morphometric variables of B. labrosus are similar in B. villosus and B. castaneus, forming a B. villosus species group. The B. villosus group is distinct from other group formed by B. acanthochiroides and B. transmontanus in the third axis of the Principal Components Analysis. The variables with higher positive loadings in the B. villosus group, representing larger measurements, were adipose-fin base length, eye diameter, maxillary barbel length, head depth, and mouth width; the higher negative loadings representing shorter measurements were pelvic fin to anal fin distance and pectoral-fin spine length. The species is known only from the Capim River basin, where it is possibly endemic.

Objective Comparison of White Light and Narrow-Band Imaging for Detecting Scars, Sulci and Nodules.

Narrow-band imaging (NBI) can improve detection of lesions in the aerodigestive tract. However, its role in benign lesions of the larynx is unclear. This study aims to determine whether NBI improves the detection of scars, sulci, and nodules compared to panchromatic lighting using objective image analysis. In total, 120 vocal folds (VFs) were analyzed with and without NBI (21 normal, 15 scars, 16 sulci, and 45 nodules). Each VF image had anterior, middle, and posterior thirds analyzed for brightness using an area morphometry software (Optimas 5.1a). The middle-third with the lesion was analyzed against surrounding VF segments for average and standard deviation (SD) in absolute grayscale. The use of panchromatic light resulted in greater illumination and grayscale values than NBI. All lesions tended to be in the mid-membranous fold. Under panchromatic light, change in brightness when comparing anterior versus middle (A-M) was +6.1% for normal, versus 6.5%, 8.1%, and 7.1% for sulci, nodules, and scars, respectively. Under NBI, they were 9.0% (normal), 12.3% (sulci), 13.7% (nodules), and 13.1% (scars). A greater SD of luminescence was observed at pathology sites (p < 0.05) when using NBI. The change in absolute grayscale at all lesion sites was greater when using NBI than when using panchromatic light (p < 0.05). NBI significantly enhanced the area of pathology in patients with nodules, sulci, and scars. Greater SD values in grayscale at pathologic sites were observed compared at normal sites. Thus, NBI may improve the detection of phonotraumatic lesions compared to panchromatic light. N/A Laryngoscope, 134:4066-4070, 2024.

The Application of Shear Wave Elastography to Determine the Elasticity of the Levator Ani Muscle and Vaginal Tissue in Patients With Pelvic Organ Prolapse.

The changes of the extracellular matrix of the connective tissue have significantly contributed to the incidence of pelvic organ prolapse (POP). It seems reasonable that sonoelastography could be a useful tool to evaluate the elasticity of pelvic floor tissue in patients with POP and compare it to those without POP. The main aim of this pilot study was to determine if there are differences in the elasticity of the levator ani muscle (LAM) and vaginal tissue between patients with and without POP. Prospective observation study, including 60 patients (30 with POP and 30 without POP). Sonoelastography was performed to evaluate the elasticity (in kilopascals, kPa) of the following regions of interest: vagina at the level of middle third of the urethra; vagina at the level of the bladder trigone; vagina in the anterior and posterior fornix; vagina at the level of middle third of the anorectal canal; posterior third of the LAM. A total of 60 patients completed the study (30 with POP, 30 without POP). In the POP group, 18/30 (60%) had an anterior vaginal wall prolapse, 3/30 (10%) a uterine prolapse, 15/30 (50%) a rectocele, and 6/30 (20%) a enterocele. Patients with POP had higher elasticity in all anatomical study areas, with statistically significant differences in the anterior fornix (13.6 vs 11.2 kPa; P: .012). A multiple regression (controlling age, menopausal stage, and parity) allowed to detect statistically significant differences in the elasticity of the middle third of the urethra (P: .03) and the middle third of the anorectal canal (P: .019). It is possible to evaluate the elasticity of the LAM and vaginal tissue using sonoelastography, detecting a higher elasticity in patients with POP than in those without POP.

