Postoperative Healing Period Research Articles

Comparison of a minimal invasive technique micro-marsupialization versus surgical excision for mucocele of lower lip.

Objective: To compare the efficacy of micro-marsupialization with surgical excision for the treatment of mucoceles originating from the minor salivary glands of the lower lip. Our primary endpoints were the mean procedural time and the duration of post-operative healing. Study Design: Randomized Controlled Trial (RCT). Setting: Department of Oral and Maxillofacial Surgery, Faisalabad Medical University, Faisalabad. Period: 1st July 2022 to 31th Dec 2022. Material & Methods: We enrolled a total of 60 patients, with 30 in each group (Group X: micro-marsupialization, Group Y: surgical excision). Random allocation was performed using a lottery method. Procedural time (in minutes) and post-operative healing duration (in days) were recorded for both groups, with follow-up assessments conducted over a 3-month period. Results: The study comprised 60 patients (40 males and 20 females) with a mean age of 34.60±10.15 years in Group X and 36.03±9.25 years in Group Y. In Group X, the mean surgical time was 6.23±0.935 minutes, while in Group Y, it was 34.70±2.493 minutes. A statistically significant difference in surgical time was observed between the two groups (p 0.0001). Regarding post-operative healing, Group X had a mean duration of 4.67±0.844 days, while Group Y had a mean duration of 6.57±0.504 days. A statistically significant difference was also noted in post-operative healing duration between the two groups (p 0.008). Conclusion: This study underscores the superiority of micro-marsupialization over surgical excision as a treatment option for mucoceles originating from the minor salivary glands of the lower lip. Micro-marsupialization offers several advantages, including significantly shorter procedural times and faster post-operative healing periods.

Sinonasal Stent Coated with Sustained-Release Varnish of Mometasone Furoate Inhibits Pro-Inflammatory Cytokine Release from Macrophages: An In Vitro Study

The aim of the study was to develop a sustained-release varnish (SRV) containing mometasone furoate (MMF) for sinonasal stents (SNS) to reduce mucosa inflammation in the sinonasal cavity. The SNS' segments coated with SRV-MMF or an SRV-placebo were incubated daily in a fresh DMEM at 37 °C for 20 days. The immunosuppressive activity of the collected DMEM supernatants was tested on the ability of mouse RAW 264.7 macrophages to secrete the cytokines' tumor necrosis factor α (TNFα) and interleukin (IL)-10 and IL-6 in response to lipopolysaccharide (LPS). The cytokine levels were determined by respective Enzyme-Linked Immunosorbent Assays (ELISAs). We found that the daily amount of MMF released from the coated SNS was sufficient to significantly inhibit LPS-induced IL-6 and IL-10 secretion from the macrophages up to days 14 and 17, respectively. SRV-MMF had, however, only a mild inhibitory effect on LPS-induced TNFα secretion as compared to the SRV-placebo-coated SNS. In conclusion, the coating of SNS with SRV-MMF provides a sustained delivery of MMF for at least 2 weeks, maintaining a level sufficient for inhibiting pro-inflammatory cytokine release. This technological platform is, therefore, expected to provide anti-inflammatory benefits during the postoperative healing period and may play a significant role in the future treatment of chronic rhinosinusitis.

Effect of PARP-1 Inhibition on Rotator Cuff Healing: A Feasibility Study Using Veliparib in a Rat Model of Acute Rotator Cuff Repair