493 Predictors of Recurrence After Surgical Resection of Parafalcine and Parasagittal Meningiomas

INTRODUCTION: Parasagittal and parafalcine meningiomas are challenging tumors to resect, owing to their proximity to the sagittal sinus and associated collateralized venous channels. More research is needed to elucidate relevant factors that affect risk of recurrence. METHODS: This is a retrospective study of all patients who underwent resection of parasagittal and parafalcine meningiomas between 2012-2018. Multivariable Cox regression and Kaplan Meier analysis was performed to assess for factors that influence progression free survival (primary endpoint). RESULTS: A total of 110 consecutive subjects (mean age: 59.4+/-15.2 years, 67.3% female) with 74 parasagittal and 36 parafalcine meningiomas (92 WHO grade 1, 18 WHO grade 2/3) are included in the study. A total of 37 patients (33.6%) exhibited recurrence with median follow-up of 42 months (IQR: 10-71). In the overall cohort, parasagittal meningiomas exhibited shorter progression free survival compared to parafalcine meningiomas (p = 0.045). On univariate analysis, predictors of recurrence include WHO grade 2/3 vs. grade 1 tumors (HR 4.27, 95%CI: 2.01-9.09; p &lt; 0.001), higher Ki-67 indices (HR, 1.11, 95% CI: 1.07-1.14; p &lt; 0.001), partial (Sindou class 2-4) (HR 2.32, 95% CI: 1.03-5.19; p = 0.04) or complete (Sindou class 5-6) sinus invasion (HR 4.65, 95% CI: 2.07-10.42; p &lt; 0.001), and subtotal resection (HR 4.13, 95% CI: 2.05-8.32; p &lt; 0.001). Location along the anterior, middle or posterior third of the sagittal sinus did not influence risk of recurrence (HR 0.82, 95%CI: 0.30-2.28; p=0.71). Multivariable Cox regression analysis revealed high grade meningiomas (HR: 3.62, 95% CI: 1.60-8.22; p = 0.002), complete sinus invasion (HR: 3.00, 95% CI: 1.16-7.79; p = 0.024), and subtotal resection (HR: 3.10, 95% CI: 1.38-6.96; p = 0.006) portend increased risk of recurrence. CONCLUSIONS: This is the largest study to date that identifies predictors that confer increased risk of recurrence after resection of parasagittal and parafalcine meningiomas, which can be used to

Proposals for the delineation of neck clinical target volume for definitive Radiation therapy in patients with oral/ oropharyngeal squamous cell cancer based on lymph node distribution

Purpose/Objective(s)To establish the distribution pattern of cervical lymph node metastasis (LNM) and propose optimized clinical target volume (CTV) boundaries specific to oral/ oropharyngeal squamous cell cancer (OSCC/OPSCC). Materials/Methods531 patients with pathologically confirmed OSCC/OPSCC were enrolled from January 2013 to June 2022. Patients were stratified into two groups based on the minimal distance from the lesion's edge to the body's midline: ≤1 cm or > 1 cm. The geometric center of cervical metastatic LN was marked on a template CT. LN distribution probability maps were established. The relationships between the LN distribution and consensus guidelines were analyzed to propose modifications for CTV boundaries specific to OSCC/OPSCC. ResultsA total of 1962 positive LNs were enrolled. Compared with the > 1 cm group, the ≤ 1 cm group has following feature tendencies: male smokers, younger, median organs, large gross lesion, infiltrative growth pattern, contralateral LNM. The most frequently involved level of LNM was ipsilateral II, but ipsilateral Ib had the highest involvement rate in the > 1 cm OSCC group. In addition, tongue cancer had a higher incidence of LN extranodal extension (ENE), which mainly distributes in ipsilateral level II. The skip metastasis was prone to from level III to Vb (3.5 %) in LN(+)/ENE (-), and level Ib to VIa (3.7 %) in LN(+)/ENE (+). Accordingly, we proposed the following modifications: 1. only including lateral and posterior margin of submandibular gland within 5 mm; 2. retracting posterior boundary of level II to front edge of levator scapula muscle, and descending the upper boundary to transverse process of C2 vertebra only for OSCC; 3. including posterior third of thyroglossal muscle or anterior edge of sternocleidomastoid muscle; 4. sparing level Va in case of only level II involvement; 5. including upper area of the thyroid cartilage plate in case of level Ib LN(+)/ENE (+); 6. sparing level VIIa is considered. ConclusionThis is the first description of LN topographic spread patterns for OSCC/OPSCC. Modified CTV for prophylactic irradiation was proposed to spare the organs at risk and minimize adverse effects.