Background: PARP-1 (poly[ADP-ribose]) was shown to influence the inflammatory response after rotator cuff tear, leading to fibrosis, muscular atrophy, and fatty infiltration in mouse rotator cuff degeneration. So far, it is not known how PARP-1 influences enthesis healing after rotator cuff tear repair. Hypothesis/Purpose: This study aimed to examine the feasibility of oral PARP-1 inhibition and investigate its influence on rat supraspinatus enthesis and muscle healing after rotator cuff repair. The hypothesis was that oral PARP-1 inhibition would improve enthesis healing after acute rotator cuff repair in a rat model. Study Design: Controlled laboratory study. Methods: In 24 Sprague-Dawley rats, the supraspinatus tendon was sharply detached and immediately repaired with a single transosseous suture. The rats were randomly allocated into 2 groups, with the rats in the inhibitor group receiving veliparib with a target dose of 12.5 mg/kg/d via drinking water during the postoperative recovery period. The animals were sacrificed 8 weeks after surgery. For the analysis, macroscopic, biomechanical, and histologic methods were used. Results: Oral veliparib was safe for the rats, with no adverse effects observed. In total, the inhibitor group had a significantly better histologic grading of the enthesis with less scar tissue formation. The macroscopic cross-sectional area of the supraspinatus muscles was 10.5% higher (P = .034) in the inhibitor group, which was in agreement with an 8.7% higher microscopic muscle fiber diameter on histologic sections (P < .0001). There were no statistically significant differences in the biomechanical properties between the groups. Conclusion: This study is the first to investigate the influence of PARP-1 inhibition on healing enthesis. On the basis of these findings, we conclude that oral veliparib, which was previously shown to inhibit PARP-1 effectively, is safe to apply and has beneficial effects on morphologic enthesis healing and muscle fiber size. Clinical Relevance: Modulating the inflammatory response through PARP-1 inhibition during the postoperative healing period is a promising approach to improve enthesis healing and reduce rotator cuff retearing. With substances already approved by the Food and Drug Administration, PARP-1 inhibition bears high potential for future translation into clinical application.

Functional Outcome of Management of Isolated Supraspinatus Tendon Tear by Mini-open repair TechniqueA Prospective Interventional Study

Introduction: Rotator Cuff Injuries (RCIs) are common shoulder injuries, and the supraspinatus muscle, which is part of the rotator cuff, plays a crucial role in shoulder abduction. The mini-open repair technique offers several advantages, including being less invasive, leading to reduced postoperative morbidity, and shorter operative times. Aim: The aim of this prospective interventional study was to assess the functional consequences of open microscopic repair and the functional implications of supraspinatus tendon repair following the procedure and during the postoperative healing period. Materials and Methods: The study was conducted at the Department of Orthopaedics at Great Eastern Medical School and Hospital in Srikakulam, Andhra Pradesh, India. The study duration was one year, from July 2020 to July 2022. A total of 120 patients aged between 20 and 60 years were included, and all surgeries were performed by the same surgeon. Patients were followed up for one year and evaluated with ConstantMurley Score (CMS) system. Patient data were analysed based on gender, age, degree of tears, clinical test results, and postoperative scores. Levene’s test was used to determine variance homogeneity, and the Student’s t-test (two-tailed, dependent) was used to determine the statistical significance of study parameters on a continuous scale within each group. Results: The study included 120 patients (84 males and 36 females), and the majority of them had traumatic tears. When data was analysed based on patient age, the majority were between 46 and 50 years (33 patients, 27%), followed by the age group of 41-45 years. At the end of one year, the outcomes were excellent in 68 patients, good in 24 patients, satisfactory in 16 patients, and poor in 12 patients. Conclusion: Based on the results of the mini-open technique, the authors concluded that mini-open rotator cuff repair resulted in superior repair integrity and shoulder function.

Laser Bandage: Deal to Heal

Introduction of LASER to the field of dentistry has been proved to be a boon to the dental professionals. It can be used for a variety of treatments ranging from simple procedures like removal of caries to more complex procedures such as soft and hard tissue surgeries. The reasons for its increasing demand in dentistry includes decreased operator time enhanced efficiency and better clinical outcome. In the previous years Light Amplification by Stimulated Emission of Radiation LASER has also been used for haemostasis in which a ldquochar layerrdquo or an ldquoescharrdquo is usually formed. Recently with the advancements in LASER technology and knowledge about LASER the term LASER bandage has been proposed in which the LASER is used in the lowest settings settings of low wattage no water and some air with fewer pulses per second to put a coating on the tissues for haemostasis to decrease pain from an oral lesion or to make small alterations to a soft tissue surgery. Application of laser bandage after any surgical procedure decreases post-operative pain healing period thereby enhancing post-operative patient comfort.

Increased HbA1c Levels in Diabetics During the Postoperative 3-6 Months After Rotator Cuff Repair Correlated With Increased Retear Rates

To evaluate whether glycemic control affects the integrity of the repaired rotator cuff during the postoperative healing period after arthroscopic double-row suture bridge rotator cuff repair (RCR) METHODS: We retrospectively reviewed patients with diabetes mellitus (DM) who underwent arthroscopic double-row suture bridge RCR at our institution between March 2016 and November 2019. We included the patients who evaluated for serum glycosylated hemoglobin (HbA1c) levels within 1 month before and 3-6 months after surgery. Magnetic resonance imaging was conducted 6 months after surgery to evaluate the integrity of the repaired cuff tendon. Patients were categorized into two groups based on comparison between preoperative and postoperative HbA1c values: Group I (increased postoperative HbA1c) and Group D (same or decreased postoperative HbA1c). The correlation between preoperative/postoperative HbA1c, HbA1c increase/same or decrease (during the healing period), and post-RCR integrity was evaluated, including various demographic and radiologic factors. A total of 103 patients were analyzed, group I was 47, and group D was 56, respectively. The retear rate of 51.1% (24/47) in Group I was significantly higher than 14.3% (8/56) in Group D (P < .001). HbA1c levels measured 3-6 months after surgery (mean: 6.9; 95% CI: 6.6-7.3 vs mean: 6.5; 95% CI: 6.3-6.7, P= .034), and the proportion of group I and group D were significantly different (75%/25% vs 32.4%/67.6%, P < .001) between the retear and healing groups. Multivariable logistic regression analysis identified increased HbA1c as an independent risk factor for retear (odds ratio: 5.402; 95% CI: 2.072-14.086; P < .001). The glycemic control within 3-6 months after surgery when the healing process of the tendon was in progress had a significant effect on retear rate. In particular, the retear rate was higher when the HbA1c level increased at postoperative 3-6 months compared to before surgery. Retrospective case-control comparative study, Level III.

The “Sling” Technique for Horizontal Guided Bone Regeneration: A Retrospective Case Series

The aim of this retrospective case series was to present a new technique, called the “sling technique”, for massive horizontal alveolar ridge augmentation through the innovative use of an expanded polytetrafluoroethylene (e-PTFE) membrane to reduce the risk of biological complications related to membrane exposure. Materials and Methods: Eligible patients for implant rehabilitation with a horizontal bone defect were enrolled in our study. All patients were treated with our new GBR approach, called the “sling technique” (ST), which consisted of covering the vestibular side of the bone defect with a stretched e-PTFE membrane. This technique allowed the amplification of the membrane surface as long as the compression and the immobilization of the underlying graft material remained (1:1 autologous bone and bovine xenograft). The membrane was placed far from the surgical incision of the mucosa to avoid infective complications. Pre- and post-regenerative surgery CBCT scans were used to assess the tissue gain amount after the GBR. Results: A total of 10 patients (4 females, 6 males; age range: 45–60 years old) were enrolled in our study and 33 implants were placed in regenerated bone. An average of 4 mm bone gain was achieved using the ST. No membrane exposures or biological complications were registered during the post-operative healing period. After a 24-month follow-up, a 100% implant survival rate was observed without hard or soft tissue dehiscence. Conclusion: The e-PTFE membrane positioned with the “sling technique” gave satisfactory results in horizontal bone augmentation. Considering the small sample, further confirmations with larger studies are needed.

ROLE OF PRE-CESAREAN SECTION CEFOTAXIME IN AMELIORATED POST-CESAREAN COMPLICATION.

The aim: The purpose of this study was to examine the efficacy of cefotaxime before and after skin incision in avoiding post-operative infection complications in caesarean section women, also evaluation the efficacy of cefotaxime in reducing post-caesarean section complications. Materials and methods: We conducted 150 women who undergoing caesarean section in the Obstetrics & Gynecological Department, Babylon government from January, 2021 to March, 2021. The caesarean operations were done by using standard protocols. Each patient was examined daily and post-operative infectious. Women were randomly divided into three groups; each group contains 50 women; Group 1: (control) given normal saline 12 hr. before and after skin incision. Group 2 (pre-operation antibiotic): given single dose of cefotaxime 1 g intravenously 12 hr. before skin incision, and Group 3 (post-operation antibiotic): given single dose of cefotaxime 1 g intravenously 12 hr after operation. Results: The outcome measures were post-operative febrile morbidity, healing period and urinary tract infections, in addition to socioeconomic state of each woman. Conclusions: cefotaxime pre-cesarean section could ameliorate post-operative problems such as infection of surgical wound, febrile, and urinary tract infections.