Cardiocondyla hashemi sp. n., a new species of the C. batesii species-group (Hymenoptera: Formicidae) from Saudi Arabia, with a key to the Saudi species

A new species, Cardiocondyla hashemi sp. n. is described and illustrated using a Scanning Electron Microscope (SEM) based on the worker caste. Cardiocondyla hashemi is a member of the C. batesii species-group with a resemblance to C. tenuifrons Seifert, 2003 from Jordan. Cardiocondyla hashemi can be readily distinguished by the uniform yellow body, the rare or distinctly scattered foveolae on the posterior third of cephalic surface, the broadly medially concave anterior clypeal margin, the sculptured mesosomal dorsum except for the mesonotum which is shallowly sculptured with faint longitudinal rugae, and petiolar node distinctly densely microreticulate. Ecological and biological remarks on the type locality are given. A key to the Saudi fauna of the genus Cardiocondyla is presented. http://www.zoobank.org/urn:lsid:zoobank.org:pub:1DB79558-0CE0-413B-A6EB-9E0ABB884882

Stable Regional and Global Alignment in Patients Treated With Minimally Invasive Lateral Retropleural Thoracic Diskectomy Without Fixation.

Thoracic disk herniations are challenging to treat, and open transthoracic or minimally invasive thoracoscopic approaches are associated with significant morbidity, substantial costs, and steep learning curves. The minimally invasive lateral retropleural thoracic diskectomy (MIS-LRP-TD) approach is straightforward and is associated with lower perioperative morbidity. With MIS-LRP-TD, the overlying rib, ipsilateral pedicle, ligamentum flavum, posterior longitudinal ligament, and posterior third of the adjacent vertebral bodies are resected. Adjunct fixation is typically not performed, eliminating hardware-related complications and costs. This radiographic study investigates long-term global and thoracic spine alignment after MIS-LRP-TD without fixation. This study was a single-institution, retrospective evaluation of all patients who underwent MIS-LRP-TD without fixation between November 7, 2017 and July 19, 2022. Preoperative and the most recent postoperative radiographs were used to determine the C7 plumb line to central sacral vertical line, thoracic Cobb angle (TCA), segmental Cobb angle, C7 to sagittal vertical axis, thoracic kyphosis, and segmental kyphosis. In total, 22 patients with 24 disk herniations underwent MIS-LRP-TD without fixation. The mean (SD) radiographic follow-up was 12.9 (11.2) months. Overall, no significant differences were seen in C7 plumb line to central sacral vertical line (P = .65), C7 to sagittal vertical axis (P = .99), thoracic kyphosis (P = .30), TCA (P = .28), segmental kyphosis (P = .27), or segmental Cobb angle (P = .56) at follow-up. One patient demonstrated a >5° change in TCA but remained asymptomatic. Despite requiring extensive resection of the middle column and ipsilateral costovertebral joint at the index level, MIS-LRP-TD without adjunct fixation does not lead to significant global, regional, or segmental deformity. Thus, MIS-LRP-TD appears to be a safe, effective treatment approach for challenging thoracic disk herniations.

Angles of Needle Insertion for True Vocal Fold Access Via the Thyrohyoid and Cricothyroid Membranes of the Larynx

This study aims to provide an analysis of the cricothyroid and thyrohyoid membrane approaches for laryngeal injections in cadaveric vocal cords. The primary objective is to determine the optimal techniques, needle trajectories, and anatomical landmarks for accessing different regions of the vocal cords percutaneously. The study was conducted on 23 adult cadavers, consisting of 8 females and 15 males. The cadaveric larynges were mounted vertically to ensure proper anatomical positioning. Both the cricothyroid and thyrohyoid membrane approaches were utilized for reaching the vocal cords. Measurements were taken for needle trajectories, angles, and distances to determine the optimal approach for accessing the anterior, middle, and posterior thirds of the vocal cord. Through the thyrohyoid membrane approach, the anterior, middle, and posterior thirds of the vocal cords can be accessed with the optimal needle insertion coronal angles of 15.46±7.86°, 16.52±7.15° and 18.29±14.46°, and sagittal angles of 126.01±9.65°, 116.67±8.04° and 111.02±8.86° respectively at a lateral distance of 1.92±1.62mm from the midline and 8.48±2.73mm below the vertical line. From the cricothyroid membrane approach, optimal coronal and sagittal insertion angles of the anterior, middle, and posterior thirds of the vocal cord were respectively: 158.95±9.3°, 156.09±11.59°, 152.4±14.46°, 11.5±7.77°, 21.83±12.47° and 32.91±12.59°. This analysis of the cricothyroid and thyrohyoid membrane approaches in cadaveric larynges provides valuable insights for clinicians and researchers in the field of laryngology. The findings serve as a reference for optimizing laryngeal injection techniques, enhancing patient outcomes, and minimizing complications.