The fate of sutures post rotator cuff repair

Ultrasonographic imaging has been widely used as a diagnostic tool for rotator cuff tears. Several studies have explored the changes in rotator cuff tendon morphology after arthroscopic cuff repair; however, none have addressed the fate of sutures. The aim of this study was to determine (1) if the sutures migrate through the tendon during the postoperative healing period in patients who have had arthroscopic rotator cuff repair; (2) if the sutures do migrate, the time point at which it does; and (3) if the quality of the tendon, in terms of tendon stiffness, modulus of elasticity, bursal thickness, and anatomic footprint, affects suture migration. This was a prospective study involving 21 patients who had primary arthroscopic rotator cuff repair performed by a single surgeon. All patients were assessed at 8 days, 6 weeks, 12 weeks, and 24 weeks postrepair; during each assessment, patients underwent an ultrasonographic examination (using a Siemens ACUSON S3000 ultrasonographic system, following a standardized protocol), where supraspinatus tendon thickness and thickness of tendon tissues below and above the suture were measured. Measurements of anatomic footprint, bursal thickness, tendon stiffness, and modulus of elasticity were obtained to assess tendon quality. Of the 21 participants, 14 (67%) had full-thickness tears and 7 (33%) had partial-thickness tears. Between the 12th- and 24th-week follow-up, 2 patients' tendons were found to be not intact. Within the first 12 weeks of the postrepair healing period, the sutures migrated inferiorly, through to the middle of the tendon at the footprint-articular junction (ie, ratio of tendon tissue thickness below the suture to the total tendon thickness = 0.5) (P = .03). The mean anatomic footprint increased from 8.4 ± 1.6 mm to 9.1 ± 1.2 mm between 8 days and 6 weeks (P = .04); bursal thickness decreased during the 24-week period from 1.5 ± 0.9 mm to 0.7 ± 0.4 mm (P = .005); tendon modulus of elasticity increased from 154 ± 75 kPa to 205 ± 96 kPa between 8 days and 24 weeks (P = .05). This is the first study to investigate suture position and migration post arthroscopic rotator cuff repair. The findings of this study suggest that sutures migrating to the middle of the tendon during the postoperative healing process is a normal phenomenon observed on ultrasonography.

Quality Analysis of Hallux Valgus Videos on YouTube

The aim of this study was to evaluate the information quality of YouTube videos on hallux valgus. A YouTube search was performed using the phrase "hallux valgus" to determine the first 300 videos related to hallux valgus. A total of 54 videos met our inclusion criteria and were evaluated for information quality by using DISCERN, Journal of the American Medical Association (JAMA), and hallux valgus information assessment (HAVIA) scores. Number of views, time since the upload date, view rate, number of comments, number of likes, number of dislikes, and video power index values were calculated to determine video popularity. Information regarding video length (in seconds), video source, and video content was also noted. The relation between information quality and these factors were statistically evaluated. The mean DISCERN score was 30.35 ± 11.56 (poor quality) (range, 14-64), the mean JAMA score was 2.28 ± 0.96 (range, 1-4), and the mean HAVIA score was 3.63 ± 2.42 (moderate quality) (range, 0.5-8.5). Although videos uploaded by physicians had higher mean DISCERN, JAMA, and HAVIA scores than videos uploaded by nonphysicians, the difference was not statistically significant. In addition, view rates and video power index values were higher for videos uploaded by health channels, but the difference did not reach statistical significance. A statistically significant positive correlation was found between video length and DISCERN (r = 0.294; P = .028), and HAVIA scores (r = 0.326; P = .015). This study demonstrated that the quality of information available on YouTube videos about hallux valgus was low and insufficient. Videos containing accurate information from reliable sources are needed to educate patients on hallux valgus, especially with regard to less frequently mentioned topics such as postoperative complications and healing period.

Wide Local Excisions and Pedicled Perforator Flaps in Hidradenitis Suppurativa: A Study of Quality of Life.

Hidradenitis suppurativa (HS) is a chronic skin pathology characterized by the occurrence of inflamed and swollen lesions, with a devastating impact of the disease on patient's quality of life. Wide local excision (WLE) of the affected tissue is the criterion-standard treatment, but there is no general consensus on the best reconstructive technique. The aim of this article is to evaluate the quality of life before and after WLE combined with pedicled perforator flap reconstruction, in patients suffering from HS. We analyzed 26 consecutive patients suffering from Hurley stage III HS. Every patient underwent WLE, followed by reconstruction with pedicled perforator flap. Dermatology Quality of Life Index (DLQI) tests were administered to every patient preoperatively and 6 months after surgery, when the clinical condition was considered stable. Dermatology Quality of Life Index scores were compared in terms of means with Student t test. Linear regression studies were used to compare the changes in DLQI score with the surgical and clinical variables. Axillary area involvement was found in 21 of 27 patients; 6 patients had more than 1 body region involved. Thirty-two pedicled perforator flaps were performed, and 22 were thoracodorsal artery perforator flaps. Mean DLQI test score before the first operation was 21.31 ± 4.79; the average DLQI score after the last follow-up was 5 ± 2.95 (P < 0.0001). Dermatology Quality of Life Index scores were not influenced by complications including reoperation. There were also no correlations found between DLQI score delta and number of reoperation (-0.18) or days of hospital stay (-0.13). Wide local excision followed by pedicled perforator flap reconstruction allows a radical excision of HS areas with short postoperative healing periods. Dermatology Quality of Life Index scores confirmed high levels of patients' satisfaction. Disadvantages of this technique include difficult learning curve, long operating time, and a nonnegligible complications rate.

Simple Wound Irrigation in the Postoperative Treatment for Surgically Drained Spontaneous Soft Tissue Abscesses: A Prospective, Randomized Controlled Trial.

Soft tissue abscesses are among the most frequently encountered medical problems treated by different surgeons. Standard therapy remains incision and drainage with sterile saline irrigation during postoperative wound healing period. Aim of this prospective randomized controlled trial was to compare sterile irrigation versus nonsterile irrigation. A single center randomized controlled trial was performed to investigate postoperative wound irrigation. The control group used sterile irrigation, and the intervention group used nonsterile irrigation. Primary endpoints were reinfection and reintervention rates, assessed during follow-up controls for up to 2years. Secondary endpoints were the duration of wound healing, inability to work, pain and quality of life. Between 04/2016 and 05/2017, 118 patients were randomized into two groups, with 61 allocated to the control- and 57 to the intervention group. Reinfection occurred in a total of 4 cases (6.6%) in the sterile protocol and 4 (7%) in the nonsterile protocol. Quality of life and pain values were comparable during the wound healing period, and patients treated according to the nonsterile irrigation protocol used significantly fewer wound care service teams. Despite equal wound persistence rates, a substantially shorter amount of time off from work was reported in the nonsterile protocol group (p value 0.086). This prospective, randomized trial indicates that a nonsterile irrigation protocol for patients operated on for soft tissue abscesses is not inferior to the standard sterile protocol. Moreover, a nonsterile irrigation protocol leads to a shorter period of inability to work with comparable pain and quality of life scores during the wound healing period.

Using digital technology to create a custom esthetic bandage for patients after rhinectomy

Patients undergoing partial or total rhinectomy surgeries are left with a lifelong facial defect that poses psychosocial and functional challenges. The extended postoperative healing period after rhinectomy can delay the timely restoration of a patient’s nose by definitive prosthesis when conventional impression methods are used. The treatment workflow for fabricating a custom esthetic nasal bandage with the use of digital technology is introduced to avoid the conventional preoperative impression, as well as to allow for immediate delivery at the postoperative follow-up visit.