The Immunoarchitecture of Human Extraocular Muscles.

The purpose of this study was to describe the immunoarchitecture of normal extraocular muscles (EOMs) in terms of presence, distribution, and organization of various immune cells. We performed unilateral orbital exenterations in six fresh human cadavers from elderly patients, followed by dissection of the medial, lateral, superior and inferior rectus, superior and inferior oblique, and superior palpebral levator muscle in their entirety. We further cross sectioned each EOM in an anterior, central, and posterior third. After immunohistochemical staining for CD3, CD8, CD20, CD138, CD68, and podoplanin, quantitative analysis was performed. We found all EOMs (rectus, oblique, and levator muscles) to harbor both T- and B-lymphocytes, with a B-lymphocyte dominance and an absence of plasma cells. The highest prevalence of immune cells was seen in the muscle bellies, with, on average, 488 ± 63 CD3+ T-lymphocytes and 44 ± 110 CD20+ B-lymphocytes per mm2, and significant differences from the anterior (T-lymphocytes) and posterior (T- and B-lymphocytes) thirds. T- and B-lymphocytes were primarily organized in hotspots in the vicinity of blood vessels. In addition, a small resident population of macrophages scattered throughout the specimens was detected. No lymphatic vessels were found in any of the EOMs. These findings can serve as a reference dataset in the assessment of EOM biopsies in the diagnostic process of inflammatory orbital and systemic disorders. Moreover, from a regenerative perspective, our results highlight the importance of taking into account the presence of a resident immune cell population when studying the host immune response on transplanted tissues or engineered constructs.

Single-incision bone bridge lateral meniscus allograft transplantation: preserving neurovascular safety with promising results for posterior horn distortion and graft maturation.

This study aimed to investigate the graft maturation and safety of single-incision bone bridge lateral meniscus allograft transplantation (LMAT). This study involved 35 patients who underwent LMAT between 2019 and 2020. All patients completed at least 2years of follow-up (median 34months; range 24-43) and underwent preoperative magnetic resonance imaging (MRI) to assess the trajectory safety of the leading suture passer and all-inside suture instrument (Fast-Fix). Graft status was evaluated according to the Stoller classification. Based on preoperative MRI measurements, the expected trajectory of the leading suture passer did not transect the common peroneal nerve (CPN), with the closest distance between the expected trajectory and CPN being 1.4mm and the average distance being 6.8 ± 3.2mm. The average distance from the lateral meniscal posterior horn (LMPH) to the popliteal neurovascular bundle (PNVB) was 7.4 ± 2.6mm and the nearest was 4.8mm. The expected trajectory of the all-inside suturing instrument did not transect the PNVB when the distance was at least 12mm, from the most lateral margin of the posterior cruciate ligament (PCL). Grade 3 signal intensity in the posterior third of the allograft on MRI was observed in 6 of 35 (17.1%) patients. Amongst the grade 3 signal intensities in the posterior one-third of the allografts, 3 of the 35 (8.5%) LMATs had a distorted contour. The single-incision bone bridge LMAT technique introduced in this study is a convenient approach that preserves neurovascular safety and provides good results for the distortion of the posterior horn of the allograft and graft maturation. The safety zone for the penetrating devices during the procedure extended from 12mm laterally to the most lateral margin of the PCL to the medial margin of the popliteal hiatus. IV.

Solitary Fibrous Tumours of the Orbit - Clinical Pathology, Therapy and Prognosis.