EVALUATION OF COMPLICATIONS OF PHACOEMULSIFICATION WITH PCIOL IMPLANTATION SURGERY

Background: Phacoemulsification is a state of the art surgery for cata­ract removal. From the simple procedure of couching practiced by sushruta to latest method of phaco emulsification of Charles kelman, cataract surgery had undergone a tremendous metamorphosis. Phacoemulsification is one of the most successful surgical procedures performed, and its popularity is due to decreased operating time and a shorter postoperative healing period. The objective of the study was to evaluate intraoperative and postoperative complications of phacoemulsification with PCIOL implantation surgery.&#x0D; Materials &amp; Methods: The present prospective study was conducted over a period of 6 months on patients having visually significant cataract that presented to or were referred to ophthalmology Department, GMCH, Jammu and after getting admission underwent planned extracapsular cataract extraction by phacoemulsification with posterior chamber intraocular lens ( PCIOL) implantation. After meeting inclusion &amp; exclusion crieteria all the patients underwent complete examination as history, ocular examination, systemic examination and laboratory tests like haemoglobin etc.&#x0D; Results: Out of 200, maximum numbers of patients were in age group of 41-50 i.e. 90 followed by 82 patients in 51-60yrs age group. Males were 112.Total of 148 patients were from urban area. Best corrected preoperative visual acuity of ≤6/36 was seen in 102 patients whereas 6th week postoperatively only 7 patients had visual acuity of ≤6/36. The final 6th week postoperative best corrected visual acuity of 6/12- 6/6 was found in 171 patients. Among intraoperative complications hyphaema &amp; constriction of pupil each were seen in 2 patients, followed by posterior capsule rent in 3 patients only while postoperatively mild uveitis was seen in 30 followed by striate keratopathy in 12 patients.&#x0D; Conclusion: From present study, we may conclude that phacoemulsification with posterior chamber intraocular lens implantation is a good surgical tecqinique for cataract which can be performed safely with good visual outcome, with few intraoperative and postoperative complications in expert hands.&#x0D; Keywords: Phacoemulsification , visual outcome, complications

Unicortical Versus Bicortical Button Fixation For Distal Biceps Brachii Tendon Rupture: A Cadaveric Biomechanical Study

Objectives: Acute distal biceps tendon rupture is an increasingly common and more recognized injury affecting active adults. Operative repair is the preferred treatment, particularly for restoration of elbow function and strength. No prior study has biomechanically compared unicortical versus bicortical distal biceps button fixation under cyclic loading, which is most representative of postoperative physiologic conditions. We hypothesized there would be no difference in loss of force, tendon gap formation, or ultimate failure load following cyclic loading between unicortical and bicortical button techniques for the repair of distal biceps tendon rupture. Methods: Experimental testing with 13 fresh-frozen matched paired cadaver elbows was conducted. One specimen from each pair was randomized to either unicortical or bicortical distal biceps button fixation techniques, with contralateral specimen assigned to the alternate technique. In both arms of the experiment, the distal 2.5 cm of the biceps tendon was whipstitched and the free suture ends threaded in opposite directions through a 2.6 x 12 mm titanium cortical button. A 3.2 mm guide pin was drilled through the central aspect of the radial tuberosity from anterior to posterior, aiming approximately 20° in the ulnar direction. The button was inserted and deployed for either unicortical or bicortical fixation and the free suture limbs tensioned to advance tendon down to bone for final fixation. Loading was performed using an MTS servohydraulic actuator. A 25-N distal biceps preload was applied and each specimen cycled from full extension to 90° of flexion at 0.5 Hz for 3000 cycles using a displacement controlled protocol. All specimens were subsequently loaded to failure at 2 mm/s to simulate an acute postoperative load. Outcome measures were a loss of force from cycle 5 to cycle 3000, tendon gapping during cyclic loading, and ultimate failure load. Results: During cyclic loading, the mean change in force from cycle 5 to cycle 3000 was -0.33 N for the unicortical fixation group and 0.36 N for the bicortical fixation group (p=0.21). The increase in tendon gap for the unicortical fixation group was 1.02 mm and for the bicortical fixation group was 1.83 mm (p=0.37). During failure loading, the unicortical button fixation group had a mean failure load of 170.45 N and the bicortical button fixation group a mean failure load of 181.25 N (p=0.89). Conclusion: No significant differences exist between the two techniques in loss of force and tendon gap formation under cyclic loading conditions. This indicates that both unicortical and bicortical distal biceps button techniques maintained an equivalent stabilization during a simulated 3 month postoperative healing period. Additionally, there was no significant difference in failure load between the two groups indicating an equivalent response in the event of an acute injury. Clinical Relevance: Distal biceps button fixation strength and tendon gap behavior under physiologic cyclic load support the implementation of early postoperative elbow range of motion, imperative in the prevention of elbow stiffness. Unicortical fixation may be sufficient in facilitating optimal bone-tendon apposition and healing, while minimizing risk of iatrogenic injury associated with bicortical fixation.

Analysis of Surgical Approaches to Skull Base Tumors Involving the Pterygopalatine and Infratemporal Fossa.

Selecting an appropriate surgical approach for resection of huge skull base tumors involving pterygopalatine and infratemporal fossa is challenging because of their rarity and high possibility of vital anatomical structure injuries. To suggest the guidance of selecting the appropriate approach by analyzing outcomes and satisfactions of known surgical approaches with our previous experience, the authors retrospectively analyzed skull base tumor cases experienced for 24 years, and condensed to 4 well-known surgical approaches: maxillary swing, infratemporal fossa type C, transzygomatic, and a combined transzygomatic-midfacial degloving approach: to review indications, advantages, and limitations of these approaches. Maxillary swing approach was useful in large-sized tumors as it provided wide surgical field; however, inevitable facial scar was the main drawbacks, especially in adolescents. Infratemporal fossa approach type C was helpful in the involvement of vital vascular structures; however, long incision scar with temporal area depression and permanent conductive hearing loss were the factors of patients' dissatisfaction. Transzygomatic approach could be the good alternative to the infratemporal fossa approach type C; however, en bloc tumor resection was impossible due to its limited operative space. To overcome limitations of these approaches, transzygomatic approach was combined with midfacial degloving approach, and it enabled lateral and anterior access without prominent facial scar and/or deformity while providing wide surgical space. Based on our 24 years of surgical experience in managing huge skull base tumors, the authors recommend the combined transzygomatic-midfacial degloving approach, which enables complete resection with short postoperative healing periods and no disfiguring facial incisions.

Evaluation of healing time of osteochemonecrosis of the jaw after surgery: Single-center retrospective study and review of the literature

Osteochemonecrosis of the jaw (ONJ) is a chronic ischemic bone exposure. It has an increasing incidence. ONJ is mainly related to bisphosphonate and denosumab therapies in oncologic settings. Healing is considered uncertain ad as occurring slowly. International recommendations suggest to treat ONJ symptomatically in a first attempt. A surgical procedure, potentially aggressive, should be carefully weight up in patients in poor condition and whose life expectancy is often limited. However, surgical treatment seems to allow for a high rate of clinical remission. Postoperative remission periods, when mentioned in the studies, are disparate. The aim of our study was to clarify the remission period of ONJ after surgical management. A retrospective study was conducted on all patients operated for an ONJ at stage 2and 3in the Department for Oral and Maxillofacial Surgery-University Hospital of Besançon (France) from January 2006to September 2015. Healing was defined as complete mucosal closure and asymptomatic site. Stage of the disease, the number and the type of surgery and the time between the last operation and the healing was noticed. These data were compared to an exhaustive review of the literature on PubMed with the following key-words: "osteonecrosis" AND "jaw" AND "surgery" AND "management". Only the articles giving the healing period were included. Regarding the single-center retrospective study, the files of 23patients could be included. Fifteen percent of the patients benefited from several procedures under general anesthesia. Twenty percent had a stage 3ONJ and 80% had a stage 2ONJ. Twenty-five interventions were performed on 23sites in 20patients. Immediate healing after surgery occurred in 35% of the patients. At 6months after surgery, 57% of the treated areas were healed. Twenty percent of the patients had died. The healing rate did not improve further after 6months postoperatively. Regarding the review of the literature, 7articles could be included. The mean postoperative healing period was 60.7% at 6months, 71.1% at 12months and 69.5% at 18months. Our study shows that the postoperative healing rate of ONJ lies between 57and 66.7% at 6months and that this rate was optimized in the order of 10% to 12months and stable at 18months postoperatively. The ONJ of our series were partially or fully linked to other drugs than bisphosphonates in 70% of the cases: 50% were related to denosumab, alone or in combination and 35% were related to an association with antiangiogenics, bevacizumab mainly.