Solitary fibrous tumours are rare. The aim of this study is to describe the clinical features, therapy and outcome of affected patients and to identify factors associated with recurrence. Retrospective study of a cohort of 20 patients who underwent surgery for orbital solitary fibrous tumour at the University Department of Oral and Maxillofacial Surgery between 2002 and 2023. Demographic, clinical, and therapeutic data as well as tumour follow-up results were collected. Tumour volume and molecular genetic mutations were retrospectively determined. The median patient age was 49.5 years at initial surgery. The left orbit was affected in 65% of cases. The most common clinical symptom was proptosis (80%). This was reported with a mean lateral difference of 3.9 mm (range: 1 - 10 mm). The tumours were localised predominantly in the intra- and extraconal space, craniolateral quadrant and middle third. The median tumour volume was 7.66 cm³ (range 2.15 - 12.57 cm³). In all patients, the diagnosis was made by pathological examination. All tumours investigated showed a NAB2-STAT6 mutation. The most frequently detected mutation was the fusion NAB2 exon 4 - STAT6 exon 2. All patients were initially managed with frontolateral orbitotomy. Incomplete resection (R1-status) occurred in 35% (n = 7). The recurrence rate was 25% (n = 5), with a median disease-free interval of 45.5 months (range 23 - 130). 80% (n = 4) of recurrences were initially R1-resected. Orbital solitary fibrous tumours are rare tumours and are clinically manifested by signs of displacement of orbital structures. Diagnosis is made by histology and immunohistochemistry and can be proven with the molecular genetic detection of the NAB2-STAT6 mutation. The therapy of choice is complete surgical resection. R1-resection is more likely in the intraconal location as well as in location in the posterior third of the orbit - due to difficult surgical accessibility. The greatest risk factor for the development of recurrence is incomplete surgical excision. Late recurrences are possible, which is why a long-term connection to a specialised clinic is necessary.

Endoscopic extended transforaminal approach (medial subchoroid) as an alternative to the classical transchoroidal approach: Technical note

The extended transforaminal endoscopic approaches allows visualization and manipulation of the middle and posterior third of the III ventricle. In selected cases where the venous anatomy is favorable, the medial subchoroidal approach can be performed as an alternative to the classic transchoroidal approach (via trans-taenia fornicis) with increased protection over the fornix and without the need to sacrifice the septal vein.We present a 14-year-old male with history of Neurofibromatosis type 1 referred for two weeks of clinical evolution with headache, dizziness, gait instability and appearance of a right VI nerve palsy. Magnetic resonance imaging showed obstructive tri-ventricular hydrocephalus due to stenosis of the aqueduct of Sylvius with suspicion of an underlying tumor. An endoscopic surgical procedure was performed through a single approach with III cisternostomy and resection of the tissue that produced the stenosis. The anatomopathological diagnosis showed reactive glial tissue with no signs of malignancy. In conclusion, the medial subchoroidal approach is a plausible alternative in the endoscopic approach to the III ventricle structures in a safe and comfortable manner.

Modified subtotal laryngectomy with formation of a tracheopharyngeal shunt for locally advanced cancer of the larynx and hypopharynx

Aim. To study the effectiveness of modified subtotal laryngectomy with the formation of a tracheopharyngeal shunt in patients with locally advanced cancer of the larynx and laryngopharynx.Materials and methods. We conducted a cohort study on the use of combined treatment (surgical and radiation/ polychemotherapy) in 25 patients: 24 men, 1 woman; median age – 56 years. The subtotal laryngectomy technique that we developed and used included the preservation of one arytenoid cartilage, the posterior third of the vocal fold, and the recurrent nerve on the side not affected by the tumor. We studied postoperative complications, the length and diameter of the tracheopharyngeal shunt, the functioning of the arytenoid cartilage, the frequency of voice recovery and its quality, and overall and relapse-free survival.Results. In the postoperative period, 8 (32%) patients developed a pharyngocutaneous fistula; tracheal stenosis after tracheostomy was observed in 8 (32%) cases. The length of the tracheopharyngeal shunt varied from 16.4 to 25.6 mm, in all cases its course was tortuous, the diameter of the preserved part of the vocal fold varied from 1.1 to 1.5 mm. 24 (96%) patients demonstrated the functioning of the arytenoid cartilage and its work as a valve. Voice function recovered in 24 (96%) patients. Fundamental frequency was 155.3 ± 20.9 Hz, maximum phonation time of the vowel “A” – 3.5 ± 1.0 s, duration of pauses in phrase – 0.24 ± 0.03 s, speech rate – 99.8 ± 8.4 words/ min, number of words in phrase 6.5 ± 0.3. The average value of the Acoustic Voice Quality Index was 6.74, which indicates dysphonia (for the Russian language, the threshold value for dysphonia is 4.86), but this did not interfere with patients’ communication at home and on the phone. Overall and relapse-free survival at 1, 2, and 3 years were 100%, 89%, 78% and 86%, 78%, 72%, respectively.Conclusion. The method of operation proposed by us contributes to the restoration of voice function in the majority of patients with oncological outcomes comparable to total laryngectomy.