Histopathological evaluation of the effect of systemic thymoquinone administration on healing of bone defects in rat tibia

ABSTRACTThe aim of the present study was to assess the systemic effect of thymoquinone (TQ) on bone healing by starting TQ administration, either 40 days before, or on the day of the surgical procedure and continuing during the healing period of 28 days. Eighteen experimental rats were divided into three groups and defects were created in their tibias. The following procedures were performed for each group: Control group (C): No systemic drug administration (n = 6); Test group 1 (T1): Systemic TQ was administered daily starting 40 days before creation of the defect and additionally during the post-operative healing period of 28 days (n = 6); Test group 2 (T2): Systemic TQ was administered daily after creation of the defect and during the healing period of 28 days (n = 6). Quantitative measurement for new bone formation, osteoblast lining and semi-quantitative measurement of capillary intensities were examined and statistically analysed. There was a significant increase in the ratio of new bone per total defect area and new bone trabeculae lined by active osteoblasts in both test groups (T1 and T2) compared to control group (p < 0.05). However the difference between T1 and T2 was not statistically significant. TQ-administered groups also showed an increase in capillary intensity in the defect area compared to the control group (p < 0.05). Systemic administration of TQ either starting 40 days before or on the day of surgery accelerated new bone formation in a rat model and can be advocated as an adjunct to expedite bone healing.

The effect of implant macro-thread design on implant stability in the early post-operative period: a randomized, controlled pilot study.

Available literature suggests there is a transient drop in implant stability from approximately week 0 to week 3-4 as a result of peri-implant bone remodeling as it transitions from a primary, mechanical stability to a secondary, biological stability. Research investigating the influence of macro-thread design on this process is scant. The specific aim of this study was to evaluate the role of macro-thread design on implant stability in the early post-operative healing period using resonance frequency analysis (RFA). Seven patients, each missing at least two posterior teeth in the same arch, were included in the study. Three patients qualified for four implants resulting in a total of 10 matched pairs. All sites were healed (>6months), non-grafted sites with sufficient bone to place implants. Each site in a matched pair was randomly assigned to receive either a control (Megagen EZ Plus Internal; EZ) or test (Megagen AnyRidge; AR) implant. The test implant incorporates a novel thread design with a wide thread depth and increased thread pitch. RFA was used to determine implant stability quotient (ISQ) values for each implant at the time of placement and weekly for the first 8weeks. Implants consistently achieved a relatively high insertion torque (30-45N/cm) and high initial ISQ value (79.8±1.49). Baseline ISQ values for test (AR; 79.55±1.61) and control (EZ; 80.05±1.37) implants were similar. A general pattern of stability from baseline through all eight follow-up evaluations was observed for the test implants. A pattern of decreasing ISQ values was observed for the control implants across the early follow-up evaluations up to week four, where the value plateaued. There was a statistically significant main effect due to implant type (P<0.01) and a statistically significant interaction between implant type and time (P<0.01), indicating that the test and control implants performed differently at certain time points. Within the limitations of this study, macro-thread design appears to play a role in implant stability in the early post-operative healing period as assessed by RFA. These findings may have important implications related to immediate or early loading protocols.

Immediate postoperative evaluation of enteric anastomosis after the use of meloxicam in rats

To compare ileal anastomoses in the immediate postoperative healing period after meloxicam use. Forty two male Wistar rats were randomly divided into two groups of 21, COX and control group. To COX meloxicam in combination with morphine was given in 3 days period. Control group received only morphine during the same period. Each group was divided into three sub-groups of 7, which were euthanized at 5, 10, and 21 days postoperatively. Comparison was based in histological evaluation of collagen type I and III using sirius red, immunohistochemical through vascular endothelial growth factor and matrix metalloproteinase-9. Healing process in scheduled periods did not show significant differences (p>0.05) between the COX and control groups during any of the periods. The use of meloxicam in the postoperative period following ileal anastomosis did not affect healing